training intravenous therapy
TRANSCRIPT
INTRAVENOUS THERAPY Training
Definition
Is the insertion of a needle or cannula into a vein based on a doctor’s written order
The needle is attached to a sterile tubing and fluid container to provide fluids and medications
Objective of this training
Serve as a guide (safety & quality)
Apply principles of IVT
Know the ethico-legal side
We are NOT ANSAP accredited
We are doing this training toRe-fresh what you have learned in school
To augment your present knowledge
To reinforce your present skill
To lower risk and elevate quality of our patient care
Why in-house training?
When do we start IVT
INDICATIONSMaintain hydration
Correct dehydration
Provide parenteral nutrition
Administration of drug
Transfusion of blood/component
Contraindications to peripheral IVT
Highly irritating drugs →IV burnConcentrated NaCl
KCl (Cardiac Arrest)
Before starting IVT
Doctor’s orderPatient’s name
Type of solution, amount
Flow rate
Name of drug, dose, frequency
Drug-Incorporated? Pushed?
Procedures that will be done ie for VP shunting? Avoid head!
Before starting IVT
Assess PatientStatus of the patient, stroke patient?
Diagnosis, stable? Shock?
Age, very old and very young
Dominant arm-left handed?
Condition of the skin
Size of the cannula
Duration of therapy
Before Starting IVT
Check what you will useCheck for expiration date
Check for breaks
in packaging
Insects, dust, sediments
Anything that spells “unclean”
Check label against MD’s written order
Make a label for any additive, date, time, dose, amount
Check function of infusion pump if any
MEDICATIONS
10 Golden Rules
right drug right patient
right dose right route
right education right time
right documentation
right evaluation- drug-drug interaction
right assessment-patient history, allergy
right to refuse
Initiation of IVT
Starts with the doctor’s order
Choice of Cannula
Would depend on thepurpose of infusion-fast hydration?type of infusion-BT?size and condition of vein-babiesduration of treatment-prolongedcondition of patient- in shock?
Selection of Site
Patient’s condition – stroke avoid the weak side
Patient’s age – babies scalp
Size and condition of the vein- avoid lower extremities among bed ridden patients (DVT-pulmonary embolism)
Anchoring of Cannula & Tubing
Allow normal blood flow
Prevent movement of cannula
Transparent for easy monitoring of cannula
When to remove the cannula
Cannula should be changed after 48-72 hours or earlier as needed
Administration of Drugs, Blood, Chemotx, TPN
Explain! Before giving!
Informed consent
Possible side effects
Indication and benefits
Check the IV Solution
Inspect IV FLUIDS
check for sediment, turbidity, discoloration, leaks, cracks, damaged caps, expiration date
Correct DocumentationLegally correct- indicate the size, type, length of the cannula; NOD who inserted, Date andTime insertedLabel the IV FLUID- type of fluid, medication added, use of pump, duration of therapy, NODs signatureChart-location and condition
of the site, complications and NOD’s intervention, education, signature
Infection Control
Infection at the site is usually caused by break in aseptic technique
Wash hands before handling any equipment and before starting IVT
Use 70% Alcohol to clean the skin
Cut hair, DON’T shave
Don’t re-use cannula!
