1. 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

2. ☼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

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

4. TPN ORDERS MUST BE ORDERED ON “PARENTERAL NURTRITION ORDER FORM”
Farmer, Edward
Dr. Jones
DOB MR 54276
Codeine
Height:
5’7
Weight:
150 lb
ALLERGIES
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

5. And Always Do The 3 Checks of the IVF with the Dr’s Order
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

6. 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
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

7. 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

8. Label Tubing 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

9. Label IV Fluids 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

10. Gather IV Equipment 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

11. 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)

12. Do 4th check at the bedside 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

13. 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

14. 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

15. 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

16. Common IV Sites of the Hand

17. Common IV Sites of the Arm

18. 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

19. 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

20. 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
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!
Avoid Antecubital Area, if Possible.
Use Most Distal Site First
Can not use any site above antecubital

21. 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.

22. 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
You are going to scrub insertion site with alcohol – clean a large area
Apply Tourniquet 5 to 6 inches above Insertion Site:
- Secure Tightly enough to Occlude Venous Flow
- Check Presence of Distal Pulse

23. 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

24. 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!
Occlude vein with last 3 fingers on nondominant hand while holding cannula with thumb and forefinger.
Pull out stylet with dominant hand
Quickly attach the IV tubing to the IV catheter

25. 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

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

27. Time to Document

28. 1 L H SITE SITE STATUS Start: Site # 3-15-11 0800 BJM Attempted x1
DATE/
TIME/ INITAL
SITE
SITE STATUS
Site Rotation Due:__________
Start:
Site #
Reason for Change (code):
0800
BJM 1
Comments:
Attempted x1
Stop:
Location
L H
Date, time and initials when you started the IV in appropriate box on form
Site: Site number:– 1st site, 2nd site, 3rd site
Site location: use site location code
Size and type: Whatever the package says for type, 22 g x 1”
Under comments: Can write how many attempts it took to start current IV
Dressing change: When you put the dressing on – dressing change: gauze dressing 48 hours, tegaderm 72 hours
Site rotation due: Trumbull and St Joes is 3 days
Must have one successful stick in the clinical setting to get certification
Size/Type
Dressing Change:
# 20/ Angio

29. START
DATE/TIME/
INITALS
SITE #
STOP
DATE/TIME/
INITALS
FLUIDS
TUBING
INFUSION
DEVICE
RATE
AMOUNT
COMMENTS
0800
BJM
1000 ML
Lactated
Ringers Y N
100ml/ hr 1
PUMP Y N Y N Y N Y N
Back of IV sheet – any IV fluid bag that is hung on the patient goes here. This is pretty much the IV med sheet – Put date, time, initials, site number, IV fluids – type and amount - must write out the type of fluid (can not write LR, NS – must write out) (example: ml Lactated Ringers), did you hang new tubing- circle y or n – infusion device (gravity or pump), rate 100 ml/hr
Will go under the IV therapy record in the computer at St Joes
Will also write on the bedside chart at TMH
Make sure that if there were several attempts to get the current IV started, that you document in the nurses notes where the attempts were made in case if there was bruising, swelling, etc.
You do not have to get new tubing every time you change a bag Y N Y N

30. TPN ORDERS MUST BE ORDERED ON “PARENTERAL NURTRITION ORDER FORM”
Farmer, Edward
Dr. Jones
DOB MR 54276
Codeine
Height:
5’7
Weight:
150 lb
ALLERGIES
Date
Time
PRESCRIBED TREATMENT, MEDICATION AND DIET
TPN ORDERS MUST BE ORDERED ON “PARENTERAL NURTRITION ORDER FORM”
1600
Change IVF to 1000 ml 5%Dextrose and Water at 150 ml/hr
T.O. Dr. Jones/B. Meyer, RN

31. 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.

32. 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

33. 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.

