Changing the IV Solution - Overview of the Skill

Overview: An IV solution is a method of replacing fluids or correcting an electrolyte imbalance.

Clients who are acutely ill, are NPO after surgery, or have severe burns are
examples of those who require IV therapy. Other clients require an IV solution
infused slowly to keep the vein open (KVO) so that an IV medication can be
administered every 4, 6, or 8 hours or venous access can be maintained.

The type of solution in an IV bag is ordered by a health care provider according to

the client's needs. Changes in solution are ordered when the client's condition
changes. To maintain sterility of the IV solution, the bag of solution is changed at
least every 24 hours. Some solutions need to be changed more frequently because
of the instability of some of the additives.
Assessment: 1. Check the health care provider's order for the IV to be infused, rate of
flow, and any medications to be given to ensure accurate
administration.
2. Review information regarding the solution and nursing implications in
order to administer the solution safely.
3. Check all additives in the solution and other medications so there
will be no incompatibilities within the solution.
4. Assess the patency of the IV to ensure that the solution will enter
the vein and not the surrounding tissue.
5. Assess the skin at the IV site so the solution will not be
administered into an inflamed or edematous site, which could
cause injury to the tissue.
6. Assess the client's understanding of the purpose of the IV infusion so
client teaching can be tailored to his or her needs.

Diagnosis:  Impaired Skin Integrity

 Risk for Infection
 Deficient Knowledge, related to the IV infusion

Planning

Planning Needs: Equipment Needed (see Figure 8-7-1):

 Disposable gloves
 IV solution in a bag
 Additives as ordered
 IV tubing
 Alcohol swab (if needed)

Expected 1. The ordered solution will be infused into the client's veins without
Outcomes: complications.
2. The IV catheter will remain patent.
3. The client will be able to discuss the purpose of the IV therapy.
4. The solution infused will not harm the client because of additive
incompatibilities or additive decomposition.

Client Education 1. Teach the client the rationale for the IV therapy and need to
Needed: change the solution.
2. Teach the client the type of solution and additives he or she is
receiving.
3. Instruct the client to report any leakage of the bag of IV solution.
4. Instruct the client to report if the solution is at a low level.

Changing the IV Solution - Implementation—Action/Rationale

Implementation ACTION RATIONALE

Action/Rationale 1. Check health care provider's order for 1. Ensures accurate administration of the
the IV solution. solution.
2. Wash hands and put on clean gloves. 2. Reduces the number of microorganisms.
 3. Check client's identification bracelet. 3. Ensures IV solution is given to the
correct client.
4. Prepare new bag with additives as 4. Laboratory tests may reveal a need for
ordered by health care provider. potassium, insulin, or magnesium.

 Plan for new bag to be hung at  Reduces clot formation in vein

least 1 hour before it is needed.
 Change solution when an
hour's infusion of solution
remains in the IV bag
(see Figure 8-7-2).
caused by empty IV bag.
 Prevents air from entering tubing
and vein from clotting from lack of
flow of fluid.

5. Be sure drip chamber is at least half
full (see Figure 8-7-3).
6. Change IV solution:
 Move roller clamp to stop flow
of fluid.
 Remove old IV bag from IV pole
and hang new bag.
 Spike new bag with tubing
(see Figure 8-7-4).
 Re-establish prescribed flow
rate.
5. Prevents entry of air into IV tubing while
bag is being changed.
6.  Prevents fluid in drip chamber
from emptying while changing
solutions.
 Prepares equipment.
 Maintains sterility of solution.
 Prevents clotting of vein.

7. Check for air in tubing. 7. Reduces risk of air embolus.

 If air bubbles are present, close

the roller clamp. While
stretching the tubing, flick the
tubing with the finger and watch
the bubbles rise to the drip
chamber.
 If a large amount of air is in the
tubing, insert a needle with an
empty syringe into a port below
the air (see Figure 8-7-5) and
allow the air to enter the syringe
as it flows to the client
(see Figure 8-7-6).

8. Empty remaining fluid from old IV if 8. Disposes of excess fluid. Reduces risk of
needed (see Figure 8-7-7). spilling large amounts of fluid in waste
can.
9. Remove gloves and dispose of all used 9. Reduces transmission of
materials. microorganisms.
10. Apply a label with date, time, and type 10. Allows for planning of next change.
of solution.
11. Wash hands. 11. Reduces transmission of
microorganisms.

Changing the IV Solution - Post-Skill

Evaluation:  The ordered solution infused into the client's vein without complications.
 The IV catheter remained patent.
 The client is able to discuss the purpose of the IV therapy.
 The solution infused did not harm the client because of additive incompatibilities
or additive decomposition.

Documentation: Flow Sheet

 Date and time new IV solution was started

 Initials of nurse changing solution

Intake and Output Record

 Amount of fluid infused from old solution

  Amount of new solution hung

Nurses' Notes

 Any unusual findings or client teaching

Variations

Geriatric Variations:  Pay special attention to assessing the IV insertion site. A good time for that
extra check is when you are changing the solution.

Pediatric Variations: Intravenous pump alarms can cause both anxiety and fear in
younger and older children. Changing the IV solution is a good
opportunity to teach children about the alarms. Remind children that
the alarm going off is not an emergency and does not mean that
they are in danger or becoming sicker.
Home Care Variations:  An approved receptacle needs to be provided for used IV
bags and tubing.
 The client or caregiver must be taught how to mix the IV
solution if additives are required.
 The client or caregiver must be taught how to assess the
new IV solution for breaks in sterility or contaminants.

Long-Term Care  Monitor the client's laboratory results so that adjustments to

Variations: the IV solution can be made if needed.

Changing the IV Solution - Common Errors

Possible Errors: The IV solution is not ready when the nurse needs it for a client.
Prevention: The nurse should anticipate when the new IV solution will be needed and be
sure it is ordered from the pharmacy. If this error does occur, slow the IV drip
rate so that the IV bag will not run dry, following institution protocol. Obtain
the new bag when ready and proceed to hang the IV solution.
Nursing Tips:  Anticipate the need for the next bag of IV solution to avoid the risk of
an IV clotting because of the solution running out.
 Keep in mind the client's laboratory results and need for fluid to be
sure the correct solution is given.

Critical Thinking Skill

Introduction: Most IV solutions are commercially made or prepared by the pharmacist. It is
the nurse's responsibility to hang them at the correct time.
Possible On a busy surgical unit, the nurse had several postoperative clients to admit.
Scenario: One client, a young man who did not speak English, took longer than usual to
assess and get settled. When the nurse returned to the first client, he noticed
that the IV bag was empty and the fluid was halfway down the tubing. There
was a small amount of blood at the hub of the IV needle.
Possible As the nurse spiked the new bag he had previously brought into the room
Outcome: and hung it from the IV pole, he watched for the fluid to start to flow through
the tubing. When this did not happen right away, he checked the client's IV
insertion site. As he was inspecting the IV insertion site, he did not notice that
the IV had started to infuse. The tubing was still half full of air. The nurse
glanced up in time to see the air infusing into her client. Unsure of what to do,
he removed the IV bag from the pole and held it below the level of the IV
insertion site. Unfortunately, by the time he had accomplished this, the air
had already infused into the client. Luckily there was not enough air in the
tubing to cause an air embolism and the client was fine.
Prevention: As the nurse was inspecting the IV site, he noticed the air start to infuse
through the venous catheter. He immediately pinched off the IV tubing and
closed the roller clamp to prevent any further air from infusing into the client.
He then used a syringe inserted into the lowest injection port to aspirate the
air in the tubing. The nurse was reminded to always keep the roller clamp
closed when the patency of an IV site is in question.