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