{"id":3700,"date":"2015-06-22T23:06:23","date_gmt":"2015-06-22T23:06:23","guid":{"rendered":"http:\/\/opentextbc.ca\/clinicalskills\/?post_type=chapter&p=3700"},"modified":"2021-05-20T21:50:26","modified_gmt":"2021-05-20T21:50:26","slug":"8-4-iv-assessment-maintenance-troubleshooting-and-discontinuation","status":"publish","type":"chapter","link":"https:\/\/opentextbc.ca\/clinicalskills\/chapter\/8-4-iv-assessment-maintenance-troubleshooting-and-discontinuation\/","title":{"raw":"8.4 Priming IV Tubing and Changing IV Fluids and Tubing","rendered":"8.4 Priming IV Tubing and Changing IV Fluids and Tubing"},"content":{"raw":"Primary and secondary IV tubing and add-on devices (extension tubing) must be primed with IV solution to remove air from the tubing. Priming refers to placing IV fluid in IV tubing to remove all air prior to attaching the IV tube to the patient. IV tubing is primed to prevent air from entering the circulatory system. An air embolism is a potential complication of IV therapy and can enter a patient's blood system through cut tubing, unprimed IV tubing, access ports, and drip chambers with too little fluid (Perry et al., 2014). It is unknown how much air will cause death, but deaths have been reported with as little as 10 ml of air.\u00a0The best way to avoid air bubbles in IV tubing is to prevent them in the first place (Perry et al., 2014). New IV tubing may also be required if leaking occurs around the tube connecting to the IV solution, if the tubing becomes damaged, or if it becomes contaminated. Checklist 66 outlines the process of priming IV tubing.\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n
<\/a>Checklist 66: Priming IV Tubing<\/caption>\r\n
\r\n
Disclaimer:\u00a0Always review and follow your hospital policy regarding this specific skill.<\/span><\/h5>\r\n<\/td>\r\n<\/tr>\r\n
\r\n
Safety considerations:\u00a0<\/span><\/h5>\r\n
    \r\n \t
  • Primary IV tubing can be macro-drip or micro-drip tubing. The drop factor of the IV tubing is required to complete the IV drip rate calculation for a gravity infusion.<\/li>\r\n \t
  • Remember to invert all access ports and backcheck valve.<\/li>\r\n<\/ul>\r\n<\/td>\r\n<\/tr>\r\n
\r\n

