NUR 141: SKILL 28-3: CHANGING INTRAVENOUS SOLUTIONS

1. NUR 141: SKILL 28-3: CHANGING INTRAVENOUS SOLUTIONS

2. SKILL 28-3: CHANGING INTRAVENOUS SOLUTIONS - INTRODUCTION • Patients receiving intravenous (IV) therapy over time require periodic changes of IV solutions. IV container include plastic bags and glass bottles. • You change a container when there is an order for a new solution or when it becomes time to add a sequential container to avoid exceeding hang time. • It becomes clinically appropriate to change the type of solution depending on a patient’s fluid and electrolyte balance, response to therapy, and goals of therapy. • The Infusion Nurses Society (INS) recommends changing a fluid container within 24 hours after adding a medication or an administration set. • The use of ambulatory infusion devices may remain longer than 24 hours if you use aseptic technique, if the system remains closed without injection ports or add-on tubing, and if the medication is stable for a longer period of time.

3. ASSESSMENT • 1. Review accuracy and completeness of health care provider’s order in patient’s medical record for patient name and correct solution; type, volume, additives, rate, and duration of IV therapy. Follow six rights of drug administration. • 2. Note date and time when IV tubing and solution were last changed. • 3. Check the IV solution for integrity including, but not limited to: • Discoloration • Cloudiness • Leakage • Expiration Date • Determine compatibility of all IV fluids and additives by consulting approved online database, drug reference, or pharmacist • If there has been a break in the integrity of the solution container, a new bag is needed. Incompatibilities cause physical, chemical and therapeutic changes with adverse patient outcomes.

4. ASSESSMENT – CONT’D • 4. Determine patient’s understanding of need for continued IV therapy – this indicates need for any type of patient education. • 5. Assess patency of current venous access device (VAD) site, observing for any signs or symptoms of complications such as redness, swelling, complaints of discomfort. • 6. Assess IV tubing for puncture, contamination, or occlusion – This indicates need for tubing change. • 7. Check laboratory data, such as potassium level

5. PLANNING • 1. Expected Outcomes following completion of the procedure: • IV solution is correct – Patient receives solution ordered for treatment of diagnosis. • VAD remains patent – This ensure infusion of fluid into intravascular space • Patient and family caregiver can explain purpose of IV solution change – this demonstrates learning

6. IMPLEMENTATION • 1. Collect equipment. Have next solution prepared at least 1 hour before if needed. If solution is prepared n pharmacy, ensure that it has been delivered to patient care unit. Allow solution to warm to room temperature if it has been refrigerated. Check that solution is correct and properly labeled. Check solution expiration date. Ensure that any light sensitivity restrictions are followed. • 2. Identify patient using two identifiers (i.e., name and birthday or name and account number) according to agency policy. Compare identifiers with information in MAR/medical record with information on patient’s identification bracelet and/or ask patient to state their name. • 3. Change solution when fluid remains only in neck of container (about 50 mL) or when new type of solution has been ordered. • 4. Prepare the patient and the family caregiver by explaining procedure, its purpose, and what is expected of the patient. • 5. Perform hand hygiene.

7. IMPLEMENTATION – CONT’D • 6. Prepare new solution for changing. If using plastic bag, hang on IV pole and remove protective cover from IV tubing port. If using glass bottle, remove metal cap and metal and rubber disks. • 7. Close roller clamp on existing solution to stop flow rate. Remove tubing from EID (if used). Then remove old IV fluid container from IV pole. Hold container with tubing port pointing upward. • 8. Quickly remove spike from old solution container and, without touching tip, insert spike into new container – this reduces the risk for the solution in drip chamber from becoming empty and it also maintains sterility. • 9. Hang new container of solution on IV pole. • 10. Check for air in tubing. If air bubbles have formed, remove them by closing roller clamp, stretching tubing downward, and tapping tubing with finger (bubbles rise in fluid to drip chamber).

8. IMPLEMENTATION – CONT’D • 11. Make sure drip chamber is one-third to one-half full. If drip chamber is too full, level can be decreased by removing bag from IV pole, pinching off tubing below drip chamber, inverting container, squeezing drip chamber, releasing and turning solution container upright, and releasing pinch on tubing. • 12. Regulate flow to ordered rate by using roller clamp on tubing or programming EID – maintains measures to restore fluid balance and deliver IV fluid as ordered. • 13. Place time label on side of container and label with time hung, time of completion, and appropriate intervals. If using plastic bags, mark only on label and not container.

9. EVALUATION • 1. Observe functioning, intactness, and patency of IV system and flow rate – This ensures proper fluid administration. • 2. Observe patient for signs of fluid volume deficit (FVD) or fluid volume excess (FVE) to determine response to IV therapy – This provided ongoing evaluation of the patient’s fluid status. • 3. Assess the patient for signs and symptoms of IV-related complications. Palpate the skin for temperature, edema, or tenderness. – This provided ongoing evaluation of VAD patency.

10. UNEXPECTED OUTCOMES • 1. Flow rate is incorrect; patient receive too little or too much fluid. • RELATED INTERVENTIONS FOR THIS PROBLEM: • Notify health care provider if patient’s anticipated infusion is 100 to 200 mL less than or greater than anticipated (follow agency policy). • Evaluate patient for adverse effects of the infusion. • Determine and correct the cause of the incorrect flow rate (e.g., change in position, tubing kink). • Use EID when accurate flow rate is critical

11. RECORDING & REPORTING • Record amount and type of solution infused, amount and type of solution started, and flow rate according to agency policy. • Record solution and tubing change on patient’s record. Use parenteral (IV) therapy flow sheet, if available.

12. END OF SKILL • There is no video provided for you by your book. • I did find one on you-tube that is presented by the College of Dupage. • The video was done by an instructor there and the video is as follows: • COD IV Solution and Tubing Changing Review. • Please remember that this video was not provided by your book and while I tried to find the best “video-fit” possible, I’m not associated with your school. • Link to the video: • http://www.youtube.com/watch?v=MpVsSM3w25U