{"id":929,"date":"2015-06-22T23:10:36","date_gmt":"2015-06-23T03:10:36","guid":{"rendered":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/chapter\/8-2-types-of-iv-therapy\/"},"modified":"2019-09-30T14:13:30","modified_gmt":"2019-09-30T18:13:30","slug":"8-5-iv-administration-equipment","status":"publish","type":"chapter","link":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/chapter\/8-5-iv-administration-equipment\/","title":{"raw":"8.5 IV Administration Equipment","rendered":"8.5 IV Administration Equipment"},"content":{"raw":"Intravenous fluids are administered through thin, flexible plastic tubing called an <em>infusion set<\/em> or <strong>primary infusion tubing\/administration set <\/strong>(Perry et al., 2018).\u00a0The infusion tubing\/administration set connects to the bag of IV solution. IVs are then run either by gravity or by an intravenous infusion pump, sometimes referred to as electronic infusion device (EID).\r\n\r\n<strong>Primary IV tubing<\/strong> is used to infuse continuous or intermittent fluids or medication. It consists of the following parts (see Figure 8.15):\r\n\r\n[caption id=\"attachment_3071\" align=\"alignleft\" width=\"200\"]<img src=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2015\/06\/IV-equipment.png\" alt=\"\" width=\"200\" height=\"268\" class=\"wp-image-3071 size-full\" \/> Figure 8.15 IV tubing (primary &amp; secondary)[\/caption]\r\n<ul>\r\n \t<li>Sterile spike: Connects the tubing into the IV bag.<\/li>\r\n \t<li>Drip chamber: Used to observe flow of IV fluids and \/ or to calculate drops per minute.<\/li>\r\n \t<li>Backcheck valve: Prevents fluid or medication from travelling up the IV.<\/li>\r\n \t<li>Access ports: Used to infuse secondary medications and give IV push medications.<\/li>\r\n \t<li>Roller clamp: Used to regulate the speed of, or to stop or start, a gravity infusion.<\/li>\r\n \t<li>Extension set:\u00a010 to 20 cm IV tubing attached to IV cannula. Helps to reduce micro-movements at IV insertion sites and protects from BBF exposure during IV tubing changes.<\/li>\r\n \t<li>Slide clamps: Used to stop the infusion. Are needed to open and close IV infusion pump (a.k.a. EID).<\/li>\r\n<\/ul>\r\nThe following table is intended to familiarize you with common IV equipment.\r\n<table style=\"border-collapse: collapse;width: 100%\" border=\"1\">\r\n<tbody>\r\n<tr>\r\n<td colspan=\"2\">\r\n<h3 style=\"text-align: center\">Table 8.7 Common IV Equipment<\/h3>\r\n<\/td>\r\n<\/tr>\r\n<tr>\r\n<td>Primary IV tubing<\/td>\r\n<td>IV tubing\/administration set that connects to the bag of IV solution. May or may not contain injection ports.\u00a0See Table 8.9 Frequency of IV Tubing Changes.\r\n\r\nPrimary IV tubing is either a macro-drip solution administration set that delivers 10, 15, or 20 gtts\/ml, or a micro-drip set that delivers 60 drops\/ml. Macro-drip sets are used for routine primary infusions. Micro-drip IV tubing is used mostly in pediatric or neonatal care, when small amounts of fluids are to be administered over a long period of time (Perry et al., 2014).\u00a0The drop factor can be located on the packaging of the IV tubing.\r\n\r\n[caption id=\"attachment_1723\" align=\"aligncenter\" width=\"300\"]<img src=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2015\/06\/drop-factor-on-IV-tubing-package-300x186.jpg\" alt=\"\" width=\"300\" height=\"186\" class=\"size-medium wp-image-1723\" \/> Figure 8.16 Drop factor located on IV tubing package[\/caption]\r\n\r\n<strong>Note<\/strong>: Suppliers provide different kinds of tubing for different purposes. Read the packaging and choose tubing that is appropriate.<\/td>\r\n<\/tr>\r\n<tr>\r\n<td>Secondary tubing<\/td>\r\n<td>It is shorter in length than primary tubing, with no access ports or backcheck valve. It is connected to a primary line via an access port near the top of the set. It is used to infuse intermittent medications or fluids. Secondary tubing should be changed every 24 hours.<\/td>\r\n<\/tr>\r\n<tr>\r\n<td>IV bags<\/td>\r\n<td>IV solutions come in a variety of solutions, concentrations, and volumes. They are considered medication, and as such the 7 Rights apply. The prescriber will order the IV solution and rate. The nurse monitors for signs of complications related to the solution and IV equipment. IV bags and tubing should have a sticker or label with the date, time, and initials of the healthcare provider marked on them to be valid. IV bags and\/or IV tubing should be changed if:\r\n<ul>\r\n \t<li>IV tubing is disconnected or becomes contaminated by touching a non-sterile surface<\/li>\r\n \t<li>Less than 100 ml is left in the IV solution bag<\/li>\r\n \t<li>Cloudiness or precipitate is found in the IV solution<\/li>\r\n \t<li>Equipment (date and time) is outdated<\/li>\r\n \t<li>IV solution is outdated (24 hours since opened)<\/li>\r\n<\/ul>\r\n[caption id=\"attachment_1957\" align=\"aligncenter\" width=\"234\"]<img src=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/08\/FAll-2018-030-300x245.jpg\" alt=\"\" width=\"234\" height=\"191\" class=\"wp-image-1957\" \/> Figure 8.17 Different volumes of IV bags[\/caption]<\/td>\r\n<\/tr>\r\n<tr>\r\n<td style=\"width: 20%\">Extension sets<\/td>\r\n<td>A.k.a. \"add on device,\" 10 to 20 cm of IV tubing attached to IV cannula. Helps to reduce micro-movements at IV insertion sites, and protects from BBF exposure during IV tubing changes. Should be added to all PVAD-short and CVADs that do not have permanent extension tubing as part of their structure if tubing changes are expected.\r\n\r\nIf added at the time of insertion\u2014does not require routine changing\u2014it is considered part of the IV cannula.\r\n\r\nIf added after the insertion, change when integrity is compromised and at each tubing change.\r\n\r\n[caption id=\"attachment_957\" align=\"aligncenter\" width=\"300\"]<img src=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2015\/06\/DSC_0903-300x199-300x199.jpg\" alt=\"\" width=\"300\" height=\"199\" class=\"wp-image-957 size-medium\" \/> PVAD-short - Saline lock with extension and needleless cap[\/caption]<\/td>\r\n<\/tr>\r\n<tr>\r\n<td>Needleless cap<\/td>\r\n<td>Added to the distal end of all extension sets of all lumens of VADs to prevent backflow of blood and BBF exposure to healthcare provider. Also added to indwelling subcutaneous devices (butterflies) to allow needleless access when administering medications.