1. Intravenous Flow Rates
Chapter 16
Intravenous Flow Rates

2. Principles Keep to a method you understand
Have some idea where your answer should be so you can ask yourself:
Is my answer reasonable?
IF IN ANY DOUBT –STOP AND GET HELP !!!

3. Drug Calculations Http://youtu.be/2o8h-8UPAak

4. SIX RIGHTS OF MEDICATION ADMINISTRATION 1. Drug 2. Dose 3. Patient
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1. Drug
2. Dose
3. Patient
4. Route
5. Time
6. Documentation

5. Copyright © 2007 by Mosby, Inc.
Objectives
Calculating drops per minute (gtt/min) when given the total volume and time over which an IV solution or intravenous piggyback is to be infused
Calculating milliliters per hour (mL/h) when given the total volume and time over which an IV solution or intravenous piggyback is to be infused
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Copyright © 2007 by Mosby, Inc.
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6. Copyright © 2007 by Mosby, Inc.
Infusions
Common additives to infusions:
Medications
Electrolyte milliequivalents
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What is an infusion? An infusion is an injection of a moderate to large quantity of fluids and nutrients into the patient’s venous system.

7. Intravenous Infusion Set
Includes:
Sealed bottle or bag
Tubing
Drip chamber connected by small tube or spike
Tubing leading from drip chamber to needle or catheter
Clamp to adjust flow rate
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The sealed bottle or bag contains the fluids that are being infused. The drip chamber is connected to the bottle or bag by a small tube or spike. The tubing connects the drip chamber to the needle or catheter attached to the patient.
How is the flow rate of the IV infusion set adjusted? The flow rate is adjusted to the desired drops per minute by a clamp placed around the tubing.

8. Intravenous Infusion Set (cont’d)
FIGURE Intravenous infusion sets. (Modified from Clayton BD, Stock YN: Basic pharmacology for nurses, ed 13, St Louis, 2004, Mosby.)
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What is the purpose of the secondary port?
The secondary port is used for connecting a piggyback setup in which two IV infusion sets are connected.
The diameter of the tubing that comes with an infusion set varies. The diameter of the tubing affects the drop factor.
What is the drop factor? The drop factor of an infusion set is the number of drops contained in 1 milliliter.

9. Intravenous Infusion Set (cont’d)
Types of infusion sets (based on drop factor)
Microdrip sets
Macrodrip sets
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Microdrip sets deliver fluids in small-sized drops and are therefore unable to deliver large volumes of fluid per hour.
Macrodrip sets deliver fluids in large-sized drops and are therefore able to deliver large volumes of fluid per hour.
Some common drop factors are 10, 15, 20, and 60 gtt/mL. Would a set that delivers 60 gtt/mL be considered a macrodrip or microdrip set? It would be considered a microdrip set because the drops have to be smaller in size to have more drops in the same volume.

10. Regulating IV Flow Rates
Regulation is the responsibility of the nurse.
Irregular rates lead to complications.
Sometimes the rate must be adjusted.
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Copyright © 2007 by Mosby, Inc.
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The physician is responsible for writing the order for the type and volume of fluids to be administered. The physician is also responsible for ordering the time period over which the fluids should be administered.
What complications can arise if the IV flow rate is irregular? Fluid overload, dehydration, or medication overdose could result from irregular IV flow.
The rate might need to be adjusted because of interruptions in flow due to needle placement, condition of vein, or infiltration.

11. Copyright © 2007 by Mosby, Inc.
Adjusting Flow Rates
FIGURE Count drops per minute by watching the drip chamber for 1 minute and adjusting the roller clamp as needed to deliver the desired number of drops per minute. (From Potter PA, Perry AG: Fundamentals of nursing, ed 6, St Louis, 2005, Mosby.)
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Copyright © 2007 by Mosby, Inc.
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The flow rate of the infusion should be checked and adjusted to the desired number of drops per minute by using the clamp placed around the tubing.