34. 1 1 Y N 100ml/ hr PUMP Y N 150ml/ hr PUMP Y N Y N Y N
START
DATE/TIME/
INITALS
SITE #
STOP
DATE/TIME/
INITALS
FLUIDS
TUBING
INFUSION
DEVICE
RATE
AMOUNT
COMMENTS
0800
BJM
1000 ML
Lactated
Ringers
1600
BJM Y N
100ml/ hr 1
PUMP
1600
BJM
1000 ML
5% Dextrose
And Water Y N
150ml/ hr 1
PUMP Y N Y N Y N
Go to IV sheet – back page- don’t have to do anything on the front, because we didn’t change the site
Would write stop date, time, and your initials next to the IV fluid already charted on
Then would document on the next line start date, time, initials, site number (would still be the same site, because the site wasn’t changed just the iv bag and tubing), IV fluids (make sure to write out the name of the IV fluid), if the tubing was changed y or n, infusion device and rate
Some abbreviations you might see – shouldn’t use, but some doctors do:
TRA – to run at
TBI – to be infused Y N Y N

35. Changing IV solution

36. TPN ORDERS MUST BE ORDERED ON “PARENTERAL NURTRITION ORDER FORM”
Farmer, Edward
Dr. Jones
DOB MR 54276
Codeine
Height:
5’7
Weight:
150 lb
ALLERGIES
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

37. 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

38. 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
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
Reestablish prescribed flow rate.
Check for air in tubing
Empty remaining fluid from old IV bag if needed into toilet

39. 1 1 1 Y N 100ml/ hr PUMP Y N 150ml/ hr PUMP Y N 150ml/ hr PUMP Y N Y N
START
DATE/TIME/
INITALS
SITE #
STOP
DATE/TIME/
INITALS
FLUIDS
TUBING
INFUSION
DEVICE
RATE
AMOUNT
COMMENTS
0800
BJM
1000 ML
Lactated
Ringers
1600
BJM Y N
100ml/ hr 1
PUMP
1600
BJM
1000 ML
5% Dextrose
And Water
1100
BJM Y N
150ml/ hr 1
PUMP
1100
BJM
1000 ML
5% Dextrose
And Water Y N
150ml/ hr 1
PUMP Y N Y N
Document date time, initials. Amount of fluid that was infused
Document on next line: date time initials, site amount of IV bag, IVF, tubing change, device, and rate. Y N Y N

40. 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

41. TPN ORDERS MUST BE ORDERED ON “PARENTERAL NURTRITION ORDER FORM”
Farmer, Edward
Dr. Jones
DOB MR 54276
Codeine
Height:
5’7
Weight:
150 lb
ALLERGIES
Date
Time
PRESCRIBED TREATMENT, MEDICATION AND DIET
TPN ORDERS MUST BE ORDERED ON “PARENTERAL NURTRITION ORDER FORM”
1200
Ampicillin 1 gram IVPB every 6 hours
X 4 doses
T.O. Dr. Jones/B. MEYER, RN
MAKE SURE IS AN ANTIBIOTIC. LPN CAN ONLY HANG IVPB ANTIBIOTICS

42. Ampicillin 1 gram IVPB q 6hrs x 4 doses
Farmer, Edward
DOB MR 54276
UNIT: ROOM: 303 B
Sex: M Hgt: 5’7” Admit Date:
Age: Wgt: 150 lb CrCl: Allergies: Codiene
Physician: Dr. Jones VERIFIED BY:___ ___ BJM_________ __________
DATE (NURSE TO WRITE IN):
MEDICATION
PRESCRIBED
DOSE
Start
Stop
00:00-07:30
07:31-15:30
15:31-23:49
Ampicillin 1 gram IVPB q 6hrs x 4 doses
3-15
3-16
1200 – 1800
INITALS SIGNATURE INITALS SIGNATURE INITALS SIGNATURE
BJM
B.MEYER,RN

43. 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!!!!!!!!!

44. 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
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
ADD Port: Port where medication/additives are instilled

45. 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

46. 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

47. 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

48. 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)
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.

49. 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 !!!!!
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
Infuse IVPB at Prescribed Rate (Look in your med book)
Assess patient’s response
Document on MAR- does not go on iv sheet

50. Ampicillin 1 gram IVPB q 6hrs x 4 doses
Farmer, Edward
DOB MR 54276
UNIT: ROOM: 303 B
Sex: M Hgt: 5’7” Admit Date:
Age: Wgt: 150 lb CrCl: Allergies: Codiene
Physician: Dr. Jones VERIFIED BY:_____ ___BJM_________ __________
DATE (NURSE TO WRITE IN):
MEDICATION
PRESCRIBED
DOSE
Start
Stop
00:00-07:30
07:31-15:30
15:31-23:49
1200
IVPB
BJM
Ampicillin 1 gram IVPB q 6hrs x 4 doses
3-15
3-16
INITALS SIGNATURE INITALS SIGNATURE INITALS SIGNATURE
BJM
B. MEYER, RN

51. YOU WILL NEED PRN adapter 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

52. TPN ORDERS MUST BE ORDERED ON “PARENTERAL NURTRITION ORDER FORM”
Farmer, Edward
Dr. Jones
DOB MR 54276
Codeine
Height:
5’7
Weight:
150 lb
ALLERGIES
Date
Time
PRESCRIBED TREATMENT, MEDICATION AND DIET
TPN ORDERS MUST BE ORDERED ON “PARENTERAL NURTRITION ORDER FORM”
0800
DISCONTINUE IVF and adapt IV site
Flush IV site with 3 ml of
Normal Saline q 8 hours and prn
T.O. Dr. Jones/B. MEYER, RN

53. Normal Saline Flush 3ml q 8 hrs & prn
Farmer, Edward
DOB MR 54276
UNIT: ROOM: 303 B
Sex: M Hgt: 5’7” Admit Date:
Age: Wgt: 150 lb CrCl: Allergies: Codiene
Physician: Dr. Jones VERIFIED BY:______ ___BJM_________ __________
DATE (NURSE TO WRITE IN):
MEDICATION
PRESCRIBED
DOSE
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

54. 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.

55. Normal Saline Flush 3ml q 8 hrs & prn
Farmer, Edward
DOB MR 54276
UNIT: ROOM: 303 B
Sex: M Hgt: 5’7” Admit Date:
Age: Wgt: 150 lb CrCl: Allergies: Codiene
Physician: Dr. Jones VERIFIED BY:______ ____BJM________ __________
DATE (NURSE TO WRITE IN):
MEDICATION
PRESCRIBED
DOSE
Start
Stop
00:00-07:30
07:31-15:30
15:31-23:49
0900
IVP
BJM
Normal Saline Flush 3ml q 8 hrs & prn
3-18
ALSO NEED TO DOCUMENT ON IV FLOW SHEET
INITALS SIGNATURE INITALS SIGNATURE INITALS SIGNATURE
BJM
B. MEYER, RN

56. 1 150 ML/ PUMP HR 1 1 600 PRN ADAPTER Y N 100ml/ hr PUMP Y N 150ml/ hr
START
DATE/TIME/
INITALS
PUMP
150 ML/ HR
600
PRN
ADAPTER
SITE #
STOP
DATE/TIME/
INITALS
FLUIDS
TUBING
INFUSION
DEVICE
RATE
AMOUNT
900
1000
COMMENTS
0800
BJM
1000 ML
Lactated
Ringers
1600
BJM Y N
100ml/ hr 1
PUMP
1600
BJM
1000 ML
5% Dextrose
And Water
2300
BJM
0900 Y N
150ml/ hr 1
PUMP
2300
BJM
0900
1000 ML
5% Dextrose
And Water
And water N
150ml/ hr 1
PUMP Y N Y N
Document date time, initials. Amount of fluid that was infused
Document on next line: date time initials, site amount of IV bag, IVF, tubing change, device, and rate. Y N Y N

57. Discontinuing IV site
HAD IN LAB

58. 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

59. TPN ORDERS MUST BE ORDERED ON “PARENTERAL NURTRITION ORDER FORM”
Farmer, Edward
Dr. Jones
DOB MR 54276
Codeine
Height:
5’7
Weight:
150 lb
ALLERGIES
Date
Time
PRESCRIBED TREATMENT, MEDICATION AND DIET
TPN ORDERS MUST BE ORDERED ON “PARENTERAL NURTRITION ORDER FORM”
0600
DISCONTINUE IV SITE
T.O. Dr. Jones/B. MEYER, RN

60. 1 L H SITE SITE STATUS Start: Site # 3-16-10 0800 BJM Attempted x1
DATE/
TIME/ INITAL
SITE
SITE STATUS
Site Rotation Due:__________
Start:
Site #
Reason for Change (code):
0800
BJM 1
Comments:
Attempted x1
Stop:
0700
BJM
Location
L H
Date, time and initials when you started the IV in appropriate box on form
Site: Site number:– 1st site, 2nd site, 3rd site
Site location: use site location code
Size and type: Whatever the package says for type, 22 g x 1”
Under comments: Can write how many attempts it took to start current IV
Dressing change: When you put the dressing on – dressing change: gauze dressing 48 hours, tegaderm 72 hours
Site rotation due: Trumbull and St Joes is 3 days
Must have one successful stick in the clinical setting to get certification
Size/Type
Dressing Change:
# 20/ Angio