\r\n\r\nCan be bonded to the extension set or can be separate (add on) to the extension set.\r\n\r\nMust be sanitized according to agency policy prior to accessing.\r\n\r\nCan be neutral, negative displacement, and positive pressure. Negative caps are not recommended.\r\n\r\nChanged q 7 days; each time a site is changed; following blood draws; following blood product administration; when all residual blood cannot be cleared for the device; when contamination is suspected or confirmed. Check agency protocols for correct flushing technique.\r\n\r\n[caption id=\"attachment_1956\" align=\"aligncenter\" width=\"300\"]<img src=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/08\/FAll-2018-028-300x160.jpg\" alt=\"\" width=\"300\" height=\"160\" class=\"size-medium wp-image-1956\" \/> Figure 8.18 Different types of needleless caps[\/caption]<\/td>\r\n<\/tr>\r\n<tr>\r\n<td>IV tubing with filter<\/td>\r\n<td>Used to filter bacterial particulate and candida. Available with different filter capabilities. Used when administering packed red blood cells, PN, and some medications. Refer to your agency\u2019s parenteral practices guidelines. When administering packed red blood cells, always use a special blood administration set with a filter.<\/td>\r\n<\/tr>\r\n<tr>\r\n<td>Vented set<\/td>\r\n<td>IV administration set used for solutions that are supplied in glass containers.<\/td>\r\n<\/tr>\r\n<tr>\r\n<td>Volume control set<\/td>\r\n<td>A type of reservoir that holds a controlled volume of fluid from the IV bag. Limits volume of IV fluids or medications able to infuse into the patient. Often used in pediatrics. IV fluids are attached above the buretrol and refilled manually as the volume decreases.\r\n\r\n[caption id=\"attachment_1954\" align=\"aligncenter\" width=\"175\"]<img src=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/08\/FAll-2018-018-175x300.jpg\" alt=\"\" width=\"175\" height=\"300\" class=\"size-medium wp-image-1954\" \/> Figure 8.19 volume control set[\/caption]<\/td>\r\n<\/tr>\r\n<tr>\r\n<td style=\"width: 50%\" colspan=\"2\">Data sources: Interior Health, 2012; Perry et al., 2018; Vancouver Coastal Health, 2008<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n<h2>Frequency of IV Tubing Changes<\/h2>\r\nPrimary and secondary administration sets should be changed regularly to minimize risk and prevent infection (CDC, 2017; Fraser Health Authority, 2014). Change IV tubing according to agency policy. Table 8.8 lists the frequency of IV tubing change.\r\n<table style=\"height: 585px\">\r\n<tbody>\r\n<tr style=\"border: 1px solid #000000\">\r\n<td style=\"border: 1px solid #000000;text-align: left;height: 17px;width: 820.896px\" colspan=\"4\">\r\n<h3 style=\"text-align: center\"><a id=\"Table 8.8\"><\/a>Table 8.8 Frequency of IV Tubing Changes<\/h3>\r\n<\/td>\r\n<\/tr>\r\n<tr style=\"border: 1px solid #000000\">\r\n<td style=\"border: 1px solid #000000;text-align: left;height: 198px;width: 820.896px\" colspan=\"4\">\r\n<h5>Safety considerations:<\/h5>\r\n<ul>\r\n \t<li>All IV tubing must be changed using principles of asepsis.<\/li>\r\n \t<li>IV tubing is changed based on the type of tubing, time used, and the type of solution.<\/li>\r\n \t<li>If possible, coordinate IV tubing changes with IV solution changes.<\/li>\r\n \t<li>Tubing that contains a large amount of blood and is suspected of being clotted requires immediate changing to prevent risk of introducing a thrombus into circulation.<\/li>\r\n<\/ul>\r\n<\/td>\r\n<\/tr>\r\n<tr style=\"border: 1px solid #000000\">\r\n<td style=\"border: 1px solid #000000;height: 87px;width: 35%\" colspan=\"2\">\r\n<h4 style=\"text-align: center\"><b>Frequency\u00a0of IV Tubing Change<\/b><\/h4>\r\n<\/td>\r\n<td style=\"border: 1px solid #000000;height: 87px;width: 710.229px\" colspan=\"2\">\r\n<h4 style=\"text-align: center\"><strong><strong>Type of IV Tubing and Solution<\/strong><\/strong><\/h4>\r\n<\/td>\r\n<\/tr>\r\n<tr style=\"border: 1px solid #000000\">\r\n<td style=\"border: 1px solid #000000;height: 35px;width: 94.8958px\" colspan=\"2\">Every 72 to 96 hours<\/td>\r\n<td style=\"border: 1px solid #000000;height: 35px;width: 710.229px\" colspan=\"2\">For continuous primary infusion sets with hypotonic, isotonic, or hypertonic solution, when insertion site is changed, or when indicated by the type of solution or medication being administered.<\/td>\r\n<\/tr>\r\n<tr style=\"border: 1px solid #000000\">\r\n<td style=\"border: 1px solid #000000;width: 94.8958px\" colspan=\"2\">Every 24 hours<\/td>\r\n<td style=\"border: 1px solid #000000;width: 710.229px\" colspan=\"2\">As of 2017, the CDC is saying n<span style=\"font-family: inherit;font-size: inherit\">o recommendation can be made regarding the frequency for replacing intermittently used administration sets. Historical thinking was that when an intermittent infusion is repeatedly disconnected and reconnected for infusion, there is increased risk of contamination at the catheter hub, needleless connector, and the male Luer end of the administration set, potentially increasing risk for CR-BSI. Follow agency protocol. <\/span>\r\n\r\n<span style=\"font-family: inherit;font-size: inherit\"><strong>Note<\/strong>: Agency policy sometimes recommends secondary tubing be changed every 24 hours.<\/span><\/td>\r\n<\/tr>\r\n<tr style=\"border: 1px solid #000000\">\r\n<td style=\"border: 1px solid #000000;width: 94.8958px\" colspan=\"2\">Every 24 hours<\/td>\r\n<td style=\"border: 1px solid #000000;width: 710.229px\" colspan=\"2\">Infusions containing fat emulsions (IV solutions combined with glucose and amino acids infused separately or in a 3-in-1 admixture). <strong>Example<\/strong>: Parenteral nutrition (PN).