INTRAVENOUS THERAPY

PURPOSE:

To provide or replace necessary fluid, electrolyte, and/or caloric intake To administer medications, e.g. Antibiotics, analgesics, & chemotherapy To facilitate an immediate or prolonged action of a drug To administer blood or blood products.

KEY POINTS: An LPN must be able to assess: When the dressing is damp, unclean or not intact The IV site is red, painful and swollen An additional bag of IV solution is required The IV site develops an untoward reaction e.g. Redness, pustules, or discharge), following removal of the IV device. A LPN may identify a patient for a blood transfusion with a RN. A LPN may collect blood from the Blood Bank.

Revised September 21, 2007

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LEARNING OBJECTIVES
After completing the package, the learner will be able to: 1. Understand and demonstrate the formula for calculating gravity infused IV fluids. 2. 3. 4. Hang a new bag of additive free IV solution. Identify the factors that affect gravity infused IV flow rates. Accurately document the procedure following the changing of an IV bag. 5. 6. 7. 8. Identify concerns and actions specific to changing an IV bag. Flushing a saline lock. Changing the IV tubing. Remove air from the tubing.

Revised September 21, 2007

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IV SITE COMPLICATIONS
PROBLEM IV site swollen (interstitial) POSSIBLE CAUSE End of catheter has come out of the vein and fluid is going into the surrounding tissues Medication or IV solution may be irritating the vein IV device may have been moving and irritated the vein Connections may not be secure Enlarged entry hole at the IV site Could be due to a variety of reasons Notify team The IV device will have to be discontinued Notify team Discontinue IV site Notify doctor Send swab for C&S WHAT TO DO Notify team The IV device will have to be discontinued Notify team The IV will have to be discontinued

IV site is red and/or painful (phlebitis = inflammation of the vein)

Leaking of fluid at the IV site

Thick, yellow discharge at the present or a previous IV site (infection)

Observe a continuous IV at least every hour, to ensure IV is infusing in accordance to ordered hourly amount, dressing remains dry and intact, site integrity remains intact- no redness, swelling or pain.

Revised September 21, 2007

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A CONTINUOUS IV OR INTERMITTENT IV
KEY POINTS: An IV will be discontinued on a physicians order or at the discretion of an RN Do not use an alcohol swab for this purpose Check to see if the patient is receiving anticoagulants Check for intactness of IV device May be necessary to elevate the extremity following the procedure May be necessary to place a warm compress on a phlebotic site STEPS IN DISCONTINUING IV SITE: 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. Check physicians order, or consult with RN prior to discontinuing IV site. Collect supplies Identify patient by I.D. band Explain procedure to patient Wash hands Apply gloves (non-sterile) Close clamp on IV tubing if applicable If IV on pump, turn pump off Remove tape; loosen one edge of transparent occlusive dressing while gently holding IV device in place. Grasp loosened edge of transparent occlusive dressing and stretch in the direction of loosened edge parallel to skin. Loosen other edge of dressing and repeat procedure. Remove device, tubing and occlusive dressing while applying a gauze sponge over IV site. Apply digital pressure on gauze over IV site for one full minute, or longer as necessary, to prevent blood from leaking and possibly causing a hematoma at site. Apply bandaid type dressing. Report excessive bleeding or hematoma formation to team. Page 4 of 13

DISCONTINUING

14. 15.

Revised September 21, 2007

DOCUMENTATION: Fluid balance/ IV Therapy Record forms: - Date and time IV device removed - Amount and type of solution absorbed - Reason removed and if intact

Patient Progress Record - Condition of IV site and reason IV device removed- e.g., IV site interstitial or inflamed - IV device removed and if intact - Comfort measures if needed - Document further observation if necessary

Revised September 21, 2007

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RESPONSIBILITIES OF THE LPN RELATED TO IV THERAPY: After reviewing the physicians orders and informing the RN: 1. The LPN may change an IV bag and then regulate the flow rate of an additive free bag only. Note: Examples of additive free IV solution: Normal Saline (N/S), 5%Dextrose (D5W) and 2/3 and 1/3 solution. 2. The LPN is not responsible for changing and regulating the infusion rate of IV bags containing medications. -Note: Examples of medications include: analgesics, antibiotics and electrolytes. 3. The LPN is not responsible for changing and regulating the infusion rate of IV bags containing blood products. Note: Examples of blood products include: whole blood, red blood cells, platelets, plasma, and albumin. 4. The LPN is responsible for changing the IV tubing, removing air from the tubing and changing the dressing if needed. 5. The LPN can regulate an IV rate on a pump. 6. The LPN will keep accurate intake and output. 7. The LPN will communicate with team members any concerns. 8. The LPN will inform the oncoming shift the amount of IV fluids the patient received, the patients output, amount left to count, the patients hydrated state- by assessing mucous membranes, auscultating lungs, output, and skin turgor.

