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Module Title: Peripheral IV FluidsPart A: Preparing for Administration of IV Fluids
Peripheral IV FluidsPreparing for Administration of IV Fluids:• **IV- Intravenous- refers to instilling into the vein• **Peripheral—located at or occurring away from
the center; usually refers to the arms and legs
• The NA II is NOT permitted to connect any tubing or IV Fluids directly to the patient.
• If the IV needs to be disconnected for patient activity, then the licensed nurse would do this and then reconnect the IV to the patient
• This will be a non-direct patient care activity which is done in preparation for the licensed nurse to initiate or continue the administration of IV fluids.
Peripheral IV FluidsTwo Main Purposes for an IV:administer fluids or to administer
medicationsA physician’s order is requiredIn North Carolina, only RN’s and LPN’s are
permitted to perform these procedures in MOST cases
Peripheral IV FluidsClasses of IV Fluids:Nutrient Solutions-- provide energy and fluid
replacement
D5W-Dextrose 5% in water Dextrose 5% in .45% sodium Chloride-dextrose in half-strength
saline (Carbohydrates in the form of sugar)
Peripheral IV FluidsClasses of IV Fluids:Electrolyte Solutions---Maintain the body’s fluid
balance and body functions and Correct electrolyte imbalances
.99% sodium chloride-Normal Saline .45% sodium chloride with 20meq KCL (potassium
chloride) Lactated Ringers Ringer’s Solution (contains mineral, i.e. sodium,
chloride, potassium) **electrolytes are a solution that conducts
electricity such as sodium, potassium and chloride. These elements must be in balance for the body to function properly.
Peripheral FluidsClasses of IV Solution:Blood/Blood Volume Expanders—increase
blood volume, treat hemorrhage (severs blood loss), plasma loss (severe burns)
Whole blood Packed red blood cells Dextran Hespan Albumin Plasma
Peripheral IV FluidsClasses of IV solutions:Total Parenteral Nutrition (TPN)—For two weeks
or more in patients with large caloric and nutrient needs, short bowel syndrome, GI fistulas, severe burns, and/or inflammatory disease
Dextrose 10/50% with electrolytes, minerals, and
lipids(fats) per MD order
**parenteral—denoting any medication route other than the alimentary canal, such as IV, SubQ, IM or mucosal
Peripheral IV FluidsInformation needed as part of
preparing the IVF (The Six Rights):
Right Patient-ID the patient by checking the arm band and
if applicable, asking the patient to state their name
If no ID band is noted, report this to the nurse for immediate replacement
Peripheral IV FluidsRight Solution: Compare the label to the MAR or orderCheck the IV three timesMake sure you have the correct preparationAlways check the expiration dateAlways check for allergies, especially for the
prep solution, dressing and tape. Make sure the patient is not allergic to
alcohol, iodine, tape or transparent dressings
Peripheral IV FluidsRight Strength:Always ask an RN to check your calculations
of drip ratesSome solutions are available in different
concentrationsIf you have any doubts about whether the
solution you are using is correct, check with the RN
Peripheral IV FluidsRight Route:Make sure the preparation you are using is
labeled for IV useMake sure all equipment is sterile and that
flawless sterile technique is maintained
Peripheral IV FluidsRight Time:Check the order for correct time
Peripheral IV FluidsRight Documentation:Never chart IV’s in advanceInitial the IV record immediately after starting the IVDocument other care (changing dressings or tubing)
on the correct formIf the patient is not on intake and output (I&O), place
an I&O worksheet at the beside and inform the RN so he or she can initiate I&O monitoring
Document vital signs, such as pulse or blood pressure and body weight, and other monitoring as warranted by patient condition, physician’s orders, and facility policy
Peripheral IV FluidsDeliver y Types: #1 The Basic Administration Set:Flexible, plastic tubing through which the
solution flows is attached to the IV solution on one end and the patient on the other
Designs will vary slightly with the manufacturer
A manual (clamp) or electronic device (IV pump) is used to control the flow of solution
Peripheral IV FluidsParts of the Basic Administration Set:Piercing pin- pierces the solution bag or bottle.
This pin is sterile and is covered with a capDrop Orifice- entrance to the drip chamber and
controls the size of the drops of fluidDrip Chamber-semi-rigid container that is
filled halfway with fluid. Allows easy visualization of the flow rate.
Y-sites-connection for administering medication into the IV tubing
Peripheral IV FluidsBasic Administration Set Parts:Flow Control Clamp-is a roller clamp used to
regulate the speed or rate of the fluid flowSlide Clamp- plastic clamp used to stop or
regulate the flow of fluid and may be used to stop the fluid quickly if needed.