<\/td>\r\n<\/tr>\r\n<tr style=\"border: 1px solid #000000\">\r\n<td style=\"border: 1px solid #000000;width: 94.8958px\" colspan=\"2\">4 hours or 4 units, whichever comes first, or between products<\/td>\r\n<td style=\"border: 1px solid #000000;width: 710.229px\" colspan=\"2\">Blood and blood products<\/td>\r\n<\/tr>\r\n<tr style=\"border: 1px solid #000000\">\r\n<td style=\"border: 1px solid #000000;height: 17px;width: 820.896px\" colspan=\"4\">Data sources: CDC, 2017; Interior Health, 2012<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n<h2>Assessing an IV System<\/h2>\r\nAll patients with IV therapy (PVAD-short, midline catheters, and CVADs) are at risk for developing IV-related complications. The assessment of an IV system (including the IV site, tubing, rate, and solution) should take into account the IV administration system AND the patient. Checklist 65 provides general guidelines for assessing an IV system.\r\n<table style=\"border-color: #000000\">\r\n<tbody>\r\n<tr style=\"border-color: #000000\">\r\n<td style=\"border: 1px solid #000000;text-align: center\" colspan=\"5\">\r\n<h3 style=\"text-align: center\">\u00a0 \u00a0 <a id=\"checklist65\"><\/a>Checklist 65: Assessing an IV System<\/h3>\r\n<h5 style=\"text-align: center\"><em><span style=\"color: #000000\">Disclaimer:\u00a0Always review and follow your agency policy regarding this specific skill.<\/span><\/em><\/h5>\r\n<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000\">\r\n<td style=\"border: 1px solid #000000\" colspan=\"5\">\r\n<h5><span style=\"color: #333333\">Safety considerations:\u00a0<\/span><\/h5>\r\n<ul>\r\n \t<li>IV systems must be assessed according to agency protocols. This might mean every 5 minutes when administering specific medications, to hourly, to every 1 to 2 hours, or to once per shift.<\/li>\r\n \t<li>An IV system should be assessed whenever the electronic infusion device alarms or sounds, or if a patient complains of pain, tenderness, or discomfort at the IV insertion site.<\/li>\r\n \t<li>Review the patient's chart to determine insertion date and type of solution ordered.<\/li>\r\n \t<li>A PVAD-short catheter is usually replaced every 72 to 96 hours, depending on agency policy.<\/li>\r\n \t<li>If a venous access device is not in use (i.e., it is locked) care and maintenance are still required to keep the site patent. Refer to agency policy for flushing guidelines.<\/li>\r\n \t<li>IV therapy is considered medication. Document according to agency guidelines.<\/li>\r\n \t<li>Patients with cardiac or renal disease, as well as the elderly and young, are at a higher risk for IV-related complications.<\/li>\r\n \t<li>Elderly patients often have fragile veins and may require closer monitoring.<\/li>\r\n<\/ul>\r\n<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000\">\r\n<td style=\"border: 1px solid #000000;text-align: center\" colspan=\"3\">\r\n<h4 style=\"text-align: center\">Steps<\/h4>\r\n<\/td>\r\n<td style=\"border: 1px solid #000000;text-align: center\" colspan=\"2\">\r\n<h4 style=\"text-align: center\">\u00a0Additional Information<\/h4>\r\n<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000\">\r\n<td style=\"border: 1px solid #000000\" colspan=\"3\">1. Perform hand hygiene.<\/td>\r\n<td style=\"border: 1px solid #000000\" colspan=\"2\">This step reduces the transmission of microorganisms.<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000\">\r\n<td style=\"border: 1px solid #000000\" colspan=\"3\">2. Introduce yourself and explain the purpose of the assessment.<\/td>\r\n<td style=\"border: 1px solid #000000\" colspan=\"2\">This builds trust with patient and allows time for the patient to ask questions.<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000\">\r\n<td style=\"border: 1px solid #000000\" colspan=\"3\">3. Confirm patient ID using two patient identifiers (e.g., name and date of birth), and compare the MAR printout with the patient's wristband.<\/td>\r\n<td style=\"border: 1px solid #000000\" colspan=\"2\">This step ensures you have the correct patient and complies with agency standard for patient identification.\r\n\r\n[caption id=\"attachment_6143\" align=\"aligncenter\" width=\"152\"]<a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/Book-pictures-2015-430.jpg\"><img src=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2015\/05\/Book-pictures-2015-430-300x231.jpg\" alt=\"Compare MAR with patient name band\" class=\"wp-image-6143\" height=\"117\" width=\"152\" \/><\/a> Compare MAR with patient wristband[\/caption]<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000\">\r\n<td style=\"border: 1px solid #000000\" colspan=\"3\">4. Assess the IV insertion site and transparent dressing on IV site.<\/td>\r\n<td style=\"border: 1px solid #000000\" colspan=\"2\">Check IV insertion site for signs and symptoms of phlebitis or infection.\u00a0Check for fluid leaking, redness, pain, tenderness, and swelling. IV site should be free from pain, tenderness, redness, or swelling.\r\n\r\n<a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_0904.jpg\"><img src=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2015\/05\/DSC_0904-300x199.jpg\" alt=\"Assess IV site prior to use\" class=\"wp-image-6163 aligncenter\" height=\"158\" width=\"238\" \/><\/a>\r\n\r\nEnsure patient is informed to alert the healthcare provider if they experience pain or notice swelling or redness at the IV site. If patient is unable to report pain at IV site, more frequent checks are required.<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000\">\r\n<td style=\"border: 1px solid #000000\" colspan=\"3\">5. Inspect the patient's arm for streaking or venous cords; assess skin temperature.<\/td>\r\n<td style=\"border: 1px solid #000000\" colspan=\"2\">Assess complications on hand and arm for signs and symptoms of phlebitis and infiltration \/ extravasation.<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000\">\r\n<td style=\"border: 1px solid #000000\" colspan=\"3\">6. Assess IV tubing for kinks or bends.<\/td>\r\n<td style=\"border: 1px solid #000000\" colspan=\"2\">Kinks or bends in tubing may decrease or stop the flow of IV fluids. Ensure tubing is not caught on equipment or side rails on bed.\r\n\r\nTubing should be properly labelled with date and time the tubing was initiated.<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000\">\r\n<td style=\"border: 1px solid #000000\" colspan=\"3\">7. Check the rate of infusion for the primary and secondary IV solutions. Verify infusion rate in physician orders or medication administration record (MAR).<\/td>\r\n<td style=\"border: 1px solid #000000\" colspan=\"2\">If IV solution is on gravity, calculate and count the drip rate for one minute.