Download Lesson 4 Intravenous IV Fluid Administration

IV therapy is an advanced life support
procedure. An intravenous (IV) line is inserted
into a vein so that blood, fluids, or medications
can be administered directly into the patient’s
circulation. The bag of fluid that feeds the IV
is usually a clear plastic bag that collapses as it
empties.
The administration set is the clear plastic
tubing that connects the fluid bag to the
needle, or catheter (or cannula). There are
three important parts to this tubing. The drip
chamber, the flow regulator, and the drug or
needle port.
SHARPS container
A container where ANYTHING that comes in
contact with human bodily fluids is placed for
destruction.
There are two types of drip chambers, the mini
drip and the macro drip. The mini drip is used
when a minimal flow of fluid is needed (with
children for example). Sixty small drops of
fluid into the mini drip chamber equal one
cubic centimeter (cc) or one milliliter (ml) of
fluid.
The macro drip is used when a higher flow of
fluid is needed (for a trauma victim in shock)
and only 10 to 15 drops equal one cc or one
ml. The flow regulator is a roller clamp located
below the drip chamber that can be pushed up
or down to start, stop, or control the rate of
flow. The drug or needle port is below the flow
regulator and this is where medication or fluid
is injected into the opening.
“Piggy – backing”
… injecting a drug or fluid into the needle port
in order for the medication to mix with saline
in in the bag and to flow into the vein through
the IV catheter.
Bolus “push”
… Forcing lots of fluid or medication into the
patient in a short period of time.
Before administering any fluids or medications
it is vital that the following safety measures be
taken by following the 5 rights: right drug,
right dose, right patient, right route, and right
time.
Failure to follow these safety considerations
can result in a fatal error!
Clarify any order that is incomplete, contains
abbreviations, is confusing or hard to read, or
raises a question. Do not ever borrow medications
from other patients or begin new medications
before an order has been received by the physician
or pharmacy (unless it is an emergency
ER/paramedic drug therapy situation).
And always have a colleague double check the
right drug and dosage before administering the
drug to the patient (the buddy system).
The general procedure for starting an IV is as
follows:


Practice BSI protocol by always wearing
rubber gloves.
Explain the procedure and reassure the
patient. Answer any questions the patient
may have.


Gather the IV bag (with primed tubing to
eliminate air bubbles), SHARPS container,
needle/catheter, tape, tourniquet, and
antiseptic swabs. Place equipment within
easy reach.
Apply the tourniquet proximal and superior
to the intended insertion site. Either mid
forearm or above the elbow.

Palpate the insertion site with the fingertips
in order to locate a vein (the insertion site is
venous because that is the fastest route to
the heart and therefore to the rest of the
systemic circulation). To further enhance
dilation, gently tap the area of insertion or
apply heat. The patient can also make a few
fists or dangle the arm below the heart (the
vein should feel firm, elastic, engorged, and
round).


Cleanse the site with an antiseptic swab in a
circular motion, moving outward from the
intended site of insertion. Avoid touching the
site once it has been prepared.
Apply skin traction in the direction opposite
of the direction of the catheter and position
the needle (bevel side up) at an angle of 15˚
to 35˚.
Bevel = hole at the top of the needle (you can
see the sharp end better)

Insert the needle into the vein and observe
for flashback of blood into the flash chamber.
Lower the catheter almost parallel to the
skin, and insert the needle 1-2 mm more to
ensure that the catheter has also entered
the vein.
Advance the catheter into the vein while
maintaining skin traction.
Skin traction = “Z – track method”
…. Pilling on the skin (toward you) in order to
stagger the skin layers to make a “natural”
bandage.


Release the tourniquet while applying
pressure just above the end of the catheter.
While maintaining pressure above the
catheter, remove the needle and discard it
into an approved SHARPS container.


Connect the IV tubing, open the flow
regulator, and observe for the free flow of IV
fluid.
Secure the catheter to the insertion site by
applying a sterile adhesive dressing or a
sterile 2X2 dressing with surgical tape.
Many sites can be used for IV therapy. Because
they are relatively safe and easy to enter, arm
veins are most commonly used. Dorsal
metacarpal, cephalic, basilic, and the medial
cubital veins are most commonly used. More
distal sites should be used first, with the
proximal sites used subsequently.
Leg veins should rarely be used, if ever,
because of the high risk of thromboembolism.
IV infusions must be monitored frequently to
make sure that the fluid is flowing at the
intended rate. The IV container should be
marked with tape to indicate at a glance
whether the correct amount is infused.
The flow rate is calculated when the solution is
started, then monitored hourly. Maintaining an
IV is a responsibility that demands knowledge
of the solutions being administered and the
principles of flow. In addition patients must
be assessed carefully for both local and
systemic complications.
IO = intraosseous injections
Placement of a catheter in the bone marrow
when a vein cannot be perforated or when
rapid fluid therapy is required
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https://www.youtube.com/watch?v=3pZxOqfB
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Sternal IO = intraosseous injection into the
sternum
Easy IO = intraosseous injection into the tibia
with a drill or hand puncture in the case of an
infant