15 Initiating & Discontinuing Intravenous Therapy

Implementation

1. Explained procedure to the client.
2. Assisted client to a comfortable position. Provided adequate lighting.
3. Correctly verified client’s identity.
4. Performed hand hygiene. Organized equipment at bedside.
5. Assisted client with a gown with snaps on the shoulders, if available.
6. Used sterile technique to open sterile packages.
7. Prepared intravenous (IV) infusion tubing and solution:
   1. Verified intravenous (IV) solution correctly prepared and labeled. Checked expiration Date.
   2. Opened infusion set.
   3. Placed roller clamp about 2 to 5 cm (1 to 2 inches) below drip chamber in the off position.
   4. Removed protective sheath over intravenous (IV) tubing port on IV solution bag.
   5. Inserted infusion set spike (sterile) into fluid bag or bottle.
   6. Primed infusion tubing by compressing drip chamber and filling to 1/3 to ½ full.
   7. Removed protector caps on end of tubing (if necessary), released roller clamp, and allowed fluid to fill tubing. Added extension tubing.
   8. Removed air bubbles.
   9. Replaced protector cap on end of infusion tubing.
8. Prepared normal saline lock for infusion.
9. Applied gloves. Applied face shield and mask, if indicated.
10. Identified accessible vein. Applied flat tourniquet over gown sleeve above proposed insertion site.
11. Selected appropriate well-dilated vein for intravenous (IV) insertion.
    1. Avoided undesirable locations.
    2. Used non dominant hand.
    3. Fostered venous distention.
    4. Placed extremity in dependent position.
    5. Stocked extremity from distal to proximal below site.
    6. Applied warmth to area for several minutes.</li?
    7. Avoided tapping or vigorous friction to vein.
12. Temporarily released tourniquet. Applied topical anesthetic as needed.
13. Placed connection of infusion set or saline lock nearby on sterile surface.
14. Reviewed client’s allergies. Cleaned site with appropriate antiseptic and allowed to dry.
15. Replaced tourniquet 4 and 5 inches above selected insertion site and checked client’s distal pulse.
16. Performed venipuncture:
    1. Anchored vein by placing thumb over vein and stretching skin distal to the selected site.
    2. Advised client to remain still. Warned client of sharp, quick stick.
    3. Inserted over –the-needle catheter (ONC), intravenous (IV) catheter safety device, or winged (butterfly) needle with bevel up at a 10-to 20-degree angle slightly distal to the actual site in the direction of the vein.
17. Observed for blood return. Lowered needle until almost flush with skin. Advanced catheter approximately ⅛ to ¼ inch. Continued to hold skin taut and advanced catheter until hub rested at insertion site.
18. Stabilized catheter/needle with one hand and released tourniquet with the other hand. Removed stylet of over –the-needle catheter (ONC); did not recap stylet. Glided protective guard over stylet of intravenous (IV) safety device.
19. Connected end of infusion tubing set of heparin/saline lock adapter to end of catheter.
20. Flushed injection cap of saline lock, if needed. Slowly slid clamp open to begin infusion.
21. Secured catheter. Followed agency policy. Used recommended dressing to secure the site.
22. Observed site for swelling.
23. Applied sterile dressing over site.
24. Looped tubing alongside arm and secured.
25. Rechecked flow rates of intravenous (IV) fluid infusions.
26. Wrote Date and time, venous access device (VAD) gauge and length and personal initials on dressing.
27. Disposed of sharps in appropriate container. Removed gloves and performed hand hygiene.
28. Instructed client how to move around without dislodging the intravenous.
29. Discontinuing IV Therapy
    1. Observed Intravenous (IV) site for signs and symptoms of infection, infiltration, and phlebitis.
    2. Reviewed accuracy and completeness of health care provider’s order for discontinuation of intravenous (IV).
    3. Determined client understanding of need for discontinuation of intravenous (IV) access.
    4. Correctly identified client.
    5. Explained procedure to client, describing sensation when catheter was removed.
    6. Turned intravenous (IV) tubing roller clamp to “off” position or turned electronic infusion device (EID) off and roller clamp to off position.
    7. Performed hand hygiene and applied gloves.
    8. Removed IV site dressing carefully and gently. Removed tape securing catheter.
    9. Cleansed site with antimicrobial swab. Allowed to dry completely.
    10. Placed sterile gauze above site and withdrew catheter carefully.
    11. Applied pressure to site from 30 seconds or until bleeding stops and according to client’s medical or medication history. (Example 5- 10 minutes if client receiving anticoagulants.)
    12. Inspected catheter for intactness after removal, noting tip integrity and length.
    13. Applied clean folded gauze dressing over site and secured with tape.
    14. Discarded used supplies, removed gloves, and performed hand hygiene.
    15. Observed site for evidence of bleeding, redness, pain, drainage, and swelling.