\r\n\r\nIf solution is on an IV pump, ensure the rate is correct and all clamps are open as per agency protocol.\r\n\r\nIf secondary IV medication is infusing, ensure clamp on secondary IV tubing is open. The EID is unable to distinguish if the primary bag or secondary bag is infusing.<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000\">\r\n<td style=\"border: 1px solid #000000\" colspan=\"3\">8. Assess the type of solution and label on bag indicating when it was hung.\r\n\r\nCheck volume of solution in bag.\r\n\r\nAssess labels on IV tubing for information about when tubing needs to be changed.<\/td>\r\n<td style=\"border: 1px solid #000000\" colspan=\"2\">IV solutions become outdated every 24 hours.\r\n\r\nEnsure the correct solution is given.\r\n\r\nIf 100 ml of solution or less is left in the bag, change the IV solution and document according to agency guidelines.\r\n\r\nIf an IV pump is used, ensure it is plugged into an outlet. This ensures good battery charge.\r\n\r\nIf IV tubing is due to be changed, consider priming a new bag and hanging it on the IV pole until the current bag is infused.<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000\">\r\n<td style=\"border: 1px solid #000000\" colspan=\"3\">9. Assist patient into comfortable position, place call bell in reach, and ensure necessary side rails are used.<\/td>\r\n<td style=\"border: 1px solid #000000\" colspan=\"2\">These precautions prevent injury to the patient.<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000\">\r\n<td style=\"border: 1px solid #000000\" colspan=\"3\">10.\u00a0Perform hand hygiene.<\/td>\r\n<td style=\"border: 1px solid #000000\" colspan=\"2\">This step prevents the spread of microorganisms.<\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000\">\r\n<td style=\"border: 1px solid #000000\" colspan=\"3\">11. Document procedure and findings as per agency policy.<\/td>\r\n<td style=\"border: 1px solid #000000\" colspan=\"2\"><span>Timely and accurate documentation promotes patient safety.<\/span><\/td>\r\n<\/tr>\r\n<tr style=\"border-color: #000000\">\r\n<td style=\"border: 1px solid #000000\" colspan=\"5\">Data sources: Fulcher &amp; Frazier, 2007; Perry et al., 2018<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n<div class=\"bcc-box bcc-info\">\r\n<h3 style=\"text-align: center\">Critical Thinking Exercises<\/h3>\r\n<ol>\r\n \t<li>What is the purpose of the back-check valve on primary IV tubing?<\/li>\r\n \t<li>When is it important for the nurse to know the drop factor of IV tubing?<\/li>\r\n \t<li>What is the purpose of extension tubing?<\/li>\r\n \t<li>The nurse has found the patient to have an IV administration set hung 96 hours prior. Explain the necessary next steps.<\/li>\r\n<\/ol>\r\n<h2>Attribution<\/h2>\r\nFigure 8.15 <a href=\"https:\/\/opentextbc.ca\/clinicalskills\/chapter\/8-2-types-of-iv-therapy\/\">IV Primary and Secondary Tubing Setup<\/a> by BCIT is\u00a0used\u00a0under a\u00a0<a href=\"https:\/\/creativecommons.org\/licenses\/by-sa\/4.0\/deed.en\"><span class=\"cc-license-identifier\">CC BY-SA 4.0<\/span><\/a>\u00a0international license.\r\n\r\nFigure 8.16. drop factor by author is used\u00a0under a\u00a0<a href=\"https:\/\/creativecommons.org\/licenses\/by-sa\/4.0\/deed.en\"><span class=\"cc-license-identifier\">CC BY-SA 4.0<\/span><\/a>\u00a0international license.\r\n\r\nFigure 8.17 Different volumes of IV bags\u00a0by author is used\u00a0under a\u00a0<a href=\"https:\/\/creativecommons.org\/licenses\/by-sa\/4.0\/deed.en\"><span class=\"cc-license-identifier\">CC BY-SA 4.0<\/span><\/a>\u00a0international license.\r\n\r\nFigure 8.18 Needleless caps by author\u00a0is used\u00a0under a\u00a0<a href=\"https:\/\/creativecommons.org\/licenses\/by-sa\/4.0\/deed.en\"><span class=\"cc-license-identifier\">CC BY-SA 4.0<\/span><\/a>\u00a0international license.\r\n\r\nFigure 8.19 Volume Control Set by author\u00a0\u00a0is used\u00a0under a\u00a0<a href=\"https:\/\/creativecommons.org\/licenses\/by-sa\/4.0\/deed.en\"><span class=\"cc-license-identifier\">CC BY-SA 4.0<\/span><\/a>\u00a0international license.\r\n\r\n<\/div>","rendered":"<p>Intravenous fluids are administered through thin, flexible plastic tubing called an <em>infusion set<\/em> or <strong>primary infusion tubing\/administration set <\/strong>(Perry et al., 2018).\u00a0The infusion tubing\/administration set connects to the bag of IV solution. IVs are then run either by gravity or by an intravenous infusion pump, sometimes referred to as electronic infusion device (EID).<\/p>\n<p><strong>Primary IV tubing<\/strong> is used to infuse continuous or intermittent fluids or medication. It consists of the following parts (see Figure 8.15):<\/p>\n<figure id=\"attachment_3071\" aria-describedby=\"caption-attachment-3071\" style=\"width: 200px\" class=\"wp-caption alignleft\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2015\/06\/IV-equipment.png\" alt=\"\" width=\"200\" height=\"268\" class=\"wp-image-3071 size-full\" srcset=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2015\/06\/IV-equipment.png 200w, https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2015\/06\/IV-equipment-65x87.png 65w\" sizes=\"auto, (max-width: 200px) 100vw, 200px\" \/><figcaption id=\"caption-attachment-3071\" class=\"wp-caption-text\">Figure 8.15 IV tubing (primary &amp; secondary)<\/figcaption><\/figure>\n<ul>\n<li>Sterile spike: Connects the tubing into the IV bag.<\/li>\n<li>Drip chamber: Used to observe flow of IV fluids and \/ or to calculate drops per minute.<\/li>\n<li>Backcheck valve: Prevents fluid or medication from travelling up the IV.<\/li>\n<li>Access ports: Used to infuse secondary medications and give IV push medications.<\/li>\n<li>Roller clamp: Used to regulate the speed of, or to stop or start, a gravity infusion.<\/li>\n<li>Extension set:\u00a010 to 20 cm IV tubing attached to IV cannula. Helps to reduce micro-movements at IV insertion sites and protects from BBF exposure during IV tubing changes.<\/li>\n<li>Slide clamps: Used to stop the infusion. Are needed to open and close IV infusion pump (a.k.a. EID).<\/li>\n<\/ul>\n<p>The following table is intended to familiarize you with common IV equipment.