Complications
Infiltration
Thrombophlebitis
Overload
Air-embolism
Catheter embolism
Systemic infection
Allergy
Problems during the Procedure
Fluctuating RateRunaway IVSluggish IVLoose connectionBlood back upObstructionClogged FilterBreak in asepsisLeaks
Staff Risks
Exposure to infectious organism
Needlestick injury
Chemical Exposure
Quality Assurance Standards
Deliver safe and quality IV Therapy
Protect Patient and Nurse
Protect IVT Nurses’ Practice
Venipuncture Audit
To ensure QUALITY IVT, we must do a continuous AUDIT
1. Verify Doctor’s order
2. Check Lab Results
3. Check Allergy and drug history
4. Compute rate
5. Established rapport with patient
6. Patient Identification
Venipuncture Audit
7. Patient education8. Hand Hygiene9. Set up needs10. Choose appropriate vein, size, cond11. Apply torniquet, check radial pulse12. Disinfects site13. Perform venipuncture14. Attach Venoset15. Anchor needle/ Venoset
Venipuncture Audit
16. Label venipuncture with date, gauge, length, NODs initials
17. Regulates flow
18. Correctly label IVF-patient’s name, additive, rate, bottle sequence, due date/time
19. Untoward reactions
20. Check height of stand 3-4 feet
Venipuncture Audit
21. Dispose Materials correctly
22. Standard Precautions
23. Record in the chart
Practicum1. Verify prescription and make IV
label
2. Observe 10 rights
3. Patient education
4. Asses vein
5. Hand hygiene
6. Prepare IV tray, IVF, Venoset, cannula, alcohol, cottonball, plaster, torniquet, gloves, splint, stand, 2x2 gauze of sterile transparent dressing
Practicum
7. Check IVF and other devices
8. Place IV label (patient’s name, room, solution, additive, bottle sequence, duration, time and date
9. Open the seal of the IVF aseptically
10. Open venoset, fill the infusate
11. Fill the drip chamber to at least half
12. Expel air bubbles
13. Verify order and check prepared needs
14. Explain to the patient15. Hand hygiene before and after16. Choose site17. Apply torniquet 5-12 cm above 18. Check radial pulse19. Prepare site, 30secs to dry, no
touch technique. WEAR gloves.
Practicum
Practicum
20. Pierce skin on a 15-30 angle21.Upon flashback, decrease angle and
advance the catheter & stylet about ¼ inch.
22. Position catheter parallel to the skin. Hold stylet stationary and advance the catheter till about 1 cm fr the site
23. Apply the sterile gauze under the hub and release the torniquet. Remove the stylet whilte appying digital pressure over the catheter.
Practicum24. Connect the infusion tubing of the
prepared IVF aseptically to the IV catheter
Changing IVF1. Verify doctor’s prescription in
doctor’s order sheet, countercheck IV label, IV card, infusate sequence, type, amount, additive, duration of infusion
2. Observe 10 rights
Practicum-changing IVF
3. Explain and reassure patient and check IV site for redness, swelling, pain, etc
4. Change IV tubing, reinsert 48-72 hours has lapsed after insertion
5. Wash hands before and after
6. Prepare necessary needs
7. Check sterility and integrity of IVF
Practicum-changing IVF
8. Place IV Label, close the clamp
9. Change the bottle aseptically
10.Regulate flow
11.Reassure patient
12.Dispose wastes
accordingly
13.Document and endorse
accordingly
Practicum- discontinuing IV Infusion
1. Verify Written doctor’s order, check if IV meds are also being discontinued
2. Prepare needs- IV Tray, sterile cotton balls, alcohol, plaster and betadiene.
3. Wash hands-before and after4. Moisten anchoring plaster to loosen
it from skin.
Practicum-discontinuing IV Infusion
5. Remove plaster, after turning off IV6. Get cottonball with alcohol7. Put over the site, without pressure on
the site, pull the canula8. Check for completeness of the
canula, while applying pressure on the site.
9. When bleeding stopped, dress with OS, asked significant other to apply pressure
10. Reassure patient. Document
Blood Transfusion
1. Verify Doctor’s order, make a treatment card
2. 10 Rights3. Educate patient, Reassure4. Request prescribed blood from Lab
include blood typing and x-matching if not yet done
5. Check if blood obtained is tested for transmissible diseases
Blood Transfusion
6. Once available, get the blood, wrap with clean towel, lay on a clean tray and keep at room tempt.
7. Check the patient’s vital signs before starting BT
8. Compare patient data with the Bag label. Check the X-matching, ABO, RH, serial number, expiry date
Blood Transfusion
9. Give the premedication- benadryl etc. warn patient and relatives of effects of premeds like dizziness and light-headedness
10.Hand hygiene before and after11.Prepare needs: IV tray, BT set,
canula (gauge 18 or else hemolyze), Plain NSS, IV Stand, gloves, sterile OS, plaster)
Blood Transfusion
Blood Transfusion
12. If ongoing IVF is D5, ask doctor if blood will be given in this site or if another site will be started. If the same line will be used, change IVF to NSS, “clean” line with NSS.
