Intravenous Therapy for Newborns

- Implementation of the Treatment Plan

Monitor vital signs and record additional physician-ordered observations.
Calculate and monitor fluid and caloric intake.
Administer prescribed medications.
Provide required interventions (oxygen therapy, phototherapy, physiotherapy, exchange transfusion, blood transfusion, pain management, pre/postoperative care, etc.).

Daily Medication Plan

Physician prescribes type and dose.
Nurse prepares and administers medication, ensuring proper knowledge of drug indications, side effects, and required precautions.

First: Dispensing the Medication

The nurse assigned to provide neonatal nursing care, according to the task distribution, reviews the infant’s treatment chart (paper or electronic) to verify discontinuation, continuation, dose modification, or addition of any medication.
The paper treatment chart is submitted to the pharmacy for dispensing the medications to the unit.
Additionally, the prescription is verbally communicated to the pharmacist, who authorizes dispensing.
The pharmacy prepares the medications and delivers them to the nurse responsible for the infant, whether through a single-dose system or daily doses.

Second: Preparation of the Medication

The nurse responsible for preparing IV fluids in the unit is also responsible for preparing the medication under full aseptic conditions and following infection control policies.
Alternatively, preparation can be performed in Laminar Air Flow Units.

Before preparation, the nurse must ensure the following:

Verify the medication’s expiration date.
Carefully inspect the container for cracks or defects, and check that the medication is stable in terms of appearance, composition, and color.
Prepare the appropriate number of containers to cover all infants’ required doses, coordinating with the medication administration schedule.
Label the container immediately after preparation with the date and time.
Single-dose ampoules are preferred over multi-dose vials.
If multi-dose vials must be used, always use a sterile syringe and needle to penetrate the rubber stopper.
Disinfect the vial’s entry point with 70% alcohol before each withdrawal.
Use a new sterile syringe for every withdrawal.
Routine handwashing or alcohol-based hand rubbing must be performed before preparing medications or fluids.

Third: The Nurse’s Role During Medication Administration

Administer the medication at the prescribed dose, correct time, and via the proper route, according to the physician’s instructions:

Read the prescription carefully from the infant’s medical chart.
Document the prescription on the treatment card.
Withdraw the dose in the designated preparation area while observing infection control precautions.
Avoid mixing medications to prevent harmful chemical interactions.
Use a new sterile syringe for each medication.
Reconfirm the dose before administration via IV cannula.
Follow the Ten Rights of Medication Administration:

Precautions to Follow

Reconstituted ampoules must be diluted only with sterile water, not saline.
Vital signs must be checked before and after drug administration.
Certain drugs (e.g., Lanoxin) must not be given if the infant’s heart rate is below 100 bpm.
For drugs such as Lasix, blood pressure must be checked before administration, and urine output monitored daily to avoid dehydration and electrolyte imbalance.
Some medications must be given very slowly IV (e.g., Calcium, Sodium Bicarbonate).
Monitor heart rate during administration of drugs such as calcium.
Allergy testing must be performed when prescribed, and the infant’s general condition observed during and after administration for adverse reactions (e.g., rash, skin discoloration, changes in vital signs).
In case of suspected reaction, stop the drug immediately, notify the physician, inform the hospital’s pharmacovigilance officer, and report the event using an Occurrence Variance Report (OVR) to the Quality Department.
Do not administer missed doses unless ordered by the physician.
Document all administered medications in the patient’s chart.

Oral Medication Administration (via the Gastrointestinal Tract)

Use a calibrated medicine measure for liquid doses.
Clean the bottle opening thoroughly after each use.
For dropper medications, ensure the exact number of drops or measured volume.
Hold the calibrated measure at eye level when pouring the medication.
Do not use medications that have changed in color or consistency, and always check expiration dates.

Common Medication Errors

Wrong dose (due to physician, pharmacy, or nursing errors).
Wrong drug (due to similar names, poor documentation, or dispensing errors).
Confusion between similar-looking or similar-colored drugs.
Administering medication to the wrong infant (e.g., due to similar names).
Incorrect timing of doses.
Duplicate administration of the same chemical drug under two different trade names.

Prevention of Medication Errors

Ensure nurse alertness and knowledge of the correct dose before administration, confirming with the physician or pharmacist if needed.
Read every medical order carefully and attentively.
Verify that the pharmacy dispensed the exact drug and quantity prescribed.
In cases where infants share similar names, apply strict Patient Identification Policy measures.
Administer medications at accurate times, since dosing intervals are calculated based on drug half-life and therapeutic effect.
Double-check the name and details on the medication label.

Procedures in Case of a Medication Error

Assess the infant’s condition immediately to determine severity of adverse reactions.
Classify the level of risk without delay.
Notify the head nurse and the treating physician immediately to decide on corrective interventions.
Document a detailed report describing the infant’s condition and the medical measures taken to preserve the infant’s safety.