IVF THERAPYSETTING UP1. Check doctors order and make IV label2. Prepare necessary materials (IV solution, administration set, IV hook, IV tray, cotton balls with alcohol, plaster, tourniquet and splint.3. Explain procedure and assess patient vein.4. Check solution and set for sterility5. Place IV label on IVF bottle6. Wash hands before and after setting up7. Maintain sterility of IVF solution container while opening the port8. Disinfect rubber port with cotton ball dipped in alcohol9. Open administration set aseptically and close roller clamp.10. Spike the container without contaminating the port11. Choose appropriate vein, location, size and condition.12. Fill drip chamber at least half13. Prime the tubing while maintaining sterility of end of tubing (kidney basin )14. Remove all air from tubing ( get ready for IV insertion)INSERTING1. Verifies the written prescription for IV therapy, check prepared IVF and other things needed (Ensure a legal order was written accurate IVF)2. Explain procedure to reassure patient and significant others and observe the 10Rs in medication. (Information decreases the patients anxiety , prevent errors in giving medications)3. Does hand hygiene before and after procedure (Reduces the transmission of microorganisms)4. Choose vein site for inserting IV ease of placement of catheter) (Promote5. Apply tourniquet 5-2 cm ( 2-6 inch ) above injection site depending on condition of patient (Distend vein to allow visual and tactile)6. Checks for radial pulse below tourniquet (To evaluate the blood flow and determine if there is arterial blood occlusion)7. Prepare site with effective topical antiseptic according to hospital policy (reduce transmission of microorganisms)8. Using the appropriate IV cannula, pierces skin with needle positioned on 15-30 degree angle. (Prevents puncture of posterior wall of vein)9. Upon flashback visualization decreases the angle, advance the catheter and stylet (1/4 inch) into the vein, check if top of catheter can be rotated freely inside the vein. (Ensure proper placement of catheter, prevents catheter from being punctured by stylet)10. Position the catheter parallel of the skin. Hold stylet stationary and slowly advance the catheter until hub is 1mm to puncture site. (Ensure proper placement of catheter, prevents catheter from being punctured by stylet)
11. Slips sterile gauze under the hub. Release the tourniquet; remove the stylet while applying digital pressure over the catheter with one finger about 1.2 inches from the tip of inserted catheter. (Prevent blood flow from leaking out of the vein. Reestablish venous blood flow)12. Connect the infusion tubing of prepared IVF aseptically to IV catheter. (Provides entry portal for IV fluids, decrease the transfer of microorganisms)13. Open the clamp, regulate flow rate, reassure patient. (Prompt initiation of infusion, maintain the patency of IV)14. Anchors needle firmly in place with the use of a. Transport tape/ dressing directly on the puncture site b. Tape c. Band aid (Ensure catheters safe position, allows visualization of site through transparent dressing and prevent dislodgement if IV)15. Tape a small loop of IV pole and regulate flow of infusion according to prescribed duration. (Prevent dislodgement of IV and allow free movement of patients arm)16. Calibrate the IVF bottle and regulate flow of infusion according to prescribed duration. (Ensure accurate IV flow rate as prescribed by doctor)17. Labels on IV tape near IV site to indicate the date of insertion, type and gauge of catheter and the signature of nurse who administer the IV (Provide information when to change IV catheter or site)18. Label with plaster on IV tubing to indicate the date when to change the IV tubing (Provide information to schedule the next change of tubing)19. Observe patient and report any untoward effect. (Helps prevent the occurrence of infection)20. Document in patients chart, and endorse to incoming shift (Proper documentation avoid errors and complication in IV therapy)21. Discards sharps and wash according to Health Care Management (DOH/DENR) wash hands. (Prevents needle prick and the spreads of microorganisms) DISCONTINUING1. Verify written doctor’s order to discontinue IV2. Prepare necessary materials, IV trays, or injector tray with cotton balls and pick up forceps.3. Wash hands before and after procedure4. Explain procedure5. Wet all adhesive tapes with alcohol before removing6. Clamp tubing7. Use pick up forcep to get cotton balls with alcohol, remove needle or catheter applying pressure8. Place cotton ball with pressure and tape9. Document time of discontinuing, status of insertion site.
