Priming and Regulation of Intravenous Device

PRIMING AND REGULATION OF
INTRAVENOUS FLUIDS
NCM 103 FUNDAMENTALS OF NURSING PRACTICE AY 2020-2021
PURPOSES OF INTRAVENOUS INFUSIONS
To supply fluids when client is unable to take in an

adequate amount by mouth
To provide salts needed for electrolyte balance
To provide glucose which is the main fuel for

metabolism
To establish a lifeline for rapidly needed medications

TYPES OF INTRAVENOUS SOLUTIONS
TYPE DESCRIPTION
• Has the same concentration of solutes
as blood plasma
Isotonic solution • Often used to restore vascular volume
• Has lesser concentration of solutes

than plasma
Hypotonic solution • Used to provide free water and treat
cellular dehydration
• Has a greater concentration of solutes
than plasma
• Draws fluid out of intracellular and
Hypertonic solution interstitial compartments into the
vascular compartment, expanding
vascular volume
TYPES OF INTRAVENOUS SOLUTIONS
ASSESSMENT
 Before starting an infusion, the

nurse should first determine the
following:
 The type and amount of solution
to be infused
 The exact amount of medications,
if any, to be added to the solution
 The rate of flow or the time over
which the infusion is to be
completed
FACTORS AFFECTING IV FLOW RATES
CLIENT FACTORS
 Change in client position
 Flexion of involved extremity
 Partial or complete occlusion of IV device
 Venous spasm
 Vein trauma
 Manipulation by client or visitor
FACTORS AFFECTING IV FLOW RATES
MECHANICAL FACTORS
 Height of parenteral container
 Viscosity of IV solution
 Occluded air vent
 Kinked tubing
 Tubing dangling below the bed
INTRAVENOUS EQUIPMENT
PARTS:
❑ IV bottle / bag
❑ Insertion spike
❑ Drip chamber
❑ Roller valve / Screw clamp
❑ Tubing with secondary
ports
❑ Needle adapter
❑ Protective cap
INSERTION SPIKE
The insertion spike is kept sterile and inserted into the
solution container when the equipment is set up and
ready to start.
DRIP CHAMBER
The drip chamber permits a predictable amount of fluid to be delivered.
Macrodrip – 10 to 20 drops per mL of solution
Microdrip – 60 drops per mL of solution
ROLLER CLAMP
The roller clamp or screw clamp compresses the lumen

of the tubing and controls the rate of the flow.
NEEDLE ADAPTER
The needle adap
ter allows the needle inserted in the client to be attached to the
tubing.
The protective cap maintains the sterility of the needle adapter.
TUBING WITH SECONDARY PORTS
Tubing with secondary ports allow for
administration of IV medications or secondary
infusions (side drip).
PRIMING INTRAVENOUS FLUIDS
 Read the label on the solution and check for the expiration
date and if there are any leaks or precipitate.
 Check the label against the doctor’s order.
 Do handwashing.
 Unpack the tubing and straighten it out.
 Slide the clamp along the tubing until it is below the drip
chamber for easy access.
 Close the clamp.
 Remove the cover from the IV bottle and the spike. Keep
these areas STERILE.
 Insert the spike into the insertion site of the IV bottle.
 Calibrate the infusion according to the duration of the
infusion ordered by the physician.
 Label the IV bottle.
 Hang the solution on the pole about 1 meter (3 feet)
above the client’s head.
 Squeeze the drip chamber gently until it is half full.
 Open the clamp and allow for fluid to run through the
tubing until all bubbles are removed.
 Reclamp the tubing.
 Do handwashing.
 Calibrate the infusion according to the duration of the
infusion ordered by the physician.
 Label the IV bottle.
 Hang the solution on the pole about 1 meter (3 feet)
above the client’s head.
 Squeeze the drip chamber gently until it is half full.
 Open the clamp and allow for fluid to run through the
tubing until all bubbles are removed.
 Reclamp the tubing.
 Do handwashing.
IV FLUIDS COLOR GUIDE
INTRAVENOUS FLUID LABEL COLOR
PNSS (plain normal saline solution) Green
D5NSS (5% dextrose in normal saline) Yellow
D50.3NSS (5% dextrose in 0.3% saline) Light Blue
PLRS (plain lactated Ringer’s solution) Dark Blue
D5LR (5% dextrose in lactated Ringer’s) Pink
D5NR (Eurosol R in dextrose 5% in water) Yellow Green
D5W (5% dextrose and water) Red
D10W (10% dextrose and water) Blue Green
D5NM (Eurosol M in dextrose 5% in water) Orange
D5IMB (Euro-Ion in dextrose 5% water) Violet
MACROSET
HOURS FLOW RATE VOLUME
(drops per (in mL)
minute) INFUSED
PER HOUR
24 KVO 42
16 21 63
12 28 84
10 33 99
8 42 126
6 56 168
4 83 249
3 111 333
2 167 500
MICROSET
HOURS FLOW VOLUME
RATE (in mL)
(drops per INFUSED
minute) PER HOUR
24 KVO 20
20 25 25
16 31 31
14 35 35
12 41 41
10 50 50
8 62 62
6 83 83
4 125 125
COLOR CODING FOR INTRAVENOUS NEEDLE
GAUGE
IV CANNULA
COMPLICATIONS OF INTRAVENOUS THERAPY
 1. Phlebitis.
- Inflammation of the vein.
- Occurs commonly after
trauma to the vessel wall,
infection, immobilization, and
prolonged insertion of IV
catheters.
 Assessment Findings:
1. Warmth
2. Swelling
3. Pain
4. Redness around the vein
 1. Phlebitis.
Management:
- Stop infusion and discontinue
IV line.
- Start new IV line in other
extremity or proximal to
previous insertion site if
continued IV therapy is
necessary.
- Apply warm moist compress
or contact IV therapy team or
health care provider if area
needs additional treatment.
 2. Circulatory overload of IV solution
- IV solution infused too rapidly or in too
great an amount
1. Depends on type of solution ECV excess
with Na+ containing isotonic fluid
(crackles in dependent portions of lungs,
shortness of breath, dependent edema)
2. Hyponatremia with hypotonic fluid
(confusion, seizures)
3. Hypernatremia with Na+ containing
hypertonic fluid (confusion, seizures)
4. Hyperkalemia from K+ containing fluid
(cardiac dysrhythmias, muscle
weakness, abdominal distention)
 2. Circulatory overload of IV solution

