Presentation on theme: "IV THERAPY PRESENTATION Go over student hand-outs: IV therapy Reminder"— Presentation transcript:
1IV THERAPY PRESENTATION Go over student hand-outs: IV therapy Reminder Nursing Note – IV antibiotics that may be administer by an LPNIV Lab ChecklistSt. 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 BAGHAVE ALL YOUR SUPPLIES FROM YOUR LAB BAGS:250 ML BAG OF FLUID50 ML BAG OF FLUIDPRIMARY ADMINISTRATION SETSECONDARY ADMINISTRATION SETPRN ADAPTERSSTART KITINJECTA PADEXTRA TEGADERMS AND TAPE
3PREPARING IV SOLUTION & TUBING What’s the first thing you always need to do?Check the Doctor’s order.
4TPN ORDERS MUST BE ORDERED ON “PARENTERAL NURTRITION ORDER FORM” Farmer, EdwardDr. JonesDOB MR 54276CodeineHeight:5’7Weight:150 lbALLERGIESDateTimePRESCRIBED TREATMENT, MEDICATION AND DIETTPN ORDERS MUST BE ORDERED ON “PARENTERAL NURTRITION ORDER FORM”Start IVF – 1000ml Lactated Ringers@ 100ml/hrT.O. Dr. Jones/B. Meyer, RN
5And Always Do The 3 Checks of the IVF with the Dr’s Order Check and Inspect the IV BagExpiration DateFor cloudiness or particles – IV Fluid should be clearFor LeakageCorrect IV fluidCorrect amountAnd Always Do The 3 Checks of the IVF with the Dr’s OrderPull out your 200ml bagOpen up IV bagInspect bag of IV fluidMake 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 bagLook at the expiration dateMake sure there are no particlesMake sure it is the right fluidDo three checks with IV bag and Doctor’s order
6Primary Tubing Open package Pull off paper tab and unroll the tubing Close the roller clampPull off clear tab on IV bagRemove plastic covering the spikeDO NOT touch part of IV bag where tab was removed or spike, IT MUST REMAIN STERILE!Spike the IV bagGet primary tubing (says solution set on package)There are perforations down the side of the package to open itPull off the paperGo over parts ofDo not touch the spike, must stay sterileRoller clamp – pull roller clamp up so it is closer to the drip chamberMake sure roller clamp is closed – if not, the fluid will flow through and you will get a lot of air bubbles in your tubingMake sure the dark blue slide clamp is openSpike bagPull off clear part on your bagThe light yellow/cream color part is if you were going to add an additive to the IV fluidPull off clear part on spikeHold IV bag upside downMade sure you insert the spike straight in – if not you will puncture right through your bag
7Primary Tubing (Cont) Hang on IV pole Fill drip chamber ½ full Remove end piece from tubingOpen roller clamp – Slowly!Flush tubing with IVFKeep end of tubing sterileNo large air bubbles in tubing (less than 1”)Be sure to prime the Y-site, alsoClose the roller clampReplace end piece on tubingFlip bag over – nothing should be running through the tubingSqueeze drip chamber – make sure to fill it at least half full – there is a line on the drip chamber for a guideYou would hook your IV bag up onto a pole to prime IV tubingNow prime tubingPull off light blue end on tubing – must keep blue cap and tubing end sterileOpen roller clamp slowly to allow fluid to go throughIf you have more than 1 inch of air in the tubing, you must get it outYou can not have more than an inch of air in your tubingAfter you have primed your tubing, replace the light blue end capIf 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
8Label Tubing Date Time Initials Label tubing and bag Tubing is good for 72 hoursPut the date, time, and initials on the label for the tubingMake it like a flag on your tubing, place it close to the drip chamberMost labels at facilities are a bright color, so that it’s eye catchingIf you find a tubing that doesn’t have a label, the tubing should be changedJoint commission requires that the tubing is labelWrite on the label before you stick it on the bag
9Label IV Fluids Date Time Initials Patient’s name Any additions made to IV fluidPlace it on the opposite side of the IV bagLPN’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
