What are IV Fluids?

 It is the isotonic solution of choice for expanding

the extracellular fluid (ECF)volume because it does
 Intravenous fluids, also known as intravenous not enter the intracellular fluid (ICF)
solutions, are supplemental fluids used in intravenous
therapy to restore or maintain normal fluid volume ISOTONIC IV FLUIDS 0.9 Na Cl (Normal Saline
and electrolyte balance when the oral route is not Solution, NSS)
possible.
 Used in the administration of blood products
IV Fluids
 Used to replace large volume losses such as in
Intravenous (IV) therapy - is therapy that delivers burn injuries and trauma  Should not be used for
fluids directly into a vein Indications of IV therapy: clients with heart failure, pulmonary edema and renal
1. Maintain hydration and/or correct dehydration in impairment or condition that cause sodium retention
patient unable to tolerate sufficient volumes of oral as it may risk fluid volume overload
fluids or medications
ISOTONIC IV FLUIDS Dextrose 5% in Water
2. Parenteral nutrition
 Is initially an isotonic solution with a serum
3. Administration of drugs osmolality of 252mOsm/L

4. Transfusion of blood or blood components   Provides free water when dextrose is metabolized
(making it a hypotonic solution) expanding the ECF
Types of IV Fluids and the ICF

Crystalloids ▪ are IV solutions containing small  Is administered to supply water and to correct an
molecules that flow easily across semipermeable increase in osmolality
membranes • they are categorized according to their
relative tonicity in relation to plasma. There are three ISOTONIC IV FLUIDS Dextrose 5% in Water
types: 1. Isotonic – solutions have the same
concentration of solutes as blood plasma 2.  1 liter of D5W provides fewer than 200 calories
Hypotonic – solutions have lesser concentration of and contain 50g of glucose
solutes than plasma 3. Hypertonic – solutions have
 Not to be used for fluid replacement because
greater concentration of solutes than plasma
hyperglycemia may result
ISOTONIC IV FLUIDS
 Should be avoided to be used in clients at risk for
 equally expand both intracellular and extracellular increased intracranial pressure as it may cause
fluid spaces cerebral edema

 have a total osmolality close to that of the ECF and ISOTONIC IV FLUIDS Lactated Ringer’s 5% in
do not cause red blood cells to shrink or swell Water

ISOTONIC IV FLUIDS 0.9 Na Cl (Normal Saline  IV fluid designed to be the near physiological
Solution, NSS) solution of balanced electrolytes

 Simply salt water that contains only water, sodium  Contains 130mEq/L of sodium, 4mEq/L of
(154mEq/L) and chloride (154mEq/L). potassium, 3mEq/L of calcium and 109mEq/L of
chloride
 Is called normal saline solution because the
percentage of sodium chloride dissolved in the  Also contains bicarbonate precursor to prevent
solution is similar to the usual concentration of acidosis
sodium and chloride in the intravascular space
 Does not provide calories or magnesium and has Nursing Considerations for Isotonic Solutions
limited potassium replacement
Elevate the head of the bed at 35 to 45 degrees.
 Used to correct dehydration, sodium depletion and Unless contraindicated, position the client in semi-
replace GI losses Fowler’s position.

ISOTONIC IV FLUIDS Lactated Ringer’s 5% in Elevate the patient’s legs. If edema is present, elevate
Water the legs of the patient to promote venous return.

 Can also be used to fluid losses due to burns, Educate patients and families. Recognize signs and
fistula drainage and trauma symptoms of fluid volume overload, instruct patients
to notify the nurse if they have trouble breathing or
 the choice for first-line fluid resuscitation for notice any swelling.
certain patients
Close monitoring for patients with heart failure.
 Often administered to patients with metabolic Carefully monitor for signs of fluid overload.
acidosis
HYPOTONIC IV FLUIDS
 Is metabolized in the liver, which converts the
lactate to bicarbonate, therefore, it should not be  have a lower osmolality and contain fewer solutes
given to patients who cannot metabolize lactate (eg. than plasma
liver disease, lactic acidosis)
 cause fluid shifts from the ECF into the ICF to
 Should be used with caution in patients with heart achieve homeostasis, therefore, causing cells to swell
failure and renal failure and may even rupture

