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IV THERAPY
PRESENTATION
☼COLLECT THE FOLLOWING SUPPLIES:
* TWO PAPERS OF LABELS (HAVE 4 LABELS)
* TWO ALCOHOL SWABS
☼TAKE ONE OF EACH OF THE FOLLOWING:
*EACH HANDOUT
*ANGIOCATH NEEDLE
*PRACTI-POWDER VIAL
*LEVER LOCK CANNULA
*3 ML WITH FLUSH & 10 ML SYRINGE
*BLUNT END CANNULA
*21 GAUGE NEEDLE
*VIAL OF SODIUM CHLORIDE
*GARBAGE BAG
HAVE ALL YOUR SUPPLIES FROM YOUR LAB BAGS:
250 ML BAG OF FLUID
50 ML BAG OF FLUID
PRIMARY ADMINISTRATION SET
SECONDARY ADMINISTRATION SET
PRN ADAPTERS
START KIT
INJECTA PAD
EXTRA TEGADERMS AND TAPE
PREPARING IV SOLUTION & TUBING
What’s the first thing you always need to do?
Check the Doctor’s order.
Farmer, Edward
Dr. Jones
DOB 10-23-50 MR 54276
ALLERGIES CodeineHeight:
5’7
Weight:
150 lbDate Time PRESCRIBED TREATMENT, MEDICATION AND DIET
TPN ORDERS MUST BE ORDERED ON “PARENTERAL NURTRITION ORDER FORM”
3- 15-11 0730 Start IVF – 1000ml Lactated Ringers
@ 100ml/hr
T.O. Dr. Jones/B. Meyer, RN
Check and Inspect the IV Bag
Expiration Date
For cloudiness or particles – IV Fluid should be clear
For Leakage
Correct IV fluid
Correct amount
And Always Do The 3 Checks of the IVF with the Dr’s Order
Primary Tubing
• Open package
• Pull off paper tab and unroll the tubing
• Close the roller clamp
• Pull off clear tab on IV bag
• Remove plastic covering the spike
• DO NOT touch part of IV bag where tab was removed or spike, IT MUST REMAIN STERILE!
• Spike the IV bag
•
Primary Tubing (Cont) Hang on IV pole Fill drip chamber ½ full Remove end piece from tubing Open roller clamp – Slowly! Flush tubing with IVF
– Keep end of tubing sterile– No large air bubbles in tubing (less than 1”)– Be sure to prime the Y-site, also
Close the roller clamp Replace end piece on tubing
Label Tubing
DateTimeInitials
Label IV Fluids
• Date
• Time
• Initials
• Patient’s name
• Any additions made to IV fluid
Gather IV Equipment
Needle/angiocath Start kit (tape, tourniquet, alcohol pad,
tegaderm, and label) Chux pad Clean gloves Goggles IV Pole
Wash Hands (Don other PPE if needed – Contact Precautions, Agitated patient, etc)
ID your patient – You MUST take the Doctor’s order in with you
Check for allergies:– Tape– Latex– Betadine (if using)
• Do 4th check at the bedside
• Explain procedure
• Provide privacy
• Body Mechanics (Bed up [if standing], etc)
Prepare Supplies
IV pole/pump Angiocath needle Label Tourniquet Cleaning solution
(depends on facility) IV solution & tubing Cut Tape Goggles Chux Tegaderm
Inspect Potential Sites
Place tourniquet around the upper arm
Inspect Potential Sites
Examine and Palpate Veins
Common IV Sites of the Hand
Common IV Sites of the Arm
What are Some Ways to Promote Venous Distention?
Place arm in a dependent position
Have patient open and close fist a couple of time
Warm compresses
“Flicking” the vein
Massaging blood flow proximal to distal
Using a blood pressure cuff instead of a tourniquet
But, Mrs. Meyer, I Can’t See a Vein!
