ROUTE
Introduction
Ideally, a person gets the fluids and electrolytes needed to live by the oral route. This route
has certain built-in safeguards against bacterial invasion. When the intravenous route of
administration must be used, the material being given is injected directly into the circulatory
system through the veins.
Check all bottles or bags of infusion solution for these specific requirements and discard any
that show:
(1) A broken vacuum seal.
(2) Cloudiness
(3) Precipitation (particles on the bottom of the bag or bottle).
(4) Foreign contamination
b. Always, use sterile equipment and wash your hands thoroughly.
c. Disinfect the patient's skin at and around the injection site. Apply antiseptic solution using
friction at and around the venipuncture site.
d. For long term therapy patients.
(1) Change the injection site every 48 to 72 hours (to lessen the possibility of infection and/or
irritation to the vein), or in accordance with (IAW) local SOP IAW with local standing
operating procedures (SOP).
(2) Replace the tubing and solution bottle (or bag) every 24 hours (to avoid infusing a
contaminated solution) or IAW local SOP.
(3) Take precautions if vein irritation or thrombophlebitis is possible.
(a) Plastic catheters are more likely to cause irritation than stainless steel needles.
(b) Use the smallest gauge needle or catheter possible.
(c) Use the shortest infusion time possible. Irritation is much more likely after 48 hours of
intravenous therapy.
(d) Veins of the lower extremities (in adults) are more likely to develop phlebitis (and
quicker) than those of the upper extremities.
(e) Do not irrigate a stopped infusion. You may dislodge an obstructive clot and endanger the
patient's life.
(f) You are less likely to irritate the large veins of the central venous system than the smaller
peripheral veins.
(g) Strict attention to aseptic techniques is required at all times to prevent sepsis.
Procedure
A. Setting up
1. Verify written prescription and make IV label.
2. Observe the Seven rights when preparing and administering intravenous fluid.
3.
Explain the procedure to reassure patient and /or significant other, secure consent if
necessary.
4. Assess patients vein, choose appropriate site, location, size / condition.
11. Fill drip chamber to at least half and prime it with IV fluid aseptically.
12. Expel air bubbles if any and put back the cover to the distal end of the IV set (get ready
for IV insertion).
B. Inserting IV cannula into patient arm
Prepare complete IV tray with IV infusions and over-the-needle catheter or
butterfly needle.
1. Verify the written prescription for IV therapy; check prepared IVF and other things
needed.
2. Explain procedure to reassure the patient and significant others and observe the 7 rights.
3. Do hand hygiene before and after the procedure.
4. Choose site for IV.
5. Apply tourniquet 5-12 cm. (2-6 inches) above injection site depending on condition of
patient.
8. Upon backflow visualization, continue inserting the catheter into the vein.
9. Position the IV catheter parallel to the skin. Hold stylet stationary and slowly advance
the catheter until the hub is 1 mm to the puncture site.
10. Slip a sterilize gauze under the hub. Release the tourniquet; remove the stylet while
applying digital pressure over the catheter with one finger about 1-2 inches from the tip
of the inserted catheter.
11. Connect the infusion tubing of the prepared IVF aseptically to the IV catheter.
12. Open the clamp and regulate the flow rate. Reassure patient.
13. Anchor needle firmly in place with the use of:
a. Transparent tape/dressing directly on the puncture site.
b. Tape (using any appropriate anchoring style)
c. Band Aid the inserted catheter.
14. Tape a small loop of IV tubing for additional anchoring. Apply splint, if needed.
15. Calibrate the IV fluid bottle and regulate flow of infusion according to prescribed
duration.
16. Label on IV tape near the IV site to indicate the date of insertion, type and gauge of
IV catheter and countersign.
17. Label with plaster on the IV tubing to indicate the date when to change the IV tubing.
18. Observe patient and report any untoward effect.
19. Discard sharps and waste according to Health Care Waste Management.
20. Document in the patients chart and endorse to incoming shift.
Discontinuing an IV infusion
1. Verify written doctors order to discontinue IV including IV medications.
2. Observe seven rights.
3. Assess and inform the patient of the discontinuation of IV infusion.
4. Prepare the necessary materials, IV tray or injection tray with sterile cotton balls with
alcohol, plaster, pick up forceps in antiseptic solution, kidney basin and band aid.
5. Wash hands before and after procedure.
6. Close the roller clamp of the IV administration set.
7. Moisten adhesive tapes around the IV catheter with cotton balls with alcohol; remove
plaster gently.
8. Use pick up forceps to get cotton ball with alcohol and without applying pressure,
remove needle or IV catheter then immediately apply pressure over the venipuncture site.
9. Inspect IV catheter for completeness.
10. Place dressing over the venipuncture site.
11. Discard all waste materials including the IV cannula according to Health Care Waste
Management.
12. Reassure patient.
13. Document time of discontinuance, status of insertion site and integrity of IV catheter
and endorse accordingly.