Procedure I: IVF infusion

A. SETTING UP:

1. Verify written prescription and make IV label.

2. Observe ten (10) rights when preparing and administering IVF.
3. Explain procedure to reassure patient and/or significant other, secure consent if necessary.
4. Assess patient's vein; choose appropriate site, location, size/condition.
5. Do hand hygiene before and after the procedure.
6. Prepare necessary materials for procedure (IV tray with IV solution, administration set, IV
cannula, forceps soaked in alcohol with cover (this should be exclusively used for I.V.), plaster,
tourniquet, gloves splint, and IV hook), sterile 2x2 gauze or transparent dressing.
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 (patient's name, room no.,
solution, time and date).
9. Open IV administration set aseptically following the infection control measures.
10. Open IV administration set aseptically and close the roller clamp and spike the infusate
container aseptically.
11. Fill the drip chamber to at least half and prime it with IV fluid aseptically.
12. Expel air bubbles if any and put back the cover to the distal end of the IV set (get ready for IV
insertion).

INSERTING IV CANNULA UTILIZING DUMMY ARM

Prepare complete IV tray with IV infusions; Dummy Arm and over-theneedle catheter or Butterfly
needle.

1. Verify the written prescription for IV therapy; check prepeared IVF and other things needed.
2. Explain procedure to reassure the patient and significant others and observe the 10 rights.
3. Do hand hygiene before and after the procedure.
4. Choose site for IV.
5. Apply tourniquet 5 to 12 cm. (2-6 in.) above injection site depending on condition of patient.
6. Check for radial pulse below tourniquet.
Prepare site with effective topical antiseptic according to hospital policy or cotton balls with
alcohol in circular motion and allow 30 seconds to dry (No touch technique).
Note: CDC Universal precuation: Always wear gloves when doing any venipuncture.
7. Using the appropriate IV cannula, pierce skin with the correct technique.
8. Upon backflow visualization, continue inserting the catheter into the vein.
9. Position the IV catheter parallel to the skin. Hold stylet stationary and slowly advance the
catheter until the hub is 1mm to the puncture site.
10. Slip a sterilize gauze under the hub. Release the tourniquet; remove the stylet while applying
digital pressure over the catheter with on finger about 1-2 inches from th etip of the inserted
catheter.
11. Connect the infusion tubing of the prepared IVF aseptically to the IV catheter.

Note: When steel-winged needle (butterfly) is used:

A. Connect the IV tubing to the steel-winged needle connector and prime the needle with
IV fluid.
B. Using the steel-winged needle, pierce skin with the needle bevel up, positioned on a 5-
10 degree angle.
C. With steel-winged needle, parallel on the skin enter the vein directly and advance
needle 1/4 inch after successfully performing venipuncture check for backflow. Remove
tourniquet.
D. Do not reinsert stylet once pulled out to prevent breakage of catheter that may cause
embolism.

12. Open the clamp and regulate the flow rate. Reassure patient.

13. 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)
c. Band-Aid

Note: Never place unsterile tape directly on IV insertion site. Instead, place a small piece of
sterile OS and then secure it with adhesive tape.

14. Tape a small loop of IV tubing for additional anchoring. Apply splint, if needed.
15. Calibrate the IVF bottle and regulate flow of infusion according to prescribed duration.
16. Label of IV tape near the IV site to indicate the date of insertion, type and gauge of IV catheter
and countersign.
17. Label with plaster on the IV tubing to indicate the date when to change the IV tubing.
18. Observe patient and report any untoward effect.
19. Document in the patient's chart and endorse to incoming shift.
20. Discard sharps and waste according to Health Care Waste Management (DOH/DENR).