Trust Your Fingers more than Your Eyes
Other things to try:
•Applying Warm Compresses
•Massaging the Blood Flow Proximal to Distal
•Using a Blood Pressure Cuff instead of a Tourniquet
•Use Two Tourniquets instead of One
Other Things to Consider When Selecting an IV site
Is the Skin Intact?
Is your Patient Left or Right Handed?
What is the IV going to be used for?
Avoid Bony Prominances and First 2” of the Inner Side of the Wrist
Avoid Antecubital Area, if Possible.
Use Most Distal Site First
Can not use any site above antecubital
Once You Have Selected Your Site
Prepare For Insertion
Put on Disposable Gloves and Goggles
Place a Chux Pad under the arm
Scrub Site with Alcohol (or what facility requires):
- Allow site to dry
Apply Tourniquet 5 to 6 inches above Insertion Site:
- Secure Tightly enough to Occlude Venous Flow
- Check Presence of Distal Pulse
Perform the Venipuncture
Use your Nondominant Hand to Anchor the Vein
- Stretch Skin Dorsal to Site - Do not “Hop Scotch” your Thumb
Warn Patient of the Stick
With dominant hand: Insert the Stylet, bevel up, at a 20 to 30° angle
- Hold by Flash Chamber, not IV hub
Watch for a “Flash Back” of Blood
Advance Stylet into Vein
Loosen Catheter from Stylet
Advance Catheter into vein
Whew! I’m in the Vein, Now What?
Occlude vein at cannula end Before pulling the stylet
completely out or
IT WILL LOOK LIKE A BLOODY MASSACRE!IT WILL LOOK LIKE A BLOODY MASSACRE!
“POP” the tourniquet (loosen it without letting go of the IV)
Quickly attach the IV tubing to the IV catheter
Moving Along…………
• Slowly open the roller clamp
• Tape the hub of the catheter – Do not tape over insertion site- Chevron- U
• Place Tegaderm over insertion site and hub of cannula
• Tape the rest of the IV tubing – Make a “J”
Clean Up Time
Remove Gloves and goggles
Dispose all used materials
Throw Stylet in Sharps Container
Time to Document
DATE/
TIME/ INITALSITE SITE STATUS
Start:
Stop:
Site #
Location
Size/Type
Site Rotation Due:__________
Dressing Change:
3-15-11
0800
BJM
1Reason for Change (code):
Comments:
3-18-11 0800
L H
# 20/ Angio
Attempted x1
START
DATE/TIME/
INITALS
SITE
#FLUIDS TUBING INFUSION
DEVICE
STOP
DATE/TIME/
INITALS
AMOUNT COMMENTSRATE
3-15-11
0800
BJM
1
1000 ML
Lactated
Ringers
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
PUMP100ml/
hr
Farmer, Edward
Dr. Jones
DOB 10-23-50 MR 54276
ALLERGIES CodeineHeight:
5’7
Weight:
150 lbDate Time PRESCRIBED TREATMENT, MEDICATION AND DIET
TPN ORDERS MUST BE ORDERED ON “PARENTERAL NURTRITION ORDER FORM”
3-15-11 1600 Change IVF to 1000 ml 5%Dextrose and Water at 150 ml/hr
T.O. Dr. Jones/B. Meyer, RN
Preparing IV Solution & Tubing(Changing the IV tubing at the IV site)
•Prepare tubing as before
•Gather Equipment (Fluid ● Tape ● Prepared Tubing ● Gloves Chux● Goggles●Tegaderm● 2x2)
•Wash Hands
•ID patient and check allergies
•Explain yourself
•Prepare Tape
Preparing IV Solution & Tubing(Changing the IV tubing at the IV site)
•Loosen Tape and Tegaderm
•Put Chux Pad under arm
•Don Clean Gloves
•Place 2x2 under IV site (optional)
•Stabilize the hub of the IV with thumb and index finger
•Occlude blood flow
•Gently disconnect old tubing from IV
•Insert new tubing into hub of the catheter & screw on tightly
Preparing IV Solution & Tubing(Changing the IV tubing at the IV site)
•Open the roller clamp to establish flow of IV solution.
