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
Whats the first thing you always need to do?
Check the Doctors order.
Farmer, Edward
Dr. Jones
DOB 10-23-50 MR 54276
ALLERGIES
Codeine
Height:
57
Weight:
150 lb
Date 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
Drs 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 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
Date
Time
Initials
Label IV Fluids
Date
Time
Initials
Patients 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 Doctors
order in with you

Check for allergies:
Tape
Latex
Betadine (if using)

Do 4
th
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

Equipment Inventory
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 Cant 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! Im in the Vein, Now What?
Occlude vein at cannula end Before pulling the stylet
completely out or
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/ INITAL
SITE SITE STATUS
Start:
Stop:
Site #
Location
Size/Type
Site Rotation Due:__________
Dressing Change:
3-15-11
0800
BJM
1
Reason 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 COMMENTS RATE
3-15-11
0800
BJM
1
1000 ML
Lactated
Ringers
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
PUMP
100ml/
hr
Farmer, Edward
Dr. Jones
DOB 10-23-50 MR 54276
ALLERGIES
Codeine
Height:
57
Weight:
150 lb
Date 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 GogglesTegaderm 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 COMMENTS RATE
3-15-11
0800
BJM
1
1000 ML
Lactated
Ringers
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
PUMP
100ml/
hr
3-15-11
1600
BJM
1
3-15-11
1600
BJM
1000 ML
5% Dextrose
And Water
PUMP
150ml/
hr
Changing IV solution
Farmer, Edward
Dr. Jones
DOB 10-23-50 MR 54276
ALLERGIES
Codeine
Height:
57
Weight:
150 lb
Date 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 COMMENTS RATE
3-15-11
0800
BJM
1
1000 ML
Lactated
Ringers
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
PUMP
100ml/
hr
3-15-11
1600
BJM
1000 ML
5% Dextrose
And Water
150ml/
hr
PUMP
3-16-11
1100
BJM
1
1
3-15-11
1600
BJM
1000 ML
5% Dextrose
And Water
PUMP
150ml/
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
Codeine
Height:
57
Weight:
150 lb
Date 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: 57 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
MEDICATION
PRESCRIBED
DOSE
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

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-Powder
1. 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: Patients 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 4
th
check at bedside.

Close roller clamp
Remove cap from SET Port on IVBP
Insert IV Tubing Spike Do not touch spike, its sterile!
Fill drip chamber 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, were 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 patients 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: 57 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
MEDICATION
PRESCRIBED
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
Codeine
Height:
57
Weight:
150 lb
Date 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: 57 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
MEDICATION
PRESCRIBED
DOSE
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
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: 57 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
MEDICATION
PRESCRIBED
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
PUMP
150 ML/
HR
600
PRN
ADAPTER
START
DATE/TIME/
INITALS
SITE
#
FLUIDS TUBING INFUSION
DEVICE
STOP
DATE/TIME/
INITALS
AMOUNT

900


1000


1000
COMMENTS RATE
3-15-11
0800
BJM
1
1000 ML
Lactated
Ringers
Y
N
Y
N

Y


Y
N
Y
N
Y
N

N
Y
N
PUMP
100ml/
hr
3-15-11
1600
BJM
1000 ML
5% Dextrose
And Water
1000 ML
5% Dextrose
And water
150ml/
hr
PUMP
3-15-11
2300
BJM
3-16-11
0900
BJM
1

1
1
3-15-11
1600
BJM
1000 ML
5% Dextrose
And Water
PUMP
150ml/
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
Codeine
Height:
57
Weight:
150 lb
Date 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/ INITAL
SITE SITE STATUS
Start:
Stop:
3-19-
11
0700
BJM
Site #
Location
Size/Type
Site Rotation Due:__________
Dressing Change:
3-16-10
0800
BJM
1
Reason for Change (code):
Comments:
3-19-10 0800
L H
# 20/ Angio
Attempted x1