STARTING AN INTRAVENOUS INFUSION
by Admin · February 3, 2008
- Gather equipment and bring to bedside. Check IV solution and medication additives with physician’s order.
- Explain procedure to patient.
- Perform hand hygiene.
- Prepare IV solution and tubing.
- Maintain aseptic technique when opening sterile packages and IV solution.
- Clamp tubing, uncap spike, and insert into entry site on bag as manufacturer directs.
- Squeeze drip chamber and allow it to fill at least half way.
- Remove cap at end of tubing, release clamp, and allow fluid to move through tubing. Allow fluid to flow until all air bubbles have disappeared. Closed clamp and recap end of tubing, maintaining sterility of setup.
- If electronic device is used, follow manufacturer’s instructions for inserting tubing and setting infusion rate.
- Apply label if medication was added to container. (Pharmacy may have added medication and applied label.)
- Place time-tape on container as necessary.
- Place patient in a low fowler’s position in bed. Place protective towel or pad under patient’s arm.
- Select appropriate site and palpate accessible veins.
- If site is hairy and agency policy permits, clip a 2-inch area around intended entry site.
- Apply tourniquet 5 to 6 inches to obstruct venous blood flow and distend vein. Direct tourniquet ends away from entry site. Check to be sure radial pulse is still present.
- Ask patient to open and close his or her fist. Observe and palpate for a suitable vein. Try the following techniques if vein cannot be felt:
- Release tourniquet and have patient lower his or her arm below the level of the heart to fill the veins. Reapply tourniquet and gently tap over the intended vein to help distend it.
- Remove tourniquet and place warm moist compresses over intended vein for 10 to 15 minutes.
- Don clean gloves.
- Cleanse the entry site with an antiseptic solution (alcohol swab) followed by antimicrobial solution (povidone iodine) according to agency policy. Use a circular motion to move from the center outward for several inches.
- Use the nondominant hand, placed about 1 to 2 inches below entry site, to hold skin taut against vein. Avoid touching prepared site.
- Enter skin gently with catheter held by the hub in the dominant hand, bevel side up, at a 10- to 30-degree angle. Catheter may be inserted from either directly over vein or from side of vein. While following the course of the vein, advance needle or catheter into vein. A sensation of “give” can be felt when needle enters vein.
- When blood returns through lumen of needle or flashback chamber of catheter, advance either device ? to ¼ inch farther into vein. A catheter needs to be advanced until the hub is at the venipuncture site, but the exact technique depends on the type of device used.
- Release tourniquet. Quickly remove protective cap from IV tubing and attach tubing to catheter or needle. Stabilize catheter or needle with nondominant hand.
- Start solution flow promptly by releasing the clamp on the tubing. Examine the tissue around entry site for signs of infiltration.
- Secure the catheter with narrow nonallergenic tape (½ inch) placed sticky side up under hub and crossed over the top of the hub.
- Place sterile dressing over venipuncture site. Agency policy may direct nurse to use gauze dressing or transparent dressing. Apply tape to dressing if necessary. Loop tubing near site and anchor to dressing.
- Mark date, time, site, and size of catheter used for infusion on the tape. Anchor tubing.
- Anchor arm to an armboard for support, if necessary, or apply site protector or tube-shaped mesh netting over insertion site.
- Adjust rate of solution flow according to amount prescribed or follow manufacturer’s directions for adjusting the flow rate infusion pump.
- Remove all equipment and dispose of in proper manner. Remove gloves and perform hand hygiene.
- Document and the patient’s response. Chart time, site, device used, and solution.
- Return to check flow rate and observe for infiltration 30 minutes after starting infusion.
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