•Reestablish drip rate, gravity or pump
•Tape cannula in place and apply a new dressing to the site
•Document on dressing site- date, time, initials
•Clean Up
•Wash Your Hands
•Document on IV sheet – bag and tubing change
START
DATE/TIME/
INITALS
SITE
#FLUIDS TUBING INFUSION
DEVICE
STOP
DATE/TIME/
INITALS
AMOUNT COMMENTSRATE
3-15-11
0800
BJM1
1000 ML
Lactated
Ringers
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
PUMP100ml/
hr
3-15-11
1600
BJM
1
3-15-11
1600
BJM
1000 ML
5% Dextrose
And Water
PUMP150ml/
hr
Changing IV solution
Farmer, Edward
Dr. Jones
DOB 10-23-50 MR 54276
ALLERGIES CodeineHeight:
5’7
Weight:
150 lbDate Time PRESCRIBED TREATMENT, MEDICATION AND DIET
TPN ORDERS MUST BE ORDERED ON “PARENTERAL NURTRITION ORDER FORM”
3-16-11 1100 Continue IVF 5% Dextrose and Water at 150 ml/hr
T.O. Dr. Jones/B. MEYER, RN
Changing IV Solution
Complete 3- Check Procedure
Label IV with date, time, and type of solution
Wash Hands (Don Clean Gloves, if indicated)
ID patient with order & Check allergies
Introduce Yourself & Explain procedure
Be sure the drip chamber is at least half full.
Close the roller clamp to stop flow of fluid or stop IV pump
Remove the old IV from the pole.
Remove the old bag from tubing.
Keep spike end sterile.
Reestablish prescribed flow rate.
Spike the new bag or bottle with tubing
Check for air in tubing
Empty remaining fluid from old IV bag if needed into toilet
START
DATE/TIME/
INITALS
SITE
#FLUIDS TUBING INFUSION
DEVICE
STOP
DATE/TIME/
INITALS
AMOUNT COMMENTSRATE
3-15-11
0800
BJM
1
1000 ML
Lactated
Ringers
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
PUMP100ml/
hr
3-15-11
1600
BJM
1000 ML
5% Dextrose
And Water
150ml/
hrPUMP
3-16-11
1100
BJM
1
1
3-15-11
1600
BJM
1000 ML
5% Dextrose
And Water
PUMP150ml/
hr
3-16-11
1100
BJM
Hanging IV Piggyback
1. How to transcribe a New Medication Order to MAR
2. How to Mix an IVPB using Practi-Powder
3. How to Hang an IVPB
Farmer, Edward
Dr. Jones
DOB 10-23-50 MR 54276
ALLERGIES CodeineHeight:
5’7
Weight:
150 lbDate Time PRESCRIBED TREATMENT, MEDICATION AND DIET
TPN ORDERS MUST BE ORDERED ON “PARENTERAL NURTRITION ORDER FORM”
3-15-11 1200
T.O. Dr. Jones/B. MEYER, RN
Ampicillin 1 gram IVPB every 6 hours
X 4 doses
Farmer, Edward
DOB 10-23-50 MR 54276
UNIT: ROOM: 303 B
Sex: M Hgt: 5’7” Admit Date: 3-16-09
Physician: Dr. Jones VERIFIED BY:___ ___ BJM_________ __________Age: 56 Wgt: 150 lb CrCl: Allergies: Codiene
DATE (NURSE TO WRITE IN): 3-15-11
MEDICATIONPRESCRIBED
DOSEStart Stop 00:00-07:30 07:31-15:30 15:31-23:49
Ampicillin 1 gram IVPB q 6hrs x 4 doses 1200 – 1800
0000 - 0600
3-15 3-16
BJM B.MEYER,RN
INITALS SIGNATURE INITALS SIGNATURE INITALS SIGNATURE
For All IV Piggybacks….
