Initiating a primary and secondary IV.m4v

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1 Initiating a primary and secondary IV.m4v So today we're going to be talking about initiating a primary and a secondary IV. We're going to do both skills in this video. When you come into lab I want to make sure that you know the complications of IV therapy and the differences between IV infiltration phlebitis and extravasation. So make sure you know that before you come in. So I've gone ahead and verified my physician order. And I've gathered my IV solutions per my physician order and they're in the electronic medical records. So I have my electronic medical record with my supplies with me. And I will show you the supplies we have in just a moment. Good evening. My name is Jennifer. I'm your registered nurse today. I'm here to go ahead and start your IV solutions that the doctor has ordered. I'm going to go ahead and just to do a quick hand hygiene here. How are you feeling? Good, glad to hear it. So can you can just tell me your full name and date of birth? OK, thank you Mrs. Smith. I'm just going to go ahead and get the supplies. And what we're going to do is we're going to start your primary IV. And we're going to connect it here right to your extension set that you already have. So no IV inserts, or anything like that. We're just going to go ahead and hook up the IV fluids. For primary IV I have my primary IV solution, which I have verified on my orders using my six rights. So here we have 0.9 normal saline that the doctor has ordered at 50 ml per hour. I also verified the policy and the procedure in the facility. That tells me what their policy and procedure are for how good are the IV solutions for. And the IV solution is good for 24 hours, and the tubing is good for 72 hours. I have my solution. Usually this solution in the facilities is in 1,000 ml bag, but for demonstration purposes we're just using this 250 ml bag. We also have our primary tubing. Most facilities are going to vary in the tubing they use depending upon the pumps that they use.

2 Our facility here uses the clear link system, and so I have my primary tubing. It will usually tell you if it's primary or secondary tubing. If it doesn't list that it's primary, it will always say if it's secondary tubing. So I have my primary tubing. I also have what's called a time tape. I have some alcohol wipes, an IV flush because we're going to flush our extensions set. I also have, we will show you these in lab, when you hang your IV solutions, your IV tubing is good for 72 hours. So you will place the day of the week that it is due to be changed on the IV tubing itself. So each day of the week has a different color and they're labeled. We will show you all of those in lab. Today is Wednesday. So 72 hours from today would be-- Thursday would be 24 hours, Friday would be 48 hours, Saturday would be 72 hours. So I would need a date change for my tubing for Saturday. So I've gone ahead and got that. These are usually on roles in the med room. And so we just wanted to show you them for demonstration purposes. Again, I've performed hand hygiene. Along with verifying my six medication rights. I also, in the supply room, looked at the integrity of my solution. I verified that the solution is not expired. It's clear. It's not cloudy. There's nothing wrong with the solution. The integrity the solution is good. Mrs. Smith I'm going to go ahead and raise up your bed just a little bit so it's just at a comfortable working height when we go to connect you. Now I'm going to and open up my tubing. And this one has a perforated edge. I'm just going to pull down. I don't need gloves for this because I am not coming in contact with blood or body fluids from the patient at all. I've got my trash can right here. They always come connected with the tape. My biggest recommendation to you that I will always tell you, whenever you are hanging an IV, the first thing to do when you take it out of the IV bag is to clamp the IV tubing. So the roller clamp right here I've clamped it all the way to the bottom so that it is clamped. You're going to notice on here this IV actually has what's called a filter on it. This is not typical on most IV tubings. This just happens to be what we have in the lab today.

3 When I prime my IV, I want to ensure a couple things. You want to ensure that you maintain sterility when connecting your tubing to your IV bag. And you want to make sure you prime it at [UNINTELLIGIBLE] level. So you're going to take the cap off your IV bag, the cap off your tubing, and you're going to insert it. And you're going to give a little twist and a pull. And it's going to come down to a connection that you'll see much better, again, we will show you in the lab. Then you can hang this on your IV pole. And you are going to fill your chamber with what we call the I. Again, this is difficult to see on the video, but there's a small line here. We're going to squeeze this chamber until we fill that chamber to that line, or that I. And now I'm going to do what's called priming my IV tubing. I've got my waste can right here. I'm going to keep my cap on. I want this at waist level because I don't want it going below my waist and hitting things. Unroll the roller clamp. And your solution will start running into the trashcan, or whatever else you have on hand. The purpose of what we want to do here is I want to make sure I'm flushing the line of any air at all. The solution is dripping out as you can see. And I'm looking at my line, and I actually do not have any air in my line so I've done a really good prime. Once that line is primed I can go ahead and clamp the tubing. If I had any air I'm just going to let it keep running, the solution running, until the air runs out of the line. So this is all good and ready to go so I can just hang this here for a second. My extension set from my IV that I started earlier, I'm going to clean off the buff cap with an alcohol wipe. Take my cap off my flush, and I'm going to go ahead again Luer-Lok, and I'm going to flush. And again, I'm checking for any infiltration, any complaints from the patient of pain, and I'm flushing my line. If I have any resistance or anything like that, the IV site would not be good. Once I've flushed, I disconnect my flush, get rid of that, and I can and connect. Again, this luer locks together, and connect my IV line. A couple different things before we get this started. We're going to do what's called time taping the bag. This here is just a tape we can add to the bag. Again, this is a 250 ml bag. I verified my six medication rights. So according to that, my rate is 50 ml per hour. So I'm going to go ahead and I'm going to place my time tape on my bag. And what I want to do is put my start time, which is the solution start, and it's 12 noon. So if my solution is running at 50 ml per hour, at the

