IV Priming

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IV Priming

• Chapter 27 (Perry Potter)

2
IV Priming

• Why do clients need an IV?
• Replacing fluids
• Correct or prevent nutritional imbalances
• Provide IV medication therapy

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Nursing Responsibilities

1. Know the correct solution equipment needed
   how to initiate the infusion
2. Regulate the infusion (with or without a pump)
3. Care for an maintain the system
4. Indentify and correct problems
5. Discontinue the infusion

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Categories of IV solutions

• Isotonic
• Hypotonic
• Hypertonic
• Determined by serum electrolyte values and
• fluid volume balance
• RN must understand the rationale for IV fluid
  administration and the type of solution ordered

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Establish IV Access

• IV catheter can remain in place for 96 hrs (check
  hospital policy, most are 72 hours), IV solution
  replaced every 24 hours
• Palpate insertion site daily and prior to
  initiating infusion
• Inspect site if client c/o pain at site or
  developed SS of infection
• Change transparent dressing if becomes damp,
  soiled, loose
• Clean injection port with antiseptic before
  accessing system

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Supplies

• Administration set (IV lines)
• Correct IV solution
• Antiseptic swabs
• Tape
• IV pole, rolling or ceiling mounted
• Hospital gown with snaps
• 1-3 ml normal saline, 3 ml syringe (or
  larger)pre-filled n/s syringes may be available,
  to flush IV catheter prior to initiating infusion

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Nursing Diagnosis

• Risk for imbalanced fluid volume
• Deficient fluid volume
• Excess fluid volume
• Risk for infection

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Assessment

• Review physicians order (type, amount and/or
  rate)
• 6 medication rights (medication, dose, client,
  route, time, documentation)
• Physical assessment pertaining to IV fluid
  administration
• Understand rationale and purpose of IV fluid,
  potential incompatibilities, and potential side
  effects

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Implementation

• Change gown
• Prepare tubing and solution
• Check solution (6 rights)
• Color
• Clarity
• Expiration date
• Leaks

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• Open infusion set (maintaining sterility of each
  end)
• Place roller clamp 2-5 cm below drip chamber and
  move to OFF position
• Remove sheath over port on IV solution bag
• Remove tubing spike (DO NOT TOUCH)
• Insert spike into IV bag

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• Priming
• Compress drip chamber, fill 1/3 to ½
• Remove cap on end of tubing, KEEP and maintain
  sterility
• Slowing open roller clamp and prime tubing with
  fluid, return roller clamp to OFF position
• Inspect for air bubbles, tap tubing where bubbles
  are visible, and invert ports and tap to fill and
  remove air
• Replace cap from end of tubing
• Label tubing and bag with date and time

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• Prepare n/s (1-3 ml) to flush intermittent
  infusion device (saline lock, PIID, clave) (p.
  749 establish IV access, pictureA)
• Saline lock is attached to end of IV catheter
  which is then
• attached to the primary line
• Has a port or stopper (needleless)
• Must be irrigated q8-12 h, and before after
  each drug infusion (hospital policy)
• Saline or heparinized saline (hospital policy)
• Sterile technique

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Regulating IV Flow Rate(Gravity)

• Flow rate established using pump (ml/hr) or
  gravity (gtt/min)
• If line patent and IV infusion initiated, flow
  rate must be established
• Educate client regarding positioning
• Inspect site often

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• What is the drop factor number of drops per ml
  (gtt/ml) IV tubing provides
• Microdrip 60 gtt/ml
• Macrodrip Abbott 15 gtt/ml
• Travenol 10 gtt/ml
• McGaw 15 gtt/ml

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• Calculating drip rate
• ml/hr x gtt/ml drops/min
• 60 min

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• If ml/hr unknown
• ml/hr total infusion (ml)
• hours of infusion

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• Remember if infusion is not exactly 1 hour
• (15 min, 30 min, 120 min, etc) you must
  calculate
• hourly rate.
• 50 ml x ? 200 ml
• 15 min 60 min hr

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• Example
• Order D5W _at_ 75 ml/hr
• Drop factor 15 gtt/ml
• Calculate drip rate ? gtt/min
• Answer 75 ml/hr x 15 gtt/ml 18.75 gtt/min
• 60 minutes
  (18-19 gtt/min)

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• Example
• Order Give 1 L Ringers Lactate over 4 hours
• Drop factor 15 gtt/ml
• Calculate drip rate ? gtt/min
• Answer 1000 ml x ?
  250 ml
• 240 min 60 min
  hr
• 250 ml/hr x 15 gtt/ml
  62.5 gtt/min
• 60 minutes
  (62- 63 gtt/min)

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Establishing Drip Rate

• Count drops in drip chamber for 1 minute (with
  second hand), adjust roller clamp as needed (2-5
  cm below drip chamber)
• If very fast or very slow, count for 30 sec (x 2)
  and adjust roller clamp. Count for 1 full minute
  once clamp is adjusted .

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Evaluation

• Monitor infusion at least q1h (note volume, rate)
• Assess for SS of overhydration or dehydration,
  response, lab values
• Assess SS of infiltration, inflammation, clot in
  catheter, kink or knot in tubing etc

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Recording and Reporting

• Rate of infusion, gtt/min, and ml/hr in nursing
  notes or IV fluid form
• Document any ordered changes in IV fluid rates
• Report rate, solution, volume remaining to the
  nurse assuming care of client at break or change
  of shift

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• Practice Priming

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IV MedicationSecondary Lines

• Chapter 21 (Perry Potter)

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Piggyback (p. 737)

• A small IV bag connected to short tubing
• that is connected to the upper Y port of a
• primary infusion line. The small bag is set
• higher than the primary infusion bag. Upon
• completion of the secondary solution when
• the solution in the tubing falls below the
• primary drip chamber the primary solution
• begins again.