ISOTONIC IV FLUIDS Ringer’s Solution  IV solutions are considered hypotonic if the total
electrolyte content is less than 250 mEq/L
 Has content similar to Lactated Ringer’s solution
but does not contain lactate  are usually used to provide free water for excretion
of body wastes, treat cellular dehydration and
 Indications are the same with Lactated Ringer’s replace the cellular fluid
but without the contraindications related to lactate
HYPOTONIC IV FLUIDS 0.45% Sodium Chloride
Nursing Considerations for Isotonic Solutions (0.45% NaCl, ½ NS )

Document baseline data. vital signs, edema status,  also known as half-strength normal saline
lung sounds, and heart sounds . Continue monitoring
during and after the infusion.  is a hypotonic IV solution used for replacing water
in patients who have hypovolemia with
Observe for signs of fluid overload. hypertension, hypernatremia
bounding pulse, pulmonary crackles, dyspnea,
shortness of breath, peripheral edema, jugular  Excess use may lead to hyponatremia due to the
venous distention, and extra heart sounds dilution of sodium, especially in patients who are
prone to water retention
Monitor manifestations of continued hypovolemia.
decreased urine output, poor skin turgor, tachycardia,  It has an osmolality of 154 mOsm/L and contains
weak pulse, and hypotension 77 mEq/L sodium and chloride

Prevent hypervolemia. Patients being treated for  are used to treat hypernatremia and other
hypovolemia can quickly develop fluid overload hyperosmolar conditions
following rapid or over infusion of isotonic IV fluids
HYPOTONIC IV FLUIDS 0.33% Sodium Chloride  have a greater concentration of solutes (375 mEq/L
Solution and greater) than plasma and cause fluids to move out
of the cells and into the ECF in order to normalize the
 Is used to allow kidneys to retain the needed concentration of particles between two
amounts of water and is typically administered with compartments.
dextrose to increase tonicity
 causes cells to shrink and may disrupt their
 It should be used in caution for patients with heart function
failure and renal insufficiency
 They are also known as volume expanders as they
HYPOTONIC IV FLUIDS 2.5% dextrose in water draw water out of the intracellular space, increasing
(D2.5W) extracellular fluid volume

 This solution is used to treat dehydration and HYPERTONIC IV FLUIDS Hypertonic Sodium
decrease the levels of sodium and potassium Chloride IV Fluids

 should not be administered with blood products as  contain a higher concentration of sodium and
it can cause hemolysis of red blood cells chloride than normally contained in plasma.

Nursing Considerations for Hypotonic Solutions  Infusion of hypertonic sodium chloride solution
shifts fluids from the intracellular space into the
 Document baseline data. vital signs, edema status,
intravascular and interstitial spaces
lung sounds, and heart sounds. Continue monitoring
during and after the infusion.  are available in the following forms and strengths:
➢ 3% sodium chloride (3% NaCl) containing 513
 Do not administer in contraindicated conditions.
mEq/L of sodium and chloride with an osmolality of
Hypotonic solutions may exacerbate existing
1030 mOsm/L. ➢ 5% sodium chloride (5% NaCl)
hypovolemia and hypotension causing cardiovascular
containing 855 mEq/L of sodium and chloride with
collapse. Avoid use in patients with liver disease,
an osmolality of 1710 mOsm/L
trauma, or burns.
HYPERTONIC IV FLUIDS Hypertonic Sodium
 Risk for increased intracranial pressure (IICP).
Chloride IV Fluids
Should not be given to patients with risk for IICP as
the fluid shift may cause cerebral edema (remember:  are used in the acute treatment of sodium
hypotonic solutions make cells swell). deficiency (severe hyponatremia) and should be used
only in critical situations to treat hyponatremia
Nursing Considerations for Hypotonic Solutions
 to be infused at a very low rate to avoid the risk of
 Monitor for manifestations of fluid volume deficit.
overload and pulmonary edema.
Signs and symptoms include confusion in older
adults. Instruct patients to inform the nurse if they  If administered in large quantities and rapidly, they
feel dizzy. may cause an extracellular volume excess and
precipitate circulatory overload and dehydration
 Warning on excessive infusion. Can lead to
intravascular fluid depletion, decreased blood  they should be administered cautiously and usually
pressure, cellular edema, and cell damage. only when the serum osmolality has decreased to
critically low levels
 Do not administer along with blood products. Can
cause hemolysis of red blood cells especially during  Some patients may need diuretic therapy to assist
rapid infusion of the solution. in fluid excretion

