Unit 3 Lesson 4 Intravenous (IV) Fluid Administration

Paragraph 1 IV therapy is an advanced life support procedure. An intravenous (IV) line is inserted into a vein so that blood, fluids, or medications can be administered directly into the patient’s circulation. The bag of fluid that feeds the IV is usually a clear plastic bag that collapses as it empties.

Paragraph 1 The administration set is the clear plastic tubing that connects the fluid bag to the needle, or catheter (or cannula). There are three important parts to this tubing. The drip chamber, the flow regulator, and the drug or needle port.

Romero footnote* SHARPS container A container where ANYTHING that comes in contact with human bodily fluids is placed for destruction.

Paragraph 2 There are two types of drip chambers, the mini drip and the macro drip. The mini drip is used when a minimal flow of fluid is needed (with children for example). Sixty small drops of fluid into the mini drip chamber equal one cubic centimeter (cc) or one milliliter (ml) of fluid.

Paragraph 2 The macro drip is used when a higher flow of fluid is needed (for a trauma victim in shock) and only 10 to 15 drops equal one cc or one ml. The flow regulator is a roller clamp located below the drip chamber that can be pushed up or down to start, stop, or control the rate of flow. The drug or needle port is below the flow regulator and this is where medication or fluid is injected into the opening.

Romero footnote* “Piggy – backing” … injecting a drug or fluid into the needle port in order for the medication to mix with saline in in the bag and to flow into the vein through the IV catheter.

Romero footnote two* Bolus “push” … Forcing lots of fluid or medication into the patient in a short period of time.

Paragraph 3 Before administering any fluids or medications it is vital that the following safety measures be taken by following the 5 rights: right drug, right dose, right patient, right route, and right time. Failure to follow these safety considerations can result in a fatal error!

Paragraph 3 Clarify any order that is incomplete, contains abbreviations, is confusing or hard to read, or raises a question. Do not ever borrow medications from other patients or begin new medications before an order has been received by the physician or pharmacy (unless it is an emergency ER/paramedic drug therapy situation). And always have a colleague double check the right drug and dosage before administering the drug to the patient (the buddy system).

Paragraph 4 The general procedure for starting an IV is as follows: Practice BSI protocol by always wearing rubber gloves. Explain the procedure and reassure the patient. Answer any questions the patient may have.

Paragraph 4 Gather the IV bag (with primed tubing to eliminate air bubbles), SHARPS container, needle/catheter, tape, tourniquet, and antiseptic swabs. Place equipment within easy reach. Apply the tourniquet proximal and superior to the intended insertion site. Either mid forearm or above the elbow.

Paragraph 4 Palpate the insertion site with the fingertips in order to locate a vein (the insertion site is venous because that is the fastest route to the heart and therefore to the rest of the systemic circulation). To further enhance dilation, gently tap the area of insertion or apply heat. The patient can also make a few fists or dangle the arm below the heart (the vein should feel firm, elastic, engorged, and round).

Paragraph 4 Cleanse the site with an antiseptic swab in a circular motion, moving outward from the intended site of insertion. Avoid touching the site once it has been prepared. Apply skin traction in the direction opposite of the direction of the catheter and position the needle (bevel side up) at an angle of 15˚ to 35˚.

Romero footnote* Bevel = hole at the top of the needle (you can see the sharp end better)

Paragraph 4 Insert the needle into the vein and observe for flashback of blood into the flash chamber. Lower the catheter almost parallel to the skin, and insert the needle 1-2 mm more to ensure that the catheter has also entered the vein. Advance the catheter into the vein while maintaining skin traction.

15 to 35 degree angle!

Romero footnote* Skin traction = “Z – track method” …. Pilling on the skin (toward you) in order to stagger the skin layers to make a “natural” bandage.

Z-track method

Blood in the flash chamber

Seating the needle in the vein

Paragraph 4 Release the tourniquet while applying pressure just above the end of the catheter. While maintaining pressure above the catheter, remove the needle and discard it into an approved SHARPS container.

Removing the needle

Removing the needle

Paragraph 4 Connect the IV tubing, open the flow regulator, and observe for the free flow of IV fluid. Secure the catheter to the insertion site by applying a sterile adhesive dressing or a sterile 2X2 dressing with surgical tape.

Paragraph 5 Many sites can be used for IV therapy. Because they are relatively safe and easy to enter, arm veins are most commonly used. Dorsal metacarpal, cephalic, basilic, and the medial cubital veins are most commonly used. More distal sites should be used first, with the proximal sites used subsequently.

Paragraph 5 Leg veins should rarely be used, if ever, because of the high risk of thromboembolism. IV infusions must be monitored frequently to make sure that the fluid is flowing at the intended rate. The IV container should be marked with tape to indicate at a glance whether the correct amount is infused.

Paragraph 5 The flow rate is calculated when the solution is started, then monitored hourly. Maintaining an IV is a responsibility that demands knowledge of the solutions being administered and the principles of flow. In addition patients must be assessed carefully for both local and systemic complications.

Romero footnote* IO = intraosseous injections Placement of a catheter in the bone marrow when a vein cannot be perforated or when rapid fluid therapy is required

Sternal IO

Easy IO

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Romero footnote* Sternal IO = intraosseous injection into the sternum Easy IO = intraosseous injection into the tibia with a drill or hand puncture in the case of an infant