MUHAIDIR UY ALAWI II LEVEL II Clinical Instructor

IV Reinforcement

CHANGING THE IV TUBING AND SOLUTION

DISCONTINUING INTRAVENOUS INFUSION

COMPETENCIES

 Verify written prescription and make IV label.

Observe 10 rights of the client.

 Explain the procedure to the patient and significant

others and secure consent if necessary. Assess patients vein, choose appropriate site, location, size/condition of the vein. Wash hands before and after the procedure.

 Prepare necessary materials for the procedure: (IV tray

with solution and administration set, IV cannula, forceps soaked in antiseptic solution, alcohol swabs or cotton ball soaked in alcohol with cover, plaster, gloves, splint and IV hook, sterile 2x2 gauze or transparent dressing). Check the sterility and integrity of the IV infusion set and other devices, if moisture is present or the entire package in damage, discard immediately. Place IV label on IVF bottle duly signed by the RN who prepared it ( patient name, room, type of solution time and date and infusion rate)

 Open IV administration set aseptically following the

infection measures. Open the IV administration set aseptically and closes the roller clamp and spikes the infusate container aseptically. Fill the drip chamber to at least half and prime it with fluid aseptically. Expel air bubbles if any and put back the cover to the distal end of the IV set.

 Legal responsibilities

Verify doctors prescription in doctors order sheet

counter check IV label, IV card, infusate sequence, type, amount, additives (if any) and duration of infusion. Observe the 10 patients rights.

 Explain the procedure to the patient, assess IV site for

redness, pain, swelling etc. Prepare necessary materials and place on IV tray. Check sterility and integrity of IV solution.

 Perform hand hygiene Carefully remove protective cover from new solution

container and expose bag/bottle site. Close clamp tubing Lift container off IV pole off IV pole and invert it quickly remove the spike from the empty/old IV container being careful not to touch the tip of the spike to avoid contamination. Steady the new IV container and insert the spike carefully. Hang on IV pole. Reopen clamp, check the drip chamber of the administration set on tubing and adjust now. Place IV label on the IV bottle filling up all the entries needed.

 Record on the IVF sheet, document on nurses notes.

Discard used equipments properly according

 Verify doctors prescription in doctors order sheet

counter check IV label, iv card, infusate sequence, type, amount additives (if any) and duration of the infusion. Observe the 10 patients rights. Health Education (HE) Explain the procedure to the patient, assess IV site for redness, pain, swelling etc.

 Prepare necessary materials and place on IV tray.

Check sterility and integrity of IV set.

Carefully remove protective cover from new solution

container and expose bag entry site. Open the new IV set and close the clamp on the new tubing. Remove the procedure the protective covering from the infusion spike using sterile technique; insert the spike into the entry port of the new container. Hang IV container on pole and squeeze.

 Remove cap at end of tubing, release clamp allow fluid

to move through the tubing until air bubbles have disappeared. Close clamp and recap end of tubing. Loosen tape at IV insertion site. Don clean gloves, carefully remove dressing and tape. Place sterile gauze square under catheter hub. Place new IV tubing close to IV site and slightly loosen protective cap.

 Close clamp of old IV tubing. Steady the needle hub

with non dominant hand and remove tubing with dominant hand using a twisting motion. Set old tubing aside while maintaining sterility. Carefully remove the covering or cap from the new administration set and insert sterile end of tubing into catheter hub. Twist to secure it: tape connection if necessary. Remove gauze square from under needle hub. Remove soiled gloves. Open flow clamp on the IV tubing and the flow. Reapply sterile dressing to site or tape catheter to patient according to agency protocol. Regulate IV flow according to physicians order.

 Assess the need for dressing change.

 Gather needed equipment and bring to bed side

 Record patients response to IV infusion

 Perform hand hygiene Carefully remove old dressing but leave tape that anchors

the needle or catheter in place, discard properly. Inspect IV site for the presence of inflammation or infiltration, discontinue and relocate IV if noted Loosen and gently remove tape, being careful to steady catheter with one hand. Use adhesive remover if necessary. Cleanse the entry site with an alcohol swab using a circular motion, moving from the center outward. Allow to dry. Follow up with Povidone-iodine swab using the same process

 Apply sterile gauze or transparent polyurethane

dressing over entry site, perform hand hygiene. Reapply tape strip to needle or catheter entry site. Secure IV tubing with additional tape if necessary. Label IV dressing with date, time of change and your initials, check IV flow rate is accurate and your initials, check the IV flow rate is accurate and system is patent.

 Discard all materials used according to hospital waste

management protocol.

 Document all that has been done on the patients chart

 Observe 10 rights of the client

Assess and inform the patient of the discontinuation

of IV infusion.

 Prepare the necessary materials: IV tray or injection

tray with sterile water, dry cotton balls, plaster, pick up forceps in aseptic solution, kidney basin and band aid.

 Wash hands before and after the procedure.

Close roller clamp of the IV administration set.

Moisten adhesive tapes around the IV catheter with

cotton ball with sterile water: remove plaster gently. Use pick up forceps to get dry cotton ball. Without applying pressure, remove needle or IV catheter then immediately apply pressure over venipuncture site. Inspect catheter for completeness. Place dressing over the venipuncture site. Discard all waste materials including the IV cannula according to health waste management (DOH/DENR)

 Reassure patient. Instruct the patient to restrict

strenuous activities for about 10 minutes and to leave the site dressing in place for about 1 hour or as necessary. Document time and date of the discontinuance: reasons for the discontinuing therapy: assessment of venipuncture site before and after the venous access device is removed: complications, patient reactions and nursing intervention and endorse accordingly.