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In a hospital environment, intravenous therapy serves as a common treatment method. This form of therapy facilitates the administration of fluids such as blood, saline, or medication to patients. Only individuals with appropriate medical training, such as nurses or authorized healthcare professionals, should undertake IV changes.
Procedures
Step 1: Preparing for IV Change
Review the physician's orders and the patient's IV documentation. Double-check the details on the IV label, including the bottle identification, solution type, volume, any additives, infusion duration, and flow rate. Confirming these particulars ensures the patient receives the correct IV solution and dosage.
- Always verify the information in the patient's medical record, as prescribed treatments may differ between individuals. For instance, while two patients may receive the same type of IV fluid, their respective infusion rates may vary.
Determine the type of fluid in the new IV bag. The fluid type influences the frequency of IV changes for the patient. Typically, IV solutions without additives last 72 hours before requiring replacement.
- IV bags containing additives necessitate daily changes, as do most medication-infused IV bags. The shorter lifespan of IV solutions with additives accounts for the potency of the additives or medications.
- IV bags containing food substitutes such as Lipid or TPN should also be changed every 24 hours to prevent spoilage. Any remaining TPNs or lipids in the bag during replacement should be discarded.
- Regardless of the IV solution type, IV lines must be changed every 24 hours to prevent tubing blockages caused by additives or TPNs.
Gather the necessary materials. These include:
- The prescribed IV fluid, ensuring it is available one hour before the procedure.
- Alcohol swabs or cotton balls soaked in alcohol.
- IV label
- IV pole/IV stand
- A watch with a second hand.
Verify the sterility of the new IV infusion. The solution should be clear and free from particulate matter, indicating sterility and good condition.
- Check the solution's expiration date, as administering expired or non-sterile fluids poses risks to patients.
Bring the necessary materials to the patient’s bedside. This minimizes trips between stations and saves time during the procedure.
Communicate the procedure to the patient. This reduces anxiety and encourages patient cooperation.
- Explain the replacement of IV fluid and its type to the patient, reassuring them that needle reinsertion is unnecessary.
- Inform the patient of the temporary cold sensation during infusion, which typically subsides within 1-2 minutes.
Phase 2: IV Change Process
Thoroughly cleanse your hands with antimicrobial soap and water. This reduces the transmission of microorganisms.
- Wet your hands and apply antimicrobial soap, lathering thoroughly.
- Rub palms together, ensuring coverage of the entire surface area.
- Interlace fingers to scrub between them and rub the backs of hands.
- Scrub the thumbs, palms, and wrists in circular motions for at least 20 seconds, approximately the time it takes to sing the Happy Birthday song twice.
- Rinse hands thoroughly from fingertips to wrists, then pat dry with a clean cloth.
Prepare the new IV solution bottle. Begin by removing the IV bottle's cover, carefully pulling off the plastic seal from the top of the fluid container.
Sanitize the rubber port on the bottle. This area, where the spike will be inserted, requires disinfection. Use alcohol swabs or cotton pads soaked in alcohol to wipe the port in a circular motion.
Secure the roller clamp on the previous IV administration set by rolling it downward. This action prevents leakage into the spike and sudden fluid flow from the new IV solution.
- The roller clamp is situated along the elongated plastic tubing, through which the IV fluid flows.
Create a bend in the tubing near the spike. Achieve this by folding the tube adjacent to the spike. This action prevents air from entering the tube.
- Ensuring the tubing is air-free is crucial, as the introduction of air into the body can result in an air embolism, posing serious risks to the patient.
Insert the spike into the container without contaminating the port. Position the new IV fluid container on a stable surface such as a bedside table and firmly insert the spike until the pointed end is fully immersed in the bottle.
- Avoid contact between the spike and any surfaces other than the port to prevent the spread of microorganisms, which could lead to infection.
Suspend the IV fluid from the designated IV pole. Ensure the pole stands 2-3 feet higher than the patient to prevent blood from flowing back into the IV tubing.
Adjust the flow rate according to the infusion duration. Accurate regulation of the flow rate, measured in drops per minute, is essential to deliver the prescribed volume of fluid to the patient's body.
- For instance, if the prescribed flow rate is 42 drops per minute, use a watch to count the drops accumulated in one minute.
- To decrease the flow rate, lower the roller clamp.
- To increase the flow rate, raise the roller clamp.
- Repeat this process until the desired drops per minute is achieved.
Update the patient’s IV record. Include details such as the solution type, incorporated medications, the date and time of IV change, and the flow rate of the new IV solution.
Part 3: Troubleshooting
If the IV fluid nears depletion, replace the IV. A fluid level approaching 100 indicates imminent depletion, necessitating timely replacement.
- Patients can also alert their nurse if they notice minimal fluid remaining in the IV.
Permit the patient to move within the hospital room. Ensure access to assistance by providing a help button or ensuring proximity to a nursing station or hallway where medical personnel are available. This ensures availability to assist the patient with moving the IV pole or stand if needed.
Regularly inspect the IV for proper fluid delivery. Additionally, monitor for any blood near the IV insertion site or within the tubing, indicating a need to adjust the IV bottle's hanging position slightly higher.
- Ensure patients do not manipulate the roller clamp, as only qualified medical personnel or nurses should adjust the IV flow rate.
Investigate patient complaints of pain or redness by examining the needle. Pain or redness at the IV insertion site may indicate needle dislodgement from the vein.
Useful Tips
Essential Supplies
- IV solution
- IV label (if required)
- IV pole/stand
- Alcohol/disinfectant
- Cotton balls
- A watch with a second hand