13.Open BT set aseptically, close roller clamp, spike blood carefully, fill drip camber to half full, prime tubing and remove air bubble, use g 18-19 needle for side drip
Blood Transfusion14.Disinfect the Y port and insert the
needle from BT set and secure with tape.
15.Close the roller clamp of IV fluid and start the BT at 10-15 drops per min for 15 minutes to observe for reaction. If none regulate to prescribed rate.
16.Observe patient while on BT. Look for signs of reaction like itchiness, chills, fever, dyspnea etc. stop BT, start IVF, REFER ASAP
Blood Transfusion
17. If there are no untoward reactions, continue BT. Swirl blood every hour to mix the components.
18.Change BT set every 2 bags.
19.When BT is consumed, closed the BTclamp, remove from Y port, careful with the needle, dispose accordingly, restart & regulate IVF
20.Re-check patient’s VS and reaction
Blood Transfusion
21.Do post BT Orders if any; repeat CBC usually, several hours later (4 hours later)
22.DOCUMENT properly: procedure, observations, interventions, ENDORSE
23.Remind MD if patient received 3-6 units of blood about CaGluconate.
Incorporations in the IVF
1. Verify wirtten medication card against doctor’s prescription.
2. 10 rights in preparing and administering drugs
3. Explain and reassure patient4. Skin test if necessary or ordered5. Hand hygiene6. Prepare tray-syringes, drug7. Prepare drugs as ordered
Incorporations in the IVF
8. Make sure that you have the right patient, drug, dosage, route, time, expiration date
9. Hand hygiene before and after
10.Disinfect the injection port
11. Introduce the Drug into the IVF
12.Swirl the drug to mix with IVF, Observe for reactions for 5-10 mins
13.Document & Discard properly.
Push through IV Port
1. Verify medication card against doctor’s prescription
2. 10 Rights
3. Explain procedure to the patient, reassure
4. Hand hygiene, use gloves for chemotherapy and other vesicants
5. Check skin test if any
Push through IV Port6. Make sure there is no drug-drug,
drug IV fluid incompatibility7. Prepare needs- right drug, check
expiration date, right diluent, syringe, needle, cottonball, alcohol
8. Prepare the drug- dilute aseptically as directed in the product insert
9. Aspirate aseptically10.Disinfect injection port, slowly or as
directed while roller clamp is close. Aspirate 1-2 cc fluid, introduce again, regulate IV, Observe for SSx
11.Document and Discard properly
Drug incorporation into Volumetric Chamber
1. Verify orders, Observe 10 Rs, Educate and reassure patient, hand hygiene
2. Check for drug-IVF incompatibility3. Put enough fluid necessary into the
chamber, introduce the drug aseptically, mix well and regulate.
4. Label the chamber with the drug name, dosage and flow rate, time exptected to be consumed.
Drug incorporation into Volumetric Chamber
5. Once drug in the chamber is consumed. Close the roller clamp, reintroduce fluid in the chamber, regulate IVF
6. Document and Discard used materials properly
Hep-Lock
1. Verify, Observe 10Rs, Reassure patient and do Hand Hygiene
2. Prepare needs: hep-lock device, tuberllin syringe, heparin, NSS, prepared medicine in a syringe, 2.5cc syringe with NSS for flushing.
Hep-lock
3. Open hep-lock, inject medicine as ordered, push medicine with NSS as ordered, push heparin in the tuberculin, close the hep-lock
4. Observe for adverse reactions
5. Document and Dispose properly
Thank you-Please answer the Post training Evaluation