When setting up your supplies, check orders for
Moral of the story? Read back any verbal order you received, have the doc sign it ASAP after giving the order or better yet, if the doc is sitting there, get the chart open it to the orders section and ask for him or her to write the order. And if you have any questions about the order, don’t be afraid to clarify what you heard. Your patient depends on it.
Of course these days, most charts are computerized and it is expected for the physician to write his or her own orders. But you can see from this incident how easy it can be to make a medication error.
Unless you are dealing with toxic chemotherapy drugs in the oncology department, gloves are not necessary. You will not be exposed to the patient’s bodily fluids during this skill.
The cover that the IV fluid bag is in has a “starting tear” at the top of it so it is the easiest place to open it. If you find the bag is slightly damp, that is ok. Just gently squeeze the bag to make sure it is not due to leaks but just normal condensation.
Make sure there is nothing floating around in the fluid.
In this case you are going to use a PRIMARY IV tubing set. There is also what is called a secondary or piggyback infusion set that will be discussed on another page.
Open the IV tubing bag, decide where you want the clamp to be on the line (as you do this you will develop a preference for it either being high up near the drip chamber or closer to the patient insertion site). Once you have pushed it up or down the line use the roller to close squeeze the line shut.
There are a few other manual clamps along the line. Just leave them open.
Remove any tape holding the tubing.
There are two ports at the bottom of the IV bag. One has a rubber stopper that is used to manually inject medication into the bag using a syringe with a needle. When priming an IV line, most of them will already have any medication added to the fluid will be done in the pharmacy and arrive with the label stating exactly what and for which patient.
The other port usually has a blue cap of some sort on it. If it has a little tag on the end, grab that and pull the cover off. It takes quite a bit of force. Just pull.
The end of the IV line with the drip chamber also has a cap over the “spike”. Remove the cap.
Keep BOTH the spike and the port that had the blue cap sterile by NOT touching it to anything other than each other.
Push the spike in until it is well attached. I have seen people twist the spike without any problems of puncturing the tubing. So it's up to you.
Then hang the bag.
Because you closed the roller clamp on the tubing nothing will drip down through the tube.
Begin the actual priming the IV line by squeezing the drip chamber will suck some fluid into the chamber and cover the bottom of the chamber. This will of course, also cover the beginning portion of the tube. Anywhere from ¼ to ½ of the drip chamber filled with fluid is enough. That still allows you to see the fluid dripping into the chamber.
This means that when you start feeding the fluid into the rest of the tubing, only fluid, not air will go down the line. This is a good thing.
Slowly open the roller clamp and watch the fluid run down the IV line.
Macro-drip chambers will deliver 1 ml of fluid in about 15 drops (gtts). A Micro-drip chamber will deliver 1 ml of fluid in about 60 drops (gtts). Check the package to see what the exact rate is for that manufacturers tubing.
If you see a small bubble of air here or there, that isn’t a big thing but patients can get anxious, so get them out of the line by flicking the tubing with your finger.
Remember that air rises so hold the portion of the tube that is towards the end higher than where the bubble is so the bubble will move along. If you see bubble in the “Y” connectors along the line, turn them upside down to get the air bubbles to dislodge and move along.
Finishing the skill of priming an IV line requires you secure the IV tubing to the patient. Make sure you don’t tape over the transparent dressing that is on the insertion site or you will have trouble removing the line without damaging the dressing.
The blue cap you see on the patient has a center button that is pushed in as you attach the IV cap to it. That opens the line to allow fluid to flow.
Also, that little clear cap that you screw onto the patient line can slide up and down the line, so make sure you have a hold of it when you are ready to screw things together.