1. Initiating and Discontinuing IV Infusion
NUR 304 1

2. Learning Objectives
At the end of the discussion and video presentation, the students will be able to:
Adhere to strict aseptic technique while performing the procedure.
State the purposes of IV infusion.
Describe essential steps when initiating a peripheral intravenous infusion.
Calculate flow rate correctly. 2

3. INTRODUCTION
Peripheral venous cannulation is when a plastic or metal tube is inserted for intravenous (IV) therapy, such as IV fluids and/or drugs or the transfusion of blood products.
Also for the administration of dyes and contrast media during clinical investigations. 3

4. INTRODUCTION
Device used is a peripheral venous catheter (PVC) commonly referred to as a cannula.
Selection of an Appropriate Cannula
PVC must never occlude a vein;
Critically ill and the situation is an emergency 4

5. Selection of an Appropriate Cannula
(hypovolemic shock), rule does not apply.
Hence, we insert a larger device to “push the fluids” into the patient’s system as quickly as possible for rapid treatment.
It should be replaced every 72 hours, but should be flushed, usually with 0.9% NaCl every hours 5

6. COLOR SIZE COMMON APPLICATIONS
Types of IV Cannula
COLOR SIZE COMMON APPLICATIONS
Orange - 14G – treaters or emergency for rapid
transfusion of blood or viscous
fluids.
Grey G – same as above 6

7. Types of IV Cannula White - 17G – blood transfusions, rapid
transfusion of large volumes
of viscous fluids.
Green G - blood transfusions, parenteral
nutrition, stem cell harvesting
and cell separation, large volume of fluids 7

8. Types of IV Cannula
Pink G – blood transfusions, large volume of fluids.
Blue G – blood transfusions, most medications and fluids. 8

9. Types of IV Cannula Yellow – 24G – medications, short term
infusions, fragile veins,
children
Purple - 26G – neonatal 9

10. Site chosen for venipuncture varies with the:
Venipuncture Sites
Site chosen for venipuncture varies with the:
Client’s age
Length of time the infusion is to run
Type of solution used, and the
Condition of the veins 10

11. Venipuncture Sites Adults: veins in the hand and arm are commonly used
Infants: veins in the scalp and dorsal foot veins are often used.
Metacarpal, basilic and cephalic veins are commonly used for intermittent or continuous infusions. 11

12. Venipuncture Sites
the ulna and radius act as natural splints at these sites, and the client has greater freedom of arm movements for activities such as eating.
Although basilic and median cubital veins in the antecubital space are convenient sites for venipuncture, they are usually used for 12

13. Venipuncture Sites
blood draws, bolus injections of medication, and insertion sites for a peripherally inserted central catheter line. 13

14. Venipuncture Sites

15. Practice Guidelines VEIN SELECTION
use distal veins of the arm first
use the client’s nondominant arm whenever possible
select a vein that is:
* easily palpated & feels soft & full
* naturally splinted by a bone 15

16. Practice Guidelines VEIN SELECTION
large enough to allow adequate circulation around the catheter.
avoid using veins that are in areas of flexion; highly visible, since they tend to roll away from the needle; damaged by previous use, phlebitis, infiltration or sclerosis; continually distended with blood, or knotted or tortous; 16

17. Practice Guidelines VEIN SELECTION
in a surgically compromised or injured extremity (e.g. following a mastectomy) because of possible impaired circulation and discomfort for the client. 17

18. INITIATING A PERIPHERAL INTRAVENOUS INFUSION
Purposes of IV Infusion:
1. Supply fluid when clients are unable to take in an adequate volume of fluids by mouth.
2. Provide salts and other electrolytes needed to maintain electrolyte balance.
3. Provide glucose (dextrose), the main fuel for 18

19. 4. Provide water-soluble vitamins and medications.
metabolism.
4. Provide water-soluble vitamins and medications.
5. Establish a lifeline for rapidly needed medications. 19

20. Vital signs (PR, RR & BP) for baseline data Skin turgor
Assessment:
Assess the following:
Vital signs (PR, RR & BP) for baseline data
Skin turgor
Allergy to latex (e.g. tourniquet), tape or iodine
Bleeding tendencies
Status of veins to determine puncture site 20

