Chapter 7 Intravenous Therapy - Brands Delmar - · PDF file · 2003-03-12Chapter 7 Intravenous Therapy ... Procedure 37 Inserting A Peripheral IV In An Adult ... PERFORMANCE REVIEW

Chapter 7 Intravenous Therapy

Procedure 36 Assembling And Priming A Basic Administration Set

Procedure 37 Inserting A Peripheral IV In An Adult

Procedure 38 Inserting A Heparin Lock

Procedure 39 Inserting A Peripheral IV With A Butterfly Needle

Procedure 40 Inserting A Peripheral IV In A Child

Procedure 41 Monitoring The Intravenous Flow Rate

Procedure 42 Applying A Transparent Film Dressing To An Intravenous Infusion Site

Procedure 43 Discontinuing A Peripheral IV

Procedure 44 Assisting The RN With A Central IV Dressing Change

Procedure 45 Obtaining And Checking Blood From The Blood Bank

Procedure 46 Checking Blood Products On The Nursing Unit

PERFORMANCE REVIEW CHECKLIST

Procedure 36

Assembling And Priming A Basic Administration Set

Name of Patient Care Technician ________________________ Date of Program ______ to ______

Social Security Number or Identification Number _______________________________

Program Code Number (if any) _________________

S=Satisfactory PerformanceU=Unsatisfactory Performance

Place a full signature to correspond with each set of initials appearing below.

Supplies needed:

• Intravenous solution• Basic administration set

Initials Corresponding Signature of Instructor Title

Procedure Guidelines S/U Date Initials S/U Date Initials

1. Perform your beginning procedure actions.

2. Open the package and remove the administration set.

3. Close the roller clamp.

4. Hold the solution to the light and examine it for particles, cloudiness, or discoloration. Examine the container for cracks or chips. Do not use the solution if it contains particles, the fluid is cloudy, or the color is abnormal. Do not use a container that is chipped or cracked.

5. Remove the cover from the piercing pin. Maintain sterility and avoid touching this device to other surfaces.

6. Remove the protective seal at the outlet of the IV solution.

__________________________________ _______________

Instructor Signature Date

__________________________________ _______________

Student Signature Date

7. Spike the container by inserting the piercing pin.

8. Hang the container of solution on an IV pole.

9. Squeeze the sides of the drip chamber gently until they meet, then release them. This allows fluid to flow into the chamber to the halfway point.

10. Slowly open the roller clamp, allowing fluid to flow through the tubing. Leave the clamp open until all air is expelled from the tubing.

11. Close the roller clamp.

12. If the set has Y-connection sites, tap them gently to remove trapped air.

13. Loop the tubing over the IV pole to keep it from touching the floor or other surfaces.

14. Prepare a label according to facility policy. Affix the label to the solution. Do not cover the markings on the container.

15. Perform your procedure completion actions or perform the venipuncture.



Procedure 37

Inserting A Peripheral IV In An Adult






Supplies needed:

• Intravenous start kit or individual supplies• Disposable exam gloves• Tourniquet• Alcohol or povidone-iodine wipes• Selection of over-the-needle catheters• IV standard• Intravenous solution with primed tubing• Puncture-resistant needle disposal container• Adhesive bandages• 1⁄2-inch tape• Plastic bag for used supplies




2. Apply a tourniquet 3 to 4 inches above the proposed insertion site and locate a vein. Select the largest, most stable distal vein in the area. When palpated, the site will feel firm and rebound slightly.

3. Release the tourniquet.

4. Cleanse the site with alcohol or povidone-iodine. Wipe in a circular motion for 60 seconds. Begin in the center of the venipuncture site and extend the circle out 3 inches in diameter.

5. Allow the alcohol or povidone-iodine to dry thoroughly. While the skin is drying, cut the tape and place it in a convenient location.

6. Reapply the tourniquet, taking care not to bump or touch the prepped skin area.

7. Remove the needle cover, holding the needle bevel facing up in your dominant hand.

8. Stabilize the vein by holding it with your nondominant thumb, approximately 1 inch below the puncture site. Warn the patient that he or she will feel a stick.

9. With the needle at a 15-degree angle, slowly enter the patient’s vein. You will feel a change of pressure when the needle enters the vein. A flashback of blood will appear in the chamber of the device. Advance the needle an additional 1⁄4 inch into the vein.