Steps<\/h4>\r\n<\/td>\r\n

\r\n

\u00a0Additional Information<\/h4>\r\n<\/td>\r\n<\/tr>\r\n

1.\u00a0Perform hand hygiene.<\/a><\/td>\r\nThis step prevents the transmission of microorganisms.<\/td>\r\n<\/tr>\r\n
2. Check order to verify solution, rate, and frequency.<\/td>\r\nThis ensures IV solution is correct and helps prevent medication error.<\/td>\r\n<\/tr>\r\n
3. Gather supplies.<\/td>\r\nYou will need IV solution, primary IV tubing, time label, change label, alcohol swab, and basin or sink.\r\n\r\n[caption id=\"attachment_6234\" align=\"aligncenter\" width=\"118\"]\"Sterile<\/a> Sterile IV solution[\/caption]<\/td>\r\n<\/tr>\r\n
4. Remove IV solution from outer packaging and gently squeeze.<\/td>\r\nTear the perforated corner of the outer packaging; check colour, clarity, and expiration date.\r\n\r\n[caption id=\"attachment_6209\" align=\"aligncenter\" width=\"102\"]\"Remove<\/a> Remove IV solution from packaging[\/caption]<\/td>\r\n<\/tr>\r\n
5. Remove primary IV tubing from outer packaging.<\/td>\r\n\r\n\r\n[caption id=\"attachment_6210\" align=\"aligncenter\" width=\"101\"]\"IV<\/a> IV tubing[\/caption]<\/td>\r\n<\/tr>\r\n
6. Move the roller clamp about 3 cm below the drip chamber and close the clamp.<\/td>\r\n\r\n\r\n[caption id=\"attachment_5807\" align=\"aligncenter\" width=\"112\"]\"Moving<\/a> Move roller clamp[\/caption]<\/td>\r\n<\/tr>\r\n
7. Remove the protective cover on the IV solution port and keep sterile.\u00a0Remove the protective cover on the IV tubing spike.<\/td>\r\nBe careful and do not contaminate the spike.\r\n\r\n[caption id=\"attachment_6502\" align=\"aligncenter\" width=\"111\"]\"Remove<\/a> Remove protective cover from spike on IV tubing[\/caption]<\/td>\r\n<\/tr>\r\n
8. Without contaminating the solution port, carefully insert the IV tubing spike into the port, gently pushing and twisting.<\/td>\r\n\r\n\r\n[caption id=\"attachment_5809\" align=\"aligncenter\" width=\"73\"]\"Spiking<\/a> Insert IV spike into sterile solution using sterile technique[\/caption]<\/td>\r\n<\/tr>\r\n
9. Hang bag on IV pole.<\/td>\r\nThe IV bag should be approximately one metre above the IV insertion site.<\/td>\r\n<\/tr>\r\n
10. Fill the drip chamber one-third to one-half full by gently squeezing the chamber. Remove protective cover on the end of the tubing and keep sterile.<\/td>\r\nFilling the drip chamber prevents air from entering the IV tubing.\r\n\r\n[caption id=\"attachment_5812\" align=\"aligncenter\" width=\"111\"]\"Fill<\/a> Fill drip chamber[\/caption]<\/td>\r\n<\/tr>\r\n
11. With distal end of tubing over a basin or sink, slowly open roller clamp to prime the IV tubing. Invert backcheck valve and ports as the fluid passes through the tubing. Tap gently to remove air and to fill with fluid.<\/td>\r\nInverting and tapping the access ports and backcheck valve helps displace and remove air when priming the IV tubing.\r\n\r\n[caption id=\"attachment_5815\" align=\"aligncenter\" width=\"124\"]\"Invert<\/a> Invert IV tubing when priming with solution[\/caption]<\/td>\r\n<\/tr>\r\n
12. Once IV tubing is primed, check the entire length of tubing to ensure no air bubbles are present.<\/td>\r\nThis step confirms that air is out of the IV tubing.<\/td>\r\n<\/tr>\r\n
13. Close roller clamp. Cover end with sterile dead-ender or sterile protective cover. Hang tubing on IV pole to prevent from touching the ground.<\/td>\r\nKeep the distal end sterile prior to connecting IV to patient.<\/td>\r\n<\/tr>\r\n
14. Label tubing and IV bag with date, time, and initials.<\/td>\r\nLabel IV solution bag as per agency policy. Do not write directly on the IV bag.\r\n\r\n[caption id=\"attachment_6500\" align=\"aligncenter\" width=\"130\"]\"Labeled<\/a> Labelled IV bag[\/caption]<\/td>\r\n<\/tr>\r\n
15. Perform hand hygiene.<\/td>\r\nThis reduces the transmission of microorganisms.\r\n\r\n[caption id=\"attachment_5972\" align=\"aligncenter\" width=\"125\"]\"Hand<\/a> Hand hygiene with ABHR[\/caption]<\/td>\r\n<\/tr>\r\n
Data source: Fulcher & Frazier, 2007; Perry et al., 2014.<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n

<\/a>Video 8.1<\/h3>\r\n
Watch the video\u00a0Priming IV Lines<\/em><\/a> by\u00a0Ren\u00e9e Anderson & Wendy McKenzie<\/a>, Thompson Rivers University.<\/div>\r\nIV solutions are considered sterile for 24 hours. An IV solution may be changed if the physician's order changes, if an IV solution infusing at TKVO is expired after 24 hours, or if the IV solution becomes contaminated. To change an IV solution bag, follow Checklist 67.\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n
<\/a>Checklist 67: Changing an IV Solution Bag<\/caption>\r\n
\r\n
Disclaimer:\u00a0Always review and follow your hospital policy regarding this specific skill.<\/span><\/h5>\r\n<\/td>\r\n<\/tr>\r\n
\r\n

