Transcript Initiating an IV Infusion

Initiating and Discontinuing IV Infusion
NUR 304
Learning Objectives
At the end of the discussion and video presentation, the
students will be able to:
1.
2.
3.
4.
Adhere to strict aseptic technique while performing the
procedure.
State the purposes of IV infusion.
Describe essential steps when initiating a peripheral
intravenous infusion.
Calculate flow rate correctly.
INTRODUCTION

Peripheral venous cannulation is when a
plastic
or metal tube is inserted for
intravenous (IV)
therapy, such as IV fluids
and/or drugs or the transfusion of blood
products.
 Also for the administration of dyes and
contrast media during clinical
investigations.
INTRODUCTION
 Device used is a peripheral venous catheter
(PVC) commonly referred to as a cannula.
Selection of an Appropriate Cannula
 PVC must never occlude a vein;
 Critically ill and the situation is an emergency
Selection of an Appropriate Cannula
 (hypovolemic shock), rule does not apply.
 Hence, we insert a larger device to “push the
fluids” into the patient’s system as quickly as
possible for rapid treatment.
 It should be replaced every 72 hours, but
should be flushed, usually with 0.9% NaCl every 46 hours
Types of IV Cannula
COLOR SIZE COMMON APPLICATIONS
Orange - 14G – treaters or emergency for
rapid
transfusion of blood or viscous
fluids.
Grey - 16G – same as above
Types of IV Cannula
- 17G – blood transfusions, rapid
transfusion of large volumes
of viscous fluids.
Green - 18G - blood transfusions, parenteral
nutrition, stem cell harvesting
and cell separation, large volume
of fluids
White
Types of IV Cannula


Pink - 20G – blood transfusions,
large volume of fluids.
Blue - 22G – blood transfusions,
most medications and fluids.
Types of IV Cannula
Yellow – 24G – medications, short term
infusions, fragile veins,
children
Purple - 26G – neonatal
Venipuncture Sites
Site chosen for venipuncture varies with the:
1.Client’s age
2.Length of time the infusion is to run
3.Type of solution used, and the
4.Condition of the veins
Venipuncture Sites
 Adults: veins in the hand and arm are
commonly used
 Infants: veins in the scalp and dorsal foot
veins are often used.
 Metacarpal, basilic and cephalic veins are
commonly used for intermittent or continuous
infusions.
Venipuncture Sites
 the ulna and radius act as natural splints at
these sites, and the client has greater freedom
of arm movements for activities such as eating.
 Although basilic and median cubital veins in
the antecubital space are convenient sites for
venipuncture, they are usually used for
Venipuncture Sites

blood draws, bolus injections of medication,
and insertion sites for a peripherally inserted
central catheter line.
Venipuncture Sites
Practice Guidelines
VEIN SELECTION
 use distal veins of the arm first
 use the client’s nondominant arm whenever
possible
 select a vein that is:
* easily palpated & feels soft & full
* naturally splinted by a bone
Practice Guidelines
VEIN SELECTION
 large enough to allow adequate circulation
around the catheter.
 avoid using veins that are in areas of flexion;
highly visible, since they tend to roll away
from the needle; damaged by previous use,
phlebitis, infiltration or sclerosis; continually
distended with blood, or knotted or tortous;
Practice Guidelines
VEIN SELECTION
 in a surgically compromised or injured
extremity (e.g. following a mastectomy)
because of possible impaired circulation
and discomfort for the client.
INITIATING A
PERIPHERAL INTRAVENOUS INFUSION
Purposes of IV Infusion:
1. Supply fluid when clients are unable to take in
an adequate volume of fluids by mouth.
2. Provide salts and other electrolytes needed to
maintain electrolyte balance.
3. Provide glucose (dextrose), the main fuel for
metabolism.
4. Provide water-soluble vitamins and
medications.
5. Establish a lifeline for rapidly needed
medications.
Assessment:
Assess the following:
 Vital signs (PR, RR & BP) for baseline data
 Skin turgor
 Allergy to latex (e.g. tourniquet), tape or iodine
 Bleeding tendencies
 Status of veins to determine puncture site
Equipment:
 infusion set
 sterile parenteral solution
 IV pole
 adhesive or non-allergenic tape
 clean gloves
 tourniquet
 antiseptic swabs
 IV catheter
 sterile gauze dressing or transparent occlusive
dressing
 arm splint if required
 towel or pad
 antiseptic ointment (check agency policy)
 electronic infusion device or pump if necessary
Preparatory Phase:
1. Prepare IV solution & administration set.
 Utilize 10 Rights of medication administration
Check IV solution to make sure it is the
correct
solution with the prescribed additives.
 Check expiration date – IV solution bag
 Check for discoloration or particulate matter
Initiating an IV Infusion
 Place a time tape on the solution container
with the prescribed infusion rate, time it begun,
& time of completion.
 Remove the administration set from its
package, label the tubing with the date and time,
& then close roller clamp.
 Remove the protective cover from the IV
solution port.
Initiating an IV Infusion
Remove the protective cover from the spike on
the IV administration set, making sure the spike
remains sterile. Position the spike into the port
of the solution container. If the solution is in a
glass bottle, clean 1st the rubber stopper with
an alcohol swab, then insert the spike through
the rubber stopper.
Initiating an IV Infusion
Make certain the tubing is clamped then hang
the IV solution container on an IV pole.
Adjust the pole so that the container is
suspended about 1 m (3 ft.) above the
client’s head. Rationale: This height
is needed to enable gravity to
Initiating an IV Infusion
overcome venous pressure &
facilitate flow of the solution into
the vein.

