Administration of Infusion Therapies
Verify, then give
Confirm the right patient (two identifiers), drug, dose, route, time, rate, and documentation, plus compatibility and allergies. For high-alert medications (vasopressors, insulin, heparin, opioids, concentrated electrolytes, chemotherapy), use an independent double check and standardized concentrations, and program the pump with a drug library where available.
Rate, route, and hardware
Peripheral administration is limited by the vein and by solution properties; central administration permits hypertonic and vasoactive therapy but demands correct pump programming. Understand primary and secondary setups, when a secondary infusion can run by gravity versus pump, and why free-flow protection matters. Syringe pumps and gravity controllers are not interchangeable in practice.
Special administration situations
Vesicants require a patent, verified blood return before and during administration, frequent site checks, and immediate availability of the extravasation kit. IV push medications go at the labeled rate - pushing a rate-dependent drug too quickly causes hypotension, arrhythmia, or seizure. Flush between incompatible drugs and after the last dose.
Trap: dose-per-minute and rate questions that give you a concentration in mg/mL and a dose in mcg/min. Convert units first, then divide.
Worked example: Dopamine 400 mg in 250 mL = 1600 mcg/mL. Ordered 5 mcg/kg/min for 80 kg = 400 mcg/min. 400 ÷ 1600 = 0.25 mL/min × 60 = 15 mL/hr.
Rule of thumb: if the answer requires you to give a vesicant without confirmed blood return, slow down and reassess - never infuse into an unverified site.