iv therapy presentation collect the following supplies: * two papers of labels (have 4 labels) * two...

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