Lightly compress the drip chamber & fill it
halfway. If extension tubing is used, attach it
to the end of the administration set.
Initiating an IV Infusion
 Prime the tubing by opening the roller clamp &
allow the fluid to slowly fill the tubing.
Rationale: The tubing is primed to
prevent the introduction of air
into the client. Air bubbles smaller
than 0.5ml usually do not cause
problems in the peripheral lines.
Initiating an IV Infusion
 Inspect the tubing for air. If air bubbles remain
in the tubing, flick it with the fingernail to
mobilize the bubbles. Recap the end of the tube
firmly.
Initiating an IV Infusion : Performance Phase
1. Locate the vein for inserting the IV catheter.
Select a vein that is most distal on the hand
or arm. Avoid using an arm or hand that has
a dialysis graft or fistula or the affected arm
of a mastectomy client. Rationale:
Because of possible impaired
circulation & discomfort for the
client.
Initiating an IV Infusion :
Performance Phase
2. Place a linen saver pad under the client’s
arms. Rationale: to protect linens.
3. Place client’s arm in a dependent position &
apply tourniquet 4 – 6 inches above the
selected site. Explain that the tourniquet will
feel tight. Rationale: The tourniquet
must be tight enough to obstruct
Initiating an IV Infusion :
Performance Phase
venous flow but not tight that it
occludes arterial flow.
4. Palpate the radial pulse. If no pulse is
present, loosen the tourniquet & reapply it
with less tension. Rationale:
Obstructing arterial flow inhibits
venous filling.
Initiating an IV Infusion :
Performance Phase
5. Palpate the vein & press it downward,
making sure that it rebounds quickly. If vein is
not adequately dilated, instruct client to open &
close his fist, apply warm compress, lightly tap
the vein or stroke the extremity from distal to
proximal below the selected venous site.
Rationale: Actions help fill the
Initiating an IV Infusion :
Performance Phase
vein. Opening & closing fist helps
by contracting the muscles which
in turn, compress the distal veins,
forcing blood along the veins and
distending them.
6. After selecting the vein, gently
tourniquet.
release the
Initiating an IV Infusion :
Performance Phase
7. If excessive hair is present at the
venipuncture site, clip it. Rationale:
Shaving is usually not recommended
because
of the potential for
microabrasions which can increase
the risk of infection.
8. Put on clean gloves.
Initiating an IV Infusion :
Performance Phase
9. Choose the appropriate IV catheter based on
the size of the vein & the solution to be used
10.Open the catheter package using aseptic
technique.
11.Reapply the tourniquet & clean the site of
insertion using an antiseptic swab that contains
2% tincture of iodine, alcohol or
Initiating an IV Infusion :
Performance Phase
chlorhexidine. Avoid using chlorhexidine in
infants under 2 months of age.
12. Clean the area using circular motion moving
from the center and going outward for
several inches. Rationale: This motion
carries microorganisms away from
the site of entry.
Initiating an IV Infusion :
Performance Phase
13. Allow the antiseptic to dry on the skin.
14. Using the nondominant hand, stabilize the
vein by stretching the skin, making sure not
to contaminate the insertion site.
15. Inform client that you are about to insert the
catheter & that, he may feel a little
uncomfortable.
Initiating an IV Infusion :
Performance Phase
16. Pick – up the catheter:
 Wing-tipped (butterfly) catheter – Grasp the
catheter by the wings using the thumb &
forefinger of the dominant hand- bevel up.
Remove protective cap from the needle.
 Over-the-needle catheter: Grasp the
catheter by the hub, using the thumb and
Initiating an IV Infusion :
Performance Phase
forefinger of the dominant hand –bevel-up.
17. Hold the catheter at a 20-30 degree angle
then pierce the skin.
18. Lower the catheter so that it is parallel to
the skin & advance the catheter into the vein.
Watch for flashback of blood into the chamber
of the catheter or the tubing of the winged
catheter.
Initiating an IV Infusion :
Performance Phase
19. Advance catheter.
Wing-tipped catheter: fully advance the
catheter.