HYPERTONIC IV FLUIDS
HYPERTONIC IV FLUIDS Hypertonic Dextrose acuity areas with constant nursing surveillance for
Solutions potential complications.

 Isotonic solutions that contain 5% dextrose (e.g.,  Verify order. Prescription for hypertonic solutions
D5NSS, D5LRS) are slightly hypertonic since they should state the specific hypertonic fluid to be
exceed the total osmolality of the ECF. However, infused, the total volume to be infused, the infusion
dextrose is quickly metabolized and only the isotonic rate and the length of time to continue the infusion.
solution remains. Therefore, any effect on the ICF is
temporary Nursing Considerations for Hypertonic Solutions

 Hypertonic dextrose solutions are used to provide  Assess health history Patients with kidney or heart
kilocalories for the patient in the short term. disease and those who are dehydrated should not
receive hypertonic IV fluids.
 Higher concentrations of dextrose (i.e., D50W) are
strong hypertonic solutions and must be administered  Prevent fluid overload Ensure that administration
into central veins so that they can be diluted by rapid of hypertonic fluids does not precipitate fluid volume
blood flow. excess or overload.

HYPERTONIC IV FLUIDS Dextrose 10% in Water  Do not administer peripherally. should be

(D10W) administered through a central vascular access device
inserted into a central vein.
 is an hypertonic IV solution used in the treatment
of ketosis of starvation and provides calories (380  Monitor blood glucose closely Rapid infusion of
kcal/L), free water, and no electrolytes. hypertonic dextrose solutions can cause
hyperglycemia. Use with caution for patients with
 It should be administered using a central line if diabetes mellitus.
possible and should not be infused using the same
line as blood products as it can cause RBC Types of IV Fluids Classified according to their
hemolysis. purpose

HYPERTONIC IV FLUIDS Dextrose 20% in Water  Nutrient solutions May contain dextrose, glucose,
(D20W) and levulose to make up the carbohydrate component
and water. Water is supplied for fluid requirements
 an osmotic diuretic that causes fluid shifts between and carbohydrate for calories and energy. Nutrient
various compartments to promote diuresis solutions are useful in preventing dehydration and
ketosis. Examples: D5W, D5NSS.
Dextrose 50% in Water (D50W
 Electrolyte solutions Contains varying amounts of
Nursing Considerations for Hypertonic Solutions cations and anions that are used to replace fluid and
electrolytes for clients with continuing losses.
 Document baseline data vital signs, edema status,
Examples: 0.9 NaCl, Ringer’s Solution, and LRS.
lung sounds, and heart sounds. Continue monitoring
during and after the infusion. Types of IV Fluids Classified according to their
purpose
 Watch for signs of hypervolemia Look for signs of
swelling in arms, legs, face, shortness of breath, high  Alkalinizing solutions Are administered to treat
blood pressure, and discomfort in the body (e.g., metabolic acidosis Examples: LRS
headache, cramping).
 Acidifying solutions Are used to counteract
 Monitor and observe the patient during metabolic alkalosis Examples: D51/2NS, 0.9 NaCl
administration. should be administered only in high
 Volume expanders Are solutions used to increase colloids with an average molecular weight of 40,000
the blood volume after a severe blood loss, or loss of (Dextran 40)  is used to improve the
plasma. Examples: Dextran, Human albumin, and microcirculation in patients with poor peripheral
Plasma circulation  contain no electrolytes and are used to
treat shock related to vascular volume loss (e.g.,
Types of IV Fluids burns, hemorrhage, trauma, or surgery)  on certain
surgical procedures, they are used to prevent venous
Colloids ▪ contain large molecules that do not pass
thromboembolism  are contraindicated in patients
through semipermeable membranes. ▪ are IV fluids
with thrombocytopenia, hypofibrinogenemia, and
that contain solutes of high molecular weight,
hypersensitivity to dextran.
technically, they are hypertonic solutions, which
when infused, exert an osmotic pull of fluids from Types of IV Fluids Colloids
interstitial and extracellular spaces. ▪ They are useful
for expanding the intravascular volume and raising  Dextran b. High-molecular-weight Dextran
blood pressure. ▪ They are indicated for patients in (HMWD)  contains polysaccharide molecules with
malnourished states and patients who cannot tolerate an average molecular weight of 70,000 (Dextran 70)
large infusions of fluid. or 75,000 (Dextran 75)

