SUBJECT: INTRAVENOUS SOLUTIONS AND ADMIXTURE I.V.SOLUTIONS

Transcription

1 COALINGA STATE HOSPITAL NURSING POLICY AND PROCEDURE MANUAL SECTION - Medications POLICY NUMBER: 519 Effective Date: August 31, 2006 SUBJECT: INTRAVENOUS SOLUTIONS AND ADMIXTURE I.V.SOLUTIONS 1. DEFINITION: Intravenous infusion is the introduction of fluid/electrolytes and/or medication directly into a vein. It is used to hydrate tissue, give nourishment, restore blood volume, or administer medication. 2. POLICY AND GENERAL INSTRUCTIONS: Only Registered Nurses who have a current Coalinga State Hospital approved I.V. Certification of Proficiency are authorized to perform "Intravenous Procedures". Upon a physician's written order a specially trained Coalinga State Hospital Certified Registered Nurse may start any I.V. except blood or blood products from the blood bank. 3. EQUIPMENT: A. Intravenous solution G. I.V. standard B. Intravenous tubing H. iodine swab C. I.V. needle or over-the needle catheter D. Tourniquet J. I. V. label E. Arm board K. Gloves F. Tape and gauze I. Antibacterial ointment as ordered by physician 4. PREPARATION OF EQUIPMENT AND INDIVIDUAL NURSING ACTION RATIONALE - PRECAUTIONS A. Check the physician's order. A. To determine what will be given and the rate of flow. -1-

2 B. Perform hand hygiene. B. Good medical asepsis will help prevent contamination during I.V. procedure. C. Assemble equipment. C. Organization helps to expedite the procedure. D. Check the label and clarity of the solution. D. To ensure that the correct solution is used and to avoid introduction of contaminated material into the body. E. Remove cap or plastic sheath cover from plastic I.V. bags. F. Pharmacy will add medication to Intravenous Solution bottles (Admixture) and label bottle with name of medication amount, and expiration date. G. Listen for vacuum sound when removing rubber seal; attach tubing to bottle. H. Attach Butterfly Needle to end of tubing (if Butterfly Needle is to be used instead of over-the-needle catheter. I. Run solution through tubing to clear air. Clamp tubing. J. Take equipment to bedside. Identify the Individual by checking his picture or rand card. K. Explain venipuncture procedure and the purpose of the I.V. to the Individual. L. Help the Individual to a comfortable position with the arm well supported. Find a comfortable position for yourself where you will have good access to the arm. F. To identify contents of Admixture Solution G. A vacuum sound is heard when the rubber seal is removed from a sterile bottle unless the seal has been perforated by adding medication. I. To prevent forming air emboli in Individual, when I.V. is started. J. To ensure that the I.V. is given to the intended Individual. K. To relieve anxiety and elicit cooperation by increasing his confidence in you. 5. NURSING CARE DURING INTRAVENOUS ADMINISTRATION: NURSING ACTION A. Explain function and process of Intravenous Administration. RATIONALE - PRECAUTIONS A. To allay fears/anxiety and elicit Individual cooperation. -2-

3 B. After I.V. is started, adjust rate of flow as ordered by physician. Label bottle for time, date started and flow rate. C. Check I.V. site frequently, observe connection between needle and tubing for back up blood. D. I.V. site care. The I.V. site must be covered with a sterile dressing or a transparent covering such as op-site designed for this purpose. I.V. site should be changed every 72 hours. E. Observe Individual for possible side effects from any medications added. F. Change I.V. bottle and tubing every 24 hours. Label tubing and bottle with start and DC date. B. To maintain proper hydration and avoid over-loading the circulatory system. C. To look for infiltration, edema, pain, redness, infection and blockage of flow, or first stage phlebitis. Back flow of venous blood in connector when I.V. bottle is lowered indicates needle is patent. E. Adverse medication reaction may occur. F. To reduce risk of on site bacterial growth in I.V. equipment with concomitant infection to Individual. 6. DISCONTINUING OF I.V: NURSING ACTION RATIONALE - PRECAUTIONS A. Check physician's orders. A. To ensure that the I.V. is being discontinued on the proper date and time. B. Perform hand hygiene and put on B. Standard Universal Precautions gloves. C. To discontinue I.V, close the tubing C. To stop fluid being administered. clamp. D. Carefully remove the I.V. site tape and dressing. E. Remove I.V. device and apply pressure until bleeding stops, then apply band-aid or dressing. F. Empty solution from I.V. container and discard empty bottle and I.V. tubing in the contaminated trash container. G. Discard contaminated I.V. needle or intracath in specially marked needle puncture resistant container from Central Supply. F. This equipment is considered contraband. G. Dirty needle can be potential source of disease and possible injury to others. -3-

4 H. Remove gloves, wash hands. 7. ADMINISTRATION OF ADMIXTURE I.V. SOLUTION It is be the policy Coalinga State Hospital that all admixture I.V. solutions will be prepared and labeled as outlined in the Pharmacy Formulary and Policy Manual Admixture labeling will record the type and dosage of medicine added, as well as the expiration date of the admixture. 8. EQUIPMENT A. Primary I.V. solution/tubing set/extension hook or I.V. controller B. Piggyback additive I.V. solution with secondary transfer tubing set C. Antimicrobial preparation of povidone-iodine D. Alcohol sponges 9. PROCEDURE Piggyback medications are administered through an established I.V. line via a secondary (piggyback) container. All I.V. procedures are performed by Coalinga State Hospital I.V. Certified Registered Nurses only upon direct order of the physician. NURSING ACTION RATIONALE-PRECAUTIONS A. Check physician's orders. A. To ensure that the Individual receives the proper type and dose of admixture solution. B. Perform hand hygiene. B. Hand hygiene helps to prevent cross contamination. C. Look at admixture solution holding it to C. To avoid use of contaminated solution. a light, for clarity, integrity of container. D. Before administering the admixture solution, the R.N. must have a thorough knowledge of the admixture medication, its action dosage, and possible adverse side effects. D. To be able to adequately assess the beneficial effects or adverse side effects the Individual may manifest. Caution: Be sure medication is compatible with fluid being administered; when in doubt, the Registered Nurse is required to contact the Pharmacist (on call if after hours) for clearance on compatibility of the admixture solution to be infused with the primary I.V. solution being administered. -4-

