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WORKBOOK ON IV THERAPY, Study Guides, Projects, Research of Nursing

This Laboratory Manual of Skill Procedures focuses on Intravenous Therapy. It contains 2 (two) Manuals. The first Manual is the Initiation and maintenance of peripheral Intravenous (IV) therapies, monitoring of established IV’s and the second Manual is the Administration of medication thru heparin lock or the 3 way stopcock. Administering IV drugs are required competencies for healthcare professionals in the Philippines, the ASEAN region and the world.

Typology: Study Guides, Projects, Research

2019/2020

Available from 01/29/2023

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BACKGROUND OF THE LABORATORY MANUAL
This Laboratory Manual of Skill Procedures focuses on Intravenous Therapy. It contains 2 (two) Manuals.
The first Manual is the Initiation and maintenance of peripheral Intravenous (IV) therapies, monitoring of
established IV’s and the second Manual is the Administration of medication thru heparin lock or the 3 way
stopcock. Administering IV drugs are required competencies for healthcare professionals in the Philippines,
the ASEAN region and the world.
This clinical procedure manual is intended for the College of Nursing Level III students of Western
Mindanao State University to develop their skills, knowledge, attitude and values befitting an effective and
skilled nurse.
The Level III College of Nursing faculty is dedicated in providing these components to enable the
successful implementation of each student’s scope of practice. These endeavors will prepare the learners to
be competent to practice these skills independently adhering to standard procedure.
INTRODUCTION
The human body is made up of 50 – 60% water. The balance between water, plasma and
electrolytes is essential to maintaining homeostasis within the body. Understanding this balance will enable
the Level III Nursing students to assess and manage their patients’ fluid and electrolyte disturbances.
Current Intravenous (IV) therapy is less than 100 years old. Yet, it was known as early as the 1600s
that medications could be injected into a vein. Because of a lack of understanding about sterility, infection
control, and other scientific methods, original attempts to deliver IV fluids and drugs met with little success.
The greatest advance in drugs, equipment, and procedures has occurred in the past 25 years. The practice
and regulation surrounding IV therapy continues to evolve.
Intravenous (IV) therapy is the administration of fluid and electrolytes directly into the client’s
circulatory system through a vein. An IV catheter may be placed in a peripheral or a central vein. Factors
determining IV placement location include, the length of therapy, type of medication or nutritional solution
and physician preference.
GOAL:
To produce health care professionals who have acquired the fundamental principles and
competencies required to begin, maintain, and discontinue intravenous therapy.
LEARNING OBJECTIVES:
At the end of 20 hours of RLE, utilizing critical thinking and the nursing process, the student can:
1. Apply the facts, principles, and concepts related to intravenous therapy.
2. Initiate IV therapy including needle, tubing, and solution selection
3. Determine the appropriate supplies and convert an IV to a heparin lock observing the principles
of aseptic and sterile techniques.
4. Select the appropriate supplies to change an IV tubing and containers without contamination.
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BACKGROUND OF THE LABORATORY MANUAL

This Laboratory Manual of Skill Procedures focuses on Intravenous Therapy. It contains 2 (two) Manuals. The first Manual is the Initiation and maintenance of peripheral Intravenous (IV) therapies, monitoring of established IV’s and the second Manual is the Administration of medication thru heparin lock or the 3 way stopcock. Administering IV drugs are required competencies for healthcare professionals in the Philippines, the ASEAN region and the world. This clinical procedure manual is intended for the College of Nursing Level III students of Western Mindanao State University to develop their skills, knowledge, attitude and values befitting an effective and skilled nurse. The Level III College of Nursing faculty is dedicated in providing these components to enable the successful implementation of each student’s scope of practice. These endeavors will prepare the learners to be competent to practice these skills independently adhering to standard procedure. INTRODUCTION The human body is made up of 50 – 60% water. The balance between water, plasma and electrolytes is essential to maintaining homeostasis within the body. Understanding this balance will enable the Level III Nursing students to assess and manage their patients’ fluid and electrolyte disturbances. Current Intravenous (IV) therapy is less than 100 years old. Yet, it was known as early as the 1600s that medications could be injected into a vein. Because of a lack of understanding about sterility, infection control, and other scientific methods, original attempts to deliver IV fluids and drugs met with little success. The greatest advance in drugs, equipment, and procedures has occurred in the past 25 years. The practice and regulation surrounding IV therapy continues to evolve. Intravenous (IV) therapy is the administration of fluid and electrolytes directly into the client’s circulatory system through a vein. An IV catheter may be placed in a peripheral or a central vein. Factors determining IV placement location include, the length of therapy, type of medication or nutritional solution and physician preference. GOAL: To produce health care professionals who have acquired the fundamental principles and competencies required to begin, maintain, and discontinue intravenous therapy. LEARNING OBJECTIVES: At the end of 20 hours of RLE, utilizing critical thinking and the nursing process, the student can:

  1. Apply the facts, principles, and concepts related to intravenous therapy.
  2. Initiate IV therapy including needle, tubing, and solution selection
  3. Determine the appropriate supplies and convert an IV to a heparin lock observing the principles of aseptic and sterile techniques.
  4. Select the appropriate supplies to change an IV tubing and containers without contamination.