12. Gravity Infusion Calculation Formula
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What do the variables represent in this equation? The “V” stands for the volume of fluid to be infused.
The “T” stands for the time period, in minutes, over which the fluid is to be administered.
The “C” stands for the constant drop factor of the tubing used for infusing the fluid.
The “R” stands for the infusion rate of the fluid in drops per minute.

13. IV Administration of Fluids by Gravity
Example: Hespan 650 mL is ordered to be infused over 3.5 hours. The drop factor is 20 gtt/mL. How many drops per minute should be administered to infuse 650 mL of Hespan over 3.5 hours?
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How many drops per minute should be administered to infuse 650 mL of Hespan over 3.5 hours?
Calculating the infusion rate (gtt/min):
[(650 mL)/(210 min)] × (20 gtt/mL) = x gtt/min
x = 61.9 gtt/min
The nurse will regulate the IV to drip at 62 gtt/min.

14. Infusion of IV Piggybacks by Gravity
FIGURE Tandem/intravenous piggyback (IVPB) administration setup. (From Potter PA, Perry AG: Fundamentals of nursing, ed 5, St Louis, 2001, Mosby.)
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What is an IV piggyback? An IV piggyback is the addition of medication to the infusion of regular IV fluids. It is also known as an IVPB.
If the physician does not include an infusion time or rate, then it is the nurse’s responsibility to follow the manufacturer’s guidelines.
The time frame for IVPB infusion is generally less than or equal to 60 minutes.

15. Infusion of IV Piggybacks by Gravity (cont’d)
Example: The physician orders gentamicin 50 mg in 80 mL D5W to be infused over 45 minutes. The tubing drop factor is 60 gtt/mL. How many drops per minute should be administered to infuse the gentamicin over 45 minutes?
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How many drops per minute should be administered to infuse the gentamicin over 45 minutes?
Calculating the infusion rate (gtt/min):
[(80 mL)/(45 min)] × (60 gtt/mL) = x gtt/min
x = gtt/min
The nurse will regulate the IV to drip at 107 gtt/min.

16. IV Pump Infusion Formula
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IV pumps are programmed to infuse IV fluids in milliliters per hour rather than in drops per minute.
Safety for the patient is an advantage of using electronic IV pumps.
Some IV pumps come with four channels, but the simpler models only have one channel.
Each company offers special tubing to be used with its pumps.

17. Infusion of IV Fluids with an IV Pump
Example: Infuse 750 mL of lactated Ringer’s solution (LR) over 8 hours. How many milliliters per hour should the IV pump be programmed to deliver?
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How many milliliters per hour should the IV pump be programmed to deliver?
Calculating the infusion rate (mL/h):
(750 mL)/(8 h) = x mL/h
x = mL/h
The nurse will program the IV pump for 94 mL/h.

18. Infusion of IV Medications with an IV Pump
Example: Administer 1.5 g of vancomycin over 90 minutes. The vancomycin is dissolved in 200 mL of D5W. How many milliliters per hour should the IV pump be programmed to deliver?
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Copyright © 2007 by Mosby, Inc.
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How many milliliters per hour should the IV pump be programmed to deliver?
Calculating the infusion rate (mL/h):
(200 mL)/(1.5 h) = x mL/h
x = mL/h
The nurse will program the IV pump for 133 mL/h.

19. Saline and Heparin Locks
Reduce the number of patient venipunctures
Allow patient greater mobility when fluid not being infused
Can be flushed with normal saline solution or heparin flush solution
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What is a saline lock?
A saline lock is an IV catheter that is inserted into a peripheral vein. It can be used for medications or other fluids on an intermittent basis. The catheter is flushed with saline to maintain patency.
What is a heparin lock?
The flushing of heparin locks is known as heparinization and prevents clotting of the heparin lock. Each institution has its own policy regarding the use and care of heparin locks.

20. Central Venous Catheters
Required for patients who need:
Frequent venipuncture
Long-term IV infusions
Hyperalimentation
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What is a central venous catheter? A central venous catheter is an indwelling, semipermanent central line that is inserted into the right atrium of the heart by way of the cephalic, subclavian, or jugular vein.
What are some types of central venous catheters? Some examples of central venous catheters are triple lumen catheters, Hickman lines, Broviac catheters, and Groshong catheters.