Luer slips- connect the tubing to the needle or IV catheter. Provides a means of locking the tubing and needle or catheter together, making them more difficult to separate
Peripheral IV Fluid#2 Secondary Set or Piggyback Set Used to run medication into an existing IV
site Can run congruently with the IV fluid or the
initial IV Fluid may be stopped while the medication is run in
The Secondary Set will be connected to the Basic Administration set at a Y-site or the IV pump will have a special connection for this set
Peripheral IV Fluid#3 Heparin Locks/Hep Locks/Saline Locks:May be used for patients who are receiving
intermittent IV medication but not IV FluidsOnce the IV catheter is inserted, the hep lock is
attached to the catheter by the Luer lock. The Hep lock is a short piece of tubing with a
luer slip at one end and an injectable cap at the other
When using a Hep lock, a liquid solution such as heparin, an anticoagulant or normal saline is injected into the lock to maintain patency when not being used.
Peripheral IV FluidMacrodrip and Microdrip Versions of IV
sets:Macrodrip most common for adultsDelivers fluid in a larger volume typically 10-
20 drops per milliliter of fluid
Microdrip most common for pediatrics and may be used for certain adults
Delivers fluid in a smaller drop, usually 60 drops per milliliter of fluid
Peripheral IV FluidsAdministering Fluids:By Controller or PumpAttached to the IV Pole or Standard and run
on electricityThere are many manufacturers of IV Pumps
and operating instructions will vary
Peripheral IV FluidsVolumetric Intravenous Pumps- regulate the
flow of fluids electronicallyEnsure accurate flow of IV Fluids and drugsCan measure flow of fluids in milliliters per
hour of solution infusedIV Controllers – regulate gravity flow of IV
fluids by counting drops of solutionControllers count drops and because the
drops are not always exactly identical, they are not as accurate as using a pump
Peripheral IV FluidWhen preparing IV Fluid for the Nurse:Always observe Strict Aseptic Technique and Standard
Precautions to include good hand washingTo infuse properly, the solution must hang at least 30-36
inches above the level of the heart and is hung on an IV Pole or IV Standard
All IV Tubing should be primed or flushed to fill the tubing with solution and remove any air bubbles to reduce the risk of air entering the vein which could lead to death
Never write directly onto the solution bag as the ink may bleed through and contaminate the solution
Labels are provided for documentation of: patient’s name, room number, date and time, flow rate, duration of IV and your name or initials (per facility policy)
Never place the label over any IV solution information on the bag
Part B: IV Fluid Monitoring Flow Rate
Peripheral FluidsMonitoring IV’s :You will be responsible for periodically monitoring
the IV flow rate and checking the infusion siteThis may mean looking at a digital display or
counting the drip rateThe nurse will inform you of the correct flow rate
and/or the designated drip rate.You will also be responsible for monitoring the
amount of fluid remaining in the solution bag/bottleYou may be required to monitor the infusion site for
signs of infection, infiltration or other complication
Peripheral IV FluidCauses of an Obstructed IV:Kinks or bends (occlusions) in the tubing that
prevent the flow of solutionPosition of the infusion site causing the IV
catheter to be kinked or bent inside the vein. Some sites such as the wrist or elbow are said to be “positional” sites and usually require that body part to be immobilized with an arm board to prevent further movement
Position of the body part or patient. If the patient is laying on the arm which has the IV, that could cause the tubing to kink or the catheter to be kinked
Peripheral IV FluidObstructed IV’s continued:
Bubbles are air in the tubing (air embolus) which if allowed to enter the patient’s vein could lead to death
Most IV Pumps will alarm if a large bubble of air is detected in the tubing and will stop the flow of IV solution until corrected
Correction of this error will usually require a nurse
Peripheral FluidsEquipment Function Checks:To ensure correct flow rate or to ensure the
ability to change a flow rate if necessaryDrip Chamber—semi-rigid container that is
filled halfway with fluid. This chamber is initially squeezed to fill with fluid
Problems will occur with the flow rate if :The chamber becomes too full of fluidThe chamber is not filled at least half full
Peripheral IV FluidEquipment Check:Clamps– Both the Flow Control Clamp and the
Slide Clamp can be used to change or stop the rate of flow
Problems—if the solution is not flowing, check both clamps to ensure that they are both open
The IV Pump usually will alarm if the solution is not flowing
Peripheral IV FluidEquipment Check:IV Pump must be attached to an IV Pole or
StandardMust be plugged inPlace the pole on the same side of the bed as the
IVTubing should never be draped across the patient
or the bedFollow manufacturer’s instructions for tubing
placement or threading the tubing through the cassette
Peripheral IV FluidObserving the patient receiving IV
Fluid:Position of Extremity:Hands, wrists, and arms should be
maintained at an elevated position while IV is infusing to prevent occlusions
Extremities should be free and clear of the body in all positions (lateral, fowlers, and supine) to prevent kinking of tubing