Types of IV Fluids Colloids  are used for patients with hypovolemia and
hypotension
1. Human albumin ▪ is a solution derived from
plasma ▪ It has two strengths: a) 5% Albumin - a  are contraindicated in patients with hemorrhagic
solution derived from plasma and is a commonly shock
utilized colloid solution. It is used to increase the
circulating volume and restore protein levels in Types of IV Fluids Colloids
conditions such as burns, pancreatitis, and plasma
3. Etherified Starch  are derived from starch and are
loss through trauma. b) 25% Albumin - used together
used to increase intravascular fluid but can interfere
with sodium and water restriction to reduce excessive
with normal coagulation  Examples include
edema. They are considered blood transfusion
EloHAES, HyperHAES, and Voluven.
products and uses the same protocols and nursing
precautions when administering albumin. 4.Gelatin ▪ have lower molecular weight than
dextrans and therefore remain in the circulation for a
Types of IV Fluids Colloids
shorter period of time. 5. Plasma Protein Fraction
2. Dextrans  are polysaccharides that act as colloids (PPF) ▪ is a solution that is also prepared from
plasma, and like albumin, is heated before infusion ▪
 they are available in two types: low-molecular- is recommended to infuse slowly to increase
weight dextran (LMWD) and high-molecular-weight circulating volume
dextran (HMWD).
Nursing Considerations for Colloid Solutions
 They are available in either saline or glucose
solutions.  Assess allergy history Most colloids can cause
allergic reactions, although rare, so take a careful
 Dextran interferes with blood cross matching, so allergy history, asking specifically if they’ve ever had
draw the patient’s blood before administering dextran a reaction to an IV infusion before.
if cross matching is anticipated.
 Use a large-bore needle (18-gauge) A larger needle
Types of IV Fluids Colloids is needed when administering colloid solutions.

Dextran a. Low-molecular-weight Dextran (LMWD)

 contains polysaccharide molecules that behave like
 Document baseline data assess vital signs, edema for quick formula
status, lung sounds, and heart sounds. Continue
monitoring during and after the infusion. Example

Nursing Considerations for Colloid Solutions  An IV of 600ml is to infuse for 3 hours. Calculate
ml/hr.
 Monitor the patient’s response Monitor intake and
output closely for signs of hypervolemia, ml / hr. = 600𝑚𝑙 3ℎ
hypertension, dyspnea, crackles in the lungs and
= 200 ml/ hr.
edema.
Example
 Monitor coagulation indexes. Colloid solutions can
interfere with platelet function and increase bleeding  An IV of 2000ml is to infuse in 12hrs using a
times, so monitor the patient’s coagulation indexes. 10gtt/ml set. Calculate the gtt/min flow rate.

