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route for administration of fluids, medications, blood, or nutrients. Provides peripheral venous access route for repetitive blood sampling, thereby minimizing pain associated with repetitive needlesticks.

Reason for initiation of IV therapy for this client. Orders fro type and rate of fluid and/or specified IV site. Status of skin on hands and arms; presence of hair or abrasions, previous IV sites. Clients ability to avoid movement of hands/arms during the procedure. Allergy to tape, iodine, or antibiotic solutions Client knowledge of IV therapy.


volume deficit related to poor oral intake Risk for infection related to invasive procedure.

Wear gloves because contact with blood is likely. Maintain strict aseptic technique. Choose tubing and needle appropriate for the solution to provide optimal fluid flow. Attempt to puncture the vein on the most distal (lower) end. NEVER ATTEMPT TO RETHREAD A CATHETER.

If the client is restless, have an assistant to hold still. Each shift should monitor and record the amount of fluid remaining in the bottle, new bottle, tubing or site change, and site care. The veins of older adults are often fragile. When veins are elevated and clearly visible, perform insertion without using tourniquet if appropriate. Monitor for complications


overload Air embolism Septicemia and other infections Infiltration and extravasations Phlebitis Thrombophlebitis Hematoma Clotting and obstruction

Non sterile gloves Butterfly device/ IV catheter over-needle IV solution Armboard (optional) Infusion tubing IV pole IV insertion kit torniquet, 1-inch wide

adhesive tape, alcohol pads, 2x2 inch gauze, transparent dressing, adhesive labels
Towel or linen saver

Figure 33.60

Syringe pump or mini-infuser for administration of IV medications.

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Hand hygiene, organize equipments. Explain procedure. Position client. Assess hand. Ask which hand is dominant. Apply tourniquet 3 to 5 inches below elbow. Ask client to open and close hand. Inspect the extremity looking for veins with the largest diameter and fewest curve or


junctions. Release tourniquet and allow client to relax.

If area is hairy, use scissors to clip excessive hair, wash area with soap and water, then dry.

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Hang IV bottle on an IV pole or wall hook; squeeze and release drip chamber until fluid level reaches the ring mark (half to 2/3 full). b. Remove cap from end of tubing and open roller clamp, allowing fluid to fill tubing and flow to the end until all air is expelled (NO BUBBLES). c. During priming, invert medication port and tap while fluid is flowing. d. Close roller clamp and replace cap on end of tubing.

Select vein. Open tubing package and check for tubing cracks or flaws. Check if roller clamp is working. Open IV fluid container. Remove protective covering. Connect the tubing by pushing the spike into port. Prime the tubing.

6. Label the clients solution bottle with the clients name, room number, date and time initiated, rate of infusion, and your initials. 7. Prepare needle. Check if without bends or chips. 8. Open several alcohol pads. 9. Place towel under extremity. 10. Apply tourniquet if appropriate. 11. Don clean gloves. 12. Clean site inner to outer, circular motion in a 2inch wide diameter. Allow to dry. 13. Encourage client to take slow, deep breaths. 14. Hold skin taut with one hand while holding catheter with the other hand. For a butterfly needle, Pinch wings of butterfly together to insert needle. 15. Maintaining sterility, inset catheter into vein with bevel up. Puncture skin at 30 degree angle, 1 cm below site where the vein will be entered.

16. Once needle has entered skin, lower it until it is almost parallel to the skin. 17. Following path of vein, insert catheter moving toward the side of the vein wall. Place index finger on the pushoff tab and thread the catheter to the desired length. 18. Watch for first backflow of blood then push needle gently into vein (1/4 inch). Pull needle out out of vein and skin. *if unable to insert catheter fully, DO NOT FORCE; WAIT UNTIL FLOW IS INITIATED. 19. Holding catheter securely, remove cap from IV tubing and insert into hub of catheter and twist to lock. 20. Remove tourniquet. 21. Open roller clamp and allow fluid to flow freely for a few seconds. 22. Monitor for swelling or pain. 23. Tape catheter in position that allows free flow of the fluid.

24. Slow IV solution to a moderate infusion rate. 25. Cover with transparent dressing. 26. Remove gloves and secure tubing. 27. Regulate IV flow as ordered. 28. Apply arm board if needed. 29. Remove towel, discard gloves, and dispose of equipment properly. 30. Review limitations in range of motion with client. Instruct client in signs and symptoms to report and encourage client to notify nurse immediately of any discomfort or problems. 31. Position client appropriately. Never allow the IV bottle to be placed below the heart level. 32. Check infusion rate and site after 5 minutes and again after 15 minutes. Check volume every 1 to 2 hour.

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Clamp the IV tubing by rolling the clamp down until tight. Remove the old bottle from the IV pole. Remove the spike from the old bottle maintaining sterility. Open the new bottle. Push the spike into the port.

5. Hang IV bottle on an IV pole or wall hook; squeeze and release drip chamber until fluid level reaches the ring mark (half to 2/3 full). 6. Regulate flow as ordered.