SETTING UP AN IV INFUSIOn 1.Verify written prescription and make IV label. 2.

Observe ten (10) Rs when preparing & administering IVF 10 Golden Rules for Administering Drug Safely (from Nursing 88 Vol. 18, August 1988) a.Administer the RIGHT DRUG. b.Administer the right drug to the RIGHT PATIENT. c.Administer the RIGHT DOSE. d.Administer the right drug by the RIGHT ROUTE. e.Administer the right drug at the RIGHT TIME. f.DOCUMENT each drug you administer. g.TE ACH your client about the drugs he is receiving. h.Take a complete patient DRUG HISTORY. (There is a risk of adverse drug reactions when a number of drugs are taken or when patient is taking alcohol drinks.) i.Find out if the patient has any DRUG ALLERGIES. j.Be aware of potential DRUG DRUG or DRUG FOOD INTERACTIONS. To protect your patient and your license, follow these guidelines for avoiding medication errors 3.Explain procedure to reassure patient and/or significant others, secure consent, if necessary 4.Assess patients vein; choose appropriate site location, size and condition 5.Do hand hygiene before and after the procedure 6.Prepare necessary materials for procedure IV tray with IV solution IV Administration Set IV cannula 7.Check the sterility and integrity of the IV solution, IV set and other devices 8.Place IV label on IVF bottle duly signed by RN who prepared it (patients name, room no., solution, drug incorporation, bottle sequence, and duration, time, and date. 9.Open the seal of the IV infusion aseptically and disinfect rubber port with cotton ball with alcohol 10. Open the IV administration set aseptically and close the roller clamp and spike the infusate container aseptically. 11. Fill drip chamber to at least half and prime it with IV fluid aseptically 12. Expel air bubble if any and put back the cover to the distal end of the IV set (get ready for IV insertion) INSERTING IV CANNULA UTILIZING A DUMMY IV ARM 1.Verify the written prescription for IV therapy check prepared IVF and other things needed 2.Explain procedure to reassure the patient & significant others and observe the 10Rs 3. Do hand hygiene before and after the Procedure 4.Choose site for IV.

5.Apply tourniquet 5 to 12 cm. (2-6inches) above injection site depending on condition of patient 6.Check for radial pulse below tourniquet 7. Prepare site with effective topicalantiseptic according to hospital policyor cotton balls with alcohol in circularmotion and allow 30 seconds to dry.(No touch technique). 8.Using the appropriate IV cannula, pierceskin with needle positioned on a 15-30degree angle 9. Upon flashback visualizationdecrease the angle, advancethe catheter and stylet (1/4inch) into the vein, check if tipof catheter can be rotatedfreely inside the vein. 10. Position the IV catheter parallel tothe skin. Hold stylet stationary andslowly advance the catheter until thehub is 1mm to the puncture site 11. Slip a sterile gauze under the hub. Release the tourniquet, remove thestylet while applying digital pressure over the catheter with one fingerabout 1-2 inch from the tip of the inserted catheter 12. Connect the infusion tubing of theprepared IVF aseptically to the IVcatheter 13. Open the clamp, regulate the flow rate. Reassure patient 14. Anchor needle firmly in place with the use of : a. transparent tape/dressing directly on the puncture site b. tape (using any appropriate anchoring style 15. Tape a small loop of IV tubing for additional anchoring; apply splint (if needed) 16. Calibrate the IVF bottle & regulate flow of infusion according to prescribed Duration 17. Label on IV tape nearthe IV site to indicate thedate of insertion, typeand gauge of IV catheterand countersign 18. Label with plaster on the IV tubing to indicate the date when to change the IV tubing 19. Observe patient and report any untoward effect. 20. Document in the patients chart and endorse to incoming shift 21. Discard sharps and waste according to Health Care Waste Management (DOH/DENR) CHANGING AN IV SOLUTION 1.Verify doctors prescription in doctors order sheet; countercheck IV label, IV card, infusate sequence, type, amount, additives (if any), duration of infusion. 2. Observe ten (10) Rs. 3.Explain procedure to reassure patient & significant others & assess IV site for redness, swelling, pain, etc. 4.Change IV tubings and cannula if 48-72 hours lapsed after IV insertion. 5.Wash hands before and after the procedure 6.Prepare necessary materials; place on IV tray. 7.Check sterility and integrity of IV solution. 8.Place IV label on the IV bottle. 9.Calibrate new IV bottle according to duration of infusion as per prescription

