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IV Priming

IV Priming. Chapter 28 (Perry & Potter). IV Priming. Why do clients need an IV? Replacing fluids Correct or prevent nutritional imbalances Provide IV medication therapy. Nursing Responsibilities. Know the correct solution & equipment needed & how to initiate the infusion

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IV Priming

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  1. IV Priming Chapter 28 (Perry & Potter)

  2. IV Priming • Why do clients need an IV? • Replacing fluids • Correct or prevent nutritional imbalances • Provide IV medication therapy

  3. Nursing Responsibilities • Know the correct solution & equipment needed & how to initiate the infusion • Regulate the infusion (with or without a pump) • Care for and maintain the system • Indentify and correct problems • Discontinue the infusion as ordered

  4. Categories of IV solutions • Isotonic • Hypotonic • Hypertonic • Determined by serum electrolyte values and fluid volume balance • RN must understand the rationale for IV fluid administration and the type of solution ordered

  5. Isotonic solution: same osmolarity as plasma. Prevents fluid shifts. (0.9% NS) *Hypotonic solution: lesser conc of solutes than plasma. Fld shifts into cell. (0.45%NS) *Hypertonic solutions: greater conc of solutes than plasma. Draws fluid out of the cells. (5% Dextrose .45 NS)

  6. Solution of lower osmotic pressure Less salt or more water than isotonic If infused into blood, RBCs draw water into cells (can swell & burst ) Solutions move into cells causing them to enlarge Solution of higher osmotic pressure 3% sodium chloride is example If infused into blood, water moves out of cells & into solution (cells wrinkle or shrivel) Solutions pull fluid from cells HYPOTONIC vs. HYPERTONIC

  7. Establish IV Access • IV catheter & tubing can remain in place for 72 hours (check hospital policy), IV solution replaced every 24 hours • Palpate insertion site daily and prior to initiating infusion • Inspect site if client c/o pain at site or developed S&S of infection • Change transparent dressing if becomes damp, soiled, loose • Clean injection port with antiseptic before accessing system

  8. Supplies • Administration set (IV lines) • Correct IV solution • Antiseptic swabs • Tape • IV pole, rolling or ceiling mounted • Hospital gown with snaps • 1-3 ml normal saline, 3 ml syringe (or larger)…pre-filled n/s syringes may be available, to flush IV catheter prior to initiating infusion

  9. Assessment • Review physician’s order (type, amount and/or rate) • 6 medication rights (medication, dose, client, route, time, documentation) • Physical assessment pertaining to IV fluid administration • Understand rationale and purpose of IV fluid, potential incompatibilities, and potential side effects

  10. Nursing Diagnosis Risk for imbalanced fluid volume Deficient fluid volume Excess fluid volume Risk for infection

  11. Implementation • Change gown • Prepare tubing and solution • Check solution (6 rights) • Color • Clarity • Expiration date • Leaks

  12. Open infusion set (maintaining sterility of each end) • Place roller clamp 2-5 cm below drip chamber and move to OFF position • Remove sheath over port on IV solution bag • Remove tubing spike (DO NOT TOUCH) • Insert spike into IV bag

  13. Priming: • Compress drip chamber, fill 1/3 to ½ • Remove cap on end of tubing, KEEP and maintain sterility • Slowly open roller clamp and prime tubing with fluid, return roller clamp to OFF position • Inspect for air bubbles, tap tubing where bubbles are visible, and invert ports and tap to fill and remove air • Replace cap from end of tubing • Label tubing and bag with date and time

  14. Prepare N/S (1-3 ml) to flush intermittent infusion device (saline lock, PIID, clave) (p. 749/750 – establish IV access) • Saline lock is attached to end of IV catheter which is then attached to the primary line • Has a port or stopper (needleless) • Must be irrigated (flushed) q8-12 h, and before & after each drug infusion (hospital policy) • Saline or heparinized saline (hospital policy & dependent on IV access Line/ site) • Sterile technique

