Skill 3-2 Adding a New Solution to the Intravenous Infusion

When an IV is to remain in place, another container of solution must be hung before the last solution container runs dry. The new solution is hung when the solution that is infusing reaches a level of about 50 mL remaining.

Supplies
Ordered IV solution Alcohol swabs

Medication administration record (MAR) Time tape

Review and carry out the Standard Steps in Appendix 6.

Assessment (Data Collection)

1. ACTION Determine which solution is required next according to the orders. RATIONALE IV solutions are an ordered medication. 2. ACTION Select the correct solution and inspect it for cloudiness, particles, and other signs of contamination. RATIONALE Contaminated solution must not be used.

Planning
3. ACTION Place a time tape label on the container, and mark it appropriately. RATIONALE A time tape makes it easy to tell at a glance if the IV is owing on schedule.

Implementation
4. ACTION Go to the patients bedside, and properly identify the patient. Inspect the IV site for signs of complications. RATIONALE Identifying the patient properly helps prevent medication errors. If the IV site shows signs of infection or infiltration, the site should be changed before the new solution is added. 5. ACTION Hang the IV container on the IV pole. Remove the container that is almost empty, fold the tubing over on itself close to the drip chamber or close the roller clamp, and remove the spike from the used container. Keep the spike from becoming contaminated. Remove the tab from the IV tubing port on the new container, and insert the tubing spike while stabilizing the container with your other hand. RATIONALE The tubing must be occluded while you change IV containers to prevent air from entering the tubing. If the spike becomes contaminated, new tubing should be obtained. Stabilizing the container helps prevent slipping and contaminating the spike while it is being inserted into the container.
From deWit, S.C. (2005). Fundamental Concepts and Skills for Nursing (2nd ed.). Philadelphia: Elsevier Saunders.

STEP 5A

STEP 5B

6. ACTION Remove any air bubbles that entered the tubing by tapping the tube with your nger or a pencil as you stretch it taut. Squeezing the tubing below the bubbles will sometimes encourage them to move up to the drip chamber. RATIONALE Air bubbles can cause an air embolus if sufcient air collects. Patients are disturbed by the sight of air bubbles in the IV tubing. Air will move upward to the drip chamber when dislodged from the side of the tubing. 7. ACTION Check the ow rate and readjust it as needed to the prescribed rate. RATIONALE The greater quantity of uid in the new container causes a bigger pressure gradient, and the new solution may ow more rapidly. 8. ACTION Dispose of the empty container in the proper receptacle. RATIONALE Some agencies require that the container be drained dry before discard.

RATIONALE Veries that the solution is the one ordered and that it is running correctly through a patent site.

Documentation
10. ACTION Record the added uid on the IV ow sheet. RATIONALE The amount and type of uid added and the infusion rate are charted along with an assessment of the IV site.

CRITICAL THINKING QUESTIONS

1. When you go to hang a new solution of intravenous uid for your patient and you nd that the bag hanging is not what should have been infusing, what would you do? 2. At what point would you switch out the old IV solution for the new solution (when how much is left in the bag)? Why would you choose this point to change the solution?

Evaluation
9. ACTION Before leaving the room, check the solution label with the order again, assess the site for signs of inltration, and make certain that the drop rate is correct.

From deWit, S.C. (2005). Fundamental Concepts and Skills for Nursing (2nd ed.). Philadelphia: Elsevier Saunders.

Skill 3-2 Adding a New Solution to the Intravenous Infusion

Student:_________________________________________________ Date: ___________________________________________________
S: Satisfactory Performance U: Unsatisfactory Performance

1. Carries out Standard Steps A, B, C, D, and E as need indicates. 2. Checks the solution for sterility and expiration date. 3. Compares label with order. 4. Places a time tape on the solution. 5. Properly identies patient before adding solution using two identiers. 6. Checks solution and additives with order for third time. 7. Removes IV tubing from completed bag and spikes new bag of IV solution. 8. Removes air bubbles that occurred in tubing. 9. Readjusts ow rate to prescribed rate. 10. Disposes of empty container. 11. Adds infused solution amount on intake and output record. 12. Records the added uid on the parenteral infusion record. 13. Carries out Standard Steps X, Y, and Z.

Successfully completed

Needs practice and retesting Comments:

Instructor: ___________________________________

Copyright 2009 by Saunders, an imprint of Elsevier Inc.