CHANGING AN IV SOLUTION

1. Verify doctor's prescription in doctor's order sheet; countercheck IV label IV card, infusate
sequence, type, amount, additives (if any), and duration of infusion.
2. Observe 10 rights.
3. Explain procedure to reassure the patient and significant others and assess IV site for redness,
swelling, pain, etc.
4. Change IV tubing and cannula if 48-72 hours has lapsed after IV insertion.
5. Prepare necessary materials; place on an I.V. tray.
6. Check sterility and integrity of IV solution.
7. Place IV label on the IV bottle.
8. Wash hands before the procedure.
9. Calibrate new IV bottle according to duration of infusion as per prescription.
10. Open and connect the I.V. tubing into the solution bottle.
11. Close the roller clamp.
12. Regulate the flow rate according to the prescribed infusion rate. Expel air bubbles, if evident.
13. Reiterate assurance to patient and significant others.
14. Discard all waste materials according to Health Care Waste Management (DOH/DENR).
15. Document and endorse accordingly.

DISCONTINUING AN IV INFUSION

1. Verify written doctor's order to discontinue IV including IV medications.

2. Observe 10 rights.
3. Assess and inform the patient of the discontinuation of IV infusion.
4. Prepare the necessary materials; IV tray or injection tray with sterile cotton balls with alcohol,
plaster, pick-up forceps in antiseptic solution, kedney basin and band aid.
5. Wash hands before and afer procedure.
6. Close the roller clam of the IV administration set.
7. Moisten adhesive tapes around the IV catheter with cotton ball with alcohol; remove plaster
gently.
8. Use pick-up forceps to get cotton ball with alcohol and without applying pressure, remove
needle or IV catheter then immediately apply pressure over the venipuncture site.
9. Inspect IV catheter for completeness.
10. Place dressing over the venipuncture site.
11. Discard all waste materials including the IV cannula according to Health Care Waste
Management (DOH/DENR).
12. Reassure patient.
13. Document time of discontinuance, status of insertion site and integrity of IV catheter and
endorse accordingly.
 Procedure III: Administering IV Drugs

A. IV MEDICATION INCORPORATION OF DRUG INTO IV BOTTLE/BAG

Note: Put the Protocol of the Hospital in consideration.

1. Verify the written medication card against the M.D. prescription; observe hospital policy on drug
administration.
2. Observe 10 rights when preparing and administering medication.
3. Explain procedure (medication and action) to reassure patient and significant others and check
patency and IV site.
4. Verify for skin test of drug for IV incorporation (if skin testing is necessary).
5. Do hand hygiene before and after the procedure.
6. Prepare the necessary materials needed for this procedure such as: injection tray, syringes
needed, right drug to be incorporated either in vial or ampule.
7. Disinfect injection port of the vial and the ampule before breaking then aspirate the right dose
aseptically.
8. Remove the cover of the administration set, maintain sterility and incorporate prepared drug
into the airway aseptically. Recap airway after.
Note: if the administration set has no airway, pull out the set and incorporate the prepared
drug and re-spike the IV set to the bottle then place the label (all these should be done
aseptically).

9. Swirl the IV bottle to mix the drug with IVF and regulate the flow rate accordingly.
10. Observe for 5-10 minutes for any drug interaction while reassuring the patient; monitor VS.
11. Document the procedure done on the patient's chart.
12. Discard sharp and other wastes according to Health Care Waste Management (DOH/DENR).

IV MEDICATION PUSH THROUGH THE IV PORT

1. Verify medication card against the written doctor's prescription.

2. Observe the 10 rights when preparing and administering medication.
3. Explain procedure to reassure patient and significant others (the name of medicine and
action/interaction of medication) before administration.
4. Do hand hygiene before and after the procedure (use gloves especially for chemotherapeutic
and other vesicant drugs).
5. Check patency and other reaction signs of swelling, redness, phlebitis, etc... if any of these are
evident, do not give the drug.
6. Check for skin rest result of drug for IV push, drug-drug, drug IV fluid incompatibility, dosage
(computation).
7. Prepare the necessary materials for the procedure such as: right drug, right diluent needed, IV
injection tray, syringes with needles, alcohol, etc.
8. Disinfect injection port of the diluent, vial or ampule as may be appropriate.
9. Aspirate right amount of diluent for the drug (if the drug needs to be diluted).
10. Aspirate the right drug dose; disinfect the Y-injection port of the IV administration set-catheter
IV port.
11. Close the roller clamp of the IV tubing from the bottle and push IV drug aseptically and slowly
according to the manufacturer’s recommendation.
12. Using same syringe, aspirate 1-2cc of IVF to flush the medicine given.
13. Regulate rate of IV fluid infusion as prescribed (if needed).
14. Reassure patient and observe for signs and symptoms of adverse drug reaction.
15. Discard sharps and other waste according to Health Care Waste Management (DOH/DENR).