Steps<\/h4>\r\n<\/td>\r\n

\r\n

\u00a0Additional Information<\/h4>\r\n<\/td>\r\n<\/tr>\r\n

1. Verify and select correct IV solution bag and compare to the medication administration record (MAR) or physician orders.<\/td>\r\nIV solutions are considered a medication and must be checked using the SEVEN RIGHTS x 3, as per agency policy.\r\n\r\n[caption id=\"attachment_6234\" align=\"aligncenter\" width=\"81\"]\"Sterile<\/a> Sterile IV solution[\/caption]<\/td>\r\n<\/tr>\r\n
2. Introduce yourself, identify patient, and explain procedure.<\/td>\r\nProper identification of a patient prevents medication errors. Explaining the procedure provides an opportunity for the patient to ask questions.<\/td>\r\n<\/tr>\r\n
3. Perform hand hygiene.<\/td>\r\nHand hygiene prevents the transmission of microorganisms.<\/td>\r\n<\/tr>\r\n
4. Remove outer plastic packaging and squeeze bag to test for leaks and expiration date. Assess for precipitates or cloudiness. Hang new IV solution on IV pole.<\/td>\r\nThis ensures the correct IV solution is used.\r\n\r\n[caption id=\"attachment_6209\" align=\"aligncenter\" width=\"100\"]\"Remove<\/a> Remove IV solution from packaging[\/caption]<\/td>\r\n<\/tr>\r\n
5. Pause the EID or close the roller clamp on a gravity infusion set.<\/td>\r\nStops the infusion to prevent air bubbles from forming in IV tubing.<\/td>\r\n<\/tr>\r\n
6. Remove protective plastic cover from the new IV solution tubing port.<\/td>\r\nKeep IV tubing port sterile at all times. If IV tubing port becomes contaminated, dispose of it immediately and replace.<\/td>\r\n<\/tr>\r\n
7. Remove the old IV solution bag from the IV pole. Turn IV bag upside down, grasping the tubing port.\r\n\r\nWith a twisting motion, carefully remove IV tubing spike from old IV solution bag.<\/td>\r\nRemoving old solution from IV pole prevents spilling of solution.\r\n\r\nEnsure IV tubing spike remains sterile during removal to avoid contaminating IV tubing.\r\n\r\n <\/td>\r\n<\/tr>\r\n
8. Using a gentle twisting motion, firmly insert the spike into the new IV bag.<\/td>\r\nThis ensures that a sterile technique is used during the process.\r\n\r\n[caption id=\"attachment_5810\" align=\"aligncenter\" width=\"118\"]\"Spiking<\/a> Spike new IV solution[\/caption]<\/td>\r\n<\/tr>\r\n
9. Fill the drip chamber by compressing it between your thumb and forefinger. Ensure the drip chamber is one-third\u00a0to one-half full. Check IV tubing for air bubbles.<\/td>\r\nFluid in the drip chamber helps prevent air from being introduced into IV tubing.\r\n\r\n[caption id=\"attachment_5811\" align=\"aligncenter\" width=\"114\"]\"Filling<\/a> Fill drip chamber[\/caption]\r\n\r\n[caption id=\"attachment_5283\" align=\"aligncenter\" width=\"115\"]\"IV<\/a> IV tubing label[\/caption]<\/td>\r\n<\/tr>\r\n
10. Open clamp and regulate IV infusion rate via gravity, or press start on the EID as per physician orders.<\/td>\r\nOnce rate is set, count the drops per minute on the gravity set or ensure the EID is running at the correct rate as per physician orders.\r\n\r\n[caption id=\"attachment_6510\" align=\"aligncenter\" width=\"129\"]\"Regulating<\/a> Regulate IV tubing with a roller clamp[\/caption]<\/td>\r\n<\/tr>\r\n
11. Label new IV solution bag as per agency policy. Time tape gravity IV solutions as per agency policy<\/td>\r\nLabelling IV solutions provides easy viewing of infusing solutions and additives.\r\n\r\n[caption id=\"attachment_6500\" align=\"aligncenter\" width=\"149\"]\"Labeled<\/a> Labelled IV bag[\/caption]<\/td>\r\n<\/tr>\r\n
12. Dispose of used supplies,\u00a0perform hand hygiene, and document IV solution bag change according to agency policy.<\/td>\r\nDocument time, date, type of solution, rate, and total volume.<\/td>\r\n<\/tr>\r\n
Data source: Fulcher & Frazier, 2007; Perry et al., 2014.<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n

<\/a>Video 8.2<\/h3>\r\n
Watch the video Changing IV bags<\/a>\u00a0<\/em>by\u00a0Ren\u00e9e Anderson & Wendy McKenzie<\/a>, Thompson Rivers University.<\/div>\r\nChecklist 68 describes how to change the IV tubing administration set and IV solution at the same time.\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n
<\/a>Checklist 68: IV Tubing Administration Set and IV Solution Change<\/caption>\r\n
\r\n
Disclaimer:\u00a0Always review and follow your hospital policy regarding this specific skill.<\/span><\/h5>\r\n<\/td>\r\n<\/tr>\r\n
\r\n

