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INTRAVENOUS THERAPY

Insertion of a needle or catheter / cannula into a vein based on a physician·s written prescription. The needle or catheter / cannula is attached to a sterile tubing and fluid container to provide medicine and fluid. PURPOSE: To maintain / correct dehydration in clients unable to tolerate sufficient volume of oral fluids / medicine. Parenteral nutrition  Administer drugs Transfusion of blood or blood components To provide a lifeline for rapidly needed medications or blood

0.) Isotonic Solution ² have roughly the same amount of dissolved particles as plasma and good choice for fluid replacement (NSS. (D5LR. solution becomes hypotonic.) Hypotonic Solutions ² have less dissolved particles than plasma.)Hypertonic Solutions ² have more dissolved particles then plasma and have initial effect of drawing water from intracellular spaces to intravascular space but once sugar content is metabolized.45%NaCl) c.COMMON TYPES OF IV SOLUTIONS a. LR) . D10. good route for medications but not good choice for fluid replacers because it leaves the vascular space (D5W) b.

SITES FOR IVF INFUSION Dorsal metacarpal veins Cephalic vein Basilic vein Radial vein Medial antebrachial vein Accessory cephalic vein Select a site distal to the heart and move proximally as necessary .

Container of sterile intravenous solution IV solutions comes in different sizes a) 150 ml b) 250 ml c) 500 ml d) 1000ml 2. Solution should be sterile and in proper condition a) Check expiration date b) There should be no particulate matter in the solution c) Check for any leaks indicative of contamination .CONSIDERATION IN THE SELECTION OF THE SITE Select a vein large enough to accommodate the needle that will be used Type of solution Client·s age Equipments 1.

Protective cap ² maintains the sterility of the end of the tubing so that it can be attached to a sterile needle inserted in the client·s vein f. Tubing e.15 or 20 drops per ml of solution) 2) Microdrip or microset (60 drops per ml of solution) a. Insertion spike ² inserted into the solution container and kept sterile b. Drip chamber ² to prevent air from entering the line c. Administration set 1) Macrodrip or macroset (10. Roller or screw clamp ² to control the rate of flow of the solution d. Needle adapter 3) Volume-control set or solute set .2.

Intravenous needle or catheter a. tourniquet. Butterfly or win-tipped needles (25 to 17 gauge) b. antiseptic solution. Catheter or angiocatheter The larger the gauge number. splint. the smaller the diameter of the shaft 5. local anesthetic. plaster. the greater the force of the solution as it enters the client and the faster the rate of flow. 4. IV poles The higher the solution container is suspended. IV Tray Contains sterile swabs. sterile 2X2 gauze squares .3.

The initiation of IV therapy is upon the written prescription of a licensed physician which is checked for the: Type of solution Flow rate Amount of solution Dose and frequency of medicine to be incorporated .

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Place IV label on IVF bottle. plaster. 4. 3. tourniquet and splint. Wash hands before and after setting up IV. cotton balls with alcohol. 5. Explain procedure to client and assess client's vein.Setting up: 1. Maintain sterility of IV solution container while opening port . 7. Check doctor's order and make IV label 2. 6. IV stand or IV hook. Check the solution and set for sterility. IV tray. Prepare necessary set.

Disinfect rubber port with cotton ball dipped in alcohol 9.Spike the container without contaminating port. 11.Prime the tubing while maintaining sterility of the end of tubing (use kidney basin) 14.Remove all air from tubing (get ready for IV insertion) .Open administration set aseptically (Venoset) and close the roller clamp 10. 12.Hang the IV bottle using the IV stand or hook.Fill drip chamber to at least half 13.8.

IV card.Changing an IV Infusion 1. Countercheck IV label. duration of infusion. amount. Calibrate IV bottle according to duration of infusion 5. kidney basin or tray) 3. Bring necessary materials at the bedside and explain procedure to the client 6. additives (if any). bottle number or bottle sequence. disinfectant. 2. type. Wash hands before and after procedure . IV label. Check doctor's order in the Doctor's Order Sheet and IV sheet. Prepare necessary materials (IV solution. Check sterility of IV solution 4.A.

Spike the container without contaminating port 10. Disinfect rubber port of new IV solution prior to inserting spike of the previous administration set 8.Regulate the flow rate based on duration of infusion. Close roller clamp or kink tubing of administration set when changing IV solution bottle 9.7. Remove air bubbles (if any) 11.Document in client's IV sheet and Kardex .

Wet all adhesive tapes with alcohol before removing them. Get another cotton ball with alcohol. status of insertion site. Prepare necessary materials (IV tray with cotton balls with alcohol. Document time of discontinuance. Explain procedure to client 5.B. . Clamp tubing 7. Wash hands before and after procedure 4. 6. Remove needle or IV cannula quickly 8. Place cotton ball with pressure and tape 9. Verify written doctor's order to discontinue IV 2. DISCONTINUING AN IV INFUSION 1. plaster) 3.

Calculating the Infusion Rate Total number of ml to be given = ml to be given / hour Hours in which the solution is to be infused Volume X drop factor = drops per min. #of hours X 60 min. .

Explain procedure (medication and action) to reassure patient and significant others and check patency and IV site. 2. syringes needed. observe hospital policy on drug administration. . 4. 3. right drug to be incorporated either in vial or ampule.D.INCORPORATION OF DRUG INTO IVF BOTTLE / BAG 1. Do hand hygiene before and after the procedure. Verify for skin test of drug of IV incorporation (if skin testing is necessary) 5. Prepare necessary material needed for the procedure such as: injection tray. 6. prescription. Observe 10 R·s when preparing and administering medication. Verify the written medication card against the M.