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IV Medication Secondary line (piggyback)

• Prepare medications 6 rights and 3 checks
• Medical history allergies
• Review medication indication

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• Drugs prescribed 1 to 6 times per day, dissolved
  in small volumes of IV fluid
• Usual infusion time 30 to 60 minutes
• Check compatibility of drug to solution

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• When mixing powders for injections, remember
• Check the type of fluid recommended to dissolve
  the powder
• The amount of fluid to add
• The strength of the solution made (mg/ml)
• Further dilution for infusion
• Infusion time

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Where to find information regarding
reconstitution of the powder

• The label of the vial
• Package insert inside the vial package
• Nursing Drug book
• Compendium of Pharmaceuticals and Specialties (
  CPS)
• Parenteral drug manual

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Medication Calculation

• Example
• Order Drug 0.65 g QID IV
• Label directions Add 2.5 ml water for
  injection. Provides approx volume of 3 ml
  (325mg/ml)
• Note the manufacturer gives the strength of the
  solution
• Desire 0.65g
• Have 325 mg/ml
• Stock in every ml

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Desire 0.65 g Have 325 mg/ml Stock in every ml
Convert 0.65g to mg 1g 1000 mg (
therefore answer should be bigger) 1000mg
Three zeros Therefore move decimal point three
spaces to the right 0.65 g 650 mg
Desire X Stock Amount Have
650 mg X 1ml 2mL 325 mg
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Calculation of Drip Rate

• Example
• Order Flagyl 500mg/100 ml normal saline IV BID
• (administered over 1 hour)
• Drop factor 15 gtt/ml
• Calculate drip rate ? gtt/min
• Answer 100 ml x ?
  100 ml
• 60 min 60 min
  hr
• 100 ml/hr x 15 gtt/ml
  25 gtt/min
• 60 minutes
  

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• When calculating IV rates, if the medication
  volume exceeds 5 10 ml, add this into
  calculations
• Example
• Amount 100 ml NS plus 8 ml penicillin108 ml
• Duration Give over 30 minutes
• Calculate rate ? ml/hr
• Answer 108 ml x
  ? 216 ml
• 30 min 60 min
  hr

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Lets Practice (vial containing a powder) p.706

• Reconstitution of medication
• Adding to secondary bag
• Attaching secondary line to primary line
• Regulating rate

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• Follow 6 rights and 3 checks
• Wash hands
• Gather supplies
• Medication, secondary line,10 ml syringe, 18-22
  gauge needle (filtered if indicated), alcohol
  swabs, dilutant (saline or sterile water), mini
  bag (medication bag), medication label, MAR

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Order

• Ampicillin 500 mg IV, q6h
• See vial for directions to have 500 mg/ml add
  5.6 ml dilutant
• IV drug manual indicates add to 50 - 100 ml
  normal saline and infuse over 60 minutes
• How many ml of medication will you add to your
  minibag?
• What is the rate (ml/hr)?
• What is the drip rate with drop factor of 15
  gtt/min?
• Answers 50 ml X ? 50 ml
  gtt/min 50 ml/hr X 15 gtt/min 12.5 gtt/min
• 60 min 60 min hr
  60 min
  (12-13)
• 100 ml X ? 100 ml
  gtt/min 100 ml/hr X 15 gtt/min 25
  gtt/min
• 60 min 60 min hr
  60 min
  

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Preparation

• Remove cap covering medication and dilutant (6
  rights, 3 checks), swab both rubber seals with
  alcohol swab and allow to dry
• Attach needle (or needleless device) to syringe,
  pull back on plunger drawing the equivalent
  amount of air (i.e. 5.6 ml) as solution and
  inject into solution (hold plunger firmly, vial
  on flat surface)
• Invert vial and allow pressure from the vial to
  fill syringe with solution (5.6 ml), pull back
  gently if required. Keep tip of needle in fluid.
  Place vial on flat surface to remove needle
• Inject dilutant into medication vial, remove
  needle and recap (scoop technique)

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• Roll in palms (DO NOT SHAKE)
• Wait until medication is clear, swab medication
  bottle again, and withdrawal desired amount
  (follow same steps as withdrawing dilutant
  (inject equal volume of air (i.e.1 ml) as
  medication to be removed)
• Add medication to secondary bag, wipe port with
  alcohol swab, lay medication bag on flat surface,
  insert needle and inject. Discard needle (no need
  to recap)
• Mix medication turning gently end to end
• Complete medication label (apply to back of
  medication bag)
• Spike bag with secondary IV tubing, ensure clamp
  is CLOSED

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• Clean port of main line and connect secondary
  tubing to medication bag, squeeze and fill drip
  chamber.
• Back prime drop medication bag below level of
  primary drip chamber, open secondary line roller
  clamp, prime line, hang medication bag above
  primary fluid bag (use hook to lower main bag)
• Regulate flow by adjusting regulator clamp or
  using IV pump
• Observe for SS of reaction
• Assess IV site frequently

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Order

• Ampicillin 500 mg IV, q6h
• See vial for directions 500 mg/ml add 5.6 ml
  solution
• IV drug manual indicates add to 50 - 100 ml
  normal saline and infuse over 60 minutes
• Answers 50 ml X ? 50 ml
  gtt/min 50 ml/hr X 15 gtt/min 12.5 gtt/min
• 60 min 60 min hr
  60 min
  (12-13)
• 100 ml X ? 100 ml
  gtt/min 100 ml/hr X 15 gtt/min 25
  gtt/min
• 60 min 60 min hr
  60 min
  

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Next Lab

• Subcutaneous Injection Insulin
• Chapter 21