10Gather IV Equipment Needle/angiocath Start kit (tape, tourniquet, alcohol pad, tegaderm, and label)Chux padClean glovesGogglesIV PoleLook at the angiocatheter18, 20, 22, 241 inch to 1 ½ inch longwhat you will usually see/useTake 2 IV catheters with you, just in case – may need to take in a couple of different sizesThe wings are twice as expensiveTMH will use the intimaSt Joes will use the wingsThere are many different types of IVIf you look, the needle is longer than the cannulaThere is a bevelYou have to make sure the bevel is upYou have to document the size and length of the angiocatherGrab your start kit – there are 3 in your bag –you can practice with 2 of the kits, make sure you save one for testingYou have to find out what the policy is at your facility for cleaning the insertion sitePut your name on your tourniquetGather a chux pad, towel, clean gloves (sterile procedure using clean technique), IV pole, IV pump, gogglesIf 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, magnesiumDon’t always have pumps in the ER
11ID 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 youCheck for allergies:TapeLatexBetadine (if using)
12Do 4th check at the bedside Explain procedure Provide privacy Body Mechanics (Bed up [if standing], etc)Do 4th check at the bedsideMake sure you identify yourselfDon’t say to your patient that “you are my first patient” or “I’m so nervous”We are not allowed to stick each otherEither sit or place the bed in a comfortable position – make sure you can put the arm in a dependent positionProvide privacy
13Prepare Supplies IV pole/pump Angiocath needle Label Tourniquet Cleaning solution (depends on facility)IV solution & tubingCut TapeGogglesChuxTegadermPull off a long piece of tape and then tear that piece in halfTear 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
14Inspect Potential Sites Place tourniquet around the upper armWhen 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 tightWho and where can you start an IV18 and aboveAntecub and belowStart distal to proximal – start with handDemonstrate how to tie a tourniquet
15Inspect Potential Sites Examine and Palpate VeinsPut the tourniquet on, find your vein, and then release your tourniquetYou 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, etcYou 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
18What are Some Ways to Promote Venous Distention? Place arm in a dependent positionHave patient open and close fist a couple of timeWarm compresses“Flicking” the veinMassaging blood flow proximal to distalUsing a blood pressure cuff instead of a tourniquet
19But, Mrs. Meyer, I Can’t See a Vein! Trust Your Fingers more than Your EyesOther things to try:Applying Warm CompressesMassaging the Blood Flow Proximal to DistalUsing a Blood Pressure Cuff instead of a TourniquetUse Two Tourniquets instead of One
20Other 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 WristMake sure you can “follow the vein” If you can’t, that section of the vein may not be long enough to hold the IV catheterAvoid junctions!Avoid Antecubital Area, if Possible.Use Most Distal Site FirstCan not use any site above antecubital
21Once You Have Selected Your Site RELEASE YOUR TOURNIQUET!If needed - Mark your IV site with your finger nail – It will leave a small indentation.
22Prepare For Insertion Put on Disposable Gloves and Goggles Place a Chux Pad under the armScrub Site with Alcohol (or what facility requires):- Allow site to dryYou are going to scrub insertion site with alcohol – clean a large areaApply Tourniquet 5 to 6 inches above Insertion Site:- Secure Tightly enough to Occlude Venous Flow- Check Presence of Distal Pulse
23Perform the Venipuncture Use your Nondominant Hand to Anchor the Vein- Stretch Skin Dorsal to Site - Do not “Hop Scotch” your ThumbWarn Patient of the StickWith dominant hand: Insert the Stylet, bevel up, at a 20 to 30° angle- Hold by Flash Chamber, not IV hubWatch for a “Flash Back” of BloodAdvance Stylet into VeinLoosen Catheter from StyletAdvance Catheter into veinMake sure you anchor the vein with your nondominate hand, can also use the 3 point touch down techniqueAnywhere 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 populationWhen you get it into the vein, you should see blood flashIf you missed the vein, pull back on the IV – do not pull out all the wayMake sure you are not pull on your cannula when you pull out the needle