  15. Regulating IV Flow Rate(Gravity) • Flow rate established using pump (ml/hr) or gravity (gtt/min) • If line patent and IV infusion initiated, flow rate must be established • Educate client regarding positioning • Inspect site often

  16. What is the drop factor: number of drops per ml (gtt/ml) IV tubing provides: Microdrip: 60 gtt/ml Macrodrip: Abbott: 15 gtt/ml Travenol: 10 gtt/ml McGaw: 15 gtt/ml

  17. Calculating drip rate: ml/hr x gtt/ml= drops/min 60 min Or ml x gtt x 1 hr = drops/min hr ml 60 min

  18. If ml/hr unknown: ml/hr = total infusion (ml) hours of infusion (hr)

  19. Remember: if infusion is not exactly 1 hour (15 min, 30 min, 2 hrs, 4 hrs etc…) you must calculate hourly rate. Example: (infusion over 15 mins) 50 ml x ? = 200 ml 15 min 60 min hr Or 50 ml x ? = 200 ml 0.25 hr 1 hr hr

  20. Example: (infusion over 4 hrs) 1000 ml x ? = 250 ml 4 hr 1 hr hr

  21. Example: Order: D5W @ 75 ml/hr Drop factor: 15 gtt/ml Calculate drip rate: ? gtt/min Answer:75 ml/hr x 15 gtt/ml = 18.75 gtt/min 60 minutes (18-19 gtt/min)

  22. Example: Order: Give 1 L Ringer’s Lactate over 4 hours Drop factor: 15 gtt/ml Calculate drip rate: ? gtt/min Answer: 1000 ml x ? = 250 ml 4 hr 1 hr hr 250 ml/hr x 15 gtt/ml = 62.5 gtt/min 60 minutes (62- 63 gtt/min)

  23. Establishing Drip Rate • Count drops in drip chamber for 1 minute (with second hand), adjust roller clamp as needed (2-5 cm below drip chamber) • If very fast or very slow, count for 30 sec (x 2) and adjust roller clamp. Count for 1 full minute once clamp is adjusted .

  24. Evaluation • Monitor infusion at least q1h (note volume, rate) • Assess for S&S of over hydration or dehydration, response, lab values • Assess S&S of infiltration, inflammation, clot in catheter, kink or knot in tubing etc…

  25. Recording and Reporting • Rate of infusion, gtt/min, and ml/hr in nursing notes or IV fluid form • Document any ordered changes in IV fluid rates • Report rate, solution, volume remaining to the nurse assuming care of client at break or change of shift

  26. Practice Priming

  27. IV MedicationSecondary Lines Chapter 22 (Perry & Potter) p.604-609

  28. Piggyback (p.609) A small IV bag connected to short tubing that is connected to the upper Y port of a primary infusion line. The small bag is set higher than the primary infusion bag. Upon completion of the secondary solution when the solution in the tubing falls below the primary drip chamber the primary solution begins again.

  29. IV Medication Secondary line (piggyback) • Prepare medications: 6 rights and 3 checks • Medical history & allergies • Review medication indication

  30. Drugs prescribed 1 to 6 times per day, dissolved in small volumes of IV fluid (mini-bag: 50mL, 100mL, 250mL) • Usual infusion time : 30 to 60 minutes • Check compatibility of drug to solution

  31. When mixing powders for injections, remember: • Check the type of fluid recommended to dissolve the powder • The amount of fluid to add • The strength of the solution made (i.e. mg/ml) • Further dilution for infusion • Infusion time

  32. Where to find information regarding reconstitution of the powder • The label of the vial • Package insert inside the vial package • Nursing Drug book • Compendium of Pharmaceuticals and Specialties ( CPS) • Parenteral drug manual • Ottawa General (most common & you should know where this is on your unit)

  33. Medication Calculation Example: • Order: Drug 0.65 g QID IV • Label directions : Add 2.5 ml water for injection. Provides approx volume of 3 ml (325mg/ml) • Note : the manufacturer gives the strength of the solution • Desire 0.65g • Have: 325 mg/ml • Stock : in every ml