10. Gently advance the catheter forward into the vein, slipping it over the needle.

11. Hold the catheter securely while you remove the needle. Discard the needle in the puncture-resistant container.

12. Release the tourniquet by pulling the upper end of the tourniquet downward, before removing the needle.

13. Attach the fluid administration set and establish the flow of fluid.


__________________________________ _______________


__________________________________ _______________


14. Secure the catheter according to facility policy, or tape by applying a piece of tape across the arm, 1⁄8 inch above the infusion site. While you continue to hold the catheter, insert a second piece of tape, sticky side up, under the needle. Cross it over the needle, securing it to the upper piece of tape on the opposite sides. Attach one more piece of tape at the bottom. Avoid taping the connections closed, and avoid covering the needle insertion site with the tape.

15. Regulate the drip rate or connect to a pump, according to facility policy.

16. Recheck the connections to the administration set, filter, and catheter to ensure that they are tight and secure.

17. Perform your procedure completion actions.



Procedure 38

Inserting A Heparin Lock






Supplies needed:

• Intravenous start kit or individual supplies• Disposable exam gloves• Tourniquet• Alcohol or povidone-iodine wipes• Selection of over-the-needle catheters• Sterile 2 x 2 gauze pad• Heparin lock to fit catheters• Syringe with designated solution for keeping lock open• Puncture-resistant needle disposal container• Adhesive bandages• 1⁄2-inch tape• Plastic bag for used supplies











9. With the needle at a 15-degree angle, slowly enter the patient’s vein. You will feel a change of pressure when the needle enters the vein. A flashback of blood will appear in the chamber of the device. Advance the needle an additional 1⁄4 inch into the vein.

10. Gently advance the catheter forward into the vein.

11. Place a sterile 2 x 2 gauze pad under the catheter.


13. Hold the catheter securely while you remove the needle. Discard the needle in the puncture-resistant container. Apply gentle pressure on the vein, approximately 1 inch above the insertion site.

14. Attach the heparin lock by removing the protective cover and twisting the lock gently into the IV catheter. After the lock is connected, release pressure on the vein. Recheck the connection to ensure that the lock is securely attached.


__________________________________ _______________


__________________________________ _______________


15. Slowly inject normal saline or heparin into the lock, if you are permitted to perform this procedure according to facility policy. If not, immediately summon the RN, using the call signal.

16. Secure the catheter according to facility policy.




Procedure 39

Inserting A Peripheral IV With A Butterfly Needle






Supplies needed:

• Intravenous start kit or individual supplies• Disposable exam gloves• Tourniquet• Alcohol or povidone-iodine wipes• Selection of butterfly needles• IV standard• Intravenous solution with primed tubing• Puncture-resistant needle disposal container• Adhesive bandages• 1⁄2-inch tape• Plastic bag for used supplies











9. Fold the wings of the butterfly up and grip them securely. With the needle at a 15-degree angle, slowly enter the patient’s vein. You will feel a change of pressure when the needle enters the vein. A flashback of blood will appear in the tubing. Gently lift the device up and slowly advance the needle into the vein.


11. Attach the fluid administration set to the butterfly and establish the flow of fluid.

12. Secure the needle according to facility policy, or apply a piece of tape vertically over each wing of the butterfly, forming an “H” shape. Avoid covering the needle insertion site.

13. Regulate the drip rate or connect to a pump, if permitted, according to facility policy.

14. Recheck the connections to ensure that they are fastened tightly.



__________________________________ _______________


__________________________________ _______________



Procedure 40

Inserting A Peripheral IV In A Child






Supplies needed:

• Intravenous start kit or individual supplies• Disposable exam gloves• Tourniquet• Alcohol or povidone-iodine wipes• Selection of over-the-needle catheters and butterfly needles• IV standard• Intravenous solution with primed tubing• Puncture-resistant needle disposal container• Adhesive bandages• 1⁄2-inch tape• Plastic bag for used supplies




2. Apply a tourniquet 2 to 3 inches above the proposed insertion site and locate a vein. Select the largest, most stable distal vein in the area. When palpated, the site will feel firm and rebound slightly. Select a butterfly needle or over-the-needle catheter appropriate to the size and location of the vein.






8. Stabilize the vein by holding it with your nondominant thumb, approximately 1 inch below the puncture site. Warn the child that he or she will feel a stick.