21. Central Venous Catheters (cont’d)
Required for patients who need (cont’d):
Chemotherapy
Intermittent blood transfusions
Antibiotics
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Central venous catheter management involves flushing the catheter when the catheter access is capped or clamped. Policy on catheter flushing varies from institution to institution.
All central venous catheter management must be performed under the supervision of a registered nurse.
The catheter site must be assessed regularly and kept sterile.
If continuous fluids are ordered to be administered by central venous catheter, then they must be regulated by an infusion pump.

22. Patient-Controlled Analgesia
IV narcotics can cause:
Depressed respirations
Hypotension
Sedation
Dizziness
Nausea or vomiting
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Copyright © 2007 by Mosby, Inc.
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What is patient-controlled analgesia (PCA)? PCA is a system in which patients self-administer IV narcotics. The IV narcotics are administered at intervals via an infusion pump.
Who can be accountable for dispensing PCA? Only a registered nurse can be accountable, and only a registered nurse is allowed to administer a PCA loading dose.

23. Patient-Controlled Analgesia (cont’d)
Requirements for PCA:
Patient must not be allergic to narcotic.
Patient must be able to understand and comply with instructions.
Patient must have a desire to use PCA.
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What are the materials required for PCA infusion? The required materials include a PCA pump, PCA tubing, a PCA pump key, a narcotic injector vial, and maintenance IV fluids.

24. IV THERAPY PRESENTATION Go over student hand-outs: IV therapy Reminder
Nursing Note – IV antibiotics that may be administer by an LPN
IV Lab Checklist
St. Joes’ IV therapy record (2 pages)
IV checklists

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

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

27. 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
Pull out your 200ml bag
Open up IV bag
Inspect bag of IV fluid
Make sure you write your name on the IV bag itself – in your practice you would never write directly on the IV bag – marker, etc will leak through the bag
Look at the expiration date
Make sure there are no particles
Make sure it is the right fluid
Do three checks with IV bag and Doctor’s order

28. Primary Tubing Get primary tubing (says solution set on package)
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
Get primary tubing (says solution set on package)
There are perforations down the side of the package to open it
Pull off the paper
Go over parts of
Do not touch the spike, must stay sterile
Roller clamp – pull roller clamp up so it is closer to the drip chamber
Make sure roller clamp is closed – if not, the fluid will flow through and you will get a lot of air bubbles in your tubing
Make sure the dark blue slide clamp is open
Spike bag
Pull off clear part on your bag
The light yellow/cream color part is if you were going to add an additive to the IV fluid
Pull off clear part on spike
Hold IV bag upside down
Made sure you insert the spike straight in – if not you will puncture right through your bag

29. 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
Flip bag over – nothing should be running through the tubing
Squeeze drip chamber – make sure to fill it at least half full – there is a line on the drip chamber for a guide
You would hook your IV bag up onto a pole to prime IV tubing
Now prime tubing
Pull off light blue end on tubing – must keep blue cap and tubing end sterile
Open roller clamp slowly to allow fluid to go through
If you have more than 1 inch of air in the tubing, you must get it out
You can not have more than an inch of air in your tubing
After you have primed your tubing, replace the light blue end cap
If your drip chamber is too full, invert the IV bag squeeze the fluid back into the drip chamber.
If you waste 10 to 15 ml of fluid into the garbage can, that’s ok. Most bags are over filled for this reason

30. Label Tubing Label tubing and bag Tubing is good for 72 hours
Date
Time
Initials
Label tubing and bag
Tubing is good for 72 hours
Put the date, time, and initials on the label for the tubing
Make it like a flag on your tubing, place it close to the drip chamber
Most labels at facilities are a bright color, so that it’s eye catching
If you find a tubing that doesn’t have a label, the tubing should be changed
Joint commission requires that the tubing is label
Write on the label before you stick it on the bag

