- Hello, and welcome to Santa Fe Nursing Labs.
Today I'm gonna be demonstrating
IV administration using a primary line.
Primary IV lines are commonly used to administer
IV fluids or continuous medications to patients.
Intermittent medications can be administered
using a primary line as well,
however, part of the medication, about 26 mLs,
is wasted in the line when the tubing is changed.
I'm gonna wash my hands.
Hello Mrs. Duncan, I'm gonna be getting ready
to get your IV medication,
so I'm just gonna check your room,
make sure we have everything here.
So before I prepare my medication
I need to check my IV sites, and my IV lines.
So I can see I have my Alaris IV pump here.
I have a channel to administer medication,
and I do not have any previous lines,
so I will need to gather all new tubing.
Miss Duncan, I'm just gonna take a look at your IV.
And you have your peripheral IV here in your left hand,
and I see there's no signs of redness or infiltration.
When administering medications to patients
you always wanna make sure you follow
the eight rights of medication administration.
The first rate is the right patient,
right drug, right dose, right time, right route,
right reason, right documentation, and right response.
We're gonna check Miss Duncan's chart
for the direct dose,
we're gonna double check it against the drug guide.
And we're also gonna make sure
that we know how quickly we're gonna administer
the medication.
And we're also going to check confirm compatibility.
She did not have any other running IV medications,
so we don't really need to, in this case,
worry about compatibility.
So I'm gonna double check her chart,
and then pull my medication.
So I can see here that we have some normal saline
that is due for maintenance IV fluid.
And I want to know my rate of administration.
And my order detail says that
it is gonna be at 75 mLs per hour.
So now I'm gonna go ahead and get my medication
or my fluid out of the medication cart.
So I have my solution that I'm gonna be administering.
I have my primary tubing set,
I have my normal saline flush
in order to check patency of her peripheral IV.
And then I have my labels for when the bag
and the tubing needs to be changed.
So I'm gonna double check my medication of my fluid
against my MAR, one more time,
make sure I have the right drug or fluid.
So I have my normal saline, and my ordered medication,
or solution is normal saline, sodium chloride.
And I'm going to be giving it IV at 75 mLs per hour.
So this is my primary tubing set up.
You can see over here that the bag tells you
how many drops per mL.
And then it also tells you over here
how much fluid you need to prime your IV line.
So, for this primary IV tubing
you need 26 mLs to prime from start to finish.
When labeling your tubing, there's certain information
that you need to include.
For IV tubing you need to make sure
that you include your initials,
and then the date that you hung the tubing,
and the date that the tubing expires.
The expiration does depend on whether you are using
the tubing for continuous infusion,
or whether it's for intermittent infusion.
Always make sure that you follow your hospital's policy
and the most recent infection control guidelines.
When labeling your fluid bag, or your medication bag,
you always wanna make sure that
your patient's name and date of birth is on the bag,
their med rec number is on the bag.
You also wanna include when the bag will expire.
So what date and time did you hang that IV bag,
and what date does it expire?
Again the expiration is gonna vary
depending on the most recent infection control policies.
Next I'm gonna administer my medication to the patient.
First you need to explain to the patient
what medication you are administering.
We're now going to scan the patient and scan all medication.
Okay Miss Duncan, I just need to
take a look at your arm band here,
and can you confirm your name and date of birth for me?
Perfect, and I'm just gonna scan your band.
Now I'm gonna scan the medication.
And this is going IV,
and I confirmed that it is at 75 mLs per hour,
continuous until discontinued.
Okay Miss Duncan, I'm just gonna come around
to the other side where your IV tubing is, or IV pump is.
So I'm gonna go ahead and put on my gloves.
And then get my IV tubing ready.
I wanna make sure as soon as I pull my tubing out
that my roller clamp is engaged.
I'm gonna attach my label to my tubing.
Okay.
I'll now open up my fluid bag,
attach my patient's label.
I'm gonna confirm again that my tubing is clamped
before spiking my bag.
It's very important that you maintain
sterility of the spike.
Hold your bag upside down, especially a large bag,
it's a lot easier to spike when it's upside down.
And I'm gonna spike my bag.
Okay,
I can then hang my bag on my IV pole.
Okay,
next you wanna prime your tubing,
which means you're gonna get all the air out of the line.
In order to prevent air bubbles
you wanna fill the drip chamber.
The drip chamber is this part right below the IV bag.
And you wanna fill it at least halfway.
Okay.
In order to control how quickly your tubing is primed
you'll wanna use the roller clamp.
A little tip to make sure
you reduce the number of air bubbles,
is to hold the injection ports upside down
as you prime them.
So I'm gonna slowly release the roller clamp.
Hold my injection port upside down.
And I'm gonna make sure the next ones
are upside down as I go through the tubing.
Okay.
I can now go ahead and put my tubing into my Alaris pump.
This is the brain, or the PC part of the Alaris IV pump.
