Name: Gallemