IV THERAPY

1. IV THERAPY PRESENTATION

2. ☼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

3. PREPARING IV SOLUTION & TUBING What’s the first thing you always need to do? Check the Doctor’s order.

4. Farmer, Edward Dr. Jones DOB 10-23-50 MR 54276 Codeine Height: 5’7 Weight: 150 lb ALLERGIES Date Time PRESCRIBED TREATMENT, MEDICATION AND DIET TPN ORDERS MUST BE ORDERED ON “PARENTERAL NURTRITION ORDER FORM” Start IVF – 1000ml Lactated Ringers 3- 15-11 0730 @ 100ml/hr T.O. Dr. Jones/B. Meyer, RN

5. 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

6. 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

7. 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

8. Label Tubing Date Time Initials

9. Label IV Fluids • Date • Time • Initials • Patient’s name • Any additions made to IV fluid

10. Gather IV Equipment • Needle/angiocath • Start kit (tape, tourniquet, alcohol pad, tegaderm, and label) • Chux pad • Clean gloves • Goggles • IV Pole

11. 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)

12. Do 4th check at the bedside • Explain procedure • Provide privacy • Body Mechanics (Bed up [if standing], etc)

13. IV pole/pump Angiocath needle Label Tourniquet Cleaning solution (depends on facility) IV solution & tubing Cut Tape Goggles Chux Tegaderm Prepare Supplies

14. Inspect Potential Sites Place tourniquet around the upper arm

15. Inspect Potential Sites Examine and Palpate Veins

16. Common IV Sites of the Hand

17. Common IV Sites of the Arm

18. 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

19. 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

20. 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

21. Once You Have Selected Your Site RELEASE YOUR TOURNIQUET!

22. 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

23. 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

24. Whew! I’m in the Vein, Now What? “POP” the tourniquet (loosen it without letting go of the IV) Occlude vein at cannula end Before pulling the stylet completely out or IT WILL LOOK LIKE A BLOODY MASSACRE! Quickly attach the IV tubing to the IV catheter

25. 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”

26. Clean Up Time Remove Gloves and goggles Dispose all used materials Throw Stylet in Sharps Container

27. Time to Document

28. DATE/ TIME/ INITAL SITE SITE STATUS 3-18-11 0800 Site Rotation Due:__________ Start: Site # Reason for Change (code): 3-15-11 0800 BJM 1 Comments: Attempted x1 Stop: Location L H Size/Type Dressing Change: # 20/ Angio

29. START DATE/TIME/ INITALS SITE # STOP DATE/TIME/ INITALS FLUIDS TUBING INFUSION DEVICE RATE AMOUNT COMMENTS 3-15-11 0800 BJM 1000 ML Lactated Ringers Y N 100ml/ hr 1 PUMP Y N Y N Y N Y N Y N Y N

30. Farmer, Edward Dr. Jones DOB 10-23-50 MR 54276 Codeine Height: 5’7 Weight: 150 lb ALLERGIES 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

31. 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

32. 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

33. 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

34. START DATE/TIME/ INITALS SITE # STOP DATE/TIME/ INITALS FLUIDS TUBING INFUSION DEVICE RATE AMOUNT COMMENTS 3-15-11 0800 BJM 1000 ML Lactated Ringers 3-15-11 1600 BJM Y N 100ml/ hr 1 PUMP 3-15-11 1600 BJM 1000 ML 5% Dextrose And Water Y N 150ml/ hr 1 PUMP Y N Y N Y N Y N Y N

35. Changing IV solution

36. Farmer, Edward Dr. Jones DOB 10-23-50 MR 54276 Codeine Height: 5’7 Weight: 150 lb ALLERGIES 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

37. 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

38. 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. Spike the new bag or bottle with tubing Reestablish prescribed flow rate. Check for air in tubing Empty remaining fluid from old IV bag if needed into toilet

39. START DATE/TIME/ INITALS SITE # STOP DATE/TIME/ INITALS FLUIDS TUBING INFUSION DEVICE RATE AMOUNT COMMENTS 3-15-11 0800 BJM 1000 ML Lactated Ringers 3-15-11 1600 BJM Y N 100ml/ hr 1 PUMP 3-15-11 1600 BJM 1000 ML 5% Dextrose And Water 3-16-11 1100 BJM Y N 150ml/ hr 1 PUMP 3-16-11 1100 BJM 1000 ML 5% Dextrose And Water Y N 150ml/ hr 1 PUMP Y N Y N Y N Y N

40. Hanging IV Piggyback • How to transcribe a New Medication Order to MAR • How to Mix an IVPB using Practi-Powder • How to Hang an IVPB

41. Farmer, Edward Dr. Jones DOB 10-23-50 MR 54276 Codeine Height: 5’7 Weight: 150 lb ALLERGIES Date Time PRESCRIBED TREATMENT, MEDICATION AND DIET TPN ORDERS MUST BE ORDERED ON “PARENTERAL NURTRITION ORDER FORM” 3-15-11 1200 Ampicillin 1 gram IVPB every 6 hours X 4 doses T.O. Dr. Jones/B. MEYER, RN

42. Farmer, Edward DOB 10-23-50 MR 54276 UNIT: ROOM: 303 B Sex: M Hgt: 5’7” Admit Date: 3-16-09 Age: 56 Wgt: 150 lb CrCl: Allergies: Codiene Physician: Dr. Jones VERIFIED BY:___ ___ BJM_________ __________ 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 3-15 3-16 1200 – 1800 0000 - 0600 INITALS SIGNATURE INITALS SIGNATURE INITALS SIGNATURE BJM B.MEYER,RN

43. 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!!!!!!!!!

44. 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

45. Pop off the blue “add” cap from IVPB bag • Attach needle to syringe – do not use blunt needle • Pop-top off of demo dose powder (the medication) • Withdraw fluid from IVPB (amt indicated on vial) • Wipe off top of demo dose powder • Instill fluid into powder • Withdraw syringe- BE CAREFUL OF AIR IN VIAL • Mix vial well • Wipe off top of vial • Reinsert syringe into vial • Withdraw all of the fluid from medication vial Mixing an IVPB using Practi-Powder

46. Mixing an IVPB using Practi-Powder • 12. Wipe off “add” port on piggy back with alcohol • Insert needle/syringe • Instill medication into piggyback bag via the “ADD” port • Recap needle/ Engage safety • Shake piggy back gently • Must label the IVPB: Patient’s name, date, time, initials, drug name and dose • 3 Checks are completed while preparing med

47. Hanging an IVPB YOU WILL NEED: • Secondary infusion set • IV tubing label • Alcohol swab • IV connector (AKA alligator clamp)

48. 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)

49. 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

50. Farmer, Edward DOB 10-23-50 MR 54276 UNIT: ROOM: 303 B Sex: M Hgt: 5’7” Admit Date: 3-17-09 Age: 56 Wgt: 150 lb CrCl: Allergies: Codiene Physician: Dr. Jones VERIFIED BY:_____ ___BJM_________ __________ 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 1200 IVPB BJM Ampicillin 1 gram IVPB q 6hrs x 4 doses 3-15 3-16 1200-1800 0000-0600 INITALS SIGNATURE INITALS SIGNATURE INITALS SIGNATURE BJM B. MEYER, RN