gtt/min = 2000 12
A physician request for IV fluid therapy must = 166.6 = 167ml/hr 2000𝑚𝑙 𝑥 10 720 min(60𝑥12) =
include:  type of solution  Quantity of solution  20000 720 = 27. 77 = 28 gtt/min (standard formula)
Time period for administration 167 𝑚𝑙 60𝑚𝑖𝑛𝑠(ℎ) x 10𝑔𝑡𝑡 𝑚𝑙 = 1670 60 = 27.83 =
28gtt/min (quick formula)
Example: D5LR 1 L to run for 8 hours
Example
Regulating IVF
 A volume of 1250 ml is to infuse in 12hours using
Flow rate is regulated either:
a 15gtt/ml set. Calculate gtt/mln flow rate.
 Manually by straight gravity
1250𝑚𝑙 12ℎ𝑟
 Via electronic infusion pump or controller
=104.16 = 104 ml/hr
Drop factors for IV tubing
104𝑚𝑙 60𝑚𝑖𝑛
 macro drop 10 gtt/ml 15 gtt/ml 20 gtt/ml
x 15𝑔𝑡𝑡 𝑚𝑙
 micro drop 60 mgtt/ml
= 1560 60
Drop Factor
= 26gtt/min
Formula for IV Computations
Example
 1. ml/hr =
 An IV of 2000 ml has been ordered to run over 16
𝑡𝑜𝑡𝑎𝑙 𝑣𝑜𝑙𝑢𝑚𝑒 𝑛𝑜.𝑜𝑓 ℎ𝑜𝑢𝑟𝑠  2. no. of hours =𝑡𝑜𝑡𝑎𝑙 hours. Set calibration is 10gtt/min. You start the
𝑣𝑜𝑙𝑢𝑚𝑒 𝑚𝑙/ℎ𝑟 infusion at 0800. a. What is the infusion time? 16hrs

 3. gtts/min = What time on the clock will the infusion be done?

O800 t 1600 =2400 or 12midnight
𝑡𝑜𝑡𝑎𝑙 𝑣𝑜𝑙𝑢𝑚𝑒 𝑥 𝑑𝑟𝑜𝑝 𝑓𝑎𝑐𝑡𝑜𝑟 𝑡𝑜𝑡𝑎𝑙 𝑡𝑖𝑚𝑒 𝑖𝑛
𝑚𝑖𝑛𝑢𝑡𝑒𝑠 b. What is the flow rate by IV pump? (ml/hr)

for standard formula 2000𝑚𝑙 16ℎ𝑟

= 𝑚𝑙 𝑝𝑒𝑟 ℎ𝑜𝑢𝑟 𝑥 𝑑𝑟𝑜𝑝 𝑓𝑎𝑐𝑡𝑜𝑟 𝑡𝑖𝑚𝑒(𝑚𝑖𝑛𝑢𝑡𝑒𝑠) = 125ml/hr

c. What is the flow rate by gravity? (gtt/min) 4 𝑚𝑔 𝑥

125 𝑚𝑙 60𝑚𝑖𝑛 2x =4 x = 4 2 x = 2 ml

x 10𝑔𝑡𝑡 𝑚𝑙 Example

= 20.83  Incorporate 40meq KCl to 1 Liter of IVF. Stock on

hand is 20meq/10 ml vial. How many ml is needed?
= 21 gtt/min 𝐷 𝐻 x Q = 40𝑚𝑒𝑞 20𝑚𝑒𝑞 x 10ml = 400 20 = 20ml

 Since 60 minutes remains constant for the quick How many vials? 40𝑚𝑒𝑞 20𝑚𝑒𝑞
formula, you can calculate constant factor for the
drop factor by dividing by 60. x 1 vial = 2 vials

drops factor constant factor Example

10 gtt (60÷10) 6 15 gtt (60÷15)  The ordered dose is Cefriazone 750mg IV. The
4 20 gtt (60÷20) 3 vial contain 1gm in 10ml. How many ml is to be
given? 
Example
750𝑚𝑔 1000𝑚𝑔
 D5LR to run for 10 hours. Drop factor 15gtt/ml.
Calculate drops per minute using quick formula with x 10ml = 7.5 ml
constant factor.
Practice
calculate ml/h = 1000 10
 To infuse 500ml of solution over 8 hours, the nurse
= 100ml/hr would give ____ml/hr.