9. With the ONC or butterfly at a 15-degree angle, slowly enter the child’s vein. You will feel a change of pressure when the needle enters the vein. A flashback of blood will appear. Slowly advance the catheter or needle into the vein. Discard the needle used to introduce the catheter, if used, in the puncture-resistant container.


11. Attach the fluid administration set and establish the flow of fluid.

12. Secure the needle according to facility policy, or apply tape appropriate to the device used. Avoid covering the needle insertion site with tape. Avoid taping tubing connections.

13. Regulate the drip rate or connect to a pump, according to facility policy.

14. Immobilize the arm on an arm board, if not done previously.

15. Recheck the connections to ensure that they are fastened tightly.


__________________________________ _______________


__________________________________ _______________





Procedure 41

Monitoring The Intravenous Flow Rate






Supplies needed:

• Watch with second hand




2. Stand so that you can clearly see the flow of fluid into the drip chamber.

3. Hold your watch so that you can see it out of the corner of your eye. Look at the second hand and begin timing.

4. Begin counting each drop of fluid as it drops into the drip chamber.

5. Count the number of drops that fall into the drip chamber. Stop counting in exactly 30 seconds. Multiply this number by 2 to determine the total drip rate for 1 minute. Report deviations in the designated rate to the RN.


__________________________________ _______________


__________________________________ _______________



Procedure 42

Applying A Transparent Film Dressing To An Intravenous Infusion Site






Supplies needed:

• Disposable exam gloves• Alcohol or povidone-iodine wipes• Sterile gauze sponges• Transparent dressing• Plastic bag for used supplies




2. If placing the dressing for the first time, clipping the hair may be necessary. Avoid shaving, which increases the risk of infection. Check with the RN if you are uncertain of the action to take. Remove oil from skin surrounding the insertion site, if present, with alcohol. Allow to dry.

3. Apply disposable exam gloves.

4. Holding gentle traction on the skin, press down on the skin, then loosen the adhesive in one corner and remove the dressing by peeling it back, toward the insertion site. Hold the hub of the IV catheter in place when removing the dressing. Stretch the dressing horizontally, gently lifting it over the open area. The stretching helps to break the adhesive bond. You cannot use two hands to remove the dressing, so you may have to remove and stretch the edges by alternating movement in two opposite corners of the dressing. Always remove the dressing by pulling in the direction of hair growth. If the skin is not hairy, a corner on opposite sides of the dressing can be lifted. Stretch the dressing from the edges toward the center, then lift off. Discard in plastic bag.

5. Evaluate the insertion site for redness, swelling, drainage, or other complications. If present, use the call signal to notify the RN.

6. Check the IV connections to ensure that they are fastened tightly.

7. Cleanse the skin with alcohol or povidone-iodine for 3 inches surrounding the insertion site. Begin at the insertion site, working outward.

8. Allow the skin cleanser to dry completely.

9. Remove gloves and discard in plastic bag.

10. Wash your hands.

11. Open the package by peeling the tabs back, and remove the dressing.

12. Grasp the tabs on the underside of the dressing, and peel them back approximately 1 inch. The dressing is sterile, and you must avoid touching the underside with your hands when opening the package or applying it to the insertion site.


__________________________________ _______________


__________________________________ _______________


13. Center the dressing over the catheter insertion site, then gently lower it, smoothing the center portion in place.

14. Peel away the backing paper slowly from one side at a time while gently smoothing the film in place. Gently smooth out wrinkles as you go.




Procedure 43

Discontinuing A Peripheral IV






Supplies needed:

• Disposable exam gloves• Alcohol or povidone-iodine wipes• Sterile 2 x 2 gauze pad• Adhesive bandage• Puncture-resistant container, if needle or butterfly removed• Plastic bag for used supplies




2. Remove the dressing covering the insertion site. Loosen the tape on the needle and administration set tubing.

3. Apply gentle pressure over the insertion site with sterile gauze. Withdraw the needle or cannula at the same angle it was inserted. Observe the plastic cannula closely. If it appears to have broken off, do not discard it. Notify the RN immediately of this potentially serious complication.

4. Hold pressure on the insertion site until bleeding stops.

__________________________________ _______________


__________________________________ _______________


5. Cleanse the area with alcohol or povidone-iodine, if necessary. Avoid direct contact with the insertion site.

6. Cover the insertion site with an adhesive bandage or other dressing, according to facility policies.

7. Discard the needle, if used, in a puncture-resistant container. Discard other supplies contaminated by blood or body fluids in the plastic bag. Discard the IV solution and tubing according to facility policy, if the IV will not be restarted.




