Setting up an intravenous infusion

Question 1

Equipment

Answer 1

• Patient’s fluid prescription chart
• 500 ml bag of Sodium Chloride 0.9%
• Alcohol gel
• IV infusion set ‘giving set’
• Drip stand
• Wipe x2
• Gloves
• Apron
• Clean receptacle
• 0.9% Sodium Chloride ampoule (for flush)
• 5ml syringe (for flush)
• Infusion rate calculation sheet

Question 2

Performance of task

Answer 2

• Check patient’s chart to check the fluid to be infused, volume and rate, and time/date of prescription. Check prescription has been signed and dated. (state you’re doing this)
• Assess fluid bag - make sure it is the correct fluid, expiry date, check for discolouration, cloudiness, particulate matter. (state you’re doing this)
• Clean hands with alcohol gel
• Don gloves and apron
• Make up flush away from patient:
• Check name and expiry date of saline ampoule
• Break cap off of ampoule
• Insert syringe straight into ampoule
• Press down firmly to maintain tight seal
• Draw saline into 5ml syringe by moving plunger backwards
• Store flush syringe back in its own packaging for transport.
• Remove infusion bag from covering - check for signs of leakage/puncture (state you’re doing this)
• Assess giving set packaging for damage/expiry date (state you’re doing this)
• Open giving set
• Uncoil giving set and check for kinks (state you’re doing this)
• Close roller clamp fully
• Remove seal from entry port (break it off) on infusion bag aseptically.
• Remove cover from spike on giving set, aseptically
• Insert spike into entry port (twisting motion) aseptically
• Put infusion bag on drip stand
• Squeeze drip chamber to half fill it (make sure clamp is shut before doing this!)
• Open roller clamp
• Check the fluid descends and air bubbles are expelled (leave it to run through into kidney dish to get the air out)
• Close roller clamp once all bubbles expelled and fluid dripping out
• Wipe injectable bung with wipe and allow to dry
• Flush cannula
• Wipe bung with wipe and allow to dry
• Remove cap of giving set and connect to cannula
• Set the drip/flow rate by opening roller clamp to desired point (drops per min)

Question 3

Aftercare

Answer 3

• Enter details on fluid prescription sheet - sign and date and time it (state that you would do this)
• Check welfare
• Ask patient to inform staff of discomfort, pain or swelling at site
• Remove gloves and apron
• Thank patient

Question 4

What would you say to inform the patient about the procedure?

Answer 4

‘I’ve been asked to set up a drip for you today to put some saline fluid through your cannula to hopefully make you feel a bit better and make sure you stay hydrated. Firstly, I will flush the cannula with some saline to make sure it is working, I will then set the drip up which will stay attached to your hand. It will not hurt but you may feel a bit of cold going up your arm. Stop me at any time if you are in pain or discomfort.’

Question 5

What are IV sets (giving sets) good for?

Answer 5

Giving fluids that are additive free and no adverse effects are anticipated if infusion rate varies

Question 6

Which patients are more at risk if the infusion rate varies (and therefore should use an infusion pump for better accuracy and control)

Answer 6

Children
Elderly
Impaired CVS status
Complex medicine regimes

Question 7

Disadvantages of infusion pumps

Answer 7

Expensive - to buy and maintain

Staff must be trained

Question 8

Troubleshoot - infusion running too slowly

Answer 8

Open roller clamp and observe flow rate
Ensure bag is 90cm+ above patient and correctly placed on drip stand
Check position of arm
Check for kinks
Flush again

Question 9

Troubleshoot - infusion running too quickly

Answer 9

Check and readjust roller clamp

Question 10

Troubleshoot - infusion won’t run

Answer 10

Check roller clamp and tubing

Flush again