INTRAVENOUS THERAPY Training

Definition

Is the insertion of a needle or cannula into a vein based on a doctor’s 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

We are NOT ANSAP accredited

We are doing this training toRe-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

Why in-house training?

When do we start IVT

INDICATIONSMaintain hydration

Correct dehydration

Provide parenteral nutrition

Administration of drug

Transfusion of blood/component

Contraindications to peripheral IVT

Highly irritating drugs →IV burnConcentrated NaCl

KCl (Cardiac Arrest)

Before starting IVT

Doctor’s orderPatient’s 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 PatientStatus 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 useCheck for expiration date

Check for breaks

in packaging

Insects, dust, sediments

Anything that spells “unclean”

Check label against MD’s 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 doctor’s order

Choice of Cannula

Would depend on thepurpose of infusion-fast hydration?type of infusion-BT?size and condition of vein-babiesduration of treatment-prolongedcondition of patient- in shock?

Selection of Site

Patient’s condition – stroke avoid the weak side

Patient’s 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 48-72 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 DocumentationLegally correct- indicate the size, type, length of the cannula; NOD who inserted, Date andTime insertedLabel the IV FLUID- type of fluid, medication added, use of pump, duration of therapy, NODs signatureChart-location and condition

of the site, complications and NOD’s 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, DON’T shave

Don’t re-use cannula!

Complications

Infiltration

Thrombophlebitis

Overload

Air-embolism

Catheter embolism

Systemic infection

Allergy

Problems during the Procedure

Fluctuating RateRunaway IVSluggish IVLoose connectionBlood back upObstructionClogged FilterBreak in asepsisLeaks

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

1. Verify Doctor’s order

2. Check Lab Results

3. Check Allergy and drug history

4. Compute rate

5. Established rapport with patient

6. Patient Identification

Venipuncture Audit

7. Patient education8. Hand Hygiene9. Set up needs10. Choose appropriate vein, size, cond11. Apply torniquet, check radial pulse12. Disinfects site13. Perform venipuncture14. Attach Venoset15. Anchor needle/ Venoset

Venipuncture Audit

16. Label venipuncture with date, gauge, length, NODs initials

17. Regulates flow

18. Correctly label IVF-patient’s 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

Practicum1. 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 (patient’s 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

13. Verify order and check prepared needs

14. Explain to the patient15. Hand hygiene before and after16. Choose site17. Apply torniquet 5-12 cm above 18. Check radial pulse19. Prepare site, 30secs to dry, no

touch technique. WEAR gloves.

Practicum

Practicum

20. Pierce skin on a 15-30 angle21.Upon flashback, decrease angle and

advance the catheter & stylet about ¼ 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.

Practicum24. Connect the infusion tubing of the

prepared IVF aseptically to the IV catheter

Changing IVF1. Verify doctor’s prescription in

doctor’s 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 doctor’s 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 after4. Moisten anchoring plaster to loosen

it from skin.

Practicum-discontinuing IV Infusion

5. Remove plaster, after turning off IV6. Get cottonball with alcohol7. Put over the site, without pressure on

the site, pull the canula8. 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

Blood Transfusion

1. Verify Doctor’s order, make a treatment card

2. 10 Rights3. Educate patient, Reassure4. 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 patient’s 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 after11.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 Transfusion14.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 patient’s 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 doctor’s prescription.

2. 10 rights in preparing and administering drugs

3. Explain and reassure patient4. Skin test if necessary or ordered5. Hand hygiene6. Prepare tray-syringes, drug7. 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 doctor’s 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 Port6. Make sure there is no drug-drug,

drug IV fluid incompatibility7. 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 aseptically10.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 incompatibility3. 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