A.

SETTING UP FOR AN IV INFUSION B. 1. 2. IV INSERTION Do hand hygiene before and after the procedure. Select the venipuncture site. a. Unless contraindicated, use the clients non-dominant arm. b. Place a towel under the extremity to protect linens. Dilate the vein. a. Place the extremity in a depentdent position. b. Apply a tourniquet firmly 15-20cm(68in) above the venipuncture site. Done clean gloves and clean the venipuncture site. Insert the catheter and initiate the infusion. Check for the radial pulse below the tourniquet. Release the tourniquet. Remove the protective cap from the distal end of the tubing, and hold it ready to attach to the catheter, maintaining the sterility of the end. Tape the catheter. Dress and label the venipuncture site and tubing according to the agency policy. Ensure appropriate infusion flow. Label the IV tubing(date, and tine of attachment and your initials). Document relevant data.

1.

Verify the written doctors order, make an IV label, check patient and explain the procedure. 2. Prepare necessary materials for the procedure. 3. Check the sterility and integrity of the IV solution, IV set and other devices. 4. Observe the 10 rights: drugs, patient, dose, route, time, documentation, health teaching, patients drug history, drug allergies, and drugfood interaction. 5. Place IV label on the IVF bottle duly signed by RN who prepared it. 6. Indicate patients name, room number, name of solution, drug incorporation, bottle sequence and duration, time and date 7. Do hand hygiene before and after the procedure. 8. Open the seal of the IV infusion aseptically and disinfect rubber port with cotton ball with alcohol. 9. Open IV administration set aseptically and close the roller clamp and spike the infusate container aseptically. 10. Fill drip chamber to at least half and prime it with IV fluid aseptically.

3.

4. 5. 6. 7. 8. 9. 10. 11. 12. 13.

12. Discard sharp and other wastes according to health care waste management. C. 1. INCORPORATION OF DRUG INTO IVF BOTTLE/BAG D. 1. IV PUSH THROUGH THE IV PORT Verify medication card against the written doctors order. 2. Observe 10 rights when preparing and administering medication. 3. Explain procedure to reassure patient and significant other (name of medication and action/interaction of medication) before administration. 4. Do hand hygiene before and after the procedure. 5. Check patency and other reaction signs of swelling, redness, phlebitis; do not give the drug. 6. Check for skin test result of drug for IV push, drug-drug, drug IV fluid incompatibility, dosage (computation). 7. Prepare the necessary materials for the procedure. 8. Disinfect injection port of the diluents, vial or ampule as appropriate. 9. Aspirate right amount of diluents for the drug (if drug needs to be diluted). 10. Aspirate the right drug dose; disinfect the Yinjection port of the IV administration set/catheter IV port.

Verify the written medication order, observe hospital policy on drug administratiion. 2. Observe the 10 rights when preparing and administering medication. 3. Explain procedure(medication and action) to reassure patient and significant others and check patency and IV site. 4. Verify for skin test of drug for IV incorporation(if skin testing is necessary). 5. Do hand hygiene before and after the procedure. 6. Prepare necessary materials needed for the procedure such as: injection tray, syringes needed, right drug to be incorporated either in vial or ampule. 7. Disinfect injection port of the vial and ampule before breaking then aspirate the right dose aseptically. 8. Remove the cover of the admiistration set, maintain sterility and incorporate prepared drug into the airway aseptically. Recap airway after. 9. Swirl the IV bottle to mix the drug with IVF and regulate the flow rate accordingly. 10. Observe for 5-10minutes for any drug interaction while reassuring the patient; monitor VS. 11. Document in the patients chart.

11. Close the roller clamp of the IV tubing from the bottle and push IV drug aseptically and slowly/according to the manufacturers recommendation. 12. Using the same syringe 1-2cc of IVF to flush the medicine given. 13. Regulate rate of IV fluid infusion as prescribed. 14. Reassure patient and observe for signs and symptoms of adverse drug reaction. 15. Discard sharps and other waste according to health care waste management. E. CHANGING AN IV SOLUTION 1. 2. 3. Verify doctors order sheet. Observe 10 rights. Explain procedure to reassure the patient and significant others and assess IV site for redness, swelling, pain and others. 4. Change IV tubing and cannula if 48-72 hours has lapsed after IV insertion. 5. Wash hands before and after the procedure. 6. Prepare necessary materials; place on an IV tray. 7. Check sterility and integrity of IV solution. 8. Place IV label on the IV bottle. 9. Calibrate new IV bottle according to duration of infusion as per prescription. 10. Open and disinfect rubber port of IV solution to follow. 11. Close the roller clamp and spike the container aseptically.