10. Open and disinfect rubber port of IV solution to Follow 11. Close the roller clamp and spike the container aseptically. 12. Regulate the flow rate based on theprescribed infusion rate of infusion.Expel air bubbles (if any). 13. Reiterate assurance to patient and significant others. 14. Discard all waste materials according to Health Care Waste Management. 15. Document and endorse accordingly. BLOOD TRANSFUSION 1. Verify doctors written prescription andmake a treatment card according tohospital policy 2. Observe ten (10) Rs when preparing and administering any blood or blood Components 3.Explain the procedure/rationale for Giving blood transfusion toreassure patient and significantothers and secure consent. Getpatients history regarding previoustransfusion 4.Explain the importance of the benefits on Voluntary Blood Donation (RA 7719 National Blood Service Act of 1994) 5.Request prescribed blood/blood components from blood bank to include blood typing and X -matching and blood result of transmissible disease. 6.Using a clean lined tray, get compatible blood from hospital blood bank Wrap blood bag with clean towel and keep it at room temperature 8. Have a doctor and a nurse assess patientscondition. Countercheck the compatible blood tobe transfused against the X-matching sheet noting ABO grouping and Rh, serial no. of each blood unit, and expiry date with the blood bag label and other laboratory blood exam as required before transfusion (Hgb and Hct). Get the baseline vital signs BP, RR,temperature before transfusion. Refer toMD accordingly. 10. Give pre-med 30 minutes before transfusion as prescribed. 11. Do hand hygiene before and after the procedure 12. Prepare equipment needed for BT IV injection tray, IV catheter/needle G18/19, plaster, tourniquet, gloves. compatible BT set G 18 needle (only if needed)blood component to be transfuse, Plain NSS 500 cc,IV set, sterile 2x2 gauze or transparent dressing, IV hook and stand, 13.If main IVF is with dextrose 5% initiatean IV line with appropriate IV catheterwith Plain NSS on another site, anchorcatheter properly and regulate IV drops 14. Open compatible blood set aseptically and close roller clamp. Spike bloodbag carefully; fill the drip chamber at least half full; prime tubing andremove air bubbles (if any). Use needle G 18 or 19 for side drip (foradults) or of 22 for pedia (if blood is given through the Y-injection port, thegauge of needle is disregarded) 15. Disinfect the Y-injection port of IV tubing(Plain NSS) and insert the needle from BTadministration set and secure with adhesivetape 16. Close roller clamp of IV fluid of Plain NSS and regulate to KVO while transfusion is going on. 17. Transfuse the blood via the injection portand regulate at 10-15 gtts initially for 15minutes and then at the prescribed rate(usually based on the patients condition) 18. Observe patient for 10-15minutes for any immediatereaction. 19. Observe patient on an on-going basis for anyuntoward signs and symptoms such as flushedskin, chills, elevated temperature,itchiness,urticaria and dyspnea. Ifany of these symptomsoccurs stop the transfusion, open the rollerclamp of the IV line withPlain NSS, and report todoctor immediately. 20. Swirl the bag hourly to mix the solid with the plasma. N.B. one BT set should be used for 1-2 units of blood. 21. When blood is consumed, close the roller clamp of BT, and disconnect from IV lines then regulate the IVF of plain NSS as prescribed 22. Continue to observe and monitor patient post transfusion for delayed reaction could still occur.

23. Re-check Hgb and Hct, bleeding time, serialplatelet count within specified hours as prescribed&/or per institutions policy. 24. Discard blood bag and BT set and sharps According to Health Care Waste Management 25. Document the procedure, pertinent observations and nursing intervention and endorse accordingly 26. Remind the doctor about the administrationof Ca gluconate if patient had several unitsof blood transfusion (3-6 or more units ofblood) TPN UTILIZING PERIPHERAL ACCESS 1.Verifies doctors prescription. 2.Explains the procedure to reassure patientand significant others (benefits, risks,duration, changes in volume and flow rate,etc.) 3. Secures consent form from patient and/or authorized member of the family. 4. Prepares parenteral solution and all otherdevices needed for the parenteral administrationtaking into consideration the mode ofadministration such as: a. Peripheral Access b. Central AccesS 5. Assesses patient and choose suitable vein, location, and get baseline vital signs 6. Checks the integrity and functionality of the parenteral solution and IV devices 7.Observes the ten (10) Rs in safe drug administration 8. Do hand hygiene and maintain asepsis throughout the procedure 9.Prepare TPN solution (follow procedure of Setting Up) 10. Inserts the IV catheter aseptically(large, bore catheter. Followprocedure I in IV insertion). 11. Connects the tubng to the prepared parenteral solution and regulate flow rate as prescribed. 12. Dresses IV site as per IV standard. 13. Labels IV site and solution as per IV standard. 14. Continue to reassure patient and do pertinent health education. 15. Disposes waste materials according to Health Care Waste Management (DOH/DENR) 16. Documents procedure and observations withcorresponding nursing intervention in thepatients chart like I&O, weight daily, etc. 17. Monitors patient periodically and report unusual findings if any: such assigns of infection, hyper & hypoglycemia, change of color and consistencyof solution, etc. 18. Document observation and intervention as necessary. 19. Reassure patient. TPN UTILIZING CENTRAL VASCULAR ACCESS 1.Follow procedure in Procedure of Peripheral Access from steps 1-9 2. Assist surgeon in Open or Closed CentralVascular Access Procedures (maintain asepsisthroughout the procedure). 3. Connects the IV administration set to thecentral vascular access catheter asepticallyand regulate flow rate as prescribed 4.Assess dressing over central vascular accessfor swelling, redness, pain and foul smelling discharges. Change dressingaseptically everyday 5. Monitor/reassure patient. 6. Document observations and circumstances as necessary 7.Discard waste materials according to Health Care Waste Management (DOH/DENR)