24Whew! 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 styletcompletely out orIT 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 handQuickly attach the IV tubing to the IV catheter
25Moving Along………… Slowly open the roller clamp Tape the hub of the catheter – Do not tape over insertion site- Chevron- UPlace Tegaderm over insertion site and hub of cannulaTape the rest of the IV tubing – Make a “J”Make sure you take off your tourniquet before you start your IV fluidDo not tape over the connecting part, tape over the clear hubPlace tegaderm – only place on the angiocatheter itself – do not place on the connecterDo not place any tape on the tegadermPlace the label on the tegaderm – initials, date, time, angiocatheter size and lengthYou must be able to see your insertion siteTeach your patient:Be careful with IVIf it starts burning, swelling, hurtingDo not take a shower – needs to be wrappedMust take IV/IV pole with them
26Clean Up Time Remove Gloves and goggles Dispose all used materials Throw Stylet in Sharps ContainerDo not stick needle into mattress
281 L H SITE SITE STATUS Start: Site # 3-15-11 0800 BJM Attempted x1 DATE/TIME/ INITALSITESITE STATUSSite Rotation Due:__________Start:Site #Reason for Change (code):0800BJM1Comments:Attempted x1Stop:LocationL HDate, time and initials when you started the IV in appropriate box on formSite: Site number:– 1st site, 2nd site, 3rd siteSite location: use site location codeSize and type: Whatever the package says for type, 22 g x 1”Under comments: Can write how many attempts it took to start current IVDressing change: When you put the dressing on – dressing change: gauze dressing 48 hours, tegaderm 72 hoursSite rotation due: Trumbull and St Joes is 3 daysMust have one successful stick in the clinical setting to get certificationSize/TypeDressing Change:# 20/ Angio
29STARTDATE/TIME/INITALSSITE#STOPDATE/TIME/INITALSFLUIDSTUBINGINFUSIONDEVICERATEAMOUNTCOMMENTS0800BJM1000 MLLactatedRingersYN100ml/hr1PUMPYNYNYNYNBack 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/hrWill go under the IV therapy record in the computer at St JoesWill also write on the bedside chart at TMHMake 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 bagYNYN
30TPN ORDERS MUST BE ORDERED ON “PARENTERAL NURTRITION ORDER FORM” Farmer, EdwardDr. JonesDOB MR 54276CodeineHeight:5’7Weight:150 lbALLERGIESDateTimePRESCRIBED TREATMENT, MEDICATION AND DIETTPN ORDERS MUST BE ORDERED ON “PARENTERAL NURTRITION ORDER FORM”1600Change IVF to 1000 ml 5%Dextrose and Water at 150 ml/hrT.O. Dr. Jones/B. Meyer, RN
31Preparing IV Solution & Tubing (Changing the IV tubing at the IV site) Prepare tubing as beforeGather Equipment (Fluid ● Tape ● Prepared Tubing ● Gloves Chux● Goggles●Tegaderm● 2x2)Wash HandsID patient and check allergiesExplain yourselfPrepare TapeIf you are going to start a new site, put up new tubingIf they are a difficult stick, can get a doctor’s order to leave IV in for _____days.
32Preparing IV Solution & Tubing (Changing the IV tubing at the IV site) Loosen Tape and TegadermPut Chux Pad under armDon Clean GlovesPlace 2x2 under IV site (optional)Stabilize the hub of the IV with thumb and index fingerOcclude blood flowGently disconnect old tubing from IVInsert new tubing into hub of the catheter & screw on tightly
33Preparing 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 pumpTape cannula in place and apply a new dressing to the siteDocument on dressing site- date, time, initialsClean UpWash Your HandsDocument on IV sheet – bag and tubing changeShould empty rest of IV fluid into toilet or hopper – not the sink, especially dextrose – it will plug up the sink.
