STARTING an INTRAVENOUS INFUSION

Definition: Intravenous therapy is the aseptic instillation of fluid, electrolytes, nutrients or

medications through a needle into a vein.

Purposes:

1. To administer fluids and chemical substances when circumstances prevent the patient
from consuming a normal diet and oral liquids.
2. To replace fluids and chemical substances when the patient has experienced their loss
through vomiting, diarrhea, bleeding, etc.
3. To provide access to the circulatory system if it becomes necessary to administer
emergency medications.
4. To maintain an access to the circulatory system for the intermittent administration of
scheduled medications.

Nursing Considerations:

1. The solution will infuse safely at the prescribed rate.

2. The venipuncture site will remain nontender and not infected throughout the infusion.

Factors Affecting Flow Rate:

1. Age 5. Patency of the needle
2. Condition of patient 6. Position of the site
3. Solution used 7. Height of the IV pole
4. Manufacturer’s drop factor 8. Kinking of the tube

Equipment:
A. An IV tray containing the following:
1. IV solution as ordered
2. IV tubing
3. Needle (butterfly or vasocan as the case may be)
4. Tourniquet
5. Antiseptic swabs or CB soaked in ROH
6. Plaster and masking tape for the label
7. Armboard, if needed
8. Scissors
9. Medicine ticket
10. IVF label

B:
1. IV stand
Procedure

Action Rationale

1. Check the IV solution and medication Checking ensures that the patient receives the
additives with the physician’s order. correct IV solution and medication as ordered
(compare medicine ticket with what is by the physician.
written on the medical order sheet.)

2. Wash your hands. This prevents the spread of microorganisms.

3. Gather all equipment and prepare the IV Having all equipment available saves time.
solution and tubing.
a. Maintain aseptic technique when Prevents the contamination of IV solution and
opening sterile packages and IV set which can infect rapidly the patient.
solution.

b. Clamp tubing, uncap the spike and This punctures the seal in the IV bag or bottle.
insert it into the entry site on the bag
or bottle as the manufacturer
directs. If an additive is ordered,
incorporate it before inserting the
spike into the entry site.
c. Suspend the IV solution on a hook Suction effect causes fluids to move into the
in the preparation area and press the drip chamber and also prevents air from
drip chamber and allow it to fill at moving down the tubing.
least halfway.

d. Remove the cap at the end of the This removes air from the tubing which can in
tubing, release the clamp and allow larger amounts, act as an air embolus.
the fluid to move through the
tubing. (This is termed as priming
the tubing). Allow fluid to flow
until all air bubbles have
disappeared. Close the clamp and
recap the end of the tubing,
maintaining sterility of the set–up.

4. Notify the physician or nurse who will Facilitates accomplishment of the task.
insert the IV. When he/she arrives, bring
preparation to the bedside.

5. Identify the patient and explain the Explanation allays the patient’s anxiety.
procedure.
6. Have the patient in a supine or low The supine position permits either arm to be
Fowler’s position in bed. used and allows for good body alignment. The
low Fowler’s position is usually the most
comfortable for the patient.

7. Suspend the bag or bottle of solution on The fluid height should be 18 – 24 inches
the IV stand. above level of the vein. This height is sufficient
to overcome the venous pressure.

8. Hand the tourniquet to the doctor / Anticipating the needs of the doctor is one
nurse, followed by a CB with alcohol good characteristics of a nurse.
and the needle or vasocan. Observe
while the doctor / nurse is inserting.

9. Release the tourniquet when he/she The tourniquet causes increased venous
indicates or when a return flow of blood pressure resulting in automatic backflow, an
to the adapter is observed (optional - can indication that the needle is inserted into the
be done by doctor.) vein.

10. Connect the tubing to the needle.

11. Start the flow of solution promptly by Blood will clot readily if IV flow is not
releasing the clamp on the tubing. maintained. If the needle accidentally slips out
Examine the site for signs of infiltration. of the vein, solution will accumulate and
infiltrate into surrounding tissue.
12. Support the needle with a small piece of
gauze or tissue paper under the hub, if The pressure of the wall of the vein against the
necessary, to keep the needle in place. bevel of the needle will interrupt the rate of
flow of the solution. The wall of the vein can
13. Loop the tubing near the site of entry be easily punctured by the needle.
and anchor it with plaster to prevent
pulling of the needle. The smooth structure of the vein does not offer
resistance to the movement of the needle. The
weight of the tubing is sufficient to pull the
needle out of the vein if it is not well anchored.
14. Anchor the arm to an armboard for
support, if necessary. An armboard protects against change in the
position of the vein and acts as a reminder to
the patient to minimize arm movements.
15. Adjust the rate of flow according to the
doctor’s order The physician prescribes the rate of flow in
accordance to the patient’s condition.
16. Complete the label and tape to the IVF
bag/ bottle.

17. Do the after care of equipment and wash

your hands. Deters the spread of microorganisms.
18. Document the procedure and the
 patient’s response. Chart the time, site, This provides accurate documentation and
device used, solution and rate of flow ensures continuity of care.
and the physician / nurse who inserted
the needle.
19. Monitor periodically (at least every 30
minutes) to check flow rate and observe This documents the patient’s response to the
for infiltration and other untoward infusion.
symptoms .

