IV ADMINISTRATION

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IV ADMINISTRATION
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IV Needle-Free System

• Normal Saline Flushes and Medications
• 1000cc NS IV Bag
• Label bag with med additive label
• containing date, time, and your name
• Spike IV with Access Device Tubing
• Label tubing with day/color coded tubing
• Keep bag in a locked device
• Change IV Bag Tubing every 96 hours

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• Flushing Capped IV
• Swab valve septum with alcohol swab
• Insert syringe tip into valve septum
• Turn luer lock clockwise to secure
• Administer flush
• Clamp IV tubing before twisting syringe off valve
  septum
• Turn syringe counterclockwise and remove it

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IV Therapy Protocol

• Read Policy in Orientation Book
• To be competent in IV therapy
• Pass IV Test with 85
• Demonstrate management according to MMH policies
  and unit competency criteria
• All LVNs must take MMH IV Class during first year
  of employment
• IV Conscious Sedation requires a separate
  competency

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IV Therapy Protocol

• Verify doctors order
• Obtain patients permission
• Patient teaching
• Assemble equipment
• Aseptic technique
• Standard precautions

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Choose IV Site

• Upper vs. Lower extremity
• External jugular
• Avoid
• Arms with compromised circulation
• Areas of flexion
• Antecubital veins
• Areas with existing phlebitis, bruises,
  infiltration
• Hands in elderly

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Prep IV Site

• Scrub with antiseptic solution in policy for 30
  seconds
• 0.1cc of 1Lidocaine without Epinephrine
• Perform venipuncture
• Connect tubing
• Set rate of infusion according to physician order
• On IMED rate, it is ml or cc/hour
• KVO or TKO rate is 20 ml/hr for adults and 5ml/hr
  for pediatrics

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Apply Sterile Dressing

• Secure cannula hub
• Use transparent dressing if possible
• Sterile gauze dressing may be used
• No antibiotic ointment unless ordered
• If gauze is used under a transparent dressing, it
  is changed like a gauze dressing

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Label

• IV site with date/time, gauge, and initials
• IV tubing including secondary IVPB set with day
  color coded labels
• IV Solution with
• Patient name
• Room number
• Date/Time
• IV fluid
• Additives

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Document

• Date/Time
• Gauge
• Site location
• Solution
• Rate
• of attempts
• Name of practitioner that started IV
• Condition of IV site

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IV Checks

• Palpate for swelling, induration, palpable cord,
  heat or coolness in skin temp.
• Examine for redness, blanching, bruises, purulent
  drainage, leaking of IV Fluid
• Ask patient about pain/discomfort
• Document IV site check at least every 2 hours
• What do you do if you notice purulent drainage?

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Change

• Dressing
• Gauze 48 hours
• If antibiotic ointment used 24 hours
• Transparent 96 hours
• Whenever dressing becomes loosened, moist, or
  soiled
• Peripheral IV site
• Adult 96 hours
• Pediatric leave in place as long as no
  complications
• Outside hospital start 24 hours
• What do you do if you can not find another IV
• site and present IV is infusing without
• complications?

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Change

• IV Solutions and tubing every 96 hours
• Includes PCA Pump solutions
• Includes IVPB tubing
• All IV Solutions - document in MAH
• TPN Lipid tubing changed every 24 hours
• Change solutions and tubing at the same time
  maintaining a closed system
• Document tubing changes in Nurses Notes

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Discontinuing IV

• Document in Nurses Notes
• Date/Time discontinued
• Condition of site
• Condition of IV catheter

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Peripheral Intermittent Infusion (Saline Lock)
Device

• Flush with 5 ml preservative free normal saline
• At least every 8 hours
• Before and after giving medications
• Document saline flushes in BCMA
• Use positive pressure flush

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Solution Rates

• For infusing through IMED Pump
• need to know ml or cc/hour
• Amount of Solution cc or ml/hour
• Number of Hours
• Example
• Order is for 1000cc D5NS every 10 hours
• 1000cc 100 cc/hour
• 10 hours

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Solution Rates

• For Drip Rates, pick one formula that works for
  you and stick with it
• Example 1volume (cc or ml) X drop factor
• time (in minutes)
• Order of 500 cc NS to infuse over 8 hours.
• Drop factor is 60 drops/cc
• 500 cc X 60 gtts/cc 62.5 gtts/min
• 480 minutes(8 hrs X 60 min.) rounded to 63
  gtts/min

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Solution Rates

• Example 2 ml/hour X drop factor (gtt/ml)
• 60 minutes
• An antibiotic is in 100cc of solution and is to
  be infused over 1 hour into heparin lock.
• Drop factor is 20 gtts/ml
• 100cc/hr X 20 gtts/cc 33 gtts/min
• 60 minutes
• Work through Practice problems in next slides.

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A patient is to receive 1 Gram of Ampicillin over
30 minutes in 50 cc Normal Saline.

• What is your drip rate if you give above drug by
  gravity with an IV set drop factor of 20 drops
  per ml?
• What is the IMED rate if you use the pump to
  infuse medication in above scenario?
• What is your drip rate if you give above drug via
  microdrip tubing (60 gtts/ml)?

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The physician writes an order for 350cc of NS to
be given over 90 minutes.

• What is your drip rate if you give above NS by
  gravity with an IV set drop factor of 20 drops
  per ml?
• What is the IMED rate if you use the pump to
  infuse NS in above scenario?

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The physician orders that one unit of PRBC
(350cc) is to be given over 3½ hours.

• What is your drip rate if you give blood by
  gravity with an IV set drop factor of 15 drops
  per ml?
• What is the IMED rate if you use the pump to
  infuse blood in above scenario?

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• IMED Pump directions can be found on the last
  page of the IV section