Assessment/Planning:
Gather all equipments and bring to bedside, as follows: IV solution, IV pole, IV infusion set, tape, IV tubing, Dressing with betadine or other antiseptic ointment, Needle, tourniquet, arm board, antiseptic swabs, clean disposable gloves. Check IV solution and medication additives with physician orders.
Implementation:
Explain procedure to client. Wash your hands. Prepare IV solution and tubing. Maintain aseptic technique when opening sterile packages and IV solution. Clamp tubing, uncap spike, and insert into entry site on bag or bottle as manufacturer directs. Squeeze drp chamber and allow it to fill at least halfway. Remove cap at end of tubing, release clamp, and allow until all air bubbles have disappeared. Close clamp and recap end tubing maintaining sterility of set up. If an electronic device is to be used, follow manufacture’s instructions for inserting tubing and setting infusion rate. Have the client in a low fowler’s position in bed.
Select an appropriate site and palpate accessible veins. If the site is hairy and agency policy permits, shave a 2-inch area around the intended site of entry. Apply a tourniquet 5 to 6 inches above the venipuncture site to obstruct venous blood flow and distend the vein. Direct the ends of the tourniquet away from the site of entry. Check to be sure that the radial pulse is still present. Ask the client to open and close his or her fist. Observe and palpate for a suitable vein. Try the following techniques if the vein cannot be felt. Release the tourniquet and have the client lower his or her arm below the level of the heart to fill the vein. Reapply tourniquet and gently tap over the intended vein to help distend it. Remove tourniquet and place warm compress over the intended vein for 10 to 15 minutes. Don clean, disposable gloves. Cleanse the entry site with an antiseptic solution. Use a circular motion to move from the center outward for several inches. Use the nondominant hand; place about 1 inch or 2 inches below entry site, to hold the skin taut against the vein. Enter the skin gently with the needle held in dominant hand, bevel side-up, at a 30 to 45º angle, and when the needle is through the skin, lower the needle until it is nearby parallel to the skin. While following the course of the vein, advance the needle or catheter into the vein. A sensation of “give” can be felt when the needle enters the vein.
When blood returns to the lumen of the needle, advance the needle farther into the vein. The exact technique depends on the type of the needle used. With an angiocather, the needle is removed, leaving the catheter in place. Quickly remove protective cap from the IV tubing and attach the tubing to the catheter or needle. Stabilize the catheter or needle with nondominant hand and release the tourniquet with your hand. Start the flow of solution promptly by releasing the clamp on the tubing. Examine the tissue around the entry site for signs of infiltration. Support the needle with small piece of gauze under the hub, if necessary, to keep the needle properly positioned in the vein. An antiseptic ointment may be applied to the needle’s site of entry with a sterile dressing according to agency policy. Remove soiled gloves and discard appropriately. Loop the tubing nea the site of entry, and anchor with tape to prevent pull on the needle. Mark the date, time, and type and size of the needle used for the infusion on the tape anchoring the tubing. Anchor arm to an arm board to support, if necessary. Adjust the rate of solution flow according to the amount prescribed and follow manufacturer’s directions of adjusting flow rate on infusion pump. Remove all equipment. Wash hands.
Evaluation
Document the procedure and client’s response. Chart time, site, device used and solution. Return to check flow rate and observe for infiltration 30 minutes after starting infusion.