NURSING ALERT:
If infusion is not flowing well, lower the bottle/bag to check if the line is still patent.
NEVER FLUSH or PINCH IV tubings of infusion.

Sample Documentation:
Date Time Nurse’s Notes
4/28/2017 3:30 PM D5LR 1L with 1 ampule Benutrex C
inserted as venoclysis by Dr. Flores to the
left dorsal metacarpal vein and regulated
at 30 gtt/min. No untoward symptoms
noted.

Leny Rodrigo, St. N.

 SAN PEDRO COLLEGE
Davao City

PERFORMANCE CHECKLIST
STARTING an INTRAVENOUS INFUSION

Name: _________________________________ Grade: _____________________

Year and Sec.: _________________ Date : ____________________

Legend: 5 – Excellent; 4 – Very good; 3 – Good; 2 – Fair; 1 – Poor

Rating

5 4 3 2 1
1. Checks the written medical order.
2. Washes hands.
3. Assembles needed equipment.
4. Closes the roller clamp in the tubing.
5. Removes the protective covering of the IV bag / bottle
and tubing without contamination.
6. Incorporates additives aseptically as needed
7. Connects the tubing to the IV bag/bottle.
8. Partially fills the drip chamber.
9. Opens the clamp and flushes air from the tubing (primes
the tubing).
10. Calls the doctor/nurse and brings preparation to bedside.
11. Identifies the patient. Explain the prcedure to the client
12. Hangs the fluid container on the IV stand.
13. Assists the patient to a low Fowler’s position.
14. Assists the physician / nurse in the insertion of IV fluid.
15. Releases the tourniquet.
16. Opens the roller clamp to allow slow but gradual infusion
of solution.
17. Notes that solution continues to drip and site does not
become swollen.
 18. Secures tubing with strips of plaster.
19. Adjusts the flow rate as prescribed.
20. Restrains the arm with an armboard as necessary.
21. Positions patient comfortably.
22. Attaches the completed IVF label.
23. Does after care of equipment.
24. Washes hands.
25. Records the appropriate information on patient’s chart.
26. Maintains body mechanics throughout the
performance of the procedures.
27. Manifests neatness in the performed procedure.
28. Receptive to criticisms.
29. Observes courtesy.
30. Shows calmness while performing the procedure.
31. Uses correct English.
32. Shows mastery of the procedure.

Remarks:

Criteria : I Knowledge (quiz) 30%

II Performance 70%
100%

________________________________ __________________________
Student’s Signature Over Printed Name Date

________________________________ __________________________
Instructor’s Signature Over Printed Name Date
PERIPHERAL VEINS USED IN INTRAVENOUS THERAPY
 REGULATING INTRAVENOUS FLOW RATE

To prevent circulatory overload or underload, the nurse must administer IVF medication
at the prescribed flow rate – the amount of fluid given at a specified time. The nurse should
mathematically convert the rate of infusion prescribed by the physician into comparable drops per
minute. Use the standard formula hereunder to calculate the correct flowrate:

a. Standard Formula:
Rate = Volume (cc) x gtt factor (cc)
Duration (hrs) x 60 min/hr (constant)

Duration = Volume (cc) x gtt factor (cc) .

Rate (gtt/min) x 60 min/hr (constant)

Drop Factor:

Blood – wgtts/cc
Macroset – 15 or 20 gtts/cc (check manufacturer’s direction)
Microset – 60 mgtts/cc

Example:
1. How many hours would 500 cc D5IMB last if the rate is 30 mgtts/min.

Duration = 500 cc x 60 mgtts/cc .

30 mgtts/min x 60 min/hr

= 16.7 hours
2. How many cc/hr will you consume?

= 500
16.7
= 30 cc/hr.

Purposes:

1. To comply with prescribed rate ordered by the physician.

2. To assist in reassessing the progress of the fluid infusion.
3. To prevent circulatory overload or insufficient correction of hypovolemia.

Nursing Consideration:

1. Read the current written medical order for the volume and number of hours of infusion.
2. Determine the manufacturer’s drop factor and the ratio of drops per milliliter.
Equipment:

1. Jotdown notebook and ballpen.

2. Wrist watch with a swift second hand.
3. Strip of plaster or masking tape as marker or to be used as time strip if necessary.
Procedure

Action Rationale

1. Check the physician’s order. This ensures that the correct solution is being
given with the correct medication and
determines the exact time/period for
administration of the IV solution.

2. Check the patency of the IV line and Any interference with the patency of the IV
needle. line will influence the IV flow rate.

3. Assess the IVF site, drip rate, volume The drop factor of the equipment varies
infused and correct operation of the according to the manufacturer and will be
device at least every hour for adults and displayed on the outer package. Equipment
more frequently for children. labeled as micro drop or minidrop is standard
and delivers 60 mgtt/ml but macrodrop
delivery systems vary. Some of the more
common types of equipment according to
manufacturer are Travenol Macrodrop, 10
gtt/ml, Abbott Macrodrop, 15 gtt/ml, and
McGaw Macrodrop, 15gtt/ml.