Steps<\/h4>\r\n<\/td>\r\n

\r\n

\u00a0Additional Information<\/h4>\r\n<\/td>\r\n<\/tr>\r\n

1. Verify physician orders for the type of solution, rate, and duration. Collect necessary supplies.<\/td>\r\nThis step verifies the patient's need for IV fluids\/medications. It also confirms the correct rate and solution for patient safety.<\/td>\r\n<\/tr>\r\n
2. Perform hand hygiene.<\/td>\r\nHand hygiene prevents the transmission of microorganisms.<\/td>\r\n<\/tr>\r\n
3. Identify yourself, identify the patient using two identifiers, and explain the procedure to the patient.<\/td>\r\nProper identification of patient prevents errors.\r\n\r\n[caption id=\"attachment_6143\" align=\"aligncenter\" width=\"163\"]\"Compare<\/a> Compare MAR with patient wristband[\/caption]<\/td>\r\n<\/tr>\r\n
4. Prime new administration set using a new IV solution bag and new IV tubing.<\/td>\r\nIV solutions are considered a medication. Prime as per Checklist 66<\/a>. Keep distal protective cap attached to IV tubing to ensure sterility of distal end. Label IV solution and IV tubing as per agency policy.\r\n\r\n[caption id=\"attachment_6798\" align=\"aligncenter\" width=\"176\"]\"Keep<\/a> Keep distal end sterile with sterile cap[\/caption]<\/td>\r\n<\/tr>\r\n
5. Hang new administration set (primed primary line and IV solution) on IV pole.<\/td>\r\nThis prepares the equipment and adheres to the principles of aseptic technique.<\/td>\r\n<\/tr>\r\n
6. Clamp old IV administration set. Remove IV tubing if on an EID.<\/td>\r\nStop the flow of infusion during tubing and solution change.<\/td>\r\n<\/tr>\r\n
7. Clean the connection between the distal end of old IV tubing and the positive pressure cap. Scrub the area for 15 seconds and let it dry for 30 seconds.<\/td>\r\nProper disinfection of equipment decreases bacterial load and prevents infections.\r\n\r\n[caption id=\"attachment_6178\" align=\"aligncenter\" width=\"162\"]\"Scrub<\/a> Scrub the connection between the IV tubing and positive pressure cap[\/caption]<\/td>\r\n<\/tr>\r\n
8. Remove the protective cap on the distal end of the new IV administration set.<\/td>\r\n\r\n\r\n[caption id=\"attachment_6798\" align=\"aligncenter\" width=\"163\"]\"Removing<\/a> Remove sterile cap[\/caption]<\/td>\r\n<\/tr>\r\n
9. Carefully disconnect the old tubing from the positive pressure cap and insert the new IV tubing into the positive pressure cap attached to the extension tubing.<\/td>\r\n\r\n\r\n[caption id=\"attachment_6181\" align=\"aligncenter\" width=\"151\"]\"Disconnecting<\/a> Disconnect IV tubing from hub[\/caption]<\/td>\r\n<\/tr>\r\n
10. Open the roller clamp on the new tubing to regulate flow rate, or insert new tubing into the EID and restart IV rate.<\/td>\r\nThis step ensures the IV solution is infusing at the correct rate.\r\n\r\n[caption id=\"attachment_6510\" align=\"aligncenter\" width=\"140\"]\"Regulating<\/a> Regulate IV tubing using a roller clamp[\/caption]<\/td>\r\n<\/tr>\r\n
11. Check IV site for patency, and signs and symptoms of phlebitis.<\/td>\r\nIV site should be free from redness, swelling, and pain. Dressing on IV site should be dry and intact.\r\n\r\n[caption id=\"attachment_6170\" align=\"aligncenter\" width=\"139\"]\"Assess<\/a> Assess IV site for patency[\/caption]<\/td>\r\n<\/tr>\r\n
12. Discard old supplies and perform hand hygiene.<\/td>\r\nThis step prevents the spread of microorganisms.\r\n\r\n[caption id=\"attachment_112\" align=\"aligncenter\" width=\"176\"]\"Perform<\/a> Perform hand hygiene[\/caption]<\/td>\r\n<\/tr>\r\n
13. Document procedure as per agency policy.<\/td>\r\nDocument the date and time of IV tubing and solution change.<\/td>\r\n<\/tr>\r\n
Data source: BCIT,\u00a02015b; Fulcher & Frazier, 2007; Perry et al., 2014<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n
\r\n