IV PUSH/ IV BOLUS1. Wash hands thoroughly (Minimizes possibility of infection)2. Set up primary infusion set (The primary set should be functioning effectively before the secondary ( piggyback) set can be attached.3. Lower the primary flash on the IV pole usually an extension hook accompanies the set (This will permit to check valve function)4. Prime secondary set hang it on IV pole (This maybe a partial additive container. Priming allows all air to escape from the system)5. Use antiseptic swab to carefully cleanse infection site (Usually, this is a Y connection on the primary site)6. Open clamp on secondary set, check the valve to ensure that it closes off the flow of solution from the primary source (Pressure is greater from the secondary source since it is more elevated, Increase pressure forces the disc upward in the check valve. This close the flow from the primary source)7. When Fluid from secondary source reaches level of fluid in primary set drip chamber, hydrostatic pressure between the two sets equalizer. (The release check valve and flow will resume automatically from primary source)INCORPORATION OF DRUG INTO IVF1. Counter check with written doctors order. Make medication card2. Observe 10Rs when preparing and administering medications3. Explain procedure to patient (medication and action) and check IV site, check for ANST of drug for IV push4. Wash hands before and after procedure5. Remove cover of airway administration set, maintain the sterility6. Incorporate the prepared drugs7. Retain the cover of the airway8. Shake bottle lightly to mix the incorporated medications with IV solution, regulate flow rate, Place IV label9. Document in patients chart INCORPORATION INTO SOLUTION SET1. Counter check with written doctors order, make medicine card2. Observe 10R when preparing and administering medications3. Explain procedure to the patient (medication and action) check IV site, check for ANST of the drug for IV push4. Wash hands before and after procedure5. Check for IVF level6. Disinfect injection port
7. Incorporate prepared drugs and add desired IVF as dilution PIGGY BACK1. Wash hand thoroughly (Minimizes possibility of infection)2. Set up primary infusion set (Primary set should be functioning effectively before secondary (piggyback) set can be attached.3. Lower primary flash on IV pole usually on extension hook accompanies the set (Permit to check valve to function)4. Prime secondary set, hang it on IV pole (This may be partial additive container. Priming allows all air to escape from system)5. Use antiseptic swab to carefully cleanse injection site (Usually this is a Y connection on primary site)6. Open clamp on secondary set, check the valve to ensure that it is close (Pressure is greater from secondary force since it is more elevated, increased pressure forces the disc upward in check valve. This closes the flow from primary source.7. When fluid from secondary source reaches level of fluid in primary set drip chamber, hydrostatic pressure between the two set equalizers. (The releases check valve and flow will then resume automatically from primary source) BLOOD TRANSFUSION 1. Verify doctors written prescription and make a treatment card according to hospital policy. 2. Observe the procedure/ rationale for giving transfuse to reassure patient and significant others and secure consent. Gets patients history regarding previous transfusion. 3. Explain the procedure / rationale fro given transfusion to reassure Patient and SO and secure consent. Set patients diagnosis regarding previous transfusion. 4. Explain importance or benefits on voluntary blood donation ( RA 7719- National Blood Service Act - 1994) 5. Reԛ uest presented blood/ blood components from blood bank to include blood typing and xmatching and blood result of transmissible disease. 6. Using a clean lined tray, get compatible from hospital blood bank 7. Wrap blood bag with clean towel and keep it at room temperature. 8. Have doctor and nurse assess the patients condition. Counter check the compatible blood to be transfused against Xmatching sheet noting ABO grouping, RH serial, no. of each blood unit and expiry date with bag blood label and other lab. 9. Get baseline vital sign, BP, RR, temp, before transfusion, refer to doctor accordingly. 10. Give premedication 30 minutes before transfusion as prescribed 11. Do hand hygiene before and after procedure 12. Prepare equipment needed for BT/ IV injection tray, compatible BT set, IV catheter, needle gauge 18/19, plaster, tourniquet, blood component to be transfused, Plain NSS 500cc, IV set, g18 needle(if needed), IV hook, gloves, sterile 2x2 gauge or transparent dressing etc.
13. The main IVF is with dextrose, 5% initiates an IV line with appropriate IV catheter with plain NSS on another site, Anchor catheter properly and regulate IV drops.14. Open compatible blood set aseptically and close roler clamp, Spike blood carefully , fill drip chamber at least half full, prime tubing and remove air bubbles ( if any) Use needle g18 or 19 for side drip (for adults) or 22 for pedia. (if blood is given through the Y injection port, the gauge of needle is disregarded)15. Disinfect Y injection port of IV tubing (plain NSS) and inject the needle from BT administration set16. Close the roller clamp of IV fluid of plain NSS and regulate to KVO while transfusion is going on.17. Transfuse the blood via injection port and regular initially for 15 min. and at prescribed rate.(usually base on patients condition)18. Observe patient for 10-15 min for any immediate reaction19. Observe patient on ongoing basis for any untoward signs and symptoms such as flushed skin, chills, elevated temperature, itchiness, urticaria and dyspnea. If any of the symptoms occur, stop transfusion, open roller of IV line with plain NSS and report to doctor immediately.20. Swirl the bag hourly to mix the solid with plasma. IV and BT set be used for 1-2 units of blood.21. Blood is consumed, close roler clamp of BT , disconnect from IV line the regulate IVF plain NSS as prescribed.22. Continue to observe and monitor patient post transfusion for delayed reaction could still occur.23. Rechecks HGB/HCT, bleeding time, serial platelet count within specified hours as prescribed and on per institution policy.24. Discard blood bag and BT set and sharps accordingly to Health care wash management (DOH/DENR)25. Document procedure, pertinent observation and nursing intervention and endorse26. Reminds doctor for administration of calcium gluconate. If patient had several units of blood transfuse (3-6 units of blood)