Procedure 44

Assisting The RN With A Central IV Dressing Change






Supplies needed:

• Central IV dressing change kit or individual supplies• Disposable exam gloves• Sterile gloves, size to fit the RN• 3 masks• Transparent film dressing or other sterile dressing• Tape, if needed to secure dressing• Sterile drape• 3 povidone-iodine applicator sticks• Plastic bag for used supplies




2. Cleanse the table that will be used to establish the sterile field with alcohol or other disinfectant. Allow to dry.

3. Apply a mask. Instruct the patient to apply a mask, or turn the patient’s head to the side opposite the insertion site, according to facility policy.

4. Wash your hands.

__________________________________ _______________


__________________________________ _______________


5. Using the sterile drape, set up the sterile field. Open packages of sterile supplies, placing them on the sterile field. Avoid turning your back on the sterile field.

6. Apply disposable exam gloves and remove the soiled dressing. Discard in the plastic bag. Keep the soiled dressing and plastic bag well away from the sterile field. Avoid reaching over the field to discard the dressing.

7. Remove gloves and discard in the plastic bag.

8. Wash your hands.

9. Open a package of povidone-iodine applicators, holding the end to the RN, who will use the applicator to cleanse the skin. If packaged in individual packages, repeat two more times. Three applicators are needed to cleanse the skin for this procedure. Hold the plastic bag open for the RN to discard each applicator.

10. After the skin dries, open the gauze dressing or transparent film dressing, holding it open for the RN. He or she will use it to cover the insertion site. Cut and hand him or her tape, if a gauze dressing is used.

11. Hold the plastic bag open for the RN to discard his or her gloves.

12. Remove your mask. Assist the patient to remove his or her mask, if necessary. Discard the masks in the plastic bag.

13. Remove used supplies, and discard according to facility policy.




Procedure 45

Obtaining And Checking Blood From The Blood Bank






Supplies needed:

• Blood requisition form



1. Wash your hands.

2. Obtain the blood requisition form from the RN and take it to the blood bank.

3. Identify yourself to blood bank personnel and state that you have a requisition for blood.

4. Follow facility policy for checking the blood with a laboratory technician. One employee reads the following information aloud:

Patient’s first name, middle initial, and last name

Patient’s identification number

Patient’s blood type

Patient’s blood Rh

The number of the blood donor

The blood expiration date

__________________________________ _______________


__________________________________ _______________


While one employee reads the information on the requisition form, the other verifies the information on the bag of blood. After the information is confirmed, the laboratory employee will release the blood to you. He or she will also provide a blood identification band.

5. Obtain the blood and return immediately to your unit.

6. Upon return to the unit, inform the RN that you have obtained the blood. He or she will provide further instructions.

7. Wash your hands.



Procedure 46

Checking Blood Products On The Nursing Unit






Supplies needed:

• Unit of blood• Blood requisition• Blood identification band from the laboratory



1. Go to the patient’s room with the RN.

2. Wash your hands.

3. Ask the patient to spell his or her name out loud. If the patient is unable, read the patient’s name aloud from the identification band. The RN will compare this with the information on the blood slip. He or she will also verify the information with the label on the bag of blood, or may ask you to do this.

4. Read the patient identification number aloud. The RN will compare this with the information on the blood slip. He or she will also verify the information with the label on the bag of blood, or may ask you to do this.

__________________________________ _______________


__________________________________ _______________


5. From the requisition, read aloud the blood bank identification number, blood expiration date, and patient’s blood type. The RN will compare this with the information on the bag of blood.

6. The RN will read aloud from the label on the bag of blood the blood bank identification number, blood expiration date, and patient’s blood type. You will compare this with the information on the requisition form.

7. If a discrepancy is noted at any time during the procedure, inform the RN immediately. After the blood has been verified, you will both sign the blood requisition form.

8. Apply the blood identification band to the patient’s wrist, according to facility policy. (In some facilities, this may be done at the time the blood is drawn for typing. If the bracelet comes off for any reason, another type and screen must be drawn and a new identification band applied.)

9. Wash your hands.


Documents

Chapter 7 Intravenous Therapy - Brands Delmar - · PDF file · 2003-03-12Chapter 7 Intravenous Therapy ... Procedure 37 Inserting A Peripheral IV In An Adult ... PERFORMANCE REVIEW