IV MEDICATION INCORPORATION INTO VOLUMETRIC CHAMBER

1. Verify the written M.D. prescription and follow hospital policy on drug administration.
2. Observe 10 rights when preparing and administering medication.
3. Explain procedures to patient (medicine and action) and check IV site. Verify for skin test of the
drug before IV incorporation.
4. Prepare the necessary materials for the procedure such as right drug and dose, right diluent
needed, IV injection tray, syringes and needles.
5. Do hand hygiene before and after procedure.
6. Check present IV fluid label, level and the incorporated medicine in the Volumetric Chamber or
IV bottle if with incorporated medicine, check for drug-drug incompatibility and if the on-going
IV fluid in the Volumetric Chamber is to be consumed in 6-8 hours, request a prescription and
keep the hole set sterile for succeeding doses.
7. Aspirate prepared right drug with correct dose.
8. Add desired IVF diluent into volumetric chamber by opening the sliding clamp from the bottle
then close the clamp.
9. Disinfect rubber injection port of the volumetric chamber and incorporate the drug. Mix gently.
10. Open the clamp of the airway at the volumetric chamber and incorporate the drug. Mix gently.
11. Regulate flow rate of IVF infusion accordingly.
12. Place IV label on volumetric chamber indicating drug incorporated and flow rate.
13. Reassure/monitor patient when incorporated medicine is consumed; clamp airway of
Volumetric Chamber, add IVF and regulate flow rate of main IVF as prescribed.
14. Discard waste according to Health Care waste Management (DOH/DENR).
15. Document in the patient's chart the drug administered and patient's condition.
16. Document in the patient's chart the IVF Sheet and Kardex (of changes in IV rate/time due).
 IV MEDICATION PUSH THROUGH THE HEPARIN-LOCK DEVICE

Note: Some Hospitals do not use Heparin anymore

1. Check medication card against the written doctor's prescription.

2. Observe 10 rights when preparing and administering medication.
3. Explain procedure to the patient (name of the medicine and action) before administration.
4. Gather equipment to include/but not limited to IV tray, Normal Saline diluent or Isotonic
solution, 2.5 cc syringes (2-3 pcs) as needed.
5. Do hand hygiene before and after the procedure (use gloves especially for chemo drugs).
6. Prepare medication to be administered, e.g. antibiotic, and draw it up into a syringe.
7. Fill a tuberculin syringe with Heparin solution. N.B. Heparin solution is usually prepared with 0.1
cc Heparin plus 0.9 cc Normal Saline or isotonic solution as prescribed by the doctor.
8. Fill the 2.5 cc syringe with isotonic solution or Normal Saline Solution; 1cc each.
9. If using Heparin Lock device with 3-way stop cock with luer-lock, rotate the stop cock so that the
line going to the patient is closed (this will prevent backflow of blood).
10. Remove the cover of the injection por aseptically and keep the sterility of the cover.
11. Check the patency, open the IV line and inject NSS or isotonic solution to flush the Heparin
Solution as prescribed by the Doctor.
12. Close the IV line and remove saline syringe and insert medication syringe into the port. Give IV
push 5-10 minutes for IV potent drug. For 2-3 IV medication, give at least 30 minutes to 1-hour
interval. After each drug administered via IV push, flush with 2-3 cc saline solution.

Note: Normal Saline can take the place of Heparin. Studies have shown the efficacy of NSS.
Heparin solution can be used if normal saline or Isotonic solution is not available and as prescribed by
the MD.