4 50 it's going to be one o'clock, at the 100 it's going to be two o'clock, three o'clock, four o'clock, and my solution will be done by five. So I can write at I'm going to put my initials, the date, and we already know the start time. If you have scanners in your institution it will calculate that as well. The other thing I'm going to put on here is my drip factor. So you have to figure out your drip factor, or your drip rate. You went through that in class. My drip factor for my actual primary IV tubing here is on here. It's ten drops per ml. I figured out my drip factor, and at 50 ml per hour I want about 8 drops per minute. So I'm going to adjust my roller clamp until I get eight drops per minute. I'm not going to run this for demonstration purposes because we don't want to run solutions into this manikin, since this manikin does not allow that. The last thing I'm going to place is my change date for me tubing on my IV tubing. So first thing when you come in the room, this is a fantastic visual for you to see if your tubings need to be changed that day. That's it for a primary IV. So now we have orders for a secondary IV. Those usually are antibiotics and things like that. We already have a primary IV running, so our line is patent. Same principles as we did with our primary. This is a secondary IV. Most medications in most facilities come already pre-mixed from the pharmacy. So we are, for demonstration purposes, going to say this is already labeled with the patient name, the medication, the time that it needs to be hung, et cetera. If you're in an environment which you need to add things to the bag you will have labels that you can add. But you're going to check with the policy and procedure of the facility that you're working in. Again, I've got my tubing. The difference is this is secondary tubing. And it's labeled as such. My drop factor is the same as my primary, which is 10 drops per ml. I don't need to flush because I already have a primary line running. However, I do need my date change for my secondary IV.

5 So again, this is exactly the same as a primary IV. We're going to open this up. We have an extra hanger in here. And I'll show you that in one second. So you can place that up on your line. Rule of thumb, first thing to do, take out any IV tubing, clamp the line. Otherwise it's going to run all over the floor. First couple times you do it you'll never do it again, guaranteed. So here we're going to remove our cap, maintaining sterile technique, connect in. This is already labeled with our medication of what it is. Place your day that your tubing needs to be changed. And with a secondary IV we're going to do what's called back priming because we don't want to lose any of the solution that is in this bag. So when we back prime we're going to connect to the primary Y connection on this tubing set. So I need to clean off that primary Y connection with my alcohol wipe. So the primary Y connection on this tubing is up here so we're going to clean this with an alcohol wipe, take the cap off the primary tubing, me and connect. On some IV tubings, primaries, you may find the buff caps further down as well. But you've got to be in the primary connection, so up here. To back prime what you're going to do is the bags are going to be at the same level. You're going to open up your secondary clamp. And you're seeing this drip, and the solution is running back up. And hopefully you can see this on the video. It's running back up, and we want to run it to the I on the secondary line. So I did not need to adjust my primary roller clamp at this point. So now my line is back primed. i'm going to clamp both at this point. I need to lower my primary bag. That's what this handy little hanger is for. Because the solution that is hanging highest is the solution that's going to run in. So I'm going to open back all the way up my secondary line. And I'm going to adjust my drip rate down here on my primary roller clamp. So for ease of purpose, our orders we verified, we have IV Ancef here. And it's going to go at 50 ml per hour. So we have the same drip factor, or drops per ml, which are 10. We want to calculate this, and look at this, and make sure it's running at eight drops per minute. We would do that.

6 The last couple of things you're always going to do on an IV is assess the site for any signs and symptoms of infiltration, extravasation or phlebitis. And lastly once I'm done I'm going to lower the bed to a low and locked position, make sure the call dials within reach. And I'm going to finish with my documentation, which includes physician orders, the IV solution, the site which I placed it because patient could have more than one IV, the assessment of the site, the rate any education I provided, and patient tolerance to procedure.

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