  34. Desire: 0.65 g Have: 325 mg/ml Stock : in every ml Convert: 0.65g to mg 1g = 1000 mg ( therefore answer should be bigger) 1000mg = Three zeros Therefore move decimal point three spaces to the right 0.65 g = 650 mg Desire X Stock = Amount Have 650 mg X 1ml = 2mL 325 mg

  35. Calculation of Drip Rate Example: Order: Flagyl 500mg/100 ml normal saline IV BID (administered over 1 hour) Drop factor: 15 gtt/ml Calculate drip rate: ? gtt/min Answer:100 ml 1 hr 100 ml/hr x 15 gtt/ml = 25 gtt/min 60 minutes

  36. When calculating IV rates, if the medication volume exceeds 10 ml, add this into calculations (i.e. 10% rule, 5 ml 10% 50 ml, 10 ml 10% of 100 ml) Example: Amount: 100 ml NS plus 10 ml penicillin=110 ml Duration: Give over 30 minutes Calculate rate: ? ml/hr Answer: 110 ml x ? = 220 ml 0.5 hr 1 hr hr

  37. Let’s Practice (vial containing a powder) p.585 • Reconstitution of medication • Adding to secondary bag • Attaching secondary line to primary line • Regulating rate

  38. Follow 6 rights and 3 checks • Wash hands • Gather supplies • Medication, secondary line,10 ml syringe, 18-22 gauge needle (filtered if indicated), alcohol swabs, dilutant (saline or sterile water), mini bag (medication bag), medication label, MAR

  39. Order Ampicillin 500 mg IV, q6h • See vial for directions: to have 500 mg/ml add 5.6 ml dilutant • IV drug manual indicates: add to 50 - 100 ml normal saline and infuse over 60 minutes • How many ml of medication will you add to your minibag? • What is the rate (ml/hr)? • What is the drip rate with drop factor of 15 gtt/ml? Answers: 50 ml50 ml/hr X 15 gtt/ml = 12.5 gtt/min (12-13) hr 60 min 100 ml100 ml/hr X 15 gtt/ml = 25 gtt/min hr 60 min

  40. Preparation • Remove cap covering medication and dilutant (6 rights, 3 checks), swab both rubber seals with alcohol swab and allow to dry • Attach needle (or needleless device) to syringe, pull back on plunger drawing the equivalent amount of air (i.e. 5.6 ml) as solution and inject into solution (hold plunger firmly, vial on flat surface) • Invert vial and allow pressure from the vial to fill syringe with solution (5.6 ml), pull back gently if required. Keep tip of needle in fluid. Place vial on flat surface to remove needle • Inject dilutant into medication vial, remove needle and recap (scoop technique)

  41. Roll in palms (DO NOT SHAKE) • Wait until medication is clear, swab medication bottle again, and withdraw desired amount (follow same steps as withdrawing dilutant (inject equal volume of air (i.e.1 ml) as medication to be removed) • Adding medication to secondary bag: wipe port with alcohol swab, lay medication bag on flat surface, insert needle and inject. Discard needle (no need to recap) • Mix medication turning gently end to end • Complete medication label (apply to back of medication bag) • Spike bag with secondary IV tubing, ensure clamp is CLOSED

  42. Clean port of main line and connect secondary tubing to medication bag, squeeze and fill drip chamber. • Back prime: drop medication bag below level of primary drip chamber, open secondary line roller clamp, prime line, hang medication bag above primary fluid bag (use hook to lower main bag) • Regulate flow by adjusting regulator clamp or using IV pump • Observe for S&S of reaction • Assess IV site frequently

  43. Order Ampicillin 500 mg IV, q6h • See vial for directions: 500 mg/ml add 5.6 ml solution • IV drug manual indicates: add to 50 - 100 ml normal saline and infuse over 60 minutes Answers: 50 ml50 ml/hr X 15 gtt/ml = 12.5 gtt/min (12-13) hr 60 min 100 ml100 ml/hr X 15 gtt/ml = 25 gtt/min hr 60 min

  44. Next Lab Subcutaneous Injection & Insulin Chapter 22 (p.573-598)

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