Critical Thinking Exercises<\/p>\r\n\r\n<\/header>\r\n

\r\n
    \r\n \t
  1. How long can IV solution be used?<\/li>\r\n \t
  2. What is the purpose of removing air from IV tubing?<\/li>\r\n<\/ol>\r\n<\/div>\r\n<\/div>","rendered":"

    Primary and secondary IV tubing and add-on devices (extension tubing) must be primed with IV solution to remove air from the tubing. Priming refers to placing IV fluid in IV tubing to remove all air prior to attaching the IV tube to the patient. IV tubing is primed to prevent air from entering the circulatory system. An air embolism is a potential complication of IV therapy and can enter a patient’s blood system through cut tubing, unprimed IV tubing, access ports, and drip chambers with too little fluid (Perry et al., 2014). It is unknown how much air will cause death, but deaths have been reported with as little as 10 ml of air.\u00a0The best way to avoid air bubbles in IV tubing is to prevent them in the first place (Perry et al., 2014). New IV tubing may also be required if leaking occurs around the tube connecting to the IV solution, if the tubing becomes damaged, or if it becomes contaminated. Checklist 66 outlines the process of priming IV tubing.<\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n
    <\/a>Checklist 66: Priming IV Tubing<\/caption>\n
    \n
    Disclaimer:\u00a0Always review and follow your hospital policy regarding this specific skill.<\/span><\/h5>\n<\/td>\n<\/tr>\n
    \n
    Safety considerations:\u00a0<\/span><\/h5>\n
      \n
    • Primary IV tubing can be macro-drip or micro-drip tubing. The drop factor of the IV tubing is required to complete the IV drip rate calculation for a gravity infusion.<\/li>\n
    • Remember to invert all access ports and backcheck valve.<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n
    \n

    Steps<\/h4>\n<\/td>\n

    		\n

    \u00a0Additional Information<\/h4>\n<\/td>\n<\/tr>\n

    1.\u00a0Perform hand hygiene.<\/a><\/td>\nThis step prevents the transmission of microorganisms.<\/td>\n<\/tr>\n
    2. Check order to verify solution, rate, and frequency.<\/td>\nThis ensures IV solution is correct and helps prevent medication error.<\/td>\n<\/tr>\n
    3. Gather supplies.<\/td>\nYou will need IV solution, primary IV tubing, time label, change label, alcohol swab, and basin or sink.<\/p>\n
    \"Sterile<\/a>
    Sterile IV solution<\/figcaption><\/figure>\n<\/td>\n<\/tr>\n
    4. Remove IV solution from outer packaging and gently squeeze.<\/td>\nTear the perforated corner of the outer packaging; check colour, clarity, and expiration date.<\/p>\n
    \"Remove<\/a>
    Remove IV solution from packaging<\/figcaption><\/figure>\n<\/td>\n<\/tr>\n
    5. Remove primary IV tubing from outer packaging.<\/td>\n\n
    \"IV<\/a>
    IV tubing<\/figcaption><\/figure>\n<\/td>\n<\/tr>\n
    6. Move the roller clamp about 3 cm below the drip chamber and close the clamp.<\/td>\n\n
    \"Moving<\/a>
    Move roller clamp<\/figcaption><\/figure>\n<\/td>\n<\/tr>\n
    7. Remove the protective cover on the IV solution port and keep sterile.\u00a0Remove the protective cover on the IV tubing spike.<\/td>\nBe careful and do not contaminate the spike.<\/p>\n
    \"Remove<\/a>
    Remove protective cover from spike on IV tubing<\/figcaption><\/figure>\n<\/td>\n<\/tr>\n
    8. Without contaminating the solution port, carefully insert the IV tubing spike into the port, gently pushing and twisting.<\/td>\n\n
    \"Spiking<\/a>
    Insert IV spike into sterile solution using sterile technique<\/figcaption><\/figure>\n<\/td>\n<\/tr>\n
    9. Hang bag on IV pole.<\/td>\nThe IV bag should be approximately one metre above the IV insertion site.<\/td>\n<\/tr>\n
    10. Fill the drip chamber one-third to one-half full by gently squeezing the chamber. Remove protective cover on the end of the tubing and keep sterile.<\/td>\nFilling the drip chamber prevents air from entering the IV tubing.<\/p>\n
    \"Fill<\/a>
    Fill drip chamber<\/figcaption><\/figure>\n<\/td>\n<\/tr>\n
    11. With distal end of tubing over a basin or sink, slowly open roller clamp to prime the IV tubing. Invert backcheck valve and ports as the fluid passes through the tubing. Tap gently to remove air and to fill with fluid.<\/td>\nInverting and tapping the access ports and backcheck valve helps displace and remove air when priming the IV tubing.<\/p>\n
    \"Invert<\/a>
    Invert IV tubing when priming with solution<\/figcaption><\/figure>\n<\/td>\n<\/tr>\n
    12. Once IV tubing is primed, check the entire length of tubing to ensure no air bubbles are present.<\/td>\nThis step confirms that air is out of the IV tubing.<\/td>\n<\/tr>\n
    13. Close roller clamp. Cover end with sterile dead-ender or sterile protective cover. Hang tubing on IV pole to prevent from touching the ground.<\/td>\nKeep the distal end sterile prior to connecting IV to patient.<\/td>\n<\/tr>\n
    14. Label tubing and IV bag with date, time, and initials.<\/td>\nLabel IV solution bag as per agency policy. Do not write directly on the IV bag.<\/p>\n
    \"Labeled<\/a>
    Labelled IV bag<\/figcaption><\/figure>\n<\/td>\n<\/tr>\n
    15. Perform hand hygiene.<\/td>\nThis reduces the transmission of microorganisms.<\/p>\n
    \"Hand<\/a>
    Hand hygiene with ABHR<\/figcaption><\/figure>\n<\/td>\n<\/tr>\n
    Data source: Fulcher & Frazier, 2007; Perry et al., 2014.<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