In Addition to Completing the Usual 4 Checks, You must also:
Ensure that the antibiotic and the fluid mixing with are compatible
Ensure that the IVPB is compatible with the primary IVF and any additives in the IVF
Verify how fast to run the IVPB- will find in med references
Ensure that it is an antibiotic you are hanging!!!!!!!!!
Mixing an IVPB using Practi-Powder
Look at the Piggyback (50 ml bag of NS)
- There are 2 ports - “Set” and “Add”
SET Port: Port where IV tubing spike is placed
ADD Port: Port where medication/additives are instilled
Mixing an IVPB using Practi-Powder1. Pop off the blue “add” cap from IVPB bag
2. Attach needle to syringe – do not use blunt needle
3. Pop-top off of demo dose powder (the medication)
4. Withdraw fluid from IVPB (amt indicated on vial)
5. Wipe off top of demo dose powder
6. Instill fluid into powder
7. Withdraw syringe- BE CAREFUL OF AIR IN VIAL
8. Mix vial well
9. Wipe off top of vial
10. Reinsert syringe into vial
11. Withdraw all of the fluid from medication vial
Mixing an IVPB using Practi-Powder
12. Wipe off “add” port on piggy back with alcohol
13. Insert needle/syringe
14. Instill medication into piggyback bag via the “ADD” port
15. Recap needle/ Engage safety
16. Shake piggy back gently
17. Must label the IVPB: Patient’s name, date, time, initials, drug name and dose
18. 3 Checks are completed while preparing med
Hanging an IVPB
• Secondary infusion set
• IV tubing label
• Alcohol swab
• IV connector (AKA alligator clamp)
Hanging an IVPB ID pt, check allergies. Do 4th check at bedside.
• Close roller clamp
• Remove cap from “SET” Port on IVBP
• Insert IV Tubing Spike – Do not touch spike, it’s sterile!
• Fill drip chamber ½ full by squeezing drip chamber
• Prime Secondary Tubing
– There are Two Ways:
1. Open roller clamp. Prime tubing & connector. (#7 on list)
2. Prime the tubing using retrograde fluid flow from the primary IV solution (See #16, 17, & 18 on your list)
Now, we’re Primed & Ready to Go…
Label Tubing (Date, Time, Initials)
Hang 1° IV bag lower than IVPB – Use hanger. Connect to primary tubing using connector.Open Roller Clamp of IVPB !!!!!
Infuse IVPB at Prescribed Rate (Look in your med book)
Assess patient’s response
Document on MAR- does not go on iv sheet
Farmer, Edward
DOB 10-23-50 MR 54276
UNIT: ROOM: 303 B
Sex: M Hgt: 5’7” Admit Date: 3-17-09
Physician: Dr. Jones VERIFIED BY:_____ ___BJM_________ __________Age: 56 Wgt: 150 lb CrCl: Allergies: Codiene
DATE (NURSE TO WRITE IN): 3-15-11
MEDICATIONPRESCRIBED
DOSE
1200 IVPB BJM
Start Stop 00:00-07:30 07:31-15:30 15:31-23:49
Ampicillin 1 gram IVPB q 6hrs x 4 doses 1200-1800
0000-0600
3-15 3-16
INITALS SIGNATURE INITALS SIGNATURE INITALS SIGNATURE
BJM B. MEYER, RN
PRN adapter
Gloves PRN adapter
Normal Saline Flush Alcohol Swab
Tape Chux
Goggles
YOU WILL NEED
Farmer, Edward
Dr. Jones
DOB 10-23-50 MR 54276
ALLERGIES CodeineHeight:
5’7
Weight:
150 lbDate Time PRESCRIBED TREATMENT, MEDICATION AND DIET
TPN ORDERS MUST BE ORDERED ON “PARENTERAL NURTRITION ORDER FORM”
3-18-11 0800
T.O. Dr. Jones/B. MEYER, RN
DISCONTINUE IVF and adapt IV site
Flush IV site with 3 ml of
Normal Saline q 8 hours and prn
Farmer, Edward
DOB 10-23-50 MR 54276
UNIT: ROOM: 303 B
Sex: M Hgt: 5’7” Admit Date: 3-16-09
Physician: Dr. Jones VERIFIED BY:______ ___BJM_________ __________Age: 56 Wgt: 150 lb CrCl: Allergies: Codiene
DATE (NURSE TO WRITE IN): 3-18-11
MEDICATIONPRESCRIBED
DOSEStart Stop 00:00-07:30 07:31-15:30 15:31-23:49
Normal Saline Flush 3ml q 8 hrs & prn
3-18
INITALS SIGNATURE INITALS SIGNATURE INITALS SIGNATURE
BJM B. MEYER, RN
PRN Adapter•Obtain 3 ml Normal Saline into syringe. Attach blunt tip end.
