1. Common Venipuncture Sites Dose Calculators Insertion of Peripheral IV Catheter Insertion of a Central Line Catheter Methods of IV Medication Administrations Six “Rights” for the administration of IV medications Classification of Fluid Replacement Common IV Solutions: Indications, Precautions, and Incompatibilities IV Delivery Methods – Advantages and Disadvantages Solution Compatibility Chart

2. Common Venipuncture Sites Cephalic Vein – thumb side Basilic Vein - little finger side Median Cubital vein – connects cephalic and basilic Medial vein of forearm – center of the forearm Radial vein – wrist area, thumb side Superficial dorsal veins Dorsal venous arch

3. Sites of IV Insertions

4. Dosage Calculators 1. Dose ordered/Dose on hand = Amount to administer 2. IV Dose Rate Calculation Dose Ordered/Solution Concentration = Volume/hour e.g. 50 mg/hr/2 mg/ml = 25 ml/hr 3. Calculation for gtts/minute # ml ordered/# hr x 60 min X # gtts/ml = # gtts/min e.g. D5W 1000 ml in 8 hours, drip factor of tubing is 15 gtts/ml. 1000 ml/8 hr x 60 minutes/hr x 15 gtts/ml = 31 gtts/min

5. Generalizations you can Make For 10 gtts /ml tubin g Rate = 1/6 (# ml/hr) e.g. For 125 ml/hr, 1/6 (125 ml/hr) = 21 gtts/min For 15 gtts/ml tubing Rate = ¼ (#ml/hr) e.g. For 125 ml/hr, ¼ (125 ml/hr) = 31 gtts/min For 20 gtts/ml tubing Rate = 1/3 ( #ml/hr) e.g. For 125 ml/hr, 1/3 (125 ml/hr) = 42 gtts/min For 60 gtts/ml tubing, Rate = (#ml/hr) e.g. For 125 ml/hr, (125 ml/hr) = 125 gtts/min

6. Tubing/Pumps Usage - Primary - Secondary Drip Factor - Macro 10, 15, 20 - Micro 60 Infusion Ports - w/ backcheck valve - w/o backcheck valve Extension Tubings Filters Flow Regulator(ml/hr) Infusion pumps ( ml/hr)

7. Types of Catheters Peripheral - Winged ( butterfly), Heparin Lock, Over-the Needle angiocath Central Catheters Short term: - single lumen ( only one sol’n) - Multi lumen ( allows for more than one sol’n at a time without regard for compatibility. - CVP (Central Venous Pressure Cath) used only to measure C/V fluid status. Long term; Hickman (single lumen), Broviac (similar to Hickman) and Groshong (single or double lumen) catheters Hickman/broviac (combined cath) Long Line cath ( PICC)

8. Things to Know ( Central Catheters) Important to verify placement by X-rays. Apply and maintain occlusive dressing (follow- protocol) Change dressing, sol’n, tubings per protocol. Instructing pt. to do valsalva maneuver when changing tubings, lessens a chance for air embolism. Flush catheter(s): all ports need to be flushed, unless being used continuously. Flushing solution: heparin solution (10 u – 1000u/ml) Saline Solution

9. 6 Rights of IV Medication Administration Right Patient Right Dose Right Route Right Time Right Attitude/Documentation. Advantages: 1. No absorption problems, drug go directly into pt. circulation, reaching therapeutic levels rapidly. 2. Accurate titration can be achieved by adjusting the concentration and administration rate. 3. Generally less discomfort. Disadvantages: 1. Incompatibility 2. IV soln containing divalent cations has a > incidence of incompatibility. 3. Loss of potency of drug can occur.- Binding, Alteration, Chemical change

10. Common IV Problems Infiltration Phlebitis Clot Formation Infections Prevention of Complications 1. Change Parenteral fluids, tubes per policy (48-72 hours) 2. Change peripheral and central sets q 48 hours ( hospitals now change central sets 72 hours). Check protocols. 3. Change dressing q 48 hours ( central lines are change dressing q weekly). 4. Label dressings 5. Rotate sites q 72 hours.

11. Reconstituting Powder IVs are generally prepared by the pharmacy - diluent - Asepsis - Mix thoroughly - label – date time, concentration, and the person who prepared the sol’n. Adding drug to IV bottles/bags; - Consider the amount of the solution in the bag before adding the med. - Check the label of the container/solution ( mix-o-vial). Hanging IV solution - Take out the sol’n out of refrigerator 1 hour before administration. - Check meds for meds expiration date/time. - Check for cloudiness, sediments, color change