Sunteți pe pagina 1din 41

Chapter 27 (Perry & Potter)

IV Priming
Why do clients need an IV?
Replacing fluids
Correct or prevent nutritional imbalances
Provide IV medication therapy

Nursing Responsibilities
1.

Know the correct solution & equipment needed & how


to initiate the infusion

2.

Regulate the infusion (with or without a pump)

3.

Care for an maintain the system

4.

Indentify and correct problems

5.

Discontinue the infusion

Categories of IV solutions
1.
2.
3.

Isotonic
Hypotonic
Hypertonic

Determined by serum electrolyte values and


fluid volume balance

RN must understand the rationale for IV fluid administration


and the type of solution ordered

Establish IV Access
IV catheter can remain in place for 96 hrs (check hospital

policy, most are 72 hours), IV solution replaced every 24 hours

Palpate insertion site daily and prior to initiating infusion


Inspect site if client c/o pain at site or developed S&S of

infection

Change transparent dressing if becomes damp, soiled, loose


Clean injection port with antiseptic before accessing system

Supplies
Administration set (IV lines)
Correct IV solution
Antiseptic swabs
Tape
IV pole, rolling or ceiling mounted
Hospital gown with snaps
1-3 ml normal saline, 3 ml syringe (or larger)pre-

filled n/s syringes may be available, to flush IV


catheter prior to initiating infusion

Nursing Diagnosis
Risk for imbalanced fluid volume
Deficient fluid volume
Excess fluid volume
Risk for infection

Assessment
Review physicians order (type, amount and/or rate)
6 medication rights (medication, dose, client, route, time,

documentation)
Physical assessment pertaining to IV fluid administration
Understand rationale and purpose of IV fluid, potential

incompatibilities, and potential side effects

Implementation
Change gown
Prepare tubing and solution
Check solution (6 rights)
Color
Clarity
Expiration date
Leaks

Open infusion set (maintaining sterility of each end)


Place roller clamp 2-5 cm below drip chamber and move to

OFF position
Remove sheath over port on IV solution bag
Remove tubing spike (DO NOT TOUCH)
Insert spike into IV bag

Priming:
Compress drip chamber, fill 1/3 to
Remove cap on end of tubing, KEEP and maintain sterility
Slowing open roller clamp and prime tubing with fluid, return roller

clamp to OFF position

Inspect for air bubbles, tap tubing where bubbles are visible, and invert

ports and tap to fill and remove air

Replace cap from end of tubing


Label tubing and bag with date and time

Prepare n/s (1-3 ml) to flush intermittent infusion device (saline

lock, PIID, clave) (p. 749 establish IV access, pictureA)

Saline lock is attached to end of IV catheter which is then

attached to the primary line

Has a port or stopper (needleless)


Must be irrigated q8-12 h, and before & after each drug infusion

(hospital policy)

Saline or heparinized saline (hospital policy)


Sterile technique

Regulating IV Flow Rate


(Gravity)
Flow rate established using pump (ml/hr) or gravity

(gtt/min)

If line patent and IV infusion initiated, flow rate must

be established

Educate client regarding positioning


Inspect site often

What is the drop factor: number of drops per ml (gtt/ml)

IV tubing provides:
Microdrip: 60 gtt/ml
Macrodrip: Abbott: 15 gtt/ml
Travenol: 10 gtt/ml
McGaw: 15 gtt/ml

Calculating drip rate:


ml/hr x gtt/ml
60 min

drops/min

If ml/hr unknown:
ml/hr = total infusion (ml)
hours of infusion

Remember: if infusion is not exactly 1 hour


(15 min, 30 min, 120 min, etc) you must calculate
hourly rate.
50 ml x ?
15 min 60 min

200 ml
hr

Example:

Order: D5W @ 75 ml/hr


Drop factor: 15 gtt/ml
Calculate drip rate: ? gtt/min
Answer: 75 ml/hr x 15 gtt/ml = 18.75 gtt/min
60 minutes

(18-19 gtt/min)

Example:

Order: Give 1 L Ringers Lactate over 4 hours


Drop factor: 15 gtt/ml
Calculate drip rate: ? gtt/min
Answer:

1000 ml x ?
240 min 60 min

250 ml
hr

250 ml/hr x 15 gtt/ml = 62.5 gtt/min


60 minutes
(62- 63 gtt/min)

Establishing Drip Rate


Count drops in drip chamber for 1 minute (with second

hand), adjust roller clamp as needed (2-5 cm below drip


chamber)
If very fast or very slow, count for 30 sec (x 2) and adjust

roller clamp. Count for 1 full minute once clamp is


adjusted .

Evaluation
Monitor infusion at least q1h (note volume, rate)
Assess for S&S of overhydration or dehydration,

response, lab values


Assess S&S of infiltration, inflammation, clot in catheter,

kink or knot in tubing etc

Recording and Reporting


Rate of infusion, gtt/min, and ml/hr in nursing notes or IV

fluid form
Document any ordered changes in IV fluid rates
Report rate, solution, volume remaining to the nurse

assuming care of client at break or change of shift

Practice Priming

Chapter 21 (Perry & Potter)

Piggyback (p. 737)


A small IV bag connected to short tubing
that is connected to the upper Y port of a
primary infusion line. The small bag is set
higher than the primary infusion bag. Upon
completion of the secondary solution when
the solution in the tubing falls below the
primary drip chamber the primary solution
begins again.