    <\/a>Video 8.1<\/h3>\n
    Watch the video\u00a0Priming IV Lines<\/em><\/a> by\u00a0Ren\u00e9e Anderson & Wendy McKenzie<\/a>, Thompson Rivers University.<\/div>\n

    IV solutions are considered sterile for 24 hours. An IV solution may be changed if the physician’s order changes, if an IV solution infusing at TKVO is expired after 24 hours, or if the IV solution becomes contaminated. To change an IV solution bag, follow Checklist 67.<\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n
    <\/a>Checklist 67: Changing an IV Solution Bag<\/caption>\n
    \n
    Disclaimer:\u00a0Always review and follow your hospital policy regarding this specific skill.<\/span><\/h5>\n<\/td>\n<\/tr>\n
    \n

    Steps<\/h4>\n<\/td>\n

    		\n

    \u00a0Additional Information<\/h4>\n<\/td>\n<\/tr>\n

    1. Verify and select correct IV solution bag and compare to the medication administration record (MAR) or physician orders.<\/td>\nIV solutions are considered a medication and must be checked using the SEVEN RIGHTS x 3, as per agency policy.<\/p>\n
    \"Sterile<\/a>
    Sterile IV solution<\/figcaption><\/figure>\n<\/td>\n<\/tr>\n
    2. Introduce yourself, identify patient, and explain procedure.<\/td>\nProper identification of a patient prevents medication errors. Explaining the procedure provides an opportunity for the patient to ask questions.<\/td>\n<\/tr>\n
    3. Perform hand hygiene.<\/td>\nHand hygiene prevents the transmission of microorganisms.<\/td>\n<\/tr>\n
    4. Remove outer plastic packaging and squeeze bag to test for leaks and expiration date. Assess for precipitates or cloudiness. Hang new IV solution on IV pole.<\/td>\nThis ensures the correct IV solution is used.<\/p>\n
    \"Remove<\/a>
    Remove IV solution from packaging<\/figcaption><\/figure>\n<\/td>\n<\/tr>\n
    5. Pause the EID or close the roller clamp on a gravity infusion set.<\/td>\nStops the infusion to prevent air bubbles from forming in IV tubing.<\/td>\n<\/tr>\n
    6. Remove protective plastic cover from the new IV solution tubing port.<\/td>\nKeep IV tubing port sterile at all times. If IV tubing port becomes contaminated, dispose of it immediately and replace.<\/td>\n<\/tr>\n
    7. Remove the old IV solution bag from the IV pole. Turn IV bag upside down, grasping the tubing port.<\/p>\n

    With a twisting motion, carefully remove IV tubing spike from old IV solution bag.<\/td>\n

    		Removing old solution from IV pole prevents spilling of solution.<\/p>\n

    Ensure IV tubing spike remains sterile during removal to avoid contaminating IV tubing.<\/p>\n