Over-the-needle catheter: advance the
catheter to half its length. Withdraw the needle
while advancing the catheter fully into the vein.

Initiating an IV Infusion :
Performance Phase
20.While holding the catheter in place with one
hand, release the tourniquet with the other hand.
21. Using aseptic technique, quickly connect
the administration set adapter to the IV
catheter.
Initiating an IV Infusion :
Performance Phase
22. Still stabilizing the catheter, slowly open the
roller clamp & allow the IV fluid to flush the
catheter. Adjust the flow rate according to
physician’s order.
23. Cover the insertion site with a sterile
semipermeable transparent dressing. If the
site isn’t clean & dry, clean the site with an
Initiating an IV Infusion :
Performance Phase
antiseptic swab & allow it to dry before applying
the dressing.
open the package containing the dressing.
Using aseptic technique, remove the
protective backing from the dressing making
sure not to touch the sterile surface.
 cover the insertion site & the hub or winged

Initiating an IV Infusion :
Performance Phase
portion of the catheter with the dressing. Do not
cover the tubing of the administration set.
 Gently pinch the transparent dressing around
the catheter hub to secure it.
 Smooth the remainder of the dressing so that
it adheres to the skin.
Initiating an IV Infusion :
Performance Phase
24. Loop the administration tubing & place a
piece of tape over the catheter tubing connection
& loop section of the tubing.
25. Label the dressing with the date & time of
insertion, catheter size & own initials.
26. If insertion site is near a joint, place armboard
under the joint & secure with tape.
Discontinuing an IV Infusion :
Performance Phase

Verify physicians order, identify patient and explain procedure.

Assist the client to a comfortable position.

Place a linen-saver pad under the extremity that contains the IV
catheter.

Close the roller clamp on the administration set.

Carefully remove the IV dressing and tape that is securing the tubing.

Apply a sterile 2×2 gauze pad above the IV insertion site and gently
remove the catheter, directing it straight along the vein. Do not press
down on the gauze pad while removing the catheter.
Discontinuing an IV Infusion :
Performance Phase
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

Immediately apply firm pressure with the gauze pad over the
insertion site. Hold pressure for 2 to 3 minutes; longer if
bleeding persists.
Remove the soiled 2×2 gauze pad and replaces it with a sterile
2×2 gauze pad. Secures it with a piece of 1-inch tape.
Dispose of the IV catheter in the appropriate sharps container.
Discard the IV tubing, linen-saver pad, IV solution container,
and gloves in the appropriate trash container, according to
agency policy.
IV Flow Rate Calculation
Formula:
Total Fluid in ml
Total hours
X IV set calibration
60 minutes
IV set calibration: Check the IV set package

Macroset- 20 macrodrops (gtts)/ ml

Microset (Secondary Inlet)- 60 microdrops (ugtts)/ml
Infusion set
Macroset
●
IV Flow Rate Calculation
Calculate for the flow rate:
1. Administer 1000 ml of D5 NSS for 8 hours.
2. Administer 200 ml/hr of D5W.