<\/p>\n<table style=\"border-collapse: collapse;width: 100%\">\n<tbody>\n<tr>\n<td colspan=\"2\">\n<h3 style=\"text-align: center\">Table 8.7 Common IV Equipment<\/h3>\n<\/td>\n<\/tr>\n<tr>\n<td>Primary IV tubing<\/td>\n<td>IV tubing\/administration set that connects to the bag of IV solution. May or may not contain injection ports.\u00a0See Table 8.9 Frequency of IV Tubing Changes.<\/p>\n<p>Primary IV tubing is either a macro-drip solution administration set that delivers 10, 15, or 20 gtts\/ml, or a micro-drip set that delivers 60 drops\/ml. Macro-drip sets are used for routine primary infusions. Micro-drip IV tubing is used mostly in pediatric or neonatal care, when small amounts of fluids are to be administered over a long period of time (Perry et al., 2014).\u00a0The drop factor can be located on the packaging of the IV tubing.<\/p>\n<figure id=\"attachment_1723\" aria-describedby=\"caption-attachment-1723\" style=\"width: 300px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2015\/06\/drop-factor-on-IV-tubing-package-300x186.jpg\" alt=\"\" width=\"300\" height=\"186\" class=\"size-medium wp-image-1723\" srcset=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2015\/06\/drop-factor-on-IV-tubing-package-300x186.jpg 300w, https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2015\/06\/drop-factor-on-IV-tubing-package-65x40.jpg 65w, https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2015\/06\/drop-factor-on-IV-tubing-package-225x140.jpg 225w, https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2015\/06\/drop-factor-on-IV-tubing-package-350x217.jpg 350w, https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2015\/06\/drop-factor-on-IV-tubing-package.jpg 600w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/><figcaption id=\"caption-attachment-1723\" class=\"wp-caption-text\">Figure 8.16 Drop factor located on IV tubing package<\/figcaption><\/figure>\n<p><strong>Note<\/strong>: Suppliers provide different kinds of tubing for different purposes. Read the packaging and choose tubing that is appropriate.<\/td>\n<\/tr>\n<tr>\n<td>Secondary tubing<\/td>\n<td>It is shorter in length than primary tubing, with no access ports or backcheck valve. It is connected to a primary line via an access port near the top of the set. It is used to infuse intermittent medications or fluids. Secondary tubing should be changed every 24 hours.<\/td>\n<\/tr>\n<tr>\n<td>IV bags<\/td>\n<td>IV solutions come in a variety of solutions, concentrations, and volumes. They are considered medication, and as such the 7 Rights apply. The prescriber will order the IV solution and rate. The nurse monitors for signs of complications related to the solution and IV equipment. IV bags and tubing should have a sticker or label with the date, time, and initials of the healthcare provider marked on them to be valid. IV bags and\/or IV tubing should be changed if:<\/p>\n<ul>\n<li>IV tubing is disconnected or becomes contaminated by touching a non-sterile surface<\/li>\n<li>Less than 100 ml is left in the IV solution bag<\/li>\n<li>Cloudiness or precipitate is found in the IV solution<\/li>\n<li>Equipment (date and time) is outdated<\/li>\n<li>IV solution is outdated (24 hours since opened)<\/li>\n<\/ul>\n<figure id=\"attachment_1957\" aria-describedby=\"caption-attachment-1957\" style=\"width: 234px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/08\/FAll-2018-030-300x245.jpg\" alt=\"\" width=\"234\" height=\"191\" class=\"wp-image-1957\" srcset=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/08\/FAll-2018-030-300x245.jpg 300w, https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/08\/FAll-2018-030-65x53.jpg 65w, https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/08\/FAll-2018-030-225x184.jpg 225w, https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/08\/FAll-2018-030-350x286.jpg 350w, https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/08\/FAll-2018-030.jpg 500w\" sizes=\"auto, (max-width: 234px) 100vw, 234px\" \/><figcaption id=\"caption-attachment-1957\" class=\"wp-caption-text\">Figure 8.17 Different volumes of IV bags<\/figcaption><\/figure>\n<\/td>\n<\/tr>\n<tr>\n<td style=\"width: 20%\">Extension sets<\/td>\n<td>A.k.a. &#8220;add on device,&#8221; 10 to 20 cm of IV tubing attached to IV cannula. Helps to reduce micro-movements at IV insertion sites, and protects from BBF exposure during IV tubing changes. Should be added to all PVAD-short and CVADs that do not have permanent extension tubing as part of their structure if tubing changes are expected.<\/p>\n<p>If added at the time of insertion\u2014does not require routine changing\u2014it is considered part of the IV cannula.<\/p>\n<p>If added after the insertion, change when integrity is compromised and at each tubing change.<\/p>\n<figure id=\"attachment_957\" aria-describedby=\"caption-attachment-957\" style=\"width: 300px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2015\/06\/DSC_0903-300x199-300x199.jpg\" alt=\"\" width=\"300\" height=\"199\" class=\"wp-image-957 size-medium\" srcset=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2015\/06\/DSC_0903-300x199.jpg 300w, https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2015\/06\/DSC_0903-300x199-65x43.jpg 65w, https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2015\/06\/DSC_0903-300x199-225x149.jpg 225w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/><figcaption id=\"caption-attachment-957\" class=\"wp-caption-text\">PVAD-short &#8211; Saline lock with extension and needleless cap<\/figcaption><\/figure>\n<\/td>\n<\/tr>\n<tr>\n<td>Needleless cap<\/td>\n<td>Added to the distal end of all extension sets of all lumens of VADs to prevent backflow of blood and BBF exposure to healthcare provider. Also added to indwelling subcutaneous devices (butterflies) to allow needleless access when administering medications.<\/p>\n<p>Can be bonded to the extension set or can be separate (add on) to the extension set.<\/p>\n<p>Must be sanitized according to agency policy prior to accessing.<\/p>\n<p>Can be neutral, negative displacement, and positive pressure. Negative caps are not recommended.<\/p>\n<p>Changed q 7 days; each time a site is changed; following blood draws; following blood product administration; when all residual blood cannot be cleared for the device; when contamination is suspected or confirmed. Check agency protocols for correct flushing technique.<\/p>\n<figure id=\"attachment_1956\" aria-describedby=\"caption-attachment-1956\" style=\"width: 300px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/08\/FAll-2018-028-300x160.jpg\" alt=\"\" width=\"300\" height=\"160\" class=\"size-medium wp-image-1956\" srcset=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/08\/FAll-2018-028-300x160.jpg 300w, https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/08\/FAll-2018-028-65x35.jpg 65w, https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/08\/FAll-2018-028-225x120.jpg 225w, https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/08\/FAll-2018-028-350x186.jpg 350w, https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/08\/FAll-2018-028.jpg 600w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/><figcaption id=\"caption-attachment-1956\" class=\"wp-caption-text\">Figure 8.18 Different types of needleless caps<\/figcaption><\/figure>\n<\/td>\n<\/tr>\n<tr>\n<td>IV tubing with filter<\/td>\n<td>Used to filter bacterial particulate and candida. Available with different filter capabilities. Used when administering packed red blood cells, PN, and some medications. Refer to your agency\u2019s parenteral practices guidelines. When administering packed red blood cells, always use a special blood administration set with a filter.<\/td>\n<\/tr>\n<tr>\n<td>Vented set<\/td>\n<td>IV administration set used for solutions that are supplied in glass containers.<\/td>\n<\/tr>\n<tr>\n<td>Volume control set<\/td>\n<td>A type of reservoir that holds a controlled volume of fluid from the IV bag. Limits volume of IV fluids or medications able to infuse into the patient. Often used in pediatrics. IV fluids are attached above the buretrol and refilled manually as the volume decreases.<\/p>\n<figure id=\"attachment_1954\" aria-describedby=\"caption-attachment-1954\" style=\"width: 175px\" class=\"wp-caption aligncenter\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/08\/FAll-2018-018-175x300.jpg\" alt=\"\" width=\"175\" height=\"300\" class=\"size-medium wp-image-1954\" srcset=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/08\/FAll-2018-018-175x300.jpg 175w, https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/08\/FAll-2018-018-65x111.jpg 65w, https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2018\/08\/FAll-2018-018.jpg 183w\" sizes=\"auto, (max-width: 175px) 100vw, 175px\" \/><figcaption id=\"caption-attachment-1954\" class=\"wp-caption-text\">Figure 8.19 volume control set<\/figcaption><\/figure>\n<\/td>\n<\/tr>\n<tr>\n<td style=\"width: 50%\" colspan=\"2\">Data sources: Interior Health, 2012; Perry et al., 2018; Vancouver Coastal Health, 2008<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<h2>Frequency of IV Tubing Changes<\/h2>\n<p>Primary and secondary administration sets should be changed regularly to minimize risk and prevent infection (CDC, 2017; Fraser Health Authority, 2014). Change IV tubing according to agency policy. Table 8.8 lists the frequency of IV tubing change.<\/p>\n<table style=\"height: 585px\">\n<tbody>\n<tr style=\"border: 1px solid #000000\">\n<td style=\"border: 1px solid #000000;text-align: left;height: 17px;width: 820.896px\" colspan=\"4\">\n<h3 style=\"text-align: center\"><a id=\"Table 8.8\"><\/a>Table 8.8 Frequency of IV Tubing Changes<\/h3>\n<\/td>\n<\/tr>\n<tr style=\"border: 1px solid #000000\">\n<td style=\"border: 1px solid #000000;text-align: left;height: 198px;width: 820.896px\" colspan=\"4\">\n<h5>Safety considerations:<\/h5>\n<ul>\n<li>All IV tubing must be changed using principles of asepsis.<\/li>\n<li>IV tubing is changed based on the type of tubing, time used, and the type of solution.<\/li>\n<li>If possible, coordinate IV tubing changes with IV solution changes.<\/li>\n<li>Tubing that contains a large amount of blood and is suspected of being clotted requires immediate changing to prevent risk of introducing a thrombus into circulation.<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n<tr style=\"border: 1px solid #000000\">\n<td style=\"border: 1px solid #000000;height: 87px;width: 35%\" colspan=\"2\">\n<h4 style=\"text-align: center\"><b>Frequency\u00a0of IV Tubing Change<\/b><\/h4>\n<\/td>\n<td style=\"border: 1px solid #000000;height: 87px;width: 710.229px\" colspan=\"2\">\n<h4 style=\"text-align: center\"><strong><strong>Type of IV Tubing and Solution<\/strong><\/strong><\/h4>\n<\/td>\n<\/tr>\n<tr style=\"border: 1px solid #000000\">\n<td style=\"border: 1px solid #000000;height: 35px;width: 94.8958px\" colspan=\"2\">Every 72 to 96 hours<\/td>\n<td style=\"border: 1px solid #000000;height: 35px;width: 710.229px\" colspan=\"2\">For continuous primary infusion sets with hypotonic, isotonic, or hypertonic solution, when insertion site is changed, or when indicated by the type of solution or medication being administered.<\/td>\n<\/tr>\n<tr style=\"border: 1px solid #000000\">\n<td style=\"border: 1px solid #000000;width: 94.8958px\" colspan=\"2\">Every 24 hours<\/td>\n<td style=\"border: 1px solid #000000;width: 710.229px\" colspan=\"2\">As of 2017, the CDC is saying n<span style=\"font-family: inherit;font-size: inherit\">o recommendation can be made regarding the frequency for replacing intermittently used administration sets. Historical thinking was that when an intermittent infusion is repeatedly disconnected and reconnected for infusion, there is increased risk of contamination at the catheter hub, needleless connector, and the male Luer end of the administration set, potentially increasing risk for CR-BSI. Follow agency protocol. <\/span><\/p>\n<p><span style=\"font-family: inherit;font-size: inherit\"><strong>Note<\/strong>: Agency policy sometimes recommends secondary tubing be changed every 24 hours.<\/span><\/td>\n<\/tr>\n<tr style=\"border: 1px solid #000000\">\n<td style=\"border: 1px solid #000000;width: 94.8958px\" colspan=\"2\">Every 24 hours<\/td>\n<td style=\"border: 1px solid #000000;width: 710.229px\" colspan=\"2\">Infusions containing fat emulsions (IV solutions combined with glucose and amino acids infused separately or in a 3-in-1 admixture). <strong>Example<\/strong>: Parenteral nutrition (PN).<\/td>\n<\/tr>\n<tr style=\"border: 1px solid #000000\">\n<td style=\"border: 1px solid #000000;width: 94.8958px\" colspan=\"2\">4 hours or 4 units, whichever comes first, or between products<\/td>\n<td style=\"border: 1px solid #000000;width: 710.229px\" colspan=\"2\">Blood and blood products<\/td>\n<\/tr>\n<tr style=\"border: 1px solid #000000\">\n<td style=\"border: 1px solid #000000;height: 17px;width: 820.896px\" colspan=\"4\">Data sources: CDC, 2017; Interior Health, 2012<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<h2>Assessing an IV System<\/h2>\n<p>All patients with IV therapy (PVAD-short, midline catheters, and CVADs) are at risk for developing IV-related complications. The assessment of an IV system (including the IV site, tubing, rate, and solution) should take into account the IV administration system AND the patient. Checklist 65 provides general guidelines for assessing an IV system.<\/p>\n<table style=\"border-color: #000000\">\n<tbody>\n<tr style=\"border-color: #000000\">\n<td style=\"border: 1px solid #000000;text-align: center\" colspan=\"5\">\n<h3 style=\"text-align: center\">\u00a0 \u00a0 <a id=\"checklist65\"><\/a>Checklist 65: Assessing an IV System<\/h3>\n<h5 style=\"text-align: center\"><em><span style=\"color: #000000\">Disclaimer:\u00a0Always review and follow your agency policy regarding this specific skill.<\/span><\/em><\/h5>\n<\/td>\n<\/tr>\n<tr style=\"border-color: #000000\">\n<td style=\"border: 1px solid #000000\" colspan=\"5\">\n<h5><span style=\"color: #333333\">Safety considerations:\u00a0<\/span><\/h5>\n<ul>\n<li>IV systems must be assessed according to agency protocols. This might mean every 5 minutes when administering specific medications, to hourly, to every 1 to 2 hours, or to once per shift.<\/li>\n<li>An IV system should be assessed whenever the electronic infusion device alarms or sounds, or if a patient complains of pain, tenderness, or discomfort at the IV insertion site.<\/li>\n<li>Review the patient&#8217;s chart to determine insertion date and type of solution ordered.<\/li>\n<li>A PVAD-short catheter is usually replaced every 72 to 96 hours, depending on agency policy.<\/li>\n<li>If a venous access device is not in use (i.e., it is locked) care and maintenance are still required to keep the site patent. Refer to agency policy for flushing guidelines.<\/li>\n<li>IV therapy is considered medication. Document according to agency guidelines.<\/li>\n<li>Patients with cardiac or renal disease, as well as the elderly and young, are at a higher risk for IV-related complications.<\/li>\n<li>Elderly patients often have fragile veins and may require closer monitoring.<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n<tr style=\"border-color: #000000\">\n<td style=\"border: 1px solid #000000;text-align: center\" colspan=\"3\">\n<h4 style=\"text-align: center\">Steps<\/h4>\n<\/td>\n<td style=\"border: 1px solid #000000;text-align: center\" colspan=\"2\">\n<h4 style=\"text-align: center\">\u00a0Additional Information<\/h4>\n<\/td>\n<\/tr>\n<tr style=\"border-color: #000000\">\n<td style=\"border: 1px solid #000000\" colspan=\"3\">1. Perform hand hygiene.<\/td>\n<td style=\"border: 1px solid #000000\" colspan=\"2\">This step reduces the transmission of microorganisms.<\/td>\n<\/tr>\n<tr style=\"border-color: #000000\">\n<td style=\"border: 1px solid #000000\" colspan=\"3\">2. Introduce yourself and explain the purpose of the assessment.<\/td>\n<td style=\"border: 1px solid #000000\" colspan=\"2\">This builds trust with patient and allows time for the patient to ask questions.<\/td>\n<\/tr>\n<tr style=\"border-color: #000000\">\n<td style=\"border: 1px solid #000000\" colspan=\"3\">3. Confirm patient ID using two patient identifiers (e.g., name and date of birth), and compare the MAR printout with the patient&#8217;s wristband.<\/td>\n<td style=\"border: 1px solid #000000\" colspan=\"2\">This step ensures you have the correct patient and complies with agency standard for patient identification.<\/p>\n<figure id=\"attachment_6143\" aria-describedby=\"caption-attachment-6143\" style=\"width: 152px\" class=\"wp-caption aligncenter\"><a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/Book-pictures-2015-430.jpg\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2015\/05\/Book-pictures-2015-430-300x231.jpg\" alt=\"Compare MAR with patient name band\" class=\"wp-image-6143\" height=\"117\" width=\"152\" \/><\/a><figcaption id=\"caption-attachment-6143\" class=\"wp-caption-text\">Compare MAR with patient wristband<\/figcaption><\/figure>\n<\/td>\n<\/tr>\n<tr style=\"border-color: #000000\">\n<td style=\"border: 1px solid #000000\" colspan=\"3\">4. Assess the IV insertion site and transparent dressing on IV site.<\/td>\n<td style=\"border: 1px solid #000000\" colspan=\"2\">Check IV insertion site for signs and symptoms of phlebitis or infection.\u00a0Check for fluid leaking, redness, pain, tenderness, and swelling. IV site should be free from pain, tenderness, redness, or swelling.<\/p>\n<p><a href=\"http:\/\/opentextbc.ca\/clinicalskills\/wp-content\/uploads\/sites\/82\/2015\/09\/DSC_0904.jpg\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-content\/uploads\/sites\/472\/2015\/05\/DSC_0904-300x199.jpg\" alt=\"Assess IV site prior to use\" class=\"wp-image-6163 aligncenter\" height=\"158\" width=\"238\" \/><\/a><\/p>\n<p>Ensure patient is informed to alert the healthcare provider if they experience pain or notice swelling or redness at the IV site. If patient is unable to report pain at IV site, more frequent checks are required.<\/td>\n<\/tr>\n<tr style=\"border-color: #000000\">\n<td style=\"border: 1px solid #000000\" colspan=\"3\">5. Inspect the patient&#8217;s arm for streaking or venous cords; assess skin temperature.<\/td>\n<td style=\"border: 1px solid #000000\" colspan=\"2\">Assess complications on hand and arm for signs and symptoms of phlebitis and infiltration \/ extravasation.<\/td>\n<\/tr>\n<tr style=\"border-color: #000000\">\n<td style=\"border: 1px solid #000000\" colspan=\"3\">6. Assess IV tubing for kinks or bends.<\/td>\n<td style=\"border: 1px solid #000000\" colspan=\"2\">Kinks or bends in tubing may decrease or stop the flow of IV fluids. Ensure tubing is not caught on equipment or side rails on bed.<\/p>\n<p>Tubing should be properly labelled with date and time the tubing was initiated.