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IV THERAPY PRESENTATION COLLECT THE FOLLOWING SUPPLIES: * TWO PAPERS OF LABELS (HAVE 4 LABELS) * TWO ALCOHOL SWABS TAKE ONE OF EACH OF THE FOLLOWING:

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Presentation on theme: "IV THERAPY PRESENTATION COLLECT THE FOLLOWING SUPPLIES: * TWO PAPERS OF LABELS (HAVE 4 LABELS) * TWO ALCOHOL SWABS TAKE ONE OF EACH OF THE FOLLOWING:"— Presentation transcript:

1

2 IV THERAPY PRESENTATION

3 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

4 PREPARING IV SOLUTION & TUBING Whats the first thing you always need to do? Check the Doctors order.

5 Farmer, Edward Dr. Jones DOB MR ALLERGIES Codeine Height: 57 Weight: 150 lb DateTime PRESCRIBED TREATMENT, MEDICATION AND DIET TPN ORDERS MUST BE ORDERED ON PARENTERAL NURTRITION ORDER FORM Start IVF – 1000ml Lactated 100ml/hr T.O. Dr. Jones/B. Meyer, RN

6 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 Drs Order

7 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

8 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

9 Label Tubing Date Time Initials

10 Label IV Fluids Date Time Initials Patients name Any additions made to IV fluid

11 Gather IV Equipment Needle/angiocath Start kit (tape, tourniquet, alcohol pad, tegaderm, and label) Chux pad Clean gloves Goggles IV Pole

12 Wash Hands (Don other PPE if needed – Contact Precautions, Agitated patient, etc) ID your patient – You MUST take the Doctors order in with you Check for allergies: – Tape – Latex – Betadine (if using)

13 Do 4 th check at the bedside Explain procedure Provide privacy Body Mechanics (Bed up [if standing], etc)

14 Prepare Supplies IV pole/pump Angiocath needle Label Tourniquet Cleaning solution (depends on facility) IV solution & tubing Cut Tape Goggles Chux Tegaderm

15 Inspect Potential Sites Place tourniquet around the upper arm

16 Inspect Potential Sites Examine and Palpate Veins

17 Common IV Sites of the Hand

18 Common IV Sites of the Arm

19 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

20 But, Mrs. Meyer, I Cant 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

21 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

22 Once You Have Selected Your Site

23 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

24 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

25 Whew! Im in the Vein, Now What? Occlude vein at cannula end Before pulling the stylet completely out or IT WILL LOOK LIKE A BLOODY MASSACRE! POP the tourniquet (loosen it without letting go of the IV) Quickly attach the IV tubing to the IV catheter

26 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

27 Clean Up Time Remove Gloves and goggles Dispose all used materials Throw Stylet in Sharps Container

28 Time to Document

29 DATE/ TIME/ INITAL SITESITE STATUS Start: Stop: Site # Location Size/Type Site Rotation Due:__________ Dressing Change: BJM 1 Reason for Change (code): Comments: L H # 20/ Angio Attempted x1

30 START DATE/TIME/ INITALS SITE # FLUIDSTUBINGINFUSION DEVICE STOP DATE/TIME/ INITALS AMOUNTCOMMENTSRATE BJM ML Lactated Ringers YNYN YNYN YNYN YNYN YNYN YNYN YNYN PUMP 100ml/ hr

31 Farmer, Edward Dr. Jones DOB MR ALLERGIES Codeine Height: 57 Weight: 150 lb DateTime PRESCRIBED TREATMENT, MEDICATION AND DIET TPN ORDERS MUST BE ORDERED ON PARENTERAL NURTRITION ORDER FORM Change IVF to 1000 ml 5%Dextrose and Water at 150 ml/hr T.O. Dr. Jones/B. Meyer, RN

32 Preparing IV Solution & Tubing (Changing the IV tubing at the IV site) Prepare tubing as before Gather Equipment (Fluid Tape Prepared Tubing Gloves Chux GogglesTegaderm 2x2) Wash Hands ID patient and check allergies Explain yourself Prepare Tape

33 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

34 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

35 START DATE/TIME/ INITALS SITE # FLUIDSTUBINGINFUSION DEVICE STOP DATE/TIME/ INITALS AMOUNTCOMMENTSRATE BJM ML Lactated Ringers YNYN YNYN YNYN YNYN YNYN YNYN YNYN PUMP 100ml/ hr BJM BJM 1000 ML 5% Dextrose And Water PUMP 150ml/ hr

36 Changing IV solution

37 Farmer, Edward Dr. Jones DOB MR ALLERGIES Codeine Height: 57 Weight: 150 lb DateTime PRESCRIBED TREATMENT, MEDICATION AND DIET TPN ORDERS MUST BE ORDERED ON PARENTERAL NURTRITION ORDER FORM Continue IVF 5% Dextrose and Water at 150 ml/hr T.O. Dr. Jones/B. MEYER, RN

38 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

39 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. Reestablish prescribed flow rate. Spike the new bag or bottle with tubing Check for air in tubing Empty remaining fluid from old IV bag if needed into toilet

40 START DATE/TIME/ INITALS SITE # FLUIDSTUBINGINFUSION DEVICE STOP DATE/TIME/ INITALS AMOUNTCOMMENTSRATE BJM ML Lactated Ringers YNYN YNYN YNYN YNYN YNYN YNYN YNYN PUMP 100ml/ hr BJM 1000 ML 5% Dextrose And Water 150ml/ hr PUMP BJM BJM 1000 ML 5% Dextrose And Water PUMP 150ml/ hr BJM

41 Hanging IV Piggyback 1.How to transcribe a New Medication Order to MAR 2.How to Mix an IVPB using Practi-Powder 3.How to Hang an IVPB

42 Farmer, Edward Dr. Jones DOB MR ALLERGIES Codeine Height: 57 Weight: 150 lb DateTime PRESCRIBED TREATMENT, MEDICATION AND DIET TPN ORDERS MUST BE ORDERED ON PARENTERAL NURTRITION ORDER FORM T.O. Dr. Jones/B. MEYER, RN Ampicillin 1 gram IVPB every 6 hours X 4 doses

43 Farmer, Edward DOB MR UNIT: ROOM: 303 B Sex: M Hgt: 57Admit Date: Physician:Dr. JonesVERIFIED BY:___ ___ BJM_________ __________ Age: 56 Wgt: 150 lbCrCl:Allergies: Codiene DATE (NURSE TO WRITE IN): MEDICATION PRESCRIBED DOSE StartStop 00:00-07:3007:31-15:3015:31-23:49 Ampicillin 1 gram IVPB q 6hrs x 4 doses 1200 – BJM B.MEYER,RN INITALS SIGNATURE INITALS SIGNATURE INITALS SIGNATURE

44 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!!!!!!!!!

45 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

46 Mixing an IVPB using Practi-Powder 1.Pop off the blue add cap from IVPB bag 2.Attach needle to syringe – do not use blunt needle 3.Pop-top off of demo dose powder (the medication) 4.Withdraw fluid from IVPB (amt indicated on vial) 5.Wipe off top of demo dose powder 6.Instill fluid into powder 7.Withdraw syringe- BE CAREFUL OF AIR IN VIAL 8.Mix vial well 9.Wipe off top of vial 10.Reinsert syringe into vial 11.Withdraw all of the fluid from medication vial

47 Mixing an IVPB using Practi-Powder 12. Wipe off add port on piggy back with alcohol 13.Insert needle/syringe 14.Instill medication into piggyback bag via the ADD port 15.Recap needle/ Engage safety 16.Shake piggy back gently 17.Must label the IVPB: Patients name, date, time, initials, drug name and dose 18.3 Checks are completed while preparing med

48 Hanging an IVPB Secondary infusion set IV tubing label Alcohol swab IV connector (AKA alligator clamp)

49 Hanging an IVPB ID pt, check allergies. Do 4 th check at bedside. Close roller clamp Remove cap from SET Port on IVBP Insert IV Tubing Spike – Do not touch spike, its 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)

50 Now, were 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 patients response Document on MAR- does not go on iv sheet

51 Farmer, Edward DOB MR UNIT: ROOM: 303 B Sex: M Hgt: 57Admit Date: Physician:Dr. JonesVERIFIED BY:_____ ___BJM_________ __________ Age: 56 Wgt: 150 lbCrCl:Allergies: Codiene DATE (NURSE TO WRITE IN): MEDICATION PRESCRIBED DOSE 1200IVPB BJM StartStop 00:00-07:3007:31-15:3015:31-23:49 Ampicillin 1 gram IVPB q 6hrs x 4 doses INITALS SIGNATURE INITALS SIGNATURE INITALS SIGNATURE BJM B. MEYER, RN

52 PRN adapter GlovesPRN adapter Normal Saline FlushAlcohol Swab TapeChux Goggles YOU WILL NEED

53 Farmer, Edward Dr. Jones DOB MR ALLERGIES Codeine Height: 57 Weight: 150 lb DateTime PRESCRIBED TREATMENT, MEDICATION AND DIET TPN ORDERS MUST BE ORDERED ON PARENTERAL NURTRITION ORDER FORM T.O. Dr. Jones/B. MEYER, RN DISCONTINUE IVF and adapt IV site Flush IV site with 3 ml of Normal Saline q 8 hours and prn

54 Farmer, Edward DOB MR UNIT: ROOM: 303 B Sex: M Hgt: 57Admit Date: Physician:Dr. JonesVERIFIED BY:______ ___BJM_________ __________ Age: 56 Wgt: 150 lbCrCl:Allergies: Codiene DATE (NURSE TO WRITE IN): MEDICATION PRESCRIBED DOSE StartStop 00:00-07:3007:31-15:3015:31-23:49 Normal Saline Flush 3ml q 8 hrs & prn 3-18 INITALS SIGNATURE INITALS SIGNATURE INITALS SIGNATURE BJM B. MEYER, RN

55 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

56 Farmer, Edward DOB MR UNIT: ROOM: 303 B Sex: M Hgt: 57Admit Date: Physician:Dr. JonesVERIFIED BY:______ ____BJM________ __________ Age: 56 Wgt: 150 lbCrCl:Allergies: Codiene DATE (NURSE TO WRITE IN): MEDICATION PRESCRIBED DOSE 0900IVPBJM StartStop 00:00-07:3007:31-15:3015:31-23:49 Normal Saline Flush 3ml q 8 hrs & prn 3-18 INITALS SIGNATURE INITALS SIGNATURE INITALS SIGNATURE BJM B. MEYER, RN

57 PUMP 150 ML/ HR 600 PRN ADAPTER START DATE/TIME/ INITALS SITE # FLUIDSTUBINGINFUSION DEVICE STOP DATE/TIME/ INITALS AMOUNT COMMENTSRATE BJM ML Lactated Ringers YNYN YNYYNY YNYN YNYN YNYN N YNYN PUMP 100ml/ hr BJM 1000 ML 5% Dextrose And Water 1000 ML 5% Dextrose And water 150ml/ hr PUMP BJM BJM BJM 1000 ML 5% Dextrose And Water PUMP 150ml/ hr BJM BJM BJM

58 Discontinuing IV site

59 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

60 Farmer, Edward Dr. Jones DOB MR ALLERGIES Codeine Height: 57 Weight: 150 lb DateTime PRESCRIBED TREATMENT, MEDICATION AND DIET TPN ORDERS MUST BE ORDERED ON PARENTERAL NURTRITION ORDER FORM T.O. Dr. Jones/B. MEYER, RN DISCONTINUE IV SITE

61 DATE/ TIME/ INITAL SITESITE STATUS Start: Stop: BJM Site # Location Size/Type Site Rotation Due:__________ Dressing Change: BJM 1 Reason for Change (code): Comments: L H # 20/ Angio Attempted x1


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