21. sterile parenteral solution IV pole adhesive or non-allergenic tape
Equipment:
infusion set
sterile parenteral solution
IV pole
adhesive or non-allergenic tape
clean gloves
tourniquet
antiseptic swabs 21

22. sterile gauze dressing or transparent occlusive dressing
IV catheter
sterile gauze dressing or transparent occlusive dressing
arm splint if required
towel or pad
antiseptic ointment (check agency policy)
electronic infusion device or pump if necessary 22

23. Preparatory Phase: 1. Prepare IV solution & administration set.
Utilize 10 Rights of medication administration
Check IV solution to make sure it is the correct
solution with the prescribed additives.
Check expiration date – IV solution bag
Check for discoloration or particulate matter 23

24. Initiating an IV Infusion
Place a time tape on the solution container with the prescribed infusion rate, time it begun, & time of completion.
Remove the administration set from its package, label the tubing with the date and time, & then close roller clamp.
Remove the protective cover from the IV solution port. 24

25. Initiating an IV Infusion
Remove the protective cover from the spike on the IV administration set, making sure the spike remains sterile. Position the spike into the port of the solution container. If the solution is in a glass bottle, clean 1st the rubber stopper with an alcohol swab, then insert the spike through the rubber stopper. 25

26. Initiating an IV Infusion
Make certain the tubing is clamped then hang the IV solution container on an IV pole. Adjust the pole so that the container is suspended about 1 m (3 ft.) above the client’s head. Rationale: This height is needed to enable gravity to 26

27. Initiating an IV Infusion
overcome venous pressure &
facilitate flow of the solution into
the vein.
Lightly compress the drip chamber & fill it halfway. If extension tubing is used, attach it to the end of the administration set. 27

28. Initiating an IV Infusion
Prime the tubing by opening the roller clamp & allow the fluid to slowly fill the tubing.
Rationale: The tubing is primed to prevent the introduction of air into the client. Air bubbles smaller than 0.5ml usually do not cause problems in the peripheral lines. 28

29. Initiating an IV Infusion
Inspect the tubing for air. If air bubbles remain in the tubing, flick it with the fingernail to mobilize the bubbles. Recap the end of the tube firmly. 29

30. Initiating an IV Infusion : Performance Phase
1. Locate the vein for inserting the IV catheter. Select a vein that is most distal on the hand or arm. Avoid using an arm or hand that has a dialysis graft or fistula or the affected arm of a mastectomy client. Rationale: Because of possible impaired circulation & discomfort for the client. 30

31. Initiating an IV Infusion : Performance Phase
2. Place a linen saver pad under the client’s arms. Rationale: to protect linens.
3. Place client’s arm in a dependent position & apply tourniquet 4 – 6 inches above the selected site. Explain that the tourniquet will feel tight. Rationale: The tourniquet must be tight enough to obstruct 31

32. Initiating an IV Infusion : Performance Phase
venous flow but not tight that it occludes arterial flow.
4. Palpate the radial pulse. If no pulse is present, loosen the tourniquet & reapply it with less tension. Rationale: Obstructing arterial flow inhibits venous filling. 32

33. Initiating an IV Infusion : Performance Phase
5. Palpate the vein & press it downward, making sure that it rebounds quickly. If vein is not adequately dilated, instruct client to open & close his fist, apply warm compress, lightly tap the vein or stroke the extremity from distal to proximal below the selected venous site. Rationale: Actions help fill the 33

34. Initiating an IV Infusion : Performance Phase
vein. Opening & closing fist helps by contracting the muscles which in turn, compress the distal veins, forcing blood along the veins and distending them.
6. After selecting the vein, gently release the tourniquet. 34

35. Initiating an IV Infusion : Performance Phase
7. If excessive hair is present at the venipuncture site, clip it. Rationale: Shaving is usually not recommended because of the potential for microabrasions which can increase the risk of infection.
8. Put on clean gloves. 35

36. Initiating an IV Infusion : Performance Phase
9. Choose the appropriate IV catheter based on the size of the vein & the solution to be used
10.Open the catheter package using aseptic technique.
11.Reapply the tourniquet & clean the site of insertion using an antiseptic swab that contains 2% tincture of iodine, alcohol or 36