<\/td>\n<\/tr>\n<tr style=\"border-color: #000000\">\n<td style=\"border: 1px solid #000000\" colspan=\"3\">7. Check the rate of infusion for the primary and secondary IV solutions. Verify infusion rate in physician orders or medication administration record (MAR).<\/td>\n<td style=\"border: 1px solid #000000\" colspan=\"2\">If IV solution is on gravity, calculate and count the drip rate for one minute.<\/p>\n<p>If solution is on an IV pump, ensure the rate is correct and all clamps are open as per agency protocol.<\/p>\n<p>If secondary IV medication is infusing, ensure clamp on secondary IV tubing is open. The EID is unable to distinguish if the primary bag or secondary bag is infusing.<\/td>\n<\/tr>\n<tr style=\"border-color: #000000\">\n<td style=\"border: 1px solid #000000\" colspan=\"3\">8. Assess the type of solution and label on bag indicating when it was hung.<\/p>\n<p>Check volume of solution in bag.<\/p>\n<p>Assess labels on IV tubing for information about when tubing needs to be changed.<\/td>\n<td style=\"border: 1px solid #000000\" colspan=\"2\">IV solutions become outdated every 24 hours.<\/p>\n<p>Ensure the correct solution is given.<\/p>\n<p>If 100 ml of solution or less is left in the bag, change the IV solution and document according to agency guidelines.<\/p>\n<p>If an IV pump is used, ensure it is plugged into an outlet. This ensures good battery charge.<\/p>\n<p>If IV tubing is due to be changed, consider priming a new bag and hanging it on the IV pole until the current bag is infused.<\/td>\n<\/tr>\n<tr style=\"border-color: #000000\">\n<td style=\"border: 1px solid #000000\" colspan=\"3\">9. Assist patient into comfortable position, place call bell in reach, and ensure necessary side rails are used.<\/td>\n<td style=\"border: 1px solid #000000\" colspan=\"2\">These precautions prevent injury to the patient.<\/td>\n<\/tr>\n<tr style=\"border-color: #000000\">\n<td style=\"border: 1px solid #000000\" colspan=\"3\">10.\u00a0Perform hand hygiene.<\/td>\n<td style=\"border: 1px solid #000000\" colspan=\"2\">This step prevents the spread of microorganisms.<\/td>\n<\/tr>\n<tr style=\"border-color: #000000\">\n<td style=\"border: 1px solid #000000\" colspan=\"3\">11. Document procedure and findings as per agency policy.<\/td>\n<td style=\"border: 1px solid #000000\" colspan=\"2\"><span>Timely and accurate documentation promotes patient safety.<\/span><\/td>\n<\/tr>\n<tr style=\"border-color: #000000\">\n<td style=\"border: 1px solid #000000\" colspan=\"5\">Data sources: Fulcher &amp; Frazier, 2007; Perry et al., 2018<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<div class=\"bcc-box bcc-info\">\n<h3 style=\"text-align: center\">Critical Thinking Exercises<\/h3>\n<ol>\n<li>What is the purpose of the back-check valve on primary IV tubing?<\/li>\n<li>When is it important for the nurse to know the drop factor of IV tubing?<\/li>\n<li>What is the purpose of extension tubing?<\/li>\n<li>The nurse has found the patient to have an IV administration set hung 96 hours prior. Explain the necessary next steps.<\/li>\n<\/ol>\n<h2>Attribution<\/h2>\n<p>Figure 8.15 <a href=\"https:\/\/opentextbc.ca\/clinicalskills\/chapter\/8-2-types-of-iv-therapy\/\">IV Primary and Secondary Tubing Setup<\/a> by BCIT is\u00a0used\u00a0under a\u00a0<a href=\"https:\/\/creativecommons.org\/licenses\/by-sa\/4.0\/deed.en\"><span class=\"cc-license-identifier\">CC BY-SA 4.0<\/span><\/a>\u00a0international license.<\/p>\n<p>Figure 8.16. drop factor by author is used\u00a0under a\u00a0<a href=\"https:\/\/creativecommons.org\/licenses\/by-sa\/4.0\/deed.en\"><span class=\"cc-license-identifier\">CC BY-SA 4.0<\/span><\/a>\u00a0international license.<\/p>\n<p>Figure 8.17 Different volumes of IV bags\u00a0by author is used\u00a0under a\u00a0<a href=\"https:\/\/creativecommons.org\/licenses\/by-sa\/4.0\/deed.en\"><span class=\"cc-license-identifier\">CC BY-SA 4.0<\/span><\/a>\u00a0international license.<\/p>\n<p>Figure 8.18 Needleless caps by author\u00a0is used\u00a0under a\u00a0<a href=\"https:\/\/creativecommons.org\/licenses\/by-sa\/4.0\/deed.en\"><span class=\"cc-license-identifier\">CC BY-SA 4.0<\/span><\/a>\u00a0international license.<\/p>\n<p>Figure 8.19 Volume Control Set by author\u00a0\u00a0is used\u00a0under a\u00a0<a href=\"https:\/\/creativecommons.org\/licenses\/by-sa\/4.0\/deed.en\"><span class=\"cc-license-identifier\">CC BY-SA 4.0<\/span><\/a>\u00a0international license.<\/p>\n<\/div>\n","protected":false},"author":397,"menu_order":5,"template":"","meta":{"pb_show_title":"on","pb_short_title":"","pb_subtitle":"","pb_authors":[],"pb_section_license":"cc-by"},"chapter-type":[],"contributor":[],"license":[50],"class_list":["post-929","chapter","type-chapter","status-publish","hentry","license-cc-by"],"part":912,"_links":{"self":[{"href":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-json\/pressbooks\/v2\/chapters\/929","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-json\/pressbooks\/v2\/chapters"}],"about":[{"href":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-json\/wp\/v2\/types\/chapter"}],"author":[{"embeddable":true,"href":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-json\/wp\/v2\/users\/397"}],"version-history":[{"count":25,"href":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-json\/pressbooks\/v2\/chapters\/929\/revisions"}],"predecessor-version":[{"id":5148,"href":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-json\/pressbooks\/v2\/chapters\/929\/revisions\/5148"}],"part":[{"href":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-json\/pressbooks\/v2\/parts\/912"}],"metadata":[{"href":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-json\/pressbooks\/v2\/chapters\/929\/metadata\/"}],"wp:attachment":[{"href":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-json\/wp\/v2\/media?parent=929"}],"wp:term":[{"taxonomy":"chapter-type","embeddable":true,"href":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-json\/pressbooks\/v2\/chapter-type?post=929"},{"taxonomy":"contributor","embeddable":true,"href":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-json\/wp\/v2\/contributor?post=929"},{"taxonomy":"license","embeddable":true,"href":"https:\/\/pressbooks.bccampus.ca\/clinicalproceduresforsaferpatientcaretrubscn\/wp-json\/wp\/v2\/license?post=929"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}