Management:
- If symptoms appear, reduce IV flow
rate and notify patient’s health care
provider.
- With ECV excess raise head of bed;
administer oxygen and diuretics if
ordered.
- Monitor vital signs and laboratory
reports of serum levels.
- Health care provider may adjust
additives in IV solution or type of IV
fluid; watch for and implement order.
 3. Infiltration or extravasation
- IV fluid entering subcutaneous
tissue around venipuncture site
- Extravasation: technical term used
when a vesicant (tissue-damaging)
drug enters tissues
1. Skin around catheter site taut,
blanched, cool to touch, edematous
2. may be painful as infiltration or
extravasation increases; infusion
may slow or stop
 3. Infiltration or extravasation
Management:
1. Stop infusion.
2. Discontinue IV infusion if no vesicant drug. If
vesicant drug, disconnect IV tubing and
aspirate drug from catheter. Agency policy
and procedures may require delivery of
antidote through catheter before removal.
3. Elevate extremity.
4. Contact health care provider if solution
contained KCl, a vasoconstrictor, or other
potential vesicant.
5. Apply warm moist or cold compress
according to procedure for type of solution
infiltrated.
6. Start new IV line in other extremity
 4. Local infection
- Infection at catheter-skin entry
point, during infusion or after
removal of IV catheter.
1. Redness
2. Heat
3. swelling at catheter-skin entry
point
4. possible purulent drainage
 4. Local infection
Management:
1. Culture any drainage (if ordered).
2. Clean skin with alcohol; remove
catheter and save for culture;
apply sterile dressing.
3. Notify health care provider.
4. Start new IV line in other
extremity.
5. Initiate appropriate wound care
 5. Bleeding at Venipucture Site
1. Oozing or slow, continuous
seepage of blood from
venipuncture site
2. Fresh blood evident at
venipuncture site,
sometimes pooling under
extremity
 5. Bleeding at Venipuncture Site

Management:
- Assess if IV system is intact.
- If catheter is within vein, apply
pressure dressing over site or
change dressing.
- Start new IV line in other extremity
or proximal to previous insertion
site if VAD is dislodged, IV is
disconnected, or bleeding from site
does not stop.

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PRIMING AND REGULATION OF

To supply fluids when client is unable to take in an

To provide salts needed for electrolyte balance

To provide glucose which is the main fuel for

To establish a lifeline for rapidly needed medications

• Has lesser concentration of solutes

 Before starting an infusion, the

The roller clamp or screw clamp compresses the lumen

 2. Circulatory overload of IV solution

 5. Bleeding at Venipucture Site

 5. Bleeding at Venipuncture Site

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