31. Label IV Fluids Place it on the opposite side of the IV bag
Date
Time
Initials
Patient’s name
Any additions made to IV fluid
Place it on the opposite side of the IV bag
LPN’s are allowed to hang IV bags with electrolytes in them – you can not hang the first bag – recommend that you have someone else check the bag with you – but you can hang a subsequent bag of IV fluid that has the exact same electrolytes

32. Gather IV Equipment Look at the angiocatheter 18, 20, 22, 24
Needle/angiocath
Start kit (tape, tourniquet, alcohol pad, tegaderm, and label)
Chux pad
Clean gloves
Goggles
IV Pole
Look at the angiocatheter
18, 20, 22, 24
1 inch to 1 ½ inch long
what you will usually see/use
Take 2 IV catheters with you, just in case – may need to take in a couple of different sizes
The wings are twice as expensive
TMH will use the intima
St Joes will use the wings
There are many different types of IV
If you look, the needle is longer than the cannula
There is a bevel
You have to make sure the bevel is up
You have to document the size and length of the angiocather
Grab your start kit – there are 3 in your bag –you can practice with 2 of the kits, make sure you save one for testing
You have to find out what the policy is at your facility for cleaning the insertion site
Put your name on your tourniquet
Gather a chux pad, towel, clean gloves (sterile procedure using clean technique), IV pole, IV pump, goggles
If you are infusing any medicine or fluids with any additives, make sure you use a pump – if not, you can kill a patient especially if you are infusing potassium, magnesium
Don’t always have pumps in the ER

33. ID your patient – You MUST take the Doctor’s order in with you
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)

34. Do 4th check at the bedside Make sure you identify yourself
Explain procedure
Provide privacy
Body Mechanics (Bed up [if standing], etc)
Do 4th check at the bedside
Make sure you identify yourself
Don’t say to your patient that “you are my first patient” or “I’m so nervous”
We are not allowed to stick each other
Either sit or place the bed in a comfortable position – make sure you can put the arm in a dependent position
Provide privacy

35. Prepare Supplies
IV pole/pump
Angiocath needle
Label
Tourniquet
Cleaning solution (depends on facility)
IV solution & tubing
Cut Tape
Goggles
Chux
Tegaderm
Pull off a long piece of tape and then tear that piece in half
Tear off another 2 long pieces of tape (should have 4 pieces all together)
If your patient is allergic to tape, make sure you obtain paper

36. Inspect Potential Sites
Place tourniquet around the upper arm
When you put on a tourniquet – you are occluding the veins, you should still be able to feel the artery (radial pulse) if not then it is too tight
Who and where can you start an IV
18 and above
Antecub and below
Start distal to proximal – start with hand
Demonstrate how to tie a tourniquet

37. Inspect Potential Sites
Examine and Palpate Veins
Put the tourniquet on, find your vein, and then release your tourniquet
You will see some nurses find a vein with there gloves on, we recommend that you find it without the gloves on then you can find the right size angiocatheter, etc
You will find nurses who will start an IV without gloves and nurses who will wear gloves, but pull off the finger – what is the point

38. Common IV Sites of the Hand

39. Common IV Sites of the Arm

40. 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

41. 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

42. 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
Make sure you can “follow the vein” If you can’t, that section of the vein may not be long enough to hold the IV catheter
Avoid junctions!

43. Once You Have Selected Your Site
RELEASE YOUR TOURNIQUET!
If needed - Mark your IV site with your finger nail – It will leave a small indentation.

44. 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
You are going to scrub insertion site with alcohol – clean a large area

45. 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
Make sure you anchor the vein with your nondominate hand, can also use the 3 point touch down technique
Anywhere from a 15 to 30 degree angle – if the vein is deep, may need to have a greater angle, if it is shallow, need a lesser angle – think of the older population
When you get it into the vein, you should see blood flash
If you missed the vein, pull back on the IV – do not pull out all the way
Make sure you are not pull on your cannula when you pull out the needle

46. 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
Occlude vein with last 3 fingers on nondominant hand while holding cannula with thumb and forefinger.
Pull out stylet with dominant hand