This is where you control your settings.
This extra part on the side here is called your channel,
that is where we're gonna be placing our IV tubing.
I'm gonna open up.
This part slides in right over here
and clicks.
And hold the door closed of the channel,
and lock in place.
So now we're gonna get ready to flush Miss Duncan's IV line
to make sure that it is patent and working.
You can see her line, at the top of it here,
is has what's called a Curos cap.
It is an alcohol disinfecting cap.
Some hospitals use them, some hospitals do not.
We are gonna follow the strictest guidelines
for our area hospitals, which requires us,
even when they have a Curos cap to still scrub the hub.
Meaning you're still scrubbing
the injection port with alcohol before accessing.
At Santa Fe nursing labs we use an acronym called SASH,
which stands for saline, administer,
saline, and then heparin.
These are general guidelines that are used
for flushing any type of IV line,
either peripheral or central line.
The amount of fluid that we use falls into majority
of the evidence-based guidelines for flushing.
Depending on the hospital you go to,
you wanna make sure that you follow their policies
for flushing peripheral and central lines.
I'm going to get the air out
of my normal saline flush syringe.
So I'm gonna go ahead and remove my Curos caps.
These are one time use only.
It is recommended that you scrub your hub,
or your injection port for at least 15 seconds
and then allow it to dry.
Once I clean the injection port I do not want to touch it.
I'm gonna to remove the cap from my normal saline,
attach my syringe, unclamp my tubing,
and flush with the five mLs.
So I'm disconnecting my saline.
These saline syringes are one time use,
so you cannot use it again.
I'm not touching the end of that,
and now I'm gonna connect my IV tubing.
Okay.
I'm gonna now set my Alaris pump.
My order was for 75 mLs per hour of my normal saline.
(Alaris pump beeps)
This is a new patient.
We are not on a peds floor,
we are on adult med search,
so you can just select the correct unit.
(Alaris pump beeps)
Her ID number, I can either check my chart,
or we can check her band here real quick.
(Alaris pump beeps)
I'm gonna confirm.
And then my infusion is going through channel A,
you can see this one says A,
this one says B, and this one says C.
So we are in channel A.
We are gonna follow, we're not giving a drop,
we're giving IV fluid.
Guardrails is a system that is designed
to prevent medication errors.
We have plain, normal saline,
so we're going to select out IV plain.
Is this correct? Yes.
Our rate as per ordered was 75 mLs per hour.
My volume to be infused, that's how much
I want the pump to infuse.
This can vary depending on where you work.
Some hospitals would only allow you
to place four hours worth of fluid.
So the unit that we are on requires us
to only put two hours worth of fluid.
We're gonna go ahead and set this for 150 mLs.
So in two hours this IV will beep,
telling us that the infusion is complete.
We are now going to unclamp our roller clamp,
and go ahead and hit start.
You wanna watch the drip chamber to make sure
that your fluid is dripping and administering.
Okay Miss Duncan, I see that your IV is complete,
and the doctor has ordered to disconnect the IV fluids.
So I'm gonna go ahead and take care of your line.
Let me wash my hands.
(Alaris pump beeps)
Put on gloves.
(Alaris pump beeps)
Gonna go ahead and just silence this
so it doesn't keep beeping on us.
Okay, so I'm just gonna turn off my pump here,
'cause I do not need it anymore.
(Alaris pump beeps)
So now we're gonna finish that acronym, the SASH acronym,
we did our first saline before we administered
the mediation, we then gave out medication or our fluid,
we're now gonna finish with a second saline.
She has a peripheral IV that does not need the heparin.
I'm gonna go ahead and get my air bubble out of my saline.
Okay, so now what I need
is a Curos tip for the end of my IV line.
If I had have left my IV just open,
I would not be able to use it again,
it is considered non-sterile.
So, to keep it sterile I'm gonna use one of the Curos tips,
and then hang it back on my pole over here.
Okay, I then need to flush my line one more time.
I'm gonna scrub the hub for 15 seconds
because I did put down my end cap of my port.
Okay, allow it to dry.
Gonna go ahead and flush with my five mLs.
So depending on the type of valve
that you have in your peripheral IV lines,
you may need to clamp with positive pressure,
or you may have a positive pressure valve
where you would disconnect your syringe, and then clamp.
So you wanna follow whatever type of valves
that your hospital uses.
These are negative pressure valves,
so when I'm finishing my flush
I need to maintain pressure as I'm flushing.
Because if I do not maintain pressure as I'm flushing,
blood can flow back into the catheter tip
and include the IV line.
I'm now gonna go ahead and place a Curos cap on the end.
Okay Miss Duncan we are all done.
You call me if you need anything,
you have your call light right over there.
And I am going to lower your bed for you.
Okay.
I'm gonna get rid of my gloves
and my trash.
This concludes our demonstration.
Thank you for joining us and remember
to check out our other Sante Fe Nursing Videos.