341 1 Y N 100ml/ hr PUMP Y N 150ml/ hr PUMP Y N Y N Y N STARTDATE/TIME/INITALSSITE#STOPDATE/TIME/INITALSFLUIDSTUBINGINFUSIONDEVICERATEAMOUNTCOMMENTS0800BJM1000 MLLactatedRingers1600BJMYN100ml/hr1PUMP1600BJM1000 ML5% DextroseAnd WaterYN150ml/hr1PUMPYNYNYNGo to IV sheet – back page- don’t have to do anything on the front, because we didn’t change the siteWould write stop date, time, and your initials next to the IV fluid already charted onThen 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 rateSome abbreviations you might see – shouldn’t use, but some doctors do:TRA – to run atTBI – to be infusedYNYN
36TPN ORDERS MUST BE ORDERED ON “PARENTERAL NURTRITION ORDER FORM” Farmer, EdwardDr. JonesDOB MR 54276CodeineHeight:5’7Weight:150 lbALLERGIESDateTimePRESCRIBED TREATMENT, MEDICATION AND DIETTPN ORDERS MUST BE ORDERED ON “PARENTERAL NURTRITION ORDER FORM”1100Continue IVF 5% Dextrose and Water at 150 ml/hrT.O. Dr. Jones/B. MEYER, RNHave to make sure that if you are switching to a different IVF that the two IVF are compatible or get new tubing
37Changing IV Solution Complete 3- Check Procedure Label IV with date, time, and type of solutionWash Hands (Don Clean Gloves, if indicated)ID patient with order & Check allergiesIntroduce Yourself & Explain procedure
38Be sure the drip chamber is at least half full. Close the roller clamp to stop flow of fluid or stop IV pumpRemove the old IV from the pole.Remove the old bag from tubing.Keep spike end sterile.Spike the new bag or bottle with tubingHow would you get air out of tubing?Couple ways – Can disconnect IV tubing from IV site and run fluid into trashIf you have a Y-site, can insert a needle/syringe (if luer lock) and pull air out – if air is above Y-siteReestablish prescribed flow rate.Check for air in tubingEmpty remaining fluid from old IV bag if needed into toilet
391 1 1 Y N 100ml/ hr PUMP Y N 150ml/ hr PUMP Y N 150ml/ hr PUMP Y N Y N STARTDATE/TIME/INITALSSITE#STOPDATE/TIME/INITALSFLUIDSTUBINGINFUSIONDEVICERATEAMOUNTCOMMENTS0800BJM1000 MLLactatedRingers1600BJMYN100ml/hr1PUMP1600BJM1000 ML5% DextroseAnd Water1100BJMYN150ml/hr1PUMP1100BJM1000 ML5% DextroseAnd WaterYN150ml/hr1PUMPYNYNDocument date time, initials. Amount of fluid that was infusedDocument on next line: date time initials, site amount of IV bag, IVF, tubing change, device, and rate.YNYN
40Hanging IV Piggyback How to transcribe a New Medication Order to MAR How to Mix an IVPB using Practi-PowderHow to Hang an IVPBTypes 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
41TPN ORDERS MUST BE ORDERED ON “PARENTERAL NURTRITION ORDER FORM” Farmer, EdwardDr. JonesDOB MR 54276CodeineHeight:5’7Weight:150 lbALLERGIESDateTimePRESCRIBED TREATMENT, MEDICATION AND DIETTPN ORDERS MUST BE ORDERED ON “PARENTERAL NURTRITION ORDER FORM”1200Ampicillin 1 gram IVPB every 6 hoursX 4 dosesT.O. Dr. Jones/B. MEYER, RNMAKE SURE IS AN ANTIBIOTIC. LPN CAN ONLY HANG IVPB ANTIBIOTICS
42Ampicillin 1 gram IVPB q 6hrs x 4 doses Farmer, EdwardDOB MR 54276UNIT: ROOM: 303 BSex: M Hgt: 5’7” Admit Date:Age: Wgt: 150 lb CrCl: Allergies: CodienePhysician: Dr. Jones VERIFIED BY:___ ___ BJM_________ __________DATE (NURSE TO WRITE IN):MEDICATIONPRESCRIBEDDOSEStartStop00:00-07:3007:31-15:3015:31-23:49Ampicillin 1 gram IVPB q 6hrs x 4 doses3-153-161200 – 1800INITALS SIGNATURE INITALS SIGNATURE INITALS SIGNATUREBJMB.MEYER,RN
43For All IV Piggybacks….In Addition to Completing the Usual 4 Checks, You must also:Ensure that the antibiotic and the fluid mixing with are compatibleEnsure that the IVPB is compatible with the primary IVF and any additives in the IVFVerify how fast to run the IVPB- will find in med referencesEnsure that it is an antibiotic you are hanging!!!!!!!!!