Use ml/h constant factor  A patient is to receive 500ml of 0.45% NSS with
20 meq of KCL to run over 8 hours. The drop factor
= gtt/min is 20gtt/ml. The nurse would give _____ ml/hr.
100𝑚𝑙/ℎ 4 60÷15  Administer 1000ml of 0.9% NSS over 8 hours.
The drop factor is 10gtt/ml. The flow rate would
=25gtt/min
be______ gtt/min.
DRUG COMPUTATION
 The patient is to receive 150 mg of Dilantin by
Formula: slow IV push for status epilepticus Dilantin is
labeled 50mg/ml. The nurse would give ______ ml.
DH
ASSISTING IN IV INSERTION
xQ
Equipment for IV Insertion
Example: Loraxepam 4mg IV Q12h.Stock on hand is
2mg/ml. How many ml are required to carry out the Parts of an IV Tubing
ordered dose? 4 𝑚𝑔 2 𝑚𝑔 𝑥 1 𝑚𝑙 = 4 2 𝑚𝑙 = 2 𝑚𝑙

Ratio and proportion: colon format Stock on hand :

Parts of an IV Cannula
Quantity = Desired amount : x 2 mg : 1 ml = 4 mg :
x 2x = 4 x = 4 2 x = 2 ml

o fraction format 2 𝑚𝑔 1 𝑚𝑙 = Procedure Assisting in IV Insertion

1.Introduce yourself and verify client’s identity. inches. Allow the solution to dry on the skin. •
2.Explain procedure to the client. 3.Make sure the NOTE: Catheter insertion is done by the physician or
client’s clothing or gown can be removed over the IV IV therapist
fluid container if necessary. 4.Gather equipment and
bring to bedside. 5.Perform hand hygiene. Procedure Assisting in IV Insertion

Procedure Assisting in IV Insertion 13. Remove the protective cap from the distal end of
the tubing, hold it ready to attach to the catheter
6.Open and prepare the infusion set a. Remove tubing maintaining sterility of the end. 14. Once the needle
from the container and straighten it out. b. Slide the was removed, engage the needle safety device and
tubing clamp along the tubing until it is just below attach the end of the infusion tubing to the catheter
the drip chamber, then close the clamp. c. Leave the hub. 15. Initiate the infusion slowly by opening the
ends of the tubing covered with the plastic caps until tubing clamp.
infusion is started.
Procedure Assisting in IV Insertion
Procedure Assisting in IV Insertion
16. Tape the catheter by the “U” method. a. Use 3
7. Spike the solution container. a. Remove the strips of adhesive tape, each about 7.5cm (3 inches)
protective cover from the entry site of the bag. b. long. b. Place the strip, sticky side up under the
Remove the cap from the spike and insert the spike catheter’s hub. c. Fold each end over so that the
into the insertion site of the bag or bottle. c. Apply a sticky side are against the skin. d. Place a second
medication label to the solution container, if strip, sticky side down over the catheter hub. e. Place
medication was added. a third strip, sticky side down, over the tubing hub.

Procedure Assisting in IV Insertion Procedure Assisting in IV Insertion

8. Hang the solution container on the pole. Adjust 17. Dress and label the venipuncture site and tubing
pole to suspend container about 1 meter (3ft) above according to agency policy. a. Apply a sterile
the client’s head. 9. Partially fill the drip chamber transparent occlusive dressing. b. Discard tourniquet,
with solution by squeezing the chamber gently until it remove the soiled gloves and dispose appropriately.
is half full of solution. c. Loop the tubing and secure it with tape. d. Label
the dressing with the date and time of insertion type
Procedure Assisting in IV Insertion and gauge of needle or catheter used and your initial.

10.Prime the tubing. a. Remove the protective cap Procedure Assisting in IV Insertion
and hold the tubing over a container, maintain
sterility of the end of the tubing and cap. b. Release 18. Apply a padded arm board to splint the joint as
the clamp and let the fluid run through the tubing needed. 19. Adjust the infusion rate of flow
until all bubbles are removed. Tap the tubing with according to the order. 20. Label the tubing with the
your fingers to help the bubbles move. c. Re-clamp date and time of attachment and your initial.
the tubing and replace the tubing cap maintaining
sterile technique. Procedure Assisting in IV Insertion