     <\/td>\n<\/tr>\n

    8. Using a gentle twisting motion, firmly insert the spike into the new IV bag.<\/td>\nThis ensures that a sterile technique is used during the process.<\/p>\n
    \"Spiking<\/a>
    Spike new IV solution<\/figcaption><\/figure>\n<\/td>\n<\/tr>\n
    9. Fill the drip chamber by compressing it between your thumb and forefinger. Ensure the drip chamber is one-third\u00a0to one-half full. Check IV tubing for air bubbles.<\/td>\nFluid in the drip chamber helps prevent air from being introduced into IV tubing.<\/p>\n
    \"Filling<\/a>
    Fill drip chamber<\/figcaption><\/figure>\n
    \"IV<\/a>
    IV tubing label<\/figcaption><\/figure>\n<\/td>\n<\/tr>\n
    10. Open clamp and regulate IV infusion rate via gravity, or press start on the EID as per physician orders.<\/td>\nOnce rate is set, count the drops per minute on the gravity set or ensure the EID is running at the correct rate as per physician orders.<\/p>\n
    \"Regulating<\/a>
    Regulate IV tubing with a roller clamp<\/figcaption><\/figure>\n<\/td>\n<\/tr>\n
    11. Label new IV solution bag as per agency policy. Time tape gravity IV solutions as per agency policy<\/td>\nLabelling IV solutions provides easy viewing of infusing solutions and additives.<\/p>\n
    \"Labeled<\/a>
    Labelled IV bag<\/figcaption><\/figure>\n<\/td>\n<\/tr>\n
    12. Dispose of used supplies,\u00a0perform hand hygiene, and document IV solution bag change according to agency policy.<\/td>\nDocument time, date, type of solution, rate, and total volume.<\/td>\n<\/tr>\n
    Data source: Fulcher & Frazier, 2007; Perry et al., 2014.<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

    <\/a>Video 8.2<\/h3>\n
    Watch the video Changing IV bags<\/a>\u00a0<\/em>by\u00a0Ren\u00e9e Anderson & Wendy McKenzie<\/a>, Thompson Rivers University.<\/div>\n

    Checklist 68 describes how to change the IV tubing administration set and IV solution at the same time.<\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n
    <\/a>Checklist 68: IV Tubing Administration Set and IV Solution Change<\/caption>\n
    \n
    Disclaimer:\u00a0Always review and follow your hospital policy regarding this specific skill.<\/span><\/h5>\n<\/td>\n<\/tr>\n
    \n