8. Document in the patient·s chart 12. Swirl the IV bottle to mix the drug with the IVF and regulate the flow rate accordingly. (all these should be done aseptically) 9. 10.7. maintain sterility and incorporate prepared drug into the airway aseptically. Remove the cover of the administration set. Disinfect injection port of the vial & the ampule before breaking then aspirate the right dose aseptically. monitor VS. Observe for 5-10 minutes for any drug interaction while reassuring the patient.Discard the sharp and other wastes according to Health Care Waste Management (DOH / DENR) . Note: if the administration set has no airway. pull out the set and incorporate the prepared drug and re-spike the IV set to the bottle then place the label. 11.

redness. check patency and other signs of swelling.IV PUSH THROUGH THE IV PORT 1. Observe 10 R·s when preparing and administering medication. right diluent needed. phlebitits. drug IV fluid incompatibility. Explain procedure to reassure patient and significant others (the name of the medicine and action / interaction of medication) before administration. observe hospital policy on drug administration. prescription. syringes and needles. 3. Verify the written medication card against the M. etc. drug-drug. IV injection tray. 2. (use gloves especially for chemotherapeutic & other vesicant drugs) 5. Prepare the necessary materials for the procedure such as: right drug. . etc« do not give the drug 6. check for skin test result of drug for IV push. 4. dosage (computation) 7.D. alcohol. Do hand hygiene before and after the procedure.

11. disinfect the Yinjection port of the IV administration set / catheter IV port. (if needed) 14. Aspirate the right drug dose. 13. Close the roller clamp of the IV tubing from the bottle and push IV drug aseptically and slowly or according to the manufacturer·s recommendation.8. Using same syringe aspirate 1-2cc of IVF to flush the medicine given. . Regulate rate of IV fluid infusion as prescribed. vial or ampule as appropriate 9. 15. Aspirate right amount of diluent for the drug (if drug needs to be diluted) 10. Disinfect the injection port of the diluent. Reassure patient and observe for signs and symptoms of adverse drug reaction. 12. Discard sharps and other waste according to Health Care Waste Management.

right diluent needed IV injection tray.DRUG INCORPORATION INTO VOLUMETRIC CHAMBER 1. follow hospital policy on drug administration. 5. Prepare the necessary materials for the procedure such as right drug and dose. Verify the written medication card against the M. Do hand hygiene before and after procedure. Explain procedure to patient (medicine and action) and check IV site. Observe 10 R·s when preparing and administering medication. 2. prescription. 4. Verify for skin test of the drug before IV incorporation. 3. .D. Syringes and needles.

10. check for drug-drug incompatibility and if the ongoing IV fluid in the Volumetic Chamber is to be consumed in 6-8 hours. 8. 7.6. mix gently. Add desired IVF diluent into Volumetric Chamber by opening the sliding clamp from the bottle then close the clamp. Open the clamp of the airway at the volumetric chamber. Aspirate prepared right drug with correct dose. Check the present IV fluid label. level and the incorporated medicine in the Volumetric Chamber or IV bottle if with incorporated medicine. Disinfect rubber injection port of the volumetric chamber and incorporate the drug. 9. request a prescription for IVF to be used solely for drug administration and keep whole set sterile for succeeding doses. .

Document in patient·s chart IVF sheet and Kardex (of changes in IV rate / time due) . 15.. C add IVF & regulate flow rate of main IVF as prescribed. 13.Document in patient·s chart the drug administered & patient condition. 14.11. clamp airway of V.Place IV label on volumetric chamber indicating drug incorporated and flow rate.Discard waste according to Health Care Waste Management (DOH / DENR).Reassure / monitor patient when incorporated medicine is consumed. 16.Regulate flow rate of IVF infusion accordingly. 12.

Explain procedure to the patient (name of medicine and action) before administration. 2. 3. . Do hand hygiene before and after the procedure (use gloves especially in chemo drugs) 5. 4. Observe 10 R·s when preparing and administering medication. Heparin solution.5 cc syringes 3 pieces tuberculin / TB syringe 1pc. 2. Gather equipment to include / but not limited to IV tray. Check medication card against the written doctor·s prescription. normal saline diluent or isotonic solution.PUSH THROUGH HEPARIN LOCK DEVICE 1.

B.. .g. rotate the stop cock so that the line going to the patient is closed (this will prevent backflow of blood) 10. 8. and draw it up into a syringe.1cc Heparin plus .6.Fill in tuberculin syringe with Heparin Solution.Remove the cover of the injection port aseptically and keep the sterility of the cover.If using Hep.Prepare medication to be administered e.Fill the 2. Loc device with 3 way stop cock with luer-lock. 9.5cc syringe with Isotonic solution or Normal Saline 1cc each. antibiotic. Heparin solution is usually prepared with 0. 7. N.9cc Normal Saline or Isotonic solution.

Close the IV line & remove saline syringe and insert medication syringe into port. and inject NSS or Isotonic Solution to flush the Heparin solution. 14.Observe patient for any adverse reactions & do nursing intervention accordingly. . timing the flow rate according to doctor·s prescription of drug manufacturer·s instructions.Close the IV line and remove medication syringe.11. 13.Check the patency.Open the IV line & inject medication into the vein. open the IV line. 15. 12.

Close the IV line. . 17. Insert the saline syringe. Note: Normal saline can take the place of Heparin. 20. 18. remove syringe and return the cover of the injection port aseptically. (DOH / DENR). Document in the patients chat and Kardex. Close & remove saline syringe. 19. Studies have shown the efficacy of NSS. Heparin solution can be used if normal saline or isotonic solution is not available. open the line & flush Catheter tubing / IV cannula to flush the line.Discard waste according to Health Care Waste Management.16.