IV Medication
Secondary line (piggyback)
Prepare medications: 6 rights and 3 checks
Medical history & allergies
Review medication indication

Drugs prescribed 1 to 6 times per day, dissolved in

small volumes of IV fluid


Usual infusion time : 30 to 60 minutes
Check compatibility of drug to solution

When mixing powders for injections, remember:


Check the type of fluid recommended to
dissolve the powder
The amount of fluid to add
The strength of the solution made (mg/ml)
Further dilution for infusion
Infusion time

The label of the vial


Package insert inside the vial package
Nursing Drug book
Compendium of Pharmaceuticals and Specialties ( CPS)
Parenteral drug manual

Medication Calculation
Example:
Order: Drug 0.65 g QID IV
Label directions : Add 2.5 ml water for injection. Provides

approx volume of 3 ml (325mg/ml)


Note : the manufacturer gives the strength of the solution
Desire 0.65g
Have: 325 mg/ml
Stock : in every ml

Desire: 0.65 g
Have: 325 mg/ml
Stock : in every ml

Convert: 0.65g to mg
1g = 1000 mg ( therefore answer should be bigger)
1000mg = Three zeros
Therefore move decimal point three spaces to the right
0.65 g = 650 mg
Desire X Stock

= Amount

Have
650 mg
325 mg

1ml

2mL

Calculation of Drip Rate


Example:
Order: Flagyl 500mg/100 ml normal saline IV BID
(administered over 1 hour)
Drop factor: 15 gtt/ml
Calculate drip rate: ? gtt/min
Answer:

100 ml x ?
60 min
60 min

100 ml/hr x 15 gtt/ml = 25 gtt/min


60 minutes

100 ml
hr

When calculating IV rates, if the medication volume exceeds

5 10 ml, add this into calculations

Example:
Amount: 100 ml NS plus 8 ml penicillin=108 ml
Duration: Give over 30 minutes
Calculate rate: ? ml/hr
Answer:

108 ml x ?
= 216 ml
30 min 60 min
hr

Lets Practice
(vial containing a powder) p.706
Reconstitution of medication
Adding to secondary bag
Attaching secondary line to primary line
Regulating rate

Follow 6 rights and 3 checks


Wash hands
Gather supplies
Medication, secondary line,10 ml syringe, 18-22 gauge

needle (filtered if indicated), alcohol swabs, dilutant (saline


or sterile water), mini bag (medication bag), medication
label, MAR

Order
Ampicillin 500 mg IV, q6h

See vial for directions: to have 500 mg/ml add 5.6 ml dilutant
IV drug manual indicates: add to 50 - 100 ml normal saline and
infuse over 60 minutes
How many ml of medication will you add to your minibag?
What is the rate (ml/hr)?
What is the drip rate with drop factor of 15 gtt/min?

Answers: 50 ml X ?
= 50 ml
60 min 60 min
hr

gtt/min = 50 ml/hr X 15 gtt/min = 12.5 gtt/min


60 min
(12-13)

100 ml X ?
= 100 ml
60 min 60 min
hr

gtt/min = 100 ml/hr X 15 gtt/min = 25 gtt/min


60 min

Preparation
Remove cap covering medication and dilutant (6 rights, 3 checks),

swab both rubber seals with alcohol swab and allow to dry

Attach needle (or needleless device) to syringe, pull back on plunger

drawing the equivalent amount of air (i.e. 5.6 ml) as solution and
inject into solution (hold plunger firmly, vial on flat surface)

Invert vial and allow pressure from the vial to fill syringe with

solution (5.6 ml), pull back gently if required. Keep tip of needle in
fluid. Place vial on flat surface to remove needle

Inject dilutant into medication vial, remove needle and recap (scoop

technique)

Roll in palms (DO NOT SHAKE)


Wait until medication is clear, swab medication bottle again,

and withdrawal desired amount (follow same steps as


withdrawing dilutant (inject equal volume of air (i.e.1 ml) as
medication to be removed)
Add medication to secondary bag, wipe port with alcohol
swab, lay medication bag on flat surface, insert needle and
inject. Discard needle (no need to recap)
Mix medication turning gently end to end
Complete medication label (apply to back of medication bag)
Spike bag with secondary IV tubing, ensure clamp is CLOSED

Clean port of main line and connect secondary tubing to

medication bag, squeeze and fill drip chamber.


Back prime: drop medication bag below level of primary
drip chamber, open secondary line roller clamp, prime
line, hang medication bag above primary fluid bag (use
hook to lower main bag)
Regulate flow by adjusting regulator clamp or using IV
pump
Observe for S&S of reaction
Assess IV site frequently

Order
Ampicillin 500 mg IV, q6h

See vial for directions: 500 mg/ml add 5.6 ml solution


IV drug manual indicates: add to 50 - 100 ml normal saline
and infuse over 60 minutes

Answers: 50 ml X ?
= 50 ml
60 min 60 min
hr

gtt/min = 50 ml/hr X 15 gtt/min = 12.5 gtt/min


60 min
(12-13)

100 ml X ?
= 100 ml
60 min 60 min
hr

gtt/min = 100 ml/hr X 15 gtt/min = 25 gtt/min


60 min

Next Lab
Subcutaneous Injection & Insulin
Chapter 21

S-ar putea să vă placă și