12. Regulate the flow rate based on the prescribed infusion rate solution. Expel air bubbles (if any). 13. Reiterate assurance to patient and significant others. 14. Discard all waste materials according to health care waste management. 15. Document and endorse accordingly.

F. 1. 2. 3.

DISCONTINUING AN IV INFISION Wash hands and observe other appropriate infection control procedures. Provide for client privacy. Prepare the equipment. a. Clamp the infusion tubing. b. Loosen the tape at the venipuncture site while holding the needle firmly and applying counter-traction to the skin. c. Done clean gloves and hold sterile gauze above the venipuncture site. Withdraw the needle/catheter from the vein. Examine the catheter removed from the client. Cover the veipuncture site.

4. 5. 6.

7. 8.

Discard the IV solution container, if infusions are being discontinued and discard the used supplies appropriately. Document all relevant information.

6.

G. 1. 2.

BLOOD TRANSFUSION Verify doctors written order and make a treatment card according to hospital policy. Request prescribed blood/blood components from blood bank to include blood typing and cross matching and blood bag with clean towel and keep it all room temperature. Observe 10 rights when preparing and administering any blood/blood components. Explain procedure, secure consent and get patient history regarding previous infusion. Explain the importance of the benefits on Voluntary Blood Donation (RA 7719, National Service Act of 1994).

3. 4. 5.

Using a clean lined tray, get compatible blood from the hospital blood bank. Wrap blood bag with clean towel and keep it at room temperature. 7. Have a doctor and a nurse assess patients condition. Countercheck the compatible blood to be transfused against the cross matching sheet, noting ABO grouping and RH, serial number unit and expiry date with the blood bag label and other laboratory blood exams as required before transfusion (Hgb & Hct). 8. Get the baseline vital signs (BP, PR & temp) before transfusion. Refer to the doctor accordingly. 9. Give the pre-medication 30 minutes before the transfusion as prescribed. 10. Done hand hygiene before and after the procedure. 11. Prepare equipment for BT (injection tray, compatible BT set, IV catheter/needle G19, plaster, tourniquet, blood, blood components to be transfused, plain NSS 500cc, IV set, needle G18, IV hook, gloves, sterile gauze 2x2, transparent dressing). 12. If main IVF is with dextrose 5%, initiate IV line with appropriate IV catheter with Plain NSS on another site, anchor catheter properly and regulate IV at desired rate. 13. Put on gloves. Open compatible blood set aseptically and close roller clamp. Spike blood

bag carefully, fill the drip chamber at least halffull, prime tubing and remove air bubbles (if any). 14. Disinfect the Y injection port of the IV tubing (PNSS) and insert the needle from the BT administration set and secure with adhesive tape. 15. Close roller clamp of IVF of PNSS and regulate to KVO while transfusion is ongoing. 16. Transfuse the blood via the injection port and regulate @ 10-15gtts/min, initially for 15 minutes and at the prescribed rate (usually based on the patients condition). 17. Monitor the patient for the first 10-15 minutes of transfusion and refer immediately to the physician for any adverse reaction. 18. Observe/assess patient on an ongoing basis for any untoward signs and symptoms such as chills, elevated temperature, itchiness, urticaria and dyspnea. If any of these symptoms occur, stop the infusion, open the IV line with PNSS and regulate accordingly. 19. Swirl bag gently from time to time to mix the cells with the plasma. One BT set should be used for 1-2 units of blood. 20. When blood is consumed, close the roller clamp of BT, and disconnect from IV lines and regulate the IVF of PNSS as prescribed.

21. Continue to observe and monitor patient post transfusion, for delayed reaction could still occur. 22. Recheck Hgb and Hct, bleeding time, serial platelet count within specified hours as prescribed and or per institutions policy. 23. Discard blood bag and BT set and sharps according to health care waste management. 24. Fill out diverse reaction sheet as per institutional policy. 25. Remind the doctor for the administration of calcium gluconate. If the patient have several units of blood transfusion (3-5 more units of blood).