47. 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”
Make sure you take off your tourniquet before you start your IV fluid
Do not tape over the connecting part, tape over the clear hub
Place tegaderm – only place on the angiocatheter itself – do not place on the connecter
Do not place any tape on the tegaderm
Place the label on the tegaderm – initials, date, time, angiocatheter size and length
You must be able to see your insertion site
Teach your patient:
Be careful with IV
If it starts burning, swelling, hurting
Do not take a shower – needs to be wrapped
Must take IV/IV pole with them

48. Clean Up Time Do not stick needle into mattress
Remove Gloves and goggles
Dispose all used materials
Throw Stylet in Sharps Container
Do not stick needle into mattress

49. 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
If you are going to start a new site, put up new tubing
If they are a difficult stick, can get a doctor’s order to leave IV in for _____days.

50. 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

51. 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
Should empty rest of IV fluid into toilet or hopper – not the sink, especially dextrose – it will plug up the sink.

52. Changing IV solution

53. Farmer, Edward
Dr. Jones
DOB MR 54276
ALLERGIES
Codeine
Height:
5’7
Weight:
150 lb
Date
Time
PRESCRIBED TREATMENT, MEDICATION AND DIET
TPN ORDERS MUST BE ORDERED ON “PARENTERAL NURTRITION ORDER FORM”
1100
Continue IVF 5% Dextrose and Water at 150 ml/hr
T.O. Dr. Jones/B. MEYER, RN
Have to make sure that if you are switching to a different IVF that the two IVF are compatible or get new tubing

54. 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

55. How would you get air out of tubing?
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
How would you get air out of tubing?
Couple ways – Can disconnect IV tubing from IV site and run fluid into trash
If you have a Y-site, can insert a needle/syringe (if luer lock) and pull air out – if air is above Y-site

56. 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
Types of how to mix IVPB – some come with vial attached to bag of fluid – have to pop open vial in bag and then mix powder with solution

57. 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!!!!!!!!!

58. 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
On the piggyback bag, there are two ports
One says add the other says set
Add: that’s where the medication is added
Set: That where the IV tubing goes

59. Mixing an IVPB using Practi-Powder
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
Pop off the blue “add” cap
Attach needle to syringe – do not use blunt needle
Pop-top off of demo dose powder (the medication)
The piggyback usually contains 50ml, 100ml of fluid
Look in your med book or PDA – it will tell you what you can mix the medication with
Normal saline, D5, etc
The tricky part is when you need a different dose than what the vial contains
You would have to do some math
Call pharmacy to see if they have a different vial
Pediatrics is where you would really see this
Withdraw fluid (as indicated on medication vial) with syringe and needle from piggy back
Wipe off top of demo dose powder
Instill fluid into powder
Withdraw syringe
Mix vial well
Wipe off top of vial
Reinsert syringe into vial
Withdraw all of the fluid (medication) Don’t want to leave anything in the vial
Wipe off add port on piggy back with alcohol
Insert needle/syringe

60. 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
Instill medication into piggyback bag
Recap needle
Shake piggy back gently
Most of the time, this will be done if pharmacy – most places don’t want the nurses doing this, because they are too busy and can’t concentrate. But some places, some ECFs, will require you to do this. So at least you will have had some experience with it.
Do no leave your piggyback lay. There are medications mixed in the bag and if another nurses comes along and pick it up and it’s not labeled that’s a big error.
Must label the bag: Patient’s name, date, time, initials, drug name and dose

61. Ampicillin 1 gram IVPB q 6hrs x 4 doses 1000 – 1600 – 2200 – 0400
Hanging an IVPB
YOU WILL NEED:
Secondary infusion set
IV tubing label
Alcohol swab
IV connector (AKA alligator clamp)
Now look at checklist
Check doctor’s order – You must make sure that the antibiotic is compatible with the IV fluid and any additives
Transcribe to mar
ON MAR
Ampicillin 1 gram IVPB q 6hrs x 4 doses
1000 – 1600 – 2200 – 0400
(Under Start time)
(Under Stop time)
You absolutely must make sure that it is an antibiotic – you can not give anything else

