CHECKLIST 66: PRIMING IV TUBING

Disclaimer: Always review and follow your hospital policy regarding this specific skill.

Safety considerations:

Primary IV tubing can be macro-drip or micro-drip tubing. The drop factor of the IV tubing is required to complete
the IV drip rate calculation for a gravity infusion.
Remember to invert all access ports and backcheck valve.

STEPS  ADDITIONAL INFORMATION

1. Perform hand hygiene. This step prevents the transmission of microorganisms.

2. Check order to verify solution, rate, and frequency. This ensures IV solution is correct and helps prevent
medication error.

3. Gather supplies. You will need IV solution, primary IV tubing, time label,
change label, alcohol swab, and basin or sink.

Sterile IV solution

4. Remove IV solution from outer packaging and gently Tear the perforated corner of the outer packaging; check
squeeze. colour, clarity, and expiration date.

Remove IV solution from

packaging

5. Remove primary IV tubing from outer packaging. IV tubing

6. Move the roller clamp about 3 cm below the drip Move roller clamp
chamber and close the clamp.

7. Remove the protective cover on the IV solution port Be careful and do not contaminate the spike.
and keep sterile. Remove the protective cover on the IV
tubing spike.

Remove protective cover from

spike on IV tubing

8. Without contaminating the solution port, carefully Insert IV spike into sterile solution using
insert the IV tubing spike into the port, gently pushing
and twisting.

sterile technique

9. Hang bag on IV pole. The IV bag should be approximately one metre above the
IV insertion site.

10. Fill the drip chamber one-third to one-half full by Filling the drip chamber prevents air from entering the
gently squeezing the chamber. Remove protective cover IV tubing.
on the end of the tubing and keep sterile.

Fill drip chamber

11. With distal end of tubing over a basin or sink, slowly Inverting and tapping the access ports and backcheck
open roller clamp to prime the IV tubing. Invert valve helps displace and remove air when priming the IV
backcheck valve and ports as the fluid passes through the tubing.
tubing. Tap gently to remove air and to fill with fluid.
 Invert IV tubing when priming
with solution

12. Once IV tubing is primed, check the entire length of This step confirms that air is out of the IV tubing.
tubing to ensure no air bubbles are present.

13. Close roller clamp. Cover end with sterile dead-ender Keep the distal end sterile prior to connecting IV to
or sterile protective cover. Hang tubing on IV pole to patient.
prevent from touching the ground.

14. Label tubing and IV bag with date, time, and initials. Label IV solution bag as per agency policy. Do not write
directly on the IV bag.

Labelled IV bag

15. Perform hand hygiene. This reduces the transmission of microorganisms.

Hand hygiene with ABHR

Data source: Fulcher & Frazier, 2007; Perry et al., 2014.

VIDEO 8.1

Watch the video Priming IV Lines by Renée Anderson & Wendy McKenzie, Thompson Rivers University.
IV solutions are considered sterile for 24 hours. An IV solution may be changed if the
physician’s order changes, if an IV solution infusing at TKVO is expired after 24
hours, or if the IV solution becomes contaminated. To change an IV solution bag,
follow Checklist 67.
CHECKLIST 67: CHANGING AN IV SOLUTION BAG

Disclaimer: Always review and follow your hospital policy regarding this specific skill.

STEPS  ADDITIONAL INFORMATION

1. Verify and select correct IV solution bag and compare IV solutions are considered a medication and must be
to the medication administration record (MAR) or checked using the SEVEN RIGHTS x 3, as per agency
physician orders. policy.

Sterile IV solution

2. Introduce yourself, identify patient, and explain Proper identification of a patient prevents medication
procedure. errors. Explaining the procedure provides an opportunity
for the patient to ask questions.

3. Perform hand hygiene. Hand hygiene prevents the transmission of

microorganisms.

4. Remove outer plastic packaging and squeeze bag to This ensures the correct IV solution is used.
test for leaks and expiration date. Assess for precipitates
or cloudiness. Hang new IV solution on IV pole.

Remove IV solution from packaging

5. Pause the EID or close the roller clamp on a gravity Stops the infusion to prevent air bubbles from forming in
infusion set. IV tubing.

6. Remove protective plastic cover from the new IV Keep IV tubing port sterile at all times. If IV tubing port
solution tubing port. becomes contaminated, dispose of it immediately and
replace.

7. Remove the old IV solution bag from the IV pole. Removing old solution from IV pole prevents spilling of
Turn IV bag upside down, grasping the tubing port. solution.

With a twisting motion, carefully remove IV tubing spike Ensure IV tubing spike remains sterile during removal to
from old IV solution bag. avoid contaminating IV tubing.

8. Using a gentle twisting motion, firmly insert the spike This ensures that a sterile technique is used during the
into the new IV bag. process.
 Spike new IV solution

9. Fill the drip chamber by compressing it between your Fluid in the drip chamber helps prevent air from being
thumb and forefinger. Ensure the drip chamber is one- introduced into IV tubing.
third to one-half full. Check IV tubing for air bubbles.

Fill drip chamber

IV tubing label

10. Open clamp and regulate IV infusion rate via gravity, Once rate is set, count the drops per minute on the
or press start on the EID as per physician orders. gravity set or ensure the EID is running at the correct rate
as per physician orders.

Regulate IV tubing with a

roller clamp

11. Label new IV solution bag as per agency policy. Labelling IV solutions provides easy viewing of infusing
Time tape gravity IV solutions as per agency policy solutions and additives.
 Labelled IV bag

12. Dispose of used supplies, perform hand hygiene, and Document time, date, type of solution, rate, and total
document IV solution bag change according to agency volume.
policy.

 Intravenous solution and IV tubing should be changed if:

 IV tubing is disconnected or becomes contaminated by touching a non-sterile surface

 Less than 100 ml is left in the IV solution bag
 Cloudiness or precipitate is found in the IV solution
 Equipment (date and time) is outdated
 IV solution is outdated (24 hours since opened)

Primary IV tubing is used to infuse continuous or intermittent fluids or medication. It

consists of the following parts:

 Backcheck valve: Prevents fluid or medication from travelling up the IV

 Access ports: Used to infuse secondary medications and give IV push medications
 Roller clamp: Used to regulate the speed of, or to stop or start, a gravity infusion
 Secondary IV tubing: Shorter in length than primary tubing, with no access ports or backcheck valve;
when connected to a primary line via an access port, used to infuse intermittent medications or fluids.
A secondary tubing administration set is used for secondary IV medication.
What are the 5 most common IV solutions?
 Here is a brief description of each:

1. 0.9% Normal Saline (NS, 0.9NaCl, or NSS) ...

2. Lactated Ringers (LR, Ringers Lactate, or RL) ...
3. Dextrose 5% in Water (D5 or D5W, an intravenous sugar solution) ...

What are the 3 main types of IV fluids?

There are three types of IV fluids:

Isotonic.
Isotonic solutions are IV fluids that have a similar concentration of dissolved particles as blood. An example of an
isotonic IV solution is 0.9% Normal Saline (0.9% NaCl).

Hypotonic.
Hypotonic IV fluids are designed to bring fluid from the bloodstream into the cells and tissues to help in body waste
excretion. In other words, they are commonly used to help patients avoid dehydration.

Hypertonic.
Hypertonic solutions have a higher concentration of dissolved particles than blood. An example of hypertonic IV
solution is 3% Normal Saline (3% NaCl).