Peripheral IV FluidVolume in Container:To infuse properly, the solution must hang at
least 30 to 36 inches over the level of the heart
The height of the IV pole will affect the rate of flow
Never allow the solution to run empty as this could cause an air embolus
Peripheral IV FluidPatient Complaints:Infiltration-occurs when the catheter or needle comes
out of the vein and fluid flows into the surrounding tissue;
can also cause the flow rate to slow or stop; S/S are swelling, cool skin at the site, a white or pale
skin color; wet or damp site dressing; rigid, taut skin at the site
Lowering the IV bag below the heart should produce a blood return if it does not, then it is infiltrated
TX is to stop the IV and apply a warm moist compress to the area to relieve pain and promote absorption
Peripheral IV FluidHematoma-can occur during venipuncture; it looks
like a bruise that fills rapidly with blood; TX is to elevate the extremity and apply firm
pressure to the area.Phlebitis-irritation of the veinCaused by IV device or from medication or due to
infectionS/S are redness, warmth, swelling and pain; possibly
a red streak extending from the site up the armTX is stop the IV, elevate the extremity, apply warm
moist compresses to the area
Peripheral IV FluidAir Embolus--air enters the vein and moves
freely throughout the bodyS/S are shortness of breath, cyanosis, weak,
rapid pulse, decreased blood pressure, loss of consciousness and cardiac arrest
TX--Stay in the room, call the nurse, turn the patient onto their left side
The nurse will administer O2 and contact the MD
Peripheral IV FluidCatheter Breakage or Embolus-loss of part or all of
the catheter into the circulatory system causes a catheter embolus
S/S are respiratory distress, chest pain, cyanosis, rapid pulse, and decreased blood pressure
May be difficult to differentiate between air embolus
TX Stay with the patient, call for the nurse; they may instruct you to apply a tourniquet above the insertion site; MD will be notified
X-ray will be used to determine placement and surgery will be used to remove the catheter
Peripheral IV FluidInfection-caused by contamination somewhere in
the IV system or by improper insertion techniqueS/S of a local infection are redness, swelling, heat
and pain at the insertion site. Also, foul smelling drainage may be noted.
S/S of a systemic infection are fever, chills, headache, and rapid respirations. The blood pressure may drop
TX Stay with the patient, call the nurse.You may be instructed to remove the catheter in
which case save it to be sent to the lab for testing
Peripheral IV FluidsFluid Overload- occurs when fluids infuse too
rapidlyMonitor the flow rate frequently and ensure
that fluid is flowing at the proper rateS/S are rapid respirations, shortness of
breath, rapid pulse, increased blood pressure, distended neck veins, then turning towards respiratory distress, and cardiac arrest
TX Stay with the patient, call the nurse, position the bed in the Fowler’s position
Peripheral IV FluidSpecial Considerations for children and the
elderlyPatients of any age may fear being stuck with a
needleBe sure to explain the procedure before beginningBoth geriatrics and pediatrics have small fragile veins
that require a smaller gauged catheterGeriatrics also have limited veins and paper thin skin
always tape with hypoallergenic tapePediatrics require the site to be taped very securely
so as not to get dislodged when playingAssistance may be required to hold a confused patient
or a frightened child
Part C:IV Fluids Site Care and Patient Activities
Peripheral IV FluidCommon IV Sites:Hands and forearms are the most commonly used
sites in adultsDorsal hand, dorsal foot and scalp veins are the
most common sites for pediatricsAvoid the antecubital (inner elbow) space
whenever possibleUse of lower extremities increases the risk of
thrombophlebitisAvoid areas of swelling, redness, sores, rash,
shunts, grafts, the arm on the side of a mastectomy or burn, cast or a severely scarred area
Peripheral IV FluidNormal IV Site:Dry, warm= clean, no swelling, no redness,
no odor, no drainageCatheter is lying flat, properly secured and
infusingVisualization of the site is to your advantage
and covering the site with dressings or roller gauze should be avoided if possible
Peripheral IV FluidsAbnormal Site Appearance: Dressing is wet or damp Moist blood is noted under the dressing The catheter is out of the skin Site is red, warm or exceptionally cool to touch,
swollen, or draining Be sure to check the underside of the arm for
edema, since infiltration allows the IV fluid to infuse into the soft tissue which could pool on the underside of the arm and not show at the site
Complaints of pain or detection of fever
Peripheral IV FluidsMost health care facilities have policies and
procedures for dressing the IV siteTechniques vary but will always be done with
Sterile TechniqueSome facilities cover the insertion site with a
transparent film dressingSome facilities tape the hub and tubing to the skinRoller gauze should be avoided but if used should
allow vision of the insertion site at all times. Frequency of the dressing change varies with
facility policy
Part D:Discontinuing Peripheral Intravenous Infusions
Peripheral IV FluidsDiscontinuing an IV:An IV is usually D/C’ d if complications
develop such as infiltration, phlebitis, or infection
If the MD orders to stop the fluids and D/C the IV
If the site is due to be changed