INTRAVENOUS THERAPY Training

Definition
Is the insertion of a needle or cannula into a vein based on a doctors written order The needle is attached to a sterile tubing and fluid container to provide fluids and medications

Objective of this training

Serve as a guide (safety & quality) Apply principles of IVT Know the ethico-legal side

Why in-house training?

We are NOT ANSAP accredited We are doing this training to
Re-fresh what you have learned in school To augment your present knowledge To reinforce your present skill To lower risk and elevate quality of our patient care

When do we start IVT

INDICATIONS
Maintain hydration Correct dehydration Provide parenteral nutrition Administration of drug Transfusion of blood/component

Contraindications to peripheral IVT

Highly irritating drugs
Concentrated NaCl KCl (Cardiac Arrest)

IV burn

Before starting IVT

Doctors order
Patients name Type of solution, amount Flow rate Name of drug, dose, frequency Drug-Incorporated? Pushed? Procedures that will be done ie for VP shunting? Avoid head!

Before starting IVT

Assess Patient
Status of the patient, stroke patient? Diagnosis, stable? Shock? Age, very old and very young Dominant arm-left handed? Condition of the skin Size of the cannula Duration of therapy

Before Starting IVT

Check what you will use
Check for expiration date Check for breaks in packaging Insects, dust, sediments Anything that spells unclean Check label against MDs written order Make a label for any additive, date, time, dose, amount Check function of infusion pump if any

MEDICATIONS
10 Golden Rules right drug right patient right dose right route right education right time right documentation right evaluation- drug-drug interaction right assessment-patient history, allergy right to refuse

Initiation of IVT
Starts with the doctors order

Choice of Cannula

Would depend on the purpose of infusion-fast hydration? type of infusion-BT? size and condition of vein-babies duration of treatment-prolonged condition of patient- in shock?

Selection of Site
Patients condition stroke avoid the weak side Patients age babies scalp Size and condition of the vein- avoid lower extremities among bed ridden patients (DVT-pulmonary embolism)

Anchoring of Cannula & Tubing

Allow normal blood flow Prevent movement of cannula Transparent for easy monitoring of cannula

When to remove the cannula

Cannula should be changed after 4872 hours or earlier as needed

Administration of Drugs, Blood, Chemotx, TPN

Explain! Before giving! Informed consent Possible side effects Indication and benefits

Check the IV Solution

Inspect IV FLUIDS check for sediment, turbidity, discoloration, leaks, cracks, damaged caps, expiration date

Correct Documentation
Legally correct- indicate the size, type, length of the cannula; NOD who inserted, Date andTime inserted Label the IV FLUID- type of fluid, medication added, use of pump, duration of therapy, NODs signature Chart-location and condition of the site, complications and NODs intervention, education, signature

Infection Control
Infection at the site is usually caused by break in aseptic technique Wash hands before handling any equipment and before starting IVT Use 70% Alcohol to clean the skin Cut hair, DONT shave Dont re-use cannula!

Complications
Infiltration Thrombophlebitis Overload Air-embolism Catheter embolism Systemic infection Allergy

Problems during the Procedure

Fluctuating Rate Runaway IV Sluggish IV Loose connection Blood back up Obstruction Clogged Filter Break in asepsis Leaks

Staff Risks
Exposure to infectious organism Needlestick injury Chemical Exposure

Quality Assurance Standards

Deliver safe and quality IV Therapy Protect Patient and Nurse Protect IVT Nurses Practice

Venipuncture Audit
To ensure QUALITY IVT, we must do a continuous AUDIT Verify Doctors order Check Lab Results Check Allergy and drug history Compute rate Established rapport with patient Patient Identification

1. 2. 3. 4. 5. 6.

Venipuncture Audit
7. Patient education 8. Hand Hygiene 9. Set up needs 10. Choose appropriate vein, size, cond 11. Apply torniquet, check radial pulse 12. Disinfects site 13. Perform venipuncture 14. Attach Venoset 15. Anchor needle/ Venoset

Venipuncture Audit
16. Label venipuncture with date, gauge, length, NODs initials 17. Regulates flow 18. Correctly label IVF-patients name, additive, rate, bottle sequence, due date/time 19. Untoward reactions 20. Check height of stand 3-4 feet

Venipuncture Audit
21. Dispose Materials correctly 22. Standard Precautions 23. Record in the chart

Practicum
1. Verify prescription and make IV label 2. Observe 10 rights 3. Patient education 4. Asses vein 5. Hand hygiene 6. Prepare IV tray, IVF, Venoset, cannula, alcohol, cottonball, plaster, torniquet, gloves, splint, stand, 2x2 gauze of sterile transparent dressing

Practicum
7. Check IVF and other devices 8. Place IV label (patients name, room, solution, additive, bottle sequence, duration, time and date 9. Open the seal of the IVF aseptically 10. Open venoset, fill the infusate 11. Fill the drip chamber to at least half 12. Expel air bubbles

Practicum
13. Verify order and check prepared needs 14. Explain to the patient 15. Hand hygiene before and after 16. Choose site 17. Apply torniquet 5-12 cm above 18. Check radial pulse 19. Prepare site, 30secs to dry, no touch technique. WEAR gloves.

Practicum
20. Pierce skin on a 15-30 angle 21.Upon flashback, decrease angle and advance the catheter & stylet about inch. 22. Position catheter parallel to the skin. Hold stylet stationary and advance the catheter till about 1 cm fr the site 23. Apply the sterile gauze under the hub and release the torniquet. Remove the stylet whilte appying digital pressure over the catheter.