44Mixing 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 placedOn the piggyback bag, there are two portsOne says add the other says setAdd: that’s where the medication is addedSet: That where the IV tubing goesADD Port: Port where medication/additives are instilled
45Mixing an IVPB using Practi-Powder Pop off the blue “add” cap from IVPB bagAttach needle to syringe – do not use blunt needlePop-top off of demo dose powder (the medication)Withdraw fluid from IVPB (amt indicated on vial)Wipe off top of demo dose powderInstill fluid into powderWithdraw syringe- BE CAREFUL OF AIR IN VIALMix vial wellWipe off top of vialReinsert syringe into vialWithdraw all of the fluid from medication vialPop off the blue “add” capAttach needle to syringe – do not use blunt needlePop-top off of demo dose powder (the medication)The piggyback usually contains 50ml, 100ml of fluidLook in your med book or PDA – it will tell you what you can mix the medication withNormal saline, D5, etcThe tricky part is when you need a different dose than what the vial containsYou would have to do some mathCall pharmacy to see if they have a different vialPediatrics is where you would really see thisWithdraw fluid (as indicated on medication vial) with syringe and needle from piggy backWipe off top of demo dose powderInstill fluid into powderWithdraw syringeMix vial wellWipe off top of vialReinsert syringe into vialWithdraw all of the fluid (medication) Don’t want to leave anything in the vialWipe off add port on piggy back with alcoholInsert needle/syringe
46Mixing an IVPB using Practi-Powder 12. Wipe off “add” port on piggy back with alcoholInsert needle/syringeInstill medication into piggyback bag via the “ADD” portRecap needle/ Engage safetyShake piggy back gentlyMust label the IVPB: Patient’s name, date, time, initials, drug name and dose3 Checks are completed while preparing medInstill medication into piggyback bagRecap needleShake piggy back gentlyMost 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
47Hanging an IVPB YOU WILL NEED: Secondary infusion set IV tubing label Alcohol swabIV connector (AKA alligator clamp)Now look at checklistCheck doctor’s order – You must make sure that the antibiotic is compatible with the IV fluid and any additivesTranscribe to marON MARAmpicillin 1 gram IVPB q 6hrs x 4 doses1000 – 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
48Hanging an IVPB ID pt, check allergies. Do 4th check at bedside. Close roller clampRemove cap from “SET” Port on IVBPInsert IV Tubing Spike – Do not touch spike, it’s sterile!Fill drip chamber ½ full by squeezing drip chamberPrime 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 setWill need a labelAn alcohol swabAn IV connectYour tubing will screw into your ports so that you won’t need youClose roller clampFlip off the capInsert spikeFill drip chamber ½ fullThere are two ways to prime secondary tubingGo to #7 on the paperOr go to #16 and 17Take 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 onThe 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.
49Now, 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, initialsEvery 72 hours the tubing needs to be changedOrange 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 pumpThe blue slide clamp slides into the pump, the tubing wraps aroundFor testing you will be doing gravity, but you need to know how to use the pumpsWhen you program the VTBI, put in a little less so that the entire bag isn’t infused when the alarmYou only use secondary tubing, if a primary IVF was ordered. If not, then you would just use primary tubing for the antibioticsIf 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 medicationIf they are getting multiple antibiotics, then this tubing has to be changed every 24 hours, because the system has been opened up multiple timesYou will flunk the skills test if you do not check the allergiesIf 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 orderInfuse IVPB at Prescribed Rate (Look in your med book)Assess patient’s responseDocument on MAR- does not go on iv sheet
50Ampicillin 1 gram IVPB q 6hrs x 4 doses Farmer, EdwardDOB MR 54276UNIT: ROOM: 303 BSex: M Hgt: 5’7” Admit Date:Age: Wgt: 150 lb CrCl: Allergies: CodienePhysician: Dr. Jones VERIFIED BY:_____ ___BJM_________ __________DATE (NURSE TO WRITE IN):MEDICATIONPRESCRIBEDDOSEStartStop00:00-07:3007:31-15:3015:31-23:491200IVPBBJMAmpicillin 1 gram IVPB q 6hrs x 4 doses3-153-16INITALS SIGNATURE INITALS SIGNATURE INITALS SIGNATUREBJMB. MEYER, RN
51YOU WILL NEED PRN adapter Gloves PRN adapter Normal Saline Flush Alcohol SwabTape ChuxGogglesD/C IVT and adapt IV siteFlush IV site with 3 ml of Normal Saline q 8 hours and prnWill probably see: Cap IV siteMost places don’t use heparin anymore for peripheral IV sites – Due to HIT and errors with giving straight heparinYou 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 policyWhen 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
52TPN ORDERS MUST BE ORDERED ON “PARENTERAL NURTRITION ORDER FORM” Farmer, EdwardDr. JonesDOB MR 54276CodeineHeight:5’7Weight:150 lbALLERGIESDateTimePRESCRIBED TREATMENT, MEDICATION AND DIETTPN ORDERS MUST BE ORDERED ON “PARENTERAL NURTRITION ORDER FORM”0800DISCONTINUE IVF and adapt IV siteFlush IV site with 3 ml ofNormal Saline q 8 hours and prnT.O. Dr. Jones/B. MEYER, RN
54PRN AdapterObtain 3 ml Normal Saline into syringe. Attach blunt tip end.Wipe off PRN Adapter end with AlcoholPrime PRN Adapter with NS – Leave Syringe AttachedDon gloves and gogglesStop the infusionLoosen the Existing Infusion TubingStabilize Site and Occlude Blood FlowRemove infusionAttach PRN Adapter and screw it securely onto the cannula hub.Flush IV with Normal SalineRe-Tape IV site and PRN AdapterWill need the NS flush and a blunt tip cannulaTake the blunt tip cannula and attach to you saline flushSave the white endWhen you pull off the capPrime your blunt tip – be carefulYou must prime your prn adapter – if you do not, then you are giving your patient a bolus of airWipe off the stopper part of the prn adapter with alcohol and attach the blunt tip of the syringe to the prn adapterFill prn adapter until fluid comes out the endYou will have to wear gloves/goggles, because it is a potential blood exposureIf 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 endRecommend 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 clampWhen 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.