    Steps<\/h4>\n<\/td>\n

    		\n

    \u00a0Additional Information<\/h4>\n<\/td>\n<\/tr>\n

    1. Verify physician orders for the type of solution, rate, and duration. Collect necessary supplies.<\/td>\nThis step verifies the patient’s need for IV fluids\/medications. It also confirms the correct rate and solution for patient safety.<\/td>\n<\/tr>\n
    2. Perform hand hygiene.<\/td>\nHand hygiene prevents the transmission of microorganisms.<\/td>\n<\/tr>\n
    3. Identify yourself, identify the patient using two identifiers, and explain the procedure to the patient.<\/td>\nProper identification of patient prevents errors.<\/p>\n
    \"Compare<\/a>
    Compare MAR with patient wristband<\/figcaption><\/figure>\n<\/td>\n<\/tr>\n
    4. Prime new administration set using a new IV solution bag and new IV tubing.<\/td>\nIV solutions are considered a medication. Prime as per Checklist 66<\/a>. Keep distal protective cap attached to IV tubing to ensure sterility of distal end. Label IV solution and IV tubing as per agency policy.<\/p>\n
    \"Keep<\/a>
    Keep distal end sterile with sterile cap<\/figcaption><\/figure>\n<\/td>\n<\/tr>\n
    5. Hang new administration set (primed primary line and IV solution) on IV pole.<\/td>\nThis prepares the equipment and adheres to the principles of aseptic technique.<\/td>\n<\/tr>\n
    6. Clamp old IV administration set. Remove IV tubing if on an EID.<\/td>\nStop the flow of infusion during tubing and solution change.<\/td>\n<\/tr>\n
    7. Clean the connection between the distal end of old IV tubing and the positive pressure cap. Scrub the area for 15 seconds and let it dry for 30 seconds.<\/td>\nProper disinfection of equipment decreases bacterial load and prevents infections.<\/p>\n
    \"Scrub<\/a>
    Scrub the connection between the IV tubing and positive pressure cap<\/figcaption><\/figure>\n<\/td>\n<\/tr>\n
    8. Remove the protective cap on the distal end of the new IV administration set.<\/td>\n\n
    \"Removing<\/a>
    Remove sterile cap<\/figcaption><\/figure>\n<\/td>\n<\/tr>\n
    9. Carefully disconnect the old tubing from the positive pressure cap and insert the new IV tubing into the positive pressure cap attached to the extension tubing.<\/td>\n\n
    \"Disconnecting<\/a>
    Disconnect IV tubing from hub<\/figcaption><\/figure>\n<\/td>\n<\/tr>\n
    10. Open the roller clamp on the new tubing to regulate flow rate, or insert new tubing into the EID and restart IV rate.<\/td>\nThis step ensures the IV solution is infusing at the correct rate.<\/p>\n
    \"Regulating<\/a>
    Regulate IV tubing using a roller clamp<\/figcaption><\/figure>\n<\/td>\n<\/tr>\n
    11. Check IV site for patency, and signs and symptoms of phlebitis.<\/td>\nIV site should be free from redness, swelling, and pain. Dressing on IV site should be dry and intact.<\/p>\n
    \"Assess<\/a>
    Assess IV site for patency<\/figcaption><\/figure>\n<\/td>\n<\/tr>\n
    12. Discard old supplies and perform hand hygiene.<\/td>\nThis step prevents the spread of microorganisms.<\/p>\n
    \"Perform<\/a>
    Perform hand hygiene<\/figcaption><\/figure>\n<\/td>\n<\/tr>\n
    13. Document procedure as per agency policy.<\/td>\nDocument the date and time of IV tubing and solution change.<\/td>\n<\/tr>\n
    Data source: BCIT,\u00a02015b; Fulcher & Frazier, 2007; Perry et al., 2014<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n
    \n
    \n

    Critical Thinking Exercises<\/p>\n<\/header>\n

    \n
      \n
    1. How long can IV solution be used?<\/li>\n
    2. What is the purpose of removing air from IV tubing?<\/li>\n<\/ol>\n<\/div>\n<\/div>\n","protected":false},"author":5,"menu_order":4,"template":"","meta":{"pb_show_title":"on","pb_short_title":"","pb_subtitle":"","pb_authors":[],"pb_section_license":""},"chapter-type":[],"contributor":[],"license":[],"class_list":["post-3700","chapter","type-chapter","status-publish","hentry"],"part":3534,"_links":{"self":[{"href":"https:\/\/opentextbc.ca\/clinicalskills\/wp-json\/pressbooks\/v2\/chapters\/3700","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/opentextbc.ca\/clinicalskills\/wp-json\/pressbooks\/v2\/chapters"}],"about":[{"href":"https:\/\/opentextbc.ca\/clinicalskills\/wp-json\/wp\/v2\/types\/chapter"}],"author":[{"embeddable":true,"href":"https:\/\/opentextbc.ca\/clinicalskills\/wp-json\/wp\/v2\/users\/5"}],"version-history":[{"count":28,"href":"https:\/\/opentextbc.ca\/clinicalskills\/wp-json\/pressbooks\/v2\/chapters\/3700\/revisions"}],"predecessor-version":[{"id":10165,"href":"https:\/\/opentextbc.ca\/clinicalskills\/wp-json\/pressbooks\/v2\/chapters\/3700\/revisions\/10165"}],"part":[{"href":"https:\/\/opentextbc.ca\/clinicalskills\/wp-json\/pressbooks\/v2\/parts\/3534"}],"metadata":[{"href":"https:\/\/opentextbc.ca\/clinicalskills\/wp-json\/pressbooks\/v2\/chapters\/3700\/metadata\/"}],"wp:attachment":[{"href":"https:\/\/opentextbc.ca\/clinicalskills\/wp-json\/wp\/v2\/media?parent=3700"}],"wp:term":[{"taxonomy":"chapter-type","embeddable":true,"href":"https:\/\/opentextbc.ca\/clinicalskills\/wp-json\/pressbooks\/v2\/chapter-type?post=3700"},{"taxonomy":"contributor","embeddable":true,"href":"https:\/\/opentextbc.ca\/clinicalskills\/wp-json\/wp\/v2\/contributor?post=3700"},{"taxonomy":"license","embeddable":true,"href":"https:\/\/opentextbc.ca\/clinicalskills\/wp-json\/wp\/v2\/license?post=3700"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}