Practicum
24. Connect the infusion tubing of the prepared IVF aseptically to the IV catheter Changing IVF 1. Verify doctors prescription in doctors order sheet, countercheck IV label, IV card, infusate sequence, type, amount, additive, duration of infusion 2. Observe 10 rights

Practicum-changing IVF
3. Explain and reassure patient and check IV site for redness, swelling, pain, etc 4. Change IV tubing, reinsert 48-72 hours has lapsed after insertion 5. Wash hands before and after 6. Prepare necessary needs 7. Check sterility and integrity of IVF

Practicum-changing IVF
8. Place IV Label, close the clamp 9. Change the bottle aseptically 10. Regulate flow 11. Reassure patient 12. Dispose wastes accordingly 13.Document and endorse accordingly

Practicum- discontinuing IV Infusion

1. Verify Written doctors order, check if IV meds are also being discontinued 2. Prepare needs- IV Tray, sterile cotton balls, alcohol, plaster and betadiene. 3. Wash hands-before and after 4. Moisten anchoring plaster to loosen it from skin.

5. Remove plaster, after turning off IV 6. Get cottonball with alcohol 7. Put over the site, without pressure on the site, pull the canula 8. Check for completeness of the canula, while applying pressure on the site. 9. When bleeding stopped, dress with OS, asked significant other to apply pressure 10. Reassure patient. Document

Practicum-discontinuing IV Infusion

Blood Transfusion
1. Verify Doctors order, make a treatment card 2. 10 Rights 3. Educate patient, Reassure 4. Request prescribed blood from Lab include blood typing and x-matching if not yet done 5. Check if blood obtained is tested for transmissible diseases

Blood Transfusion
6. Once available, get the blood, wrap with clean towel, lay on a clean tray and keep at room tempt. 7. Check the patients vital signs before starting BT 8. Compare patient data with the Bag label. Check the X-matching, ABO, RH, serial number, expiry date

Blood Transfusion
9. Give the premedication- benadryl etc. warn patient and relatives of effects of premeds like dizziness and light-headedness 10. Hand hygiene before and after 11. Prepare needs: IV tray, BT set, canula (gauge 18 or else hemolyze), Plain NSS, IV Stand, gloves, sterile OS, plaster)

Blood Transfusion

Blood Transfusion
12. If ongoing IVF is D5, ask doctor if blood will be given in this site or if another site will be started. If the same line will be used, change IVF to NSS, clean line with NSS. 13. Open BT set aseptically, close roller clamp, spike blood carefully, fill drip camber to half full, prime tubing and remove air bubble, use g 18-19 needle for side drip

Blood Transfusion
14. Disinfect the Y port and insert the needle from BT set and secure with tape. 15. Close the roller clamp of IV fluid and start the BT at 10-15 drops per min for 15 minutes to observe for reaction. If none regulate to prescribed rate. 16. Observe patient while on BT. Look for signs of reaction like itchiness, chills, fever, dyspnea etc. stop BT, start IVF, REFER ASAP

Blood Transfusion
17. If there are no untoward reactions, continue BT. Swirl blood every hour to mix the components. 18. Change BT set every 2 bags. 19. When BT is consumed, closed the BTclamp, remove from Y port, careful with the needle, dispose accordingly, restart & regulate IVF 20. Re-check patients VS and reaction

Blood Transfusion
21. Do post BT Orders if any; repeat CBC usually, several hours later (4 hours later) 22. DOCUMENT properly: procedure, observations, interventions, ENDORSE 23. Remind MD if patient received 3-6 units of blood about CaGluconate.

Incorporations in the IVF

1. Verify wirtten medication card against doctors prescription. 2. 10 rights in preparing and administering drugs 3. Explain and reassure patient 4. Skin test if necessary or ordered 5. Hand hygiene 6. Prepare tray-syringes, drug 7. Prepare drugs as ordered

Incorporations in the IVF

8. Make sure that you have the right patient, drug, dosage, route, time, expiration date 9. Hand hygiene before and after 10. Disinfect the injection port 11. Introduce the Drug into the IVF 12. Swirl the drug to mix with IVF, Observe for reactions for 5-10 mins 13. Document & Discard properly.

Push through IV Port

1. Verify medication card against doctors prescription 2. 10 Rights 3. Explain procedure to the patient, reassure 4. Hand hygiene, use gloves for chemotherapy and other vesicants 5. Check skin test if any

Push through IV Port

6. Make sure there is no drug-drug, drug IV fluid incompatibility 7. Prepare needs- right drug, check expiration date, right diluent, syringe, needle, cottonball, alcohol 8. Prepare the drug- dilute aseptically as directed in the product insert 9. Aspirate aseptically 10. Disinfect injection port, slowly or as directed while roller clamp is close. Aspirate 1-2 cc fluid, introduce again, regulate IV, Observe for SSx 11. Document and Discard properly

Drug incorporation into Volumetric Chamber

1. Verify orders, Observe 10 Rs, Educate and reassure patient, hand hygiene 2. Check for drug-IVF incompatibility 3. Put enough fluid necessary into the chamber, introduce the drug aseptically, mix well and regulate. 4. Label the chamber with the drug name, dosage and flow rate, time exptected to be consumed.

Drug incorporation into Volumetric Chamber

5. Once drug in the chamber is consumed. Close the roller clamp, reintroduce fluid in the chamber, regulate IVF 6. Document and Discard used materials properly

Hep-Lock
1. Verify, Observe 10Rs, Reassure patient and do Hand Hygiene 2. Prepare needs: hep-lock device, tuberllin syringe, heparin, NSS, prepared medicine in a syringe, 2.5cc syringe with NSS for flushing.

Hep-lock
3. Open hep-lock, inject medicine as ordered, push medicine with NSS as ordered, push heparin in the tuberculin, close the hep-lock 4. Observe for adverse reactions 5. Document and Dispose properly

Thank you-Please answer the Post training Evaluation