5 Note: During a life-threatening emergency the physician may administer or confirm the compatibility of the I.V. drug or admixture solution with the primary I.V. solution. E. Lower the primary solution bottle. This is accomplished by placing an extension hook between the bottle and the primary I.V. standard. This effectively lowers the primary I.V. solution bottle to a lower level than the piggyback I.V. solution. F. In setting up the I.V. an aseptic technique is required. E. Gravity will allow the piggyback solution to flow into the Individual, temporarily preempting the flow of the primary I.V. solution, until the piggyback solution is infused. F. To prevent contamination. G. Remove the I.V. bag outlet cover. G. Be alert that cover was tight fitting and utilize aseptic technique. H. Close tubing clamp on the secondary transfer set. I. Squeeze the drip chamber and utilizing aseptic technique insert the spike into the I.V. bottle outlet. J. Invert secondary bottle and hang on I.V. standard. Squeeze and release drip chamber until chamber is half full of solution. K. Clear air from the secondary tubing by opening clamp and running solution through the tubing to eliminate air bubbles. Clamp tubing. Replace sterile protector. L. Cleanse uppermost injection site of primary I.V. tubing with antimicrobial preparation of povidone-iodine. Followed by cleansing with an alcohol sponge. M. Attach needless connector to site of primary I.V. solution tubing at uppermost injection port. Then connect secondary tubing to needless connector. N. Open the secondary tubing clamp full and adjust the flow of the piggyback additive solution with the lower clamp of the primary I.V. tubing. (Caution: flow must not be controlled by clamp on the secondary set). H. This prevents fluid from flowing before proper connections are made. I. Use firm steady pressure to avoid slipping and contaminating equipment. J. This prevents air from collecting in tubing. K. To prevent air emboli from entering the Individual. L. To provide a contaminate free injection site. M. Solution from the primary container will run into the piggyback tubing (clearing out any remaining air), when the secondary tubing clamp is opened. N. When the flow is properly adjusted by the lower clamp of primary I.V. tubing, the flow from the additive bottle will proceed until the bottle is exhausted; then the primary solution will automatically reinstitute flow. -5-

6 O. To Note: When the piggyback container empties, you can administer the residual medication in the tubing just above the upper injection port until the fluid level reaches the needle at the upper injection port. When you release the pressure on the tubing, solution from the primary container may move into the piggyback tubing, but the back-check valve will prevent it from entering the piggyback bottle. P. Label the piggyback's infusion tubing with the time and date. Q. If you will need to hang a secondary piggyback bottle, close the roller clamp on the primary set and lower the empty bottle below the drip chamber on the primary set. Open the slide clamp on the piggyback tubing and allow the primary solution to fill the piggyback tubing. Close the slide clamp on the piggyback tubing, remove the spike from the empty container, and aseptically insert it into the newly prepared piggyback container. Hang it on the I.V. pole, open the slide clamp, and adjust the flow rate with the roller clamp on the primary set. R. Attaching a piggyback solution to an I.V. controller with a primary solution: 1.) Spike secondary I.V. solution bag and hang on second hook on I.V. pole. 2.) Fill drip chamber half full and prime tubing. 3.) Pause controller and clamp primary tubing. 4.) Insert from secondary tubing into primary I.V. tubing at the uppermost injection site. 5.) Remove drip sensor from primary chamber and place on secondary drip chamber. 6.) Set controller at prescribed rate and -6- O. This ensures Individual is receiving the dosage ordered. P. Change I.V. tubing every 24 hours to prevent infection. Q. Refilling the secondary tubing in this manner prevents having to repuncture injection site and thus avoid possible introduction of contaminants at the injection site.

7 press start. 7.) Observe drip chamber to determine if flow has begun. 8.) When piggyback container empties, alarm will sound. Pause controller and close clamp on secondary tubing. Place drip sensor back on primary chamber, set controller to prescribed rate for primary solution and press start. S. Observe for Individual's physiological and psychological reaction to administration of the admixture. Monitor vital signs as indicated. S. To determine the beneficial or adverse side effects the Individual is experiencing. 9. RECORDING/DOCUMENTATION OF I.V. THERAPY: A. I.D. Note: 1. Indicate problem number, date and time and the I.V. site. Record the I.V. device used, device size, rate of infusion, name of solution and amount. Record any type and amount of medication given to the Individual and how medicine was given (i.e. Piggyback or I.V. bottle). 2. If starting an I.V., record the amount and location of unsuccessful attempts to place the I.V. device. 3. Record pertinent observation about the I.V. site (edema, pain, redness, signs of infection) or signs of phlebitis. Record I.V. site care, tubing, bottle and I.V. device changes, as well as the Individual's reaction to the procedure. B. Medication Record: 1. Record the time administered, type and dosage of medication given I.V. C. Intake and Output Flowsheet Record the time I.V. started and discontinued, type and amount of solution, and type and dosage of medication added. At change of shift, record the amount of solution left in the bottle. All totals from the I&O worksheet should be placed on the Intake and Output Flowsheet at the end of each shift. -7-