55Normal Saline Flush 3ml q 8 hrs & prn Farmer, EdwardDOB MR 54276UNIT: ROOM: 303 BSex: M Hgt: 5’7” Admit Date:Age: Wgt: 150 lb CrCl: Allergies: CodienePhysician: Dr. Jones VERIFIED BY:______ ____BJM________ __________DATE (NURSE TO WRITE IN):MEDICATIONPRESCRIBEDDOSEStartStop00:00-07:3007:31-15:3015:31-23:490900IVPBJMNormal Saline Flush 3ml q 8 hrs & prn3-18ALSO NEED TO DOCUMENT ON IV FLOW SHEETINITALS SIGNATURE INITALS SIGNATURE INITALS SIGNATUREBJMB. MEYER, RN
561 150 ML/ PUMP HR 1 1 600 PRN ADAPTER Y N 100ml/ hr PUMP Y N 150ml/ hr STARTDATE/TIME/INITALSPUMP150 ML/HR600PRNADAPTERSITE#STOPDATE/TIME/INITALSFLUIDSTUBINGINFUSIONDEVICERATEAMOUNT9001000COMMENTS0800BJM1000 MLLactatedRingers1600BJMYN100ml/hr1PUMP1600BJM1000 ML5% DextroseAnd Water2300BJM0900YN150ml/hr1PUMP2300BJM09001000 ML5% DextroseAnd WaterAnd waterN150ml/hr1PUMPYNYNDocument date time, initials. Amount of fluid that was infusedDocument on next line: date time initials, site amount of IV bag, IVF, tubing change, device, and rate.YNYN
58DISCONTINUE IV SITE INFORMATION GIVEN IN PREVIOUS LAB WILL NOT BE TESTED ONMAKE SURE CANNULA INTACT AND CHART ACCORDING TO INSTITUTION POLICYHAVE WRITTEN ORDER BEFORE REMOVEID PT BEFORE REMOVAL
59TPN ORDERS MUST BE ORDERED ON “PARENTERAL NURTRITION ORDER FORM” Farmer, EdwardDr. JonesDOB MR 54276CodeineHeight:5’7Weight:150 lbALLERGIESDateTimePRESCRIBED TREATMENT, MEDICATION AND DIETTPN ORDERS MUST BE ORDERED ON “PARENTERAL NURTRITION ORDER FORM”0600DISCONTINUE IV SITET.O. Dr. Jones/B. MEYER, RN
601 L H SITE SITE STATUS Start: Site # 3-16-10 0800 BJM Attempted x1 DATE/TIME/ INITALSITESITE STATUSSite Rotation Due:__________Start:Site #Reason for Change (code):0800BJM1Comments:Attempted x1Stop:0700BJMLocationL HDate, time and initials when you started the IV in appropriate box on formSite: Site number:– 1st site, 2nd site, 3rd siteSite location: use site location codeSize and type: Whatever the package says for type, 22 g x 1”Under comments: Can write how many attempts it took to start current IVDressing change: When you put the dressing on – dressing change: gauze dressing 48 hours, tegaderm 72 hoursSite rotation due: Trumbull and St Joes is 3 daysMust have one successful stick in the clinical setting to get certificationSize/TypeDressing Change:# 20/ Angio