4. Count the drops per minute in the drip Holding the watch next to the drip chamber
chamber. Hold the watch beside the allows the eyes to focus on drops and the
chamber. second hand on the watch to provide an
accurate count.

5. Adjust the IV clamp as needed and This regulates the flow rate into the drip
recount the drops per minute. chamber.
6. Monitor the IV flow rate at frequent This provides for observation of the IV
intervals and the patient’s response to infusion and the patient’s response.
the infusion.
7. Document the ff:
a.) type of IV infusion
b.) amount
c.) flow rate
d.) patient’s response
Sample Documentation:

Date Time Nurse’s Notes

4/28/2017 4:45 PM D5IMB 500 cc with ½ amp. Benutrex C

regulated at 30 mgtts/ min. Armboard applied to limit
movement of extremity. IVF continues to infuse at
above rate. No tenderness or swelling at site. No
dyspnea or shortness of breath noted. Voided once,
soaking wet his diaper.

Leny Rodrigo, St. N.

 SAN PEDRO COLLEGE
Davao City

PERFORMANCE CHECKLIST
REGULATING INTRAVENOUS FLUIDS

Name: __________________________________ Grade: ___________________

Year and Sec.: ____________________________ Date : ___________________

Legend: 5 – Excellent; 4 – Very good; 3 – Good; 2 – Fair; 1 – Poor

Rating
5 4 3 2 1
1. Checks the written medical order.
2. Identifies the drop factor on the IV tubing package.
3. Calculates correctly the rate of drops per minute.
4. Checks the patency of the IV line and needle.
5. Counts the number of drops flowing into the drip chamber
for 1 full minute.
6. Tightens or releases the roller clamp until the calculated
rate is infusing.
7. Monitors the IV flow rate at frequent intervals.
8. Documents the type of infusion, amount, flowrate and
patient’s response to the prescribed infusion rate.
9. Maintains body mechanics throughout the
performance of the procedure.
10. Manifests neatness in the performed procedure.
11. Receptive to criticisms.
12. Observes courtesy.
13. Shows calmness while performing the procedure.
14. Uses correct English.
15. Shows mastery of the procedure.
Remarks:

Criteria : I Knowledge (quiz) 30%

II Performance 70%
100%

________________________________ __________________________
Student’s Printed Name and Signature Date

________________________________ __________________________
Instructor’s Printed Name and Signature Date
 DISCONTINUING an INTRAVENOUS INFUSION

When the patient no longer needs IV fluids, IV medications or access for emergency drugs,
the cannula is removed. Standard precautions must be followed when removing an IV cannula
because there is almost always a slight amount of bleeding that occurs.

Indications:
1. The patient’s oral fluid intake and hydration status are satisfactory so that no further IV
solutions are ordered.
2. There is a problem with the infusion that cannot be fixed.
3. The medications administered by IV route are no longer required.
Equipment:
An IV tray containing the following:
1. Dry CB
2. Plaster to cover the site temporarily / Band aid.
3. CB soaked in 70% ROH
4. Working gloves
5. Empty box for receptacle
6. IVF ticket
Procedure
Action Rationale
1. Check the physician’s order for Prevents inadvertently discontinuing the IV
discontinuing IVF. and having to restart it.

2. Wash hands and assemble equipment.

3. Identify the patient and explain the

procedure.

4. Release anchorage of arm, tubing and Movement of the needle can injure the vein
needle. Loosen the tape at the and cause discomfort to the patient.
venipuncture site while holding the Countertraction prevents pulling the skin that
needle firmly and applying causes discomfort.
countertraction to the skin.
5. Don gloves and clamp the infusion Clamping the tubing will prevent the fluid
tubing. from flowing out of the needle on the patient
or bed.
6. Hold a swab above the venipuncture Pulling out in line with the vein prevents injury
site, withdraw the needle quickly by at the vein.
pulling it out along the line of the vein.
7. Immediately apply firm pressure to the Pressure helps stop the bleeding and prevents
site, using the swab for 2 – 3 minutes. hematoma formation.
8. Hold the patient’s arm or leg above the Raising the limb decreases blood flow to the
body if any bleeding persists. area.
9. Check the needle or catheter to make If a piece of needle or tubing remains in the
sure it is intact. Report a broken needle patient’s vein it could move centrally (toward
or catheter to the nurse in-charge the heart or lungs) and cause serious problems.
immediately. If the broken piece can be Application of a tourniquet decreases the
palpated, apply a tourniquet above the possibility of the piece moving until a
insertion site. physician is notified.

10. Apply the dry CB / Band aid to cover the

IV site. The dressing continues the pressure and covers
the open area in the skin, preventing infection.

11. Discard used supplies appropriately. This prevents the spread of microorganisms.
Remove gloves and wash hands.

12. Record the amount of fluid infused on This ensures accurate documentation of the
the I and O record sheet and on the chart patient’s response.
if necessary. Include the type of solution
used, time and reason for discontinuing
the infusion and the patient’s response.