RUBRICS for the Student’s Actual Performance This is how you are going to be evaluated by your respective Clinical Instructors after your Supervised Practice Demonstration using the numerical value presented below.

Numerical Value Component Description

4 EXEMPLARY Reflects highest level of performance

3 ACCOMPLISHED Reflects mastery of performance

2 DEVELOPING

Reflects movement towards mastery

level of performance

1 BEGINNER Reflects beginning level of performance

D. Drip Chambers

  1. Macrodrip chamber  Used if the solution is thick or to be rapidly infused  Drop factor varies from 10 to 20 drops / mL  Read the tubing package to determine how many drops per milliliter are delivered (drop factor)
  2. Microdrip chamber  Normally, the chamber has a short vertical metal piece where the drop forms  The chamber delivers about 60 drops / mL  Read the tubing package to determine how many drops per milliliter are delivered (drop factor)  Used for the following purposes:  If fluid will be infused at a slow rate (less than 50 mL/hr.)  If the solution contains potent medication that needs to be titrated, such as in a critical care setting or in pediatrics Roller clamp / Clamp regulator Hub for Catheter Injection port Drip chamber Macro IV set Microdrip chamber Micro IV set

INTRAVENOUS NEEDLES

SPECIFICATIONS

Gauge

Color

Code

External

Diameter

(mm)

Length

(mm)

Flow Rate

(mL / min)

Recommended

Use

14G Orange 2.1 45 240 In massive trauma situations

16G Grey 1.8 45 180

Trauma, surgeries, or multiple

large-volume infusions

18G Green 1.3 32 / 45 90

Blood transfusion, or large

volume infusion

20G Pink 1.1 32 60

Multi-purpose IV; (medications,

hydration and routine therapies)

22G Blue 0.9 25 36

Most chemo infusions; patients

with small veins; elderly or

pediatric patients

24G Yellow 0.7 19 20 Very fragile veins, elderly,

26G Violet 0.6 19 13 neonates or pediatric patients

14 Rights (R’s) of Medication Administration

  1. Right Client  Check the client’s identification band/bracelet.  Compare medication order to identification bracelet and patient’s stated name and birth date  Know the agency’s name alert procedure when clients with the same or similar last names are on the nursing unit.  Verify patient’s allergies with chart and with patient.
  2. Right Medication  Perform a triple check of the medication’s label 1) When retrieving the medication 2) When preparing the medication 3) Before administering medication to the patient  Always check the medication label with the physician’s orders  Never administer medication prepared by another person  Never administer medication that is not labelled.
  3. Right Dose  Check label for medication concentration  Compare prepared dose with medication order  Triple all medication calculations  Check all medication calculations with another nurse  Verify that dosage is within appropriate dose range for patient and medication

MANUAL NO.

I. INTRAVENOUS INSERTION and FLUID INITIATION (Please provide the Rationale after each step)

  1. Assess patient’s vein. Choose appropriate  Site  Location  Size  Condition **Rationale:

________________________________________________**

  1. Perform hand washing. (Refer to Hand washing procedure) **Rationale:

__________________________________________________**

  1. Prepare necessary materials for the procedure. In the IV tray prepare the following: **Rationale:

______________________________________________**

  1. Verify written prescription by the physician
  2. Observe the fourteen (14) Rs in preparing and administering I.V. **Rationale:

______________________________________________**

  1. Explain procedure to reassure patient and/or significant others.
  2. Secure consent.

 IV Solution  Administration set  IV cannula  Sterile forceps  Cotton balls with alcohol  Plaster  Tourniquet  Sterile gloves Sterile 2x2 gauze or transparent dressing **Rationale:


_______________________________________________________________________________**

  1. Check the sterility, integrity and the expiration date of IV Solution, IV Set and other devices. **Rationale:


______________________________________________________________________________________**

  1. Label the IV Bottle duly signed by the RN who prepared the IV with the IV SET IV SOLUTION

**Rationale:


______________________________________________**

  1. Remove the plastic cover (without touching the rubber inside) Spike the infusate container aseptically **Rationale:

______________________________________________** Fill drip chamber at least halfway and prime the tubing aseptically **Rationale:


