2 Multidisciplinary functions RN: Monitor, Set, RegulatePCP: Determine IV FluidPharmacy: PreparationEducation: Use of Equipment
3 Primary vs secondary lines Primary lineLargerContinuous unlesssecondary is activeSecondary lineSmaller volume“Piggy-back”Must not be introducedin high-alert fluid lines!
4 Placement of secondary lines Injection portsIf pump is used, above the pumpIf no pump, close to IV insertion siteSecondary infusion bags are always placed higher than the primary solution bags
5 Drip chamber Used to monitor flow by observing drops Squeeze chamber to fillhalf-full with fluidAllows drops to be observedeasilyPrevents air from entering system
6 Iv clamps Roller clamps allow adjustment of flow Auxiliary clamps can stop flow temporarily without changing the rate set by the roller clamp
7 ports May be for needle- or needleless system Allow for injection of medication into the lineAllow for attachment of secondary lineNever puncture a needleless system port with a needle!
8 Needleless systems Designed to limit needlestick injuries Ease of disposalReduces potential bacteremia
9 Iv fluids and gravity IV fluids flow by gravity Must be above patient’sheart level3’ above the heart is thedesired heightAs the patient’s positionchanges, the IV bag heightmust be adjusted
10 Monitoring flow rate At a minimum, every hour After every position changeMore frequently for pressors,antiarrhythmics, and othercritical drugs and fluids
11 Secondary lines Infusion of medications Intermittent IVPBs hang higher than primary bagGives IVPB bag greater pressureCauses IVPB to infuse firstIVPB set includes an extender to be used on the primary bagWhen IVPB complete, primary bag will begin its flow automatically
12 Preparation of IVPBPrepackagedMixed by PharmacyMixed by RN on unit
14 Use of volume controlled burette Used for greater accuracy inmeasuring smaller volumesmlMeasured in microdropsChamber filled from primary IVto desired amountMedication injected into portDesired rate set manually or through pump
15 Use of volumetric pumps Can deliver volumes too small tomeasure by drips (e.g., 0.1 ml per hour)May be large volume (replacementfluids) or small volume (insulin, hormones)May come with several safety features (flow alarms, air alarms, drug libraries)Or, may flow even wheninfiltration occursNever turn off an IV alarm!
16 Identifying common components of iv fluids DEXTROSE: “D” May be in various percentages: D5, D10WATER: “W” Refers to sterile waterSALINE: “S” May be Normal Saline (NS or 0.9%), ½ NS or ¼ NSELECTROLYTE SOLUTION: “LR” or “RL” or “RLS” Ringer’s lactateLactated Ringer’s
17 Iv drop sizesDrops per mL (gtt/mL) required to calculate any flow rateWill be identified on IV tubing packaging“Microdrip” is always 60 gtt/mL
18 Methods of calculating flow rates Ratio and proportion methodDimensional analysis methodFormula and division methodDivision factor methodAny of these methods is helpful if you understand the principles behind it!
19 Ratio and proportion method First find the mL per min by dividing the mL per hour by 60 (60 minutes in 1 hour):125 mL ÷ 60 = 2 mL/ minIf we know we are to give 2 mL per minute, set up a proportion using the known drops per mL based on the type of tubing used (e.g., 10 gtt/mL):10 gtt = x gtt = 20 gtt/min1 ml mL
20 Dimensional analysis method Must have rate in mL per hourYour unknown is in gtt/minTherefore, start with your drop factor to have gtts = gtts in your answer:gtt = 10 gttmin mLAdd the “desired” mL per hour rate: gtt = 10 gtt x 125 mLmin mL hrAdd neutral time value: 1 hr60 minCancel repeating numerator/denominator values:gtt = 10 gtt x 125 mL x 1 hr = 21 gtt/min1 mL hr min
21 Formula and division method Useful only in small volumesMust be completed in less than 60 minutesFlow rate = mL/hr Volume x set calibrationTime (60 min or less)125 mL x 10 gtt/mL = 21 gtt/min60 min
22 Division factor method Must have rate as mL/hrCan similarly divide the mL per hour by the constant drip factorDrip factor is obtained by dividing set calibration into 60:60 ÷ 10 gtt/mL = 660 ÷ 15 gtt/mL = 460 ÷ 20 gtt/mL = 360 ÷ 60 gtt/mL = 1
23 Example factor method1 125 mL x 10 gtt/mL = 21 gtt/min 60 min 6 …is the same as: 125 ÷ 6 = 21 gtt/min