Catherine Luksic BSN, RN

 Primary infusion  “maintenance infusion”  “continuous infusion” Via gravity Via electronic pump  Secondary infusion  “piggyback”  “IVPB” Usually via electronic pump

 Primary IV administration set  Gravity infusion  Electronic pump infusion  Secondary IV administration set  “piggyback tubing”  Blood administration Y set  Extension tubing  Intermittent infusion lock  HL or SL

 Gravity Drip  Manually set, regulated w/ roller clamp  Simplest method  Count drops manually  Macrodrip tubing - drop factor determined by manufacturer  Can range from gtts/mL (common 10gtts/mL) standard primary tubing for rapid infusions  Microdrip tubing - 60gtts/mL Used for peds, elderly, slower rates

 Advantages:  Easy  Does not require power source or pump  Can set-up quickly  Disadvantages:  Not greatly accurate  No free-flow prevention  Room for error

 Volume ordered to be infused  1000 ml or 1000 cc  Drop factor of tubing being used  Rate of infusion as per order  100 ml /hr (or 100 cc/hr) **refer to IV calculations worksheets

 Check physician orders !  Gravity drip or electronic pump ?  cc/hr = ml/hr  KVO (10-20 ml/hr)  TKO  Check IV site & IV rate at least every hour

 Refer to procedure  Maintain sterility  Remember to close the roller clamp 1 st **  ?? Invert all Y-sites and tap to remove air  Demonstration  Practice

 Height of bag 36 inches above heart  Position of roller clamp is it open or closed ?  Patency of tubing Check for kinks

 Check rate - has it been changed?  Check tubing - is it kinked?  Check clamp(s) - are they open?  Check site -  is cath or vein being compressed?  ANY abnormality?  Look for sign of infiltration

 Purpose – improve accuracy of delivery.  Requires power source  Deliver a preset fluid rate over a specified period  Uses constant force  Always use pump w/ TPN, central lines, titrated medications, blood products

 Occlusion  Air-in line  Infusion complete  Power

 SINGLE CHANNEL  MULTI-CHANNEL  PCA (Patient controlled analgesia)  AMBULATORY IV PUMPS Home care use

 ASSESSMENT  DIAGNOSIS  PLANNING  IMPLEMENTATION  EVALUATION

 FIRST STEP, AS ALWAYS  chronic conditions  use of long-term medications (anticoagulants)  previous IV experiences/problems  allergies (especially latex & antimicrobial agents)  hand dominance  Skin *Cultural considerations, communication barriers, level of understanding

 Physical exam Neurological status – AAO, ability to understand and cooperate Cardiovascular status – color, pulses, edema, appearance of veins Skin – bruising, rashes, lesions

 Examples:  Risk for injury related to (lack of knowledge regarding equipment)  Knowledge deficit related to (new IV insertion) AEB (pt verbalization …)  Impaired physical mobility related to placement of peripheral IV AEB…  Anxiety related to (initiation of IV therapy) AEB...  Alteration in comfort: Pain

 Patient outcomes and goals - what do you (and the patient!) expect.  Ex: Pt. will remain free of S/S of complications related to IV therapy  More specific – Pt. will remain free of signs of phlebitis

 Nursing Care:  Check site HOURLY for complications - redness, pain, edema, infiltration  Instruct pt. to call nurse immediately: pain, bleeding, other concerns.  Instruct pt. to call nurse if pump alarm sounds.  Maintain correct infusion rate as ordered.  Secure IV (to prevent accidental dislodging of catheter during movement).  Change tubing according to hospital policy (usually q 72 hr.)  Change IV site according to hospital policy (usually q 72 hrs.)

 Nursing Care :  2011 Infusion Nurse Society (recommendations) Do not change IV tubing more frequently than q 96 hrs. If IVPB tubing is detached from continuous tubing, change q 24 hrs.

 How will you know if the goal/outcome has been achieved?  Assessment  Patient record  Lab values  Communication