Procedure Assisting in IV Insertion 21.Document relevant data. a. Date and time of

venipuncture b. The time of the start of infusion c.
11.Select the venipuncture site. a. Use client’s non The flow rate of the infusion d. The amount and type
dominant arm,unless contraindicated. b. Place towel of solution used and any additives e. The type and
or bed protector under the extremity to protect the gauge of needle or catheter f. The venipuncture site
linens. 12. Clean the venipuncture site with the g. The client’s response
topical antiseptic swab (alcohol) using a circular
motion, moving from the center outward for several
 10. Place sterile gauze square under needle hub. 11.
Place new IV tubing close to patient’s IV site and
Changing Intravenous Solution Procedure slightly loosen protective cap. Disconnect the old
tubing from the needle hub and swab the needle hub
1. Gather needed equipment and bring to bedside.
with alcohol. 12. Connect new tubing to the needle
Check IV solution and medication additives with
hub. Open clamp and adjust flow rate.
physician’s order. 2. Explain procedure to patient. 3.
Perform hand hygiene. 4. Carefully remove Procedure Changing IV Tubing
protective cover from new solution container and
expose entry site. 5. Close clamp on tubing. 13. Check IV site for patency and evidence of
complications. 14. Secure tubing with tape. 15.
Changing Intravenous Solution Procedure Discard old supplies and perform hand hygiene. 16.
Document procedure as per agency policy.
6. Lift container off IV pole and invert it. Quickly
remove spike from old IV container, being careful
not to contaminate it. 7. Steady new container and
insert spike. Hang on IV pole. 8. Reopen clamp on PROCEDURE DISCONTINUING IV FLUIDS
tubing and adjust flow.
1. Introduce yourself and verify the client’s identity.
Changing Intravenous Solution Procedure Explain to the client what you are going to do, why it
is necessary, and how client can cooperate. 2.
9. Label container according to agency policy. 10. Perform hand hygiene and observe other appropriate
Record on intake-output record and document on infection control procedures. 3. Provide for client
chart according to agency- policy. 11. Discard used privacy. 4. Prepare the equipment. 5. Clamp the
equipment in proper manner. Perform hand hygiene. infusion tubing. 6. Loosen the tape at the
venipuncture site while holding the needle firmly and
Procedure Changing IV Tubing
applying counter traction to the skin.
1. Gather equipment and bring to bedside. 2. Explain
PROCEDURE DISCONTINUING IV FLUIDS
procedure to patient. 3. Perform hand hygiene. 4.
Close clamp on tubing. 5. Carefully remove 7. Put on gloves, and hold sterile gauze above the
protective cover from new solution container and venipuncture site. 8. Withdraw the needle or catheter
expose entry site. from the vein. • Withdraw the needle or catheter by
pulling it out along the line of the vein. • Immediately
Procedure Changing IV Tubing
apply firm pressure to the site, using sterile gauze, for
6. Open administration set and close clamp on new 2-3 minutes. • Hold the client’s arm or leg above the
tubing. Remove protective covering from infusion body, if any bleeding persists.
spike. Using sterile technique, insert into new
PROCEDURE DISCONTINUING IV FLUIDS
container. 7. Hang IV container on pole and squeeze
drip chamber to fill at least halfway. 8. Remove cap 9. Examine the catheter removed from the client. •
at the end of tubing, release clamp, and allow fluid to Check the catheter to make sure it is intact. • Report a
move through tubing until all air bubbles have broken catheter to the nurse in charge or primary care
disappeared. Close clamp and recap end of tubing provider immediately. • If the broken piece can be
maintaining sterility of set-up. 9. Loosen tape at IV palpated, apply a tourniquet above the insertion site.
insertion site. Don clean gloves. Carefully remove
dressing and tape. PROCEDURE DISCONTINUING IV FLUIDS

Procedure Changing IV Tubing 10. Cover the venipuncture site. • Apply the sterile
dressing. • Discard the IV infusion container
properly. If infusions are being discontinued, discard
the used supplies appropriately. 11. Document all
relevant information. • Record the amount of fluid
infused on the intake and output record on the chart.

END