SUE NITTLER: Hi, my name is Sue Nittler,
and I'm a nurse with Sutter Infusion and Pharmacy Services,
a division of Sutter Care at Home.
Today I'm going to show you how to give your IV
medication using the gravity infusion method.
First, gather your supplies from the pharmacy supply box,
and now we'll get started.
Clean the pharmacy instructional tray with an alcohol wipe.
This is the first in several very important
cleaning steps to pay close attention to.
Now gather your supplies and place them
on the instructional tray in the pictures
provided, alcohol wipes, two saline syringes,
a heparin syringe if your nurse has instructed
you to use heparin, your medication bag, the IV
tubing, green alcohol covers, and if you'll be using your IV
tubing later today, a red cap.
Sutter Infusion Pharmacy provides soap for hand-washing.
Go ahead and wash your hands thoroughly for 20 seconds,
getting into all the nooks and crannies.
Now dry your hands thoroughly with paper towels.
Your gravity infusion medication will be provided
in one of these three forms.
The first is a pre-mixed bag from pharmacy.
This may be in your refrigerator.
If your medication is refrigerated,
remove it 30 to 60 minutes prior to your infusion time to warm
to room temperature.
The second is a pre-mixed bag from the manufacturer.
This will come in a wrapper.
Go ahead and open it up, and remove the medication
from the bag.
There may be condensation or moisture
on the outside of the bag.
This is normal.
The third bag is an IV mini bag.
You can see that the medication powder is attached to the bag,
and we'll need to mix the powder into solution before infusing.
Check the medication label for the correct name, correct drug
and dose, and the use by date.
Now I'll show you how to mix the medication into the IV mini
bag.
First, break the neck of the vial.
Now hold up the bag and squeeze the solution
into the glass vial.
Squeeze it until it's about halfway full.
Now you'll gently swirl the solution to mix the powder in.
Mix until it's completely mixed.
Once it's mixed, flip the bag upside down
and pull the solution into the bag
by squeezing the bag gently.
Find the IV tubing, remove it from the wrapper.
Then find the white paper tape, and remove that.
Now uncoil the IV tubing.
Find the white clamp and pinch it shut.
Now I'll attach the tubing to the bag.
First, remove the blue cap from the port of the bag.
Remove the cap from your spike, and spike the bag.
Now hang the bag on the pole.
Fill the drip chamber by squeezing it.
Fill it one-third to one-half way.
Find the white dial.
The arrow is pointing to open.
Turn so the arrow is pointing to 250.
Open the pinch clamp to allow the fluid to prime
through the tubing.
If there's any air bubbles, prime those out as well,
and pinch the pinch clamp shut.
Now set your infusion rate to what your nurse instructed you.
In my case, I'm going to set it to 200 milliliters per hour.
Tubing is changed once a day.
You may reuse the tubing for multiple doses
so long as you keep it clean.
If you're reusing your tubing in a 24-hour period,
go ahead and take the old bag off, remove the spike
from the old bag.
Remove the cap from that bag.
Now spike the new bag with the previous tubing.
Now hang the bag on the pole.
If there's fluid in your drip chamber,
go ahead and prime it to a third to a halfway full,
and you're ready to run your infusion.
If there is no fluid in this drip chamber,
but there is air here, you'll need to re-prime the tubing.
Go ahead and squeeze the drip chamber
to fill it one-third to one-half way full.
Remove the red cap from the tip of the tubing,
taking care not to touch the tip with your finger.
Now open the clamp and allow the air to prime through.
Once the air has primed through, pinch the clamp shut,
and replace the red cap on the end of the tubing.
Now I'll show you how to administer your IV medication.
First wash your hands with the instant hand sanitizer
that was provided in the pharmacy supplies.
Scrub thoroughly until the solution is dry on your hands.
Remove the white netting that's covering the line.
Find the blue cap, and unwrap it from around your arm.
My line does not have a clamp, but yours may.
If it does, go ahead and open it now.
Then work your way down the extension tubing,
find the white clamp, and open that.
Place the blue cap where you can easily see it.
Remove the green cap, and throw it away.
Take an alcohol wipe, place it over the center
of the blue cap, and clean back and forth for 15 seconds.
Take your first saline syringe, remove the white cap,
and throw that away.
Place the tip of the saline syringe
into the center of the blue cap, push,
and turn clockwise to make the connection.
Now turn your saline syringe so you can see the numbers.
We're going to flush the solution into the catheter
by using what we call a push stop technique.
So it looks like this push, stop, push, stop, push, stop,
push stop stopping at the one milliliter mark.
Remove the syringe, and throw it away.
If it's ever difficult to push your saline solution
into the line, or you can't push it at all,
stop, check and make sure your clamps are unclamped,
and there are no kinks or bends in the line.
If it continues to be difficult to push,
stop immediately, and call your nurse.
Do not ever attempt to force solution into your line.
Clean the tip of the blue cap thoroughly for 15 seconds.
Now attach your tubing and your IV line.
Remove the blue cap.
Place the tip of the tubing into the blue cap.
Push and turn clockwise.
Find the clamp on your IV tubing, open it,
and your solution is running.
Now you can sit back and relax while your infusion runs
for however long your nurse has instructed it to run.
Once your infusion is finished, and the bag is empty,
go ahead and pinch the clamp shut.
Now disconnect the end of the tubing from your blue cap.
If you're finished with your infusion for the day,
go ahead and take this all and just throw it away.
If you're reusing the tubing again later today,
go ahead and take a red cap, remove it from the package,
and place it over the tip of the tubing to keep it clean.
Clean the tip of the blue cap thoroughly for 15 seconds.
Now take your second saline syringe from the tray,
remove the white cap, and place it
into the center of the blue cap, and you guessed it,
you're going to flush with a push stop motion,
push stop, push stop, push stop.
Stop at the one.
Remove the syringe, and throw it away.
Clean the tip of the blue cap thoroughly for 15 seconds.
If your nurse has instructed to use heparin in your line,
go ahead and take your heparin syringe from the tray,
remove the blue cap, place the tip of the heparin syringe
into the blue cap, turn it clockwise,
and now you'll flush.
Notice that there are only five milliliters
of heparin in the syringe.
So you'll push stop, push stop, push stop,
stop at the one milliliter mark.
Remove the heparin syringe, and throw it away.
Your final step is to take the green alcohol covers,
remove it from the foil wrap, place it
over the tip of the blue cap, and screw it into place.
Now find the clamp on your extension tubing,
pinch it closed.
If you have a clamp on your IV line, close that now.
Go ahead and wrap the tubing back around your arm,
and secure it in place with the white netting.
Congratulations.
You've just completed your gravity infusion.
Your nurse will give you further instructions if needed.
If you have any questions, please
refer to your green and white pharmacy folder.
You can find phone numbers for both Sutter Infusion
and Pharmacy Services and your nursing agency here.
From all of us here at Sutter Infusion Pharmacy Services,
we look forward to working with you.