37. Initiating an IV Infusion : Performance Phase
chlorhexidine. Avoid using chlorhexidine in infants under 2 months of age.
12. Clean the area using circular motion moving from the center and going outward for several inches. Rationale: This motion carries microorganisms away from the site of entry. 37

38. Initiating an IV Infusion : Performance Phase
13. Allow the antiseptic to dry on the skin.
14. Using the nondominant hand, stabilize the vein by stretching the skin, making sure not to contaminate the insertion site.
15. Inform client that you are about to insert the catheter & that, he may feel a little uncomfortable. 38

39. Initiating an IV Infusion : Performance Phase
16. Pick – up the catheter:
Wing-tipped (butterfly) catheter – Grasp the catheter by the wings using the thumb & forefinger of the dominant hand- bevel up. Remove protective cap from the needle.
Over-the-needle catheter: Grasp the catheter by the hub, using the thumb and 39

40. Initiating an IV Infusion : Performance Phase
forefinger of the dominant hand –bevel-up.
17. Hold the catheter at a degree angle then pierce the skin.
18. Lower the catheter so that it is parallel to the skin & advance the catheter into the vein. Watch for flashback of blood into the chamber of the catheter or the tubing of the winged catheter. 40

41. Initiating an IV Infusion : Performance Phase
19. Advance catheter.
Wing-tipped catheter: fully advance the catheter.
Over-the-needle catheter: advance the catheter to half its length. Withdraw the needle while advancing the catheter fully into the vein. 41

42. Initiating an IV Infusion : Performance Phase
20.While holding the catheter in place with one hand, release the tourniquet with the other hand.
21. Using aseptic technique, quickly connect the administration set adapter to the IV catheter. 42

43. Initiating an IV Infusion : Performance Phase
22. Still stabilizing the catheter, slowly open the roller clamp & allow the IV fluid to flush the catheter. Adjust the flow rate according to physician’s order.
23. Cover the insertion site with a sterile semipermeable transparent dressing. If the site isn’t clean & dry, clean the site with an 43

44. Initiating an IV Infusion : Performance Phase
antiseptic swab & allow it to dry before applying the dressing.
open the package containing the dressing. Using aseptic technique, remove the protective backing from the dressing making sure not to touch the sterile surface.
cover the insertion site & the hub or winged 44

45. Initiating an IV Infusion : Performance Phase
portion of the catheter with the dressing. Do not cover the tubing of the administration set.
Gently pinch the transparent dressing around the catheter hub to secure it.
Smooth the remainder of the dressing so that it adheres to the skin. 45

46. Initiating an IV Infusion : Performance Phase
24. Loop the administration tubing & place a piece of tape over the catheter tubing connection & loop section of the tubing.
25. Label the dressing with the date & time of insertion, catheter size & own initials.
26. If insertion site is near a joint, place armboard under the joint & secure with tape. 46

47. Discontinuing an IV Infusion : Performance Phase
Verify physicians order, identify patient and explain procedure.
Assist the client to a comfortable position.
Place a linen-saver pad under the extremity that contains the IV catheter.
Close the roller clamp on the administration set.
Carefully remove the IV dressing and tape that is securing the tubing.
Apply a sterile 2×2 gauze pad above the IV insertion site and gently remove the catheter, directing it straight along the vein. Do not press down on the gauze pad while removing the catheter.

48. Discontinuing an IV Infusion : Performance Phase
Immediately apply firm pressure with the gauze pad over the insertion site. Hold pressure for 2 to 3 minutes; longer if bleeding persists.
Remove the soiled 2×2 gauze pad and replaces it with a sterile 2×2 gauze pad. Secures it with a piece of 1-inch tape.
Dispose of the IV catheter in the appropriate sharps container.
Discard the IV tubing, linen-saver pad, IV solution container, and gloves in the appropriate trash container, according to agency policy.

49. IV Flow Rate Calculation
Formula:
Total Fluid in ml X IV set calibration
Total hours minutes
IV set calibration: Check the IV set package
Macroset- 20 macrodrops (gtts)/ ml
Microset (Secondary Inlet)- 60 microdrops (ugtts)/ml

50. Infusion set
Macroset

51. IV Flow Rate Calculation
Calculate for the flow rate: 1. Administer 1000 ml of D5 NSS for 8 hours. 2. Administer 200 ml/hr of D5W.