IV Therapy Equipment and Procedure 2

IV Therapy Equipment

• IV tubing must match the specific IV pump brand used
• Ensure all clamps are open on the tubing before starting the pump
• Check all clamps to ensure they are open, starting from the top and moving down
• Always check the doctor's order against the medication administration record (MAR) for IV fluids and medications
• Ensure that the IV bag is properly labeled with the patient's name, expiration date, and fluid type
• Always visually inspect IV fluids prior to use; ensure the fluid is clear and free of particles or cloudiness
• Inspect the IV bag for damage to ensure the bag is intact
• IV pumps have battery backups but should be plugged in whenever possible to maintain a fully charged battery

IV Administration Methods

• There are seven rights of IV therapy: right patient, right time, right medication, right route, right dose, right documentation, and right compatibility
• Compatibility refers to the ability of two medications to be administered together safely in IV therapy
• Check compatibility by:
  • Consulting a drug book
  • Contacting the pharmacist
• Ensure at least two nurses verify the compatibility of any IV medications together

IV Administration Methods for LPNs

• A continuous infusion of IV fluids is termed a primary line; these should be administered with a pump if possible
• Intermittent infusions refer to piggyback, a hep-lock, or a saline lock

IV Therapy Hazards

• Physical hazards may not be readily visible
• Visual indicators of compatibility issues include:
  • Precipitate: snow-like appearance in the IV solution
  • Haze: shimmering or cloudy appearance
  • Gas bubbles
• Chemical hazards are interactions between two medications that may not be visually apparent
• Non-therapeutic hazards are undesirable effects that can occur due to:
  • Medications canceling each other out
  • Idiosyncratic reactions, where the response is opposite to the expected result

Preparing for IV Therapy or a Hep-lock

• Always obtain a doctor's order for IV therapy
• Gather necessary equipment: IV pole, IV pump, catheters, IV fluids, hep-lock, extension tubing, tape, and alcohol preps
• IV catheters come in various sizes, with 20 and 22 gauge catheters being most common
• Prime the IV tubing with sterile technique to ensure no air bubbles are present
• Identify the patient and explain the procedure before starting

IV Cannulation

• Apply a tourniquet 2-3 inches above the intended IV insertion site
• Maintain the tourniquet for one minute or less
• Cleanse the IV site with alcohol prep or betadine, ensuring the patient has no shellfish allergies
• Stabilize the vein by anchoring the hand and pulling back on the skin for slight traction
• Insert the catheter bevel upward, at a slight angle after feeling a flashback
• Once flashback is confirmed advance the catheter slightly further
• Release the tourniquet
• Occlude the vein by applying pressure above the catheter
• Remove the needle and immediately apply saline flush
• Watch the vein above the catheter to ensure it's not overfilled during flushing
• Never push the needle back in after withdrawing it
• If the catheter floats, withdraw the needle and flush with saline while advancing the needle

Connecting IV Fluids

• Use digital pressure when connecting IV fluids, but avoid if the vein is fragile
• Secure the catheter with a piece of tape before releasing the vein
• Apply a clear, occlusive dressing over the hub site, avoiding obstruction of the tubing connection and hub
• Loop the tubing back up and put a gauze sponge underneath it
• Place the IV tubing into the pump and program the order rate and make sure the tubing is appropriately labeled

IV Therapy Documentation

• Document:
  • Catheter size
  • Insertion site
  • IV fluids used
  • Any additives
  • IV rate
  • IV technique
  • Patient response
  • Number of venipuncture attempts
• Document all unsuccessful attempts
• Note any change to the catheter size for subsequent venipuncture attempts
• Monitor IV therapy every two hours at a minimum and check the infusion rate, site for complications, and patient's overall condition
• Change IV sites, catheters, fluids, and tubing every 72 hours; this is the standard practice in most facilities

IV Medications via Hep-lock or Saline Lock

• Obtain a doctor's order for medication administration
• Ensure the medication is approved by the Board of Nursing
• Check the medication against the MAR and the doctor’s order
• Gather equipment: primary line, syringe, alcohol prep, and IV medication
• Set up the IV piggyback, spike it, and prime the line before hanging on the pole
• Attach the tubing to the hep-lock or saline lock and program the pump
• Wipe the cap of the hep-lock or saline lock with alcohol prep prior to accessing it
• Flush with at least 2 cc of sterile saline
• Attach tubing to the hep-lock
• Open the clamp, set pump rate, and begin infusion
• After medication administration, remove tubing from the hep-lock and flush with remaining sterile saline

IV Site Care Guidelines

• Visually inspect and manually palpate the IV site, including the dressing daily, at a minimum of every two hours
• Remove and reapply any dressings that impede inspection of the site
• Wash hands prior to any site care procedure
• Wear gloves during catheter insertion and during dressing changes
• Leave dressings in place unless they become wet, loose, or soiled
• Record the date and time of insertion in a clear, visible location near the site
• Rotate IV sites every 42-72 hours, with 72 hours being the maximum timeframe
• Remove IV access under emergency conditions within 24 hours
• Remove IV devices at the first sign of infection
• Discontinue peripheral and central IV devices if not in use; obtain a discontinue order from the physician
• Avoid using inline filters for infection control

Discontinuing IV Therapy

• Obtain a doctor’s order
• Gather supplies: gloves, 4x4 gauze, tape
• Identify the patient and explain the procedure
• Turn off the IV pump
• Close the roller clamp
• Cleanse the site with alcohol prep
• Remove the tape
• Apply a 4x4 gauze over the site
• Remove the catheter
• Dispose of supplies appropriately

This quiz covers essential protocols for IV therapy equipment and administration methods. It focuses on the importance of proper labeling, checking compatibility, and the seven rights of IV therapy. Test your knowledge and ensure safe IV practices.