INTRAVENOUS THERAPY

	Wash hands.
	Organize equipments on clutter free bedside stand or over bed table.
	Open sterile packages using septic techniques.
	Check I.V. solutions using five rights of drug administration. Make sure prescribed additittes such as potassium and vitamins have been added. Check solution for colour, clarity and expiry date. Check bag for leak, which is best if done before reaching the bedside.
	Open infusion set maintaining sterility of both ends of the tubing. Many sets allow for priming of tubing without removal of end cap.
	Place roller clamp about 2 to 5 cm (1 to 2 in) below drip chamber and move roller lamper to position.
	Remove protective sheath over IV tubing port laster I.V. solution. For bottled solution remove cap and metal and rubber disks beneath.
	Insert infusion sets into fluid bag as bottle. Remove protector cap from tubing insertion spike (keeping spike sterile) and insert spike into opening of I.V. bag. Cleanse rubber stopper on bottled solution with antiseptic and insert spike into black rubber stopper of I.V. bottle.
	Prime infusion tubing by filling with I.V, solution. Compress drip chamber and release, allowing it to fill one third to one half full.
	Remove tubing protect as cap (same tubing can be primed without removal) and slowly release roller clamp to allow fluid to travel from drip chamber through tubing to needle adapter. Return roller clamps off position after tubing is primed.
	Be certain if tubing is clean of air and air bubbles. To remove air bubbles firmly tap I.V. tubing where air bubbles are located. Check entire length of tubing to ensure that all air bubbles are removed.
	Replace tubing cap protector on end of tubing.
	Optional: Prepare heparin or normal saline lock for infusion. If a loop of short extension tubing is needed because of an awkward I.V. site placement, use sterile technique to connect the I.V. plus to the loop as short extension tubing. Inject 1-3 ml of normal saline through the plug and through the loop or short extension tubing.
	Apply disposable gloves.
	Identify accessible site for I.V. replacement. Apply tourniquet 4 to 6 in (10 to 15 cm) above the proposed insertion site. Check for presence of radial pulse. OPTION: Apply blood pressure cuff instead of tourniquet. Inflate to a level just below client’s diastole (normal) pressure. Maintain inflation at the pressure until venipuncture is completed
	Select the vein Use the most distal site in non-dominant arm Select a site large enough for catheter placement Choose site that will not interfere with clients activities of daily living  or planned procedure Palpate the vein by pressing downward and note the resilient, soft , bouncy feeling as the pressure is released . always use the same finger to palpate Promote venous distention by instructing tejh client to open and close the fist several times lowering the clients arms ina  dependent position rubbing or sytroking the client arm from distal to proximal below popsed site Avoid site distal to preserve venipuncture sites hardened cordlike veins, infiltrated sites or phlebic area Avoid areas that are painful to palpitation , bruised areas and areas of venous bifurcation
	Release tourniquet temporarily and carefully .clip arm hair with scissors .(don’t shave)
	If area of insertion needs cleansing use soap and water first .then cleanse insertion site usinf firm , circular motion with povidone iodine  solution  , refrain from touching the cleansed sites , allow the sites to dry for atleast 2 minutes .if client is allergic to iodine
	Perform  venipuncture .anchor vein , by placing thumb over vein and by stretching the skin against the direction of insertion 5 to 7.5 cm distal to actual site of venipuncture Butterfly needle  : hold needle at 20 to 30 angle with bevel up slightly distal to site of venipuncture ONC : Inset ONC with bevel up at 20 -30 degree angle slightly distal to actual site of venipuncture in direction of the vein
	Look for blood return through tubing of butterfly needle  or flashback chamber of ONC , indicating that needle has  entered the  vein homer needle until almost flush with skin . advance ONC cathter ¼ into vein and then loosen stylet .Advance catheter into vein until vein hub rests at venipuncture site . DON’T reinsert the stylet once it is loosened
	Stabilize the catheter with one hand  and apply pressure  on the hub or on vein above the insertion site . release tourniquet  and remove stylet from ONC .don’t recap the stylet .for as safety device , slide catheter  off stylet.
	Quickly connect needle adapter of administration  set as heparin lock to hub of ONC  or butterfly tubing .don’t touch point of entry of needle adapter
	Bloodless method : old pressure over tip of inserted cathter with your thumb , with index finger and thumb remove cap and attach tubing to catheter hub
	Release roller clamp slowly to begin infusion at a rate to maintain potency of IV line
	Release  roller clamp  slowly to begin infusion at a rate to maintain potency of IV line
	Tape as a secure catheter ·         If applying gauze dressing , tape IV catheters , place narrow piece of tape  under tub of catheter with adhesive side up  and cross tape over hub ·         Place tape over the cathter never over the insertion site . secure the site to allow easy visual inspection and early recognition of infiltration  and phlebitis ·         If applying transparent dressing , secure catheter  with non dominant hand  while preparing to apply dressing
	For IV fluid administration adjust flow rate  to correct drops/ minute Heparin lock : flush with 1-3 ml of heparin Saline lock : flush with 1-3 ml of sterile saline
	Write data and time , gauge size and size of catheter , placement of IV line and dressing
	·         Dispose of used needles in appropriate sharp container. Discard supplies. Remove gloves and wash hands
	·         Observe client evry hour to determine if fluid is infusing correctly ·         Check if correct amount of solution is infused as prescribed  by looking at time tape ·         Count flow rate ·         Check potency of IV catheter or needle , briefly compress cannulated vein proximal to site . Observe for slowing or cessation of IV rate ·         Also observe  client during  compression of vessel  for signs of discomfort ·         Inspect insertion site for absence of infilteration , phlebitis or inflammation Observe client every hour to determine responses to therapy