intravenous infusion technique, the calculations for determining the delivery rate of IV fluid for the individual patient and the necessary spiking of the container and priming of the tubing before venipuncture and fluid administration. ▪ METHOD: The rate at which solution is to be administered by IV infusion can be determined from the procedure formula. The hands are washed thoroughly before assembling the container of IV solution, the IV pole, and the proper tubing with the flow clamp placed in a position directly beneath the drip chamber and clamped. If a bottle with a rubber stopper is used, the protective metal cap is removed, and, with the bottle held securely on a stable surface, the spike of the tubing is pushed firmly into the stopper. To spike an IV bottle with an indwelling vent and latex diaphragm, the metal cap and diaphragm are removed and the spike is inserted into the nonvented hole. If a hiss, indicating a vacuum, does not follow, the bottle is contaminated and should be discarded. Nonvented tubing is used with this kind of bottle. A plastic bag of IV fluid is hung on a hook for spiking, the cap is removed by pulling it smoothly to the right, and a nonvented spike is inserted into the port by using one quick, even motion to prevent the escape of fluid. An IV bag with a firm, easily grasped port with a lip to prevent touch contamination may be spiked before hanging by grasping the port firmly; squeezing the bag may expel air and is carefully prevented. After the hanging bag or bottle is spiked, the drip chamber is gently squeezed until it is half full before the tubing is primed. The end of the tubing is held over a sink or wastebasket as the protective cap is removed, and the cap is kept uncontaminated for reuse. The flow clamp is released, and the tubing is allowed to fill with fluid until all air bubbles are expelled; if a back check valve is on the tubing, the valve is inverted during priming. The flow clamp is then closed, the protective cap is replaced, and the tubing is looped over the IV pole so that it does not interfere with venipuncture. Once the needle or intracatheter is inserted and connected to the tubing, the fluid container is hung securely from the IV pole or a hook 3 feet (0.0762 m) above the insertion site. The flow clamp is opened, and the proper fluid delivery rate is adjusted by counting the number of drops entering the drip chamber in a minute. Throughout the administration of IV fluid, rate of flow is checked periodically and any necessary readjustments of the clamp are made. IV fluids also may be delivered via IV pump. IV pump tubing is then used, and the flow rate is calculated in mL/hr. ▪ INTERVENTIONS: The nurse assembles the apparatus for the IV infusion, spikes the fluid container, primes the tubing, calculates the proper rate for the patient, and ensures that the rate of delivery and asepsis are maintained. The nurse carefully observes the patient for signs of circulatory overload, such as a bounding pulse, engorged peripheral veins, dyspnea, cough, and pulmonary edema, indicating that the infusion rate is too rapid and requires adjustment. ▪ OUTCOME CRITERIA: IV solutions administered to maintain normal body fluid levels and electrolyte balance do not overload the circulation when delivered at the flow rate required by the individual patient.