62. Hanging an IVPB Grab your secondary infusion set Will need a label
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)
Grab your secondary infusion set
Will need a label
An alcohol swab
An IV connect
Your tubing will screw into your ports so that you won’t need you
Close roller clamp
Flip off the cap
Insert spike
Fill drip chamber ½ full
There are two ways to prime secondary tubing
Go to #7 on the paper
Or go to #16 and 17
Take the end off, open your roller clamp, and prime tubing – but you can not lose any of the fluid, because it is medication and it alter the dose given – then put end back on
The other way is – with the primary tubing running – you can prime the secondary tubing by placing the piggyback tubing lower than the primary tubing, open the roller clamp, and allow the primary fluid to flow back into the piggy back tubing to prime it.

63. 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
Label tubing: date, time, initials
Every 72 hours the tubing needs to be changed
Orange packaging- luer lock adapter (alligator clamp) – any kind of adaptor that you attach, you must prime it – if not then you are giving the patient air.
Your secondary must be higher than your primary bag in order to infuse the secondary bag even if you have the pump
The blue slide clamp slides into the pump, the tubing wraps around
For testing you will be doing gravity, but you need to know how to use the pumps
When you program the VTBI, put in a little less so that the entire bag isn’t infused when the alarm
You only use secondary tubing, if a primary IVF was ordered. If not, then you would just use primary tubing for the antibiotics
If this is the first time that the patient has got the medication, you should stay with the patient/keep checking on the patient for the first 15 minutes to make sure that they don’t have a reaction.
If you don’t open up your secondary roller clamp when you go to infuse, the pump will only infuse the primary fluid-not the medication – you will fail your test if you do not open your secondary roller clamp, because you didn’t give the patient any medication
If they are getting multiple antibiotics, then this tubing has to be changed every 24 hours, because the system has been opened up multiple times
You will flunk the skills test if you do not check the allergies
If the patient is allergic to an antibiotic and the antibiotic or a similar antibiotic is orders and the doctor still wants it to be given, write it as an order that the antibiotic is to be given and also have another nurse listen and co-sign the order

64. YOU WILL NEED PRN adapter D/C IVT and adapt IV site
Gloves PRN adapter
Normal Saline Flush Alcohol Swab
Tape Chux
Goggles
D/C IVT and adapt IV site
Flush IV site with 3 ml of Normal Saline q 8 hours and prn
Will probably see: Cap IV site
Most places don’t use heparin anymore for peripheral IV sites – Due to HIT and errors with giving straight heparin
You can not just leave an IV site – you have to flush the IV – sometimes the doctor will just right “Cap IV” Will have to flush per facility policy
When you give an intermittent IV ATB – have to do the “SAS” (SASH) It ensures that your IV patent and also ensures that if another medication was given prior to that it is not sitting in the lock and cause a precipitate

65. 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
Will need the NS flush and a blunt tip cannula
Take the blunt tip cannula and attach to you saline flush
Save the white end
When you pull off the cap
Prime your blunt tip – be careful
You must prime your prn adapter – if you do not, then you are giving your patient a bolus of air
Wipe off the stopper part of the prn adapter with alcohol and attach the blunt tip of the syringe to the prn adapter
Fill prn adapter until fluid comes out the end
You will have to wear gloves/goggles, because it is a potential blood exposure
If you get an order to cap the IV, make sure you look at the IV before you gather all of your supplies – it may already have a prn adapter on it, so all you would need is alcohol wipes, NS flush, and blunt end
Recommend that you use all of the NS except for the last ½ ml to ensure that you don’t give the patient air.
Slide clamp on the IV – make sure it is open – use pulsating flush and clamp
When you cap an IV, you have to discontinue the IVF order on the MAR, sign off on the MAR that you flushed the IV, and document on the Back of the IV therapy sheet. Can put a comment on the front of the IV therapy sheet that the IV was capped and a prn adapter was applied.
Starting an IV, hanging a piggyback, and applying a prn adapter is what you will be tested on.

66. Discontinuing IV site
HAD IN LAB

67. 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