Intravenous Medication Administration: What to Know

Some medications must be given by an intravenous (IV) injection or infusion. This means they’re sent directly into your vein using a needle or tube. In fact, the term "intravenous" means "into the vein."

With IV administration, a thin plastic tube called an IV catheter is inserted into your vein. The catheter allows your healthcare provider to give you multiple safe doses of medication without needing to poke you with a needle each time.

In most cases, you won’t give yourself an intravenous medication. While you can take some infusion medications yourself at home, you’ll likely receive your therapy from a healthcare provider. Read on to learn about the two main tools used for IV administration — standard IV lines and central venous catheters — including why they’re used and what the risks are.

IV medication is often used because of the control it provides over dosage. For instance, in some situations, people must receive medication very quickly. This includes emergencies, such as a heart attack, stroke, or poisoning. In these instances, taking pills or liquids by mouth may not be fast enough to get these drugs into the bloodstream. IV administration, on the other hand, quickly sends a medication directly into the bloodstream.

Other times, medications may need to be given slowly but constantly. IV administration can also be a controlled way to give drugs over time.

Certain drugs may be given by IV administration because if you took them orally (by mouth), enzymes in your stomach or liver would break them down. This would prevent the drugs from working well when they’re finally sent to your bloodstream. Therefore, these drugs would be much more effective if sent directly into your bloodstream by IV administration.

Standard IV lines are typically used for short-term needs. For instance, they may be used during a short hospital stay to administer medication during surgery or to give pain medications, nausea medications, or antibiotics. A standard IV line can typically be used for up to four days.

With standard IV administration, a needle is usually inserted into a vein in your wrist, elbow, or the back of your hand. The catheter is then pushed over the needle. The needle is removed, and the catheter remains in your vein. All IV catheters are typically given in a hospital or clinic.

A standard IV catheter is used for two kinds of IV medication administration:

IV push

An IV "push" or "bolus" is a rapid injection of medication. A syringe is inserted into your catheter to quickly send a one-time dose of drug into your bloodstream.

IV infusion

An IV infusion is a controlled administration of medication into your bloodstream over time. The two main methods of IV infusion use either gravity or a pump to send medication into your catheter:

Pump infusion: In the United States, a pump infusion is the most common method used. The pump is attached to your IV line and sends medication and a solution, such as sterile saline, into your catheter in a slow, steady manner. Pumps may be used when the medication dosage must be precise and controlled.

Drip infusion: This method uses gravity to deliver a constant amount of medication over a set period of time. With a drip, the medication and solution drip from a bag through a tube and into your catheter.

Long-term medication treatment, such as chemotherapy or total parenteral nutrition, usually requires a central venous catheter (CVC) instead of a standard IV catheter. A CVC is inserted into a vein in your neck, chest, arm, or groin area.

CVCs can be used for a longer period of time than a standard IV line. A CVC can stay in place for several weeks or even months.

The three main types of CVCs include:

Peripherally inserted central catheter (PICC)

A PICC has a long line that sends medication from the area of insertion, through your blood vessels, all the way to a vein near your heart. A PICC is typically placed in a vein above your elbow in your upper arm.

Tunneled catheter

With a tunneled catheter, medication can be sent directly into blood vessels in the heart. One end of the catheter is placed into a vein in the neck or chest during a short surgical procedure. The rest of the catheter is tunneled through the body, with the other end coming out through the skin. Medications can then be given into that end of the catheter.

Implanted port

Like a tunneled catheter, an implanted port inserts a catheter into a vein in the neck or chest. This device is also placed during a short surgical procedure. But unlike a tunneled catheter, an implanted port is located completely beneath the skin. To use this device, a healthcare provider injects medication through the skin into the port, which sends the medication into the bloodstream.

Many different types of medications can be given by IV. Some of the drugs more commonly given by this method include:

• chemotherapy drugs such as doxorubicin, vincristine, cisplatin, and paclitaxel
• antibiotics such as vancomycin, meropenem, and gentamicin
• antifungal drugs such as micafungin and amphotericin
• pain medications such as hydromorphone and morphine
• drugs for low blood pressure such as dopamine, epinephrine, norepinephrine, and dobutamine
• immunoglobulin medications (IVIG)

While IV medication use is generally safe, it can cause both mild and dangerous side effects. Medications given intravenously act on the body very quickly, so side effects, allergic reactions, and other effects can happen fast. In most cases, a healthcare provider will observe you throughout your infusion and sometimes for a period afterward. Examples of IV side effects include:

Infection

Infection can occur at the injection site. To help prevent infection, the administration process must be done carefully using sterile (germ-free) equipment. An infection from the injection site can also travel into the bloodstream. This can cause a severe infection throughout the body.

Infection symptoms can include fever and chills, as well as redness, pain, and swelling at the injection site. If you have any symptoms of infection, call your doctor right away.

Damage to blood vessels and injection site

A vein can be damaged during injection or by the use of an IV catheter line. This can cause infiltration. When this occurs, medication leaks into surrounding tissue instead of going into the bloodstream. Infiltration can cause tissue damage.

IV administration can also cause phlebitis, or inflammation of the veins. Symptoms of both infiltration and phlebitis include warmth, pain, and swelling at the injection site. Call your doctor right away if you have any of these symptoms.

Air embolism

If air gets into the syringe or the IV medication bag and the line runs dry, air bubbles can enter your vein. These air bubbles can then travel to your heart or lungs and block your blood flow. An air embolism can cause severe problems such as heart attack or stroke.

Blood clots

IV therapy can cause blood clots to form. Clots can block important blood vessels and cause problems such as tissue damage or death. Deep vein thrombosis is one type of dangerous blood clot that IV treatment can cause.

IV drug administration is a fast, effective way to send medication into your bloodstream. If your doctor has prescribed it for you, they will likely explain the purpose and the process for your treatment. But if you have questions, be sure to ask. Your questions may include:

• How long will I need to have my IV treatment?
• Am I at high risk of any side effects?
• Can I receive my IV medication at home? Can I give it to myself?