•Wipe off PRN Adapter end with Alcohol
•Prime PRN Adapter with NS – Leave Syringe Attached
•Don gloves and goggles
•Stop the infusion
•Loosen the Existing Infusion Tubing
•Stabilize Site and Occlude Blood Flow
•Remove infusion
•Attach PRN Adapter and screw it securely onto the cannula hub.
•Flush IV with Normal Saline
•Re-Tape IV site and PRN Adapter
Farmer, Edward
DOB 10-23-50 MR 54276
UNIT: ROOM: 303 B
Sex: M Hgt: 5’7” Admit Date: 3-19-09
Physician: Dr. Jones VERIFIED BY:______ ____BJM________ __________Age: 56 Wgt: 150 lb CrCl: Allergies: Codiene
DATE (NURSE TO WRITE IN): 3-18-11
MEDICATIONPRESCRIBED
DOSE
0900 IVP BJM
Start Stop 00:00-07:30 07:31-15:30 15:31-23:49
Normal Saline Flush 3ml q 8 hrs & prn
3-18
INITALS SIGNATURE INITALS SIGNATURE INITALS SIGNATURE
BJM B. MEYER, RN
PUMP150 ML/
HR600
PRN
ADAPTER
START
DATE/TIME/
INITALS
SITE
#FLUIDS TUBING INFUSION
DEVICE
STOP
DATE/TIME/
INITALS
AMOUNT
900
1000
1000
COMMENTSRATE
3-15-11
0800
BJM
1
1000 ML
Lactated
Ringers
Y
N
Y
N
Y
Y
N
Y
N
Y
N
N
Y
N
PUMP100ml/
hr
3-15-11
1600
BJM
1000 ML
5% Dextrose
And Water
1000 ML
5% Dextrose
And water
150ml/
hrPUMP
3-15-11
2300
BJM
3-16-11
0900
BJM
1
1
1
3-15-11
1600
BJM
1000 ML
5% Dextrose
And Water
PUMP150ml/
hr
3-15-11
2300
BJM
3-16-11
0900
BJM
3-19-11
0900
BJM
Discontinuing IV site
DISCONTINUE IV SITE
INFORMATION GIVEN IN PREVIOUS LAB WILL NOT BE TESTED ON MAKE SURE CANNULA INTACT AND CHART
ACCORDING TO INSTITUTION POLICY HAVE WRITTEN ORDER BEFORE REMOVE ID PT BEFORE REMOVAL
Farmer, Edward
Dr. Jones
DOB 10-23-50 MR 54276
ALLERGIES CodeineHeight:
5’7
Weight:
150 lbDate Time PRESCRIBED TREATMENT, MEDICATION AND DIET
TPN ORDERS MUST BE ORDERED ON “PARENTERAL NURTRITION ORDER FORM”
3-19-10 0600
T.O. Dr. Jones/B. MEYER, RN
DISCONTINUE IV SITE
DATE/
TIME/ INITALSITE SITE STATUS
Start:
Stop:
3-19-11
0700
BJM
Site #
Location
Size/Type
Site Rotation Due:__________
Dressing Change:
3-16-10
0800
BJM
1Reason for Change (code):
Comments:
3-19-10 0800
L H
# 20/ Angio
Attempted x1