Intravenous medicine administration using IV-set

Authors: Rednenko V.V., Rednenko L.I., Poplavets E.V.

Editor: Rednenko V.V.

Equipment for the practical skill:

• Workplace for injections and intravenous infusions (see PS1 - Preparing of the workplace for injections and intravenous infusions) including
  • Medications in glass (plastic) bottles or plastic IV fluid containers of 0,5 (0,4) or 1 litre volume
  • IV stand (bottle or bag holder)
  • IV set with a needle of appropriate size
  • extra needle (needle of size 1.25 x 40 mm, pink needle hilt, G18  is preferred)
  • medical records

Clinical situation:

• You are a nurse at a hospital’s therapeutic department. The doctor prescribed to the patient a intravenous infusion. Follow doctor's prescription

Order of the skill performance:

Preparatory stage:

• Prepare a workplace for injections and intravenous infusions (see Preparing of the workplace for injections and intravenous infusions)
• Prepare a IV set - fill the IV set with solution for infusion (see Filling IV-set with solution)
• prepare two 5 cm strips of adhesive tape (plaster) and stick them on the stand
• inform the patient about the infusion, get verbal consent to giving it

Maine stage:

• ask the patient to take the required position (to lay down on a bed)
• place a pad under a patient's shoulder
• put a tourniquet on patient's shoulder
• make 2-3 massaging movements with the edge of the palm toward from the periphery to the center (for a patient with poorly contoured veins)
• select, examine and palpate a puncture site of a vein
• take two swabs, soaked it with skin antiseptic;
• treat the skin at the puncture site 2 times in one direction:
  
  • with first swab a “large field” (10x10 cm in size);
  • with second one the "small field" (size 5x5 cm) ;
• place the used swabs in the container “Disinfection of dressings, PPE”;
• wait until the disinfectant has completely evaporated from the surface of the skin;
• ask the patient to clench fingers in a fist
• place the stand with IV set beside the patient bed
• take with your dominant hand a connector of the IV set
• open the roller clamp of IV set  until a drop of infusion solution appears inside a cap of the injection needle, then close the roller clamp
• wrap your hand around the connector and place the index finger on the needle hilt
• remove the needle cap and put it in the waste contaner "Plastic"
• hold the the vein in place by pulling the skin below the venipuncture site with the first finger of the nondominant hand
• check the position of the needle bevel by upward
• pierce the skin at a slight angle (no more than 15°), place the needle parallel to the vein
• holding the the vein in place, slightly change the needle direction, pierce the front wall of the vein (there is a “hit in the void”) and carefully push the needle along the vein
• untie the tourniquet with your left hand, ask the patient to unclench his fist
• open the roller clamp of IV set and make sure of abcence of a puncture site infiltration (swelling)
• fasten with strips of adhesive tape the needle hilt and IV set tube right after a injection site (port)
• adjust a speed of a solution administration with the roller clamp
• cover the venipuncture site with dry swab
• monitor the patient condition during the infusion period

 At the end of the infusion:

• wash your hands (see Hygienic hand washing) or treat it with skin antiseptic
• put on gloves
• take one swab and wet it with the skin antiseptic
• close the roller clamp of IV set
• remove the swab from the puncture site
• peel off adhesive tape
• put a swab with an antiseptic to the venipuncture site, remove the needle with a quick movement, press the swab for 3-5 minutes. For puncture of the ulnar vein, suggest that the patient bend the arm at the elbow joint.

Final stage:

• Disinfect the IV set (see Disinfection of disposable infusion IV set)