Revised September 21, 2007

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CALCULATE AND ADJUST IV FLOW RATES: Flow rate calculations are integral to the safe delivery of gravity infused IV fluids. Information required to calculate the flow rate includes the following: 1. Volume of fluid to be infused. 2. Total infusion time. 3. Number of drops per ml the administration set (IV tubing) delivers. This information is found on the administration set box. Manufactures of administration sets use a variety of different drops per ml. - macrodrop tubing = 10 macrodrops/ml - microdrop tubing = 60 microdrops/ml To calculate an hourly IV rate the following formula is used.

Volume of fluid per hour x drops per ml of tubing set 60

The IV rate is regulated with the roller clamp on the administration set.

Revised September 21, 2007

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Calculate the following orders:

1. Order = D5W 1000mls q8h macrodrop tubing

2. Order = 2/3 + 1/3 1000mls q12h via microdrop tubing

3. Order = N/S TKVO at 50mls hr

4. Order = N/S 1000mls q12h via macrodrop tubing

5. Order = 2/3 + 1/3 1000mls q8h via microdrop tubing

Revised September 21, 2007

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Factors, which affect gravity, infused flow rates:

1. 2. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. type of tubing height of fluid container patients position location of over-needle catheter size of IV canula blocked IV canula control clamp IV dressing/tape kinked tubing condition of vein faulty equipment kinked IV canula

Revised September 21, 2007

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CHANGING THE IV BAG: Special Instructions A bag of IV solution is changed minimum of every 24 hours. The LPN may change an additive free IV solution bag. Changing of the IV bag occurs before the drip chamber is empty. If not using a pump, each bag of IV solution will be marked with tape indicating the patients name, date, start time and time increments. IV tubing will be flagged with coloured, dated tape for date change. Tubing change will be every 72 hours. Steps 1. 2. 3. 4. 5. 6. 7. Check physicians orders. Check patients ID band. Allow current bag of solution to infuse until almost empty. Do not allow drip chamber to become empty. Close roller clamp on tubing. Remove completed infusion bag from IV pole. Remove spike of IV tubing from solution bag and quickly insert spike into new bag. 8. 9. 10. Maintain sterility while ensuring that air does not enter tubing. Hang new bag on IV pole. Open roller clamp and, if necessary, squeeze drip chamber to allow flow to start. 11. 12. Adjust gravity rate to prescribed flow rate. If using pump, be sure to set pump to prescribed flow rate.

Revised September 21, 2007

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DOCUMENTATION Changing IV Solution Bag 1. Record on the fluid Balance / IV Therapy Record date and time bag was changed amount of solution absorbed is entered on the line where solution was initially noted amount and type of solution hung rate of infusion initials

NOTE: This information is not documented on Progress Notes.

Revised September 21, 2007

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SELF-TEST QUESTIONS 1. What type of IV bag may a LPN change?

2. What is the first step the LPN takes before changing an IV bag?

3. Who can change and regulate the infusion rates?

4. What is the longest time period that a bag of IV solution may hang?

5. When changing a bag of IV solution, it is important that the drip chamber _________________________________________

6. The formula for an hourly IV flow rate is?

7. The infusion rate is ordered at 1000mls q8h via macrodrop tubing. Please calculate the required drops/minute?

8. What are the drops/ml for a microdrop tubing_________ and macrodrop tubing_____________.

Revised September 21, 2007

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9. List 8 factors that affect gravity infused flow rates. 1._____________________________________ 2.______________________________________ 3.______________________________________ 4.______________________________________ 5.______________________________________ 6.______________________________________ 7.______________________________________ 8.______________________________________

10. You have changed and regulated the IV flow rate of a 1000ml bag of N/S. Where do you record the information? _______________________________________________

What information do you record? _______________________________________________________

11. You hang a new bag of solution TKVO. What does TKVO mean?

Revised September 21, 2007

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