______________________________________________** Expel air bubbles if present Cover distal end of the IV set **Rationale:


______________________________________________**

II. INSERTING THE I.V. CANNULA/FLUID ADMINISTRATION

  1. Recheck the written prescription for I.V. therapy and materials needed.
  2. Explain procedure to the patient and significant others. Prepare for IV insertion **Rationale:


Rationale:


______________________________________________**

  1. Clean the I.V. site according to hospital policy.
  2. Pierce skin using the appropriate I.V. cannula observing the correct technique. At 15 to 20 degrees angle.
  3. Continue inserting the catheter into the vein once blood backflow is noted. Position IV catheter parallel to the skin o Hold stylet stationary o Slowly advance the catheter until the hub is 1mm to the puncture site.
  4. Slip sterile gauze under the hub. **Rationale:


____**

  1. Don sterile gloves / clean gloves. ( Refer to Hand Gloving Procedure) (Refer to Hand Gloving Procedure) **Rationale:



Rationale:




Rationale:



Rationale:



Rationale: _______________________________________**

  1. Apply the steri strip/transparent dressing directly to the IV site.
    1. Release the tourniquet while applying digital pressure over the I.V. site.
    2. Remove the needle of the cannula while pressing the tip of the site using the non-dominant hand and Connect the infusion tubing of the prepared IV fluid aseptically to the IV catheter. Rationale: _______________________________________ ______________________________________________ ____
  1. Label the IV tubing
  • Date and time (to determine when to change)
  1. Observe and reassure patient and report for any untoward reactions
  2. Discard sharps and waste according to health care management
  3. Wash hands **Rationale:



Rationale:




Rationale:




Rationale:




Rationale: _______________________________________**

  1. Document in the patient’s chart and endorse to incoming shift Rationale: _______________________________________ ______________________________________________ ____
  1. Don clean/sterile gloves.
  2. Clean the I.V. site according to hospital policy.
  3. Pierce skin using the appropriate I.V. cannula observing the correct technique at 15-20 degrees angle
  4. Continue inserting the catheter into the vein once blood backflow is noted.
  5. Position IV catheter parallel to the skin and  Hold stylet stationary  Slowly advance the catheter until the hub is 1mm to the puncture site
  6. Slip sterile gauze under the hub.

13. Release the tourniquet while applying digital pressure over the I.V.

14. Connect the infusion tubing of the prepared IV fluid aseptically to the IV catheter

  1. Open the clamp. Regulate the fluid as prescribed by the physician.
  2. Anchor the IV catheter securely in place with the use of:  Transparent tape / dressing directly on the puncture site
  3. Tape a small loop of IV tubing for additional anchoring. Splint if necessary
  4. Label the IV catheter according to the following:  Date and time of insertion  Type and gauge  Countersign
  5. Label the IV tubing  Date and time (to determine when to change)

20. Observe and reassure patient and report for any untoward reactions

  1. Discard sharps and waste according to Health Care Waste Management
  2. Wash hands thoroughly
  3. Document in the patient’s chart and endorse to the incoming shift 215 – 224 = 1. 204 – 214 = 1. 193 – 203 = 1. 181 – 192 = 1. 170 – 180 = 2. 159 – 169 = 2. 147 – 158 = 2. 138 – 146 = 2.75 Total Score: ____________________________ 134 - 137 = 3. 123 – 133 = 3.25 Rating: ________________________________ 112 – 122 = 3. 101 – 111 = 3.75 Student’s Signature: _____________________ 90 – 100 = 4. 80 – 89 = 4.25 C.I.’s Signature: _________________________ 70 – 79 = 4. 57 – 69 = 4.75 Remarks: ______________________________ 56 below = 5.0 ______________________________

REFERENCES American Academy of Orthopedic Surgeons (AAOS). (2014). Jones & Bartlett Learning. 8th^ Edition. 5 Wall Street Burlington, MA 01803 Association of Nursing Service Administrators of the Philippines. (2011). IV therapy handout. 9 th^ edition IV therapy Incredibly made easy.(2010). Wolters Kluwer/Lippincott Williams. 4th^ Edition

Silvestri, Linda Anne. (2014). Comprehensive Review for the NCLEX-RN Examination. Saunders Elsevier. Sixth Edition. Willis, L. (2010). IV therapy Incredibly Made Easy. Fourth Edition. Wolters Kluwer Health/Lippincott Williams & Wilkins, ebook Polymed medical services. I.V. Cannula. Retrieved from http://www.polymedicure.comi-v- cannula. Vera, M. (2016). 50 IV therapy tips & tricks: How to hit the vein in one shot. Retrieved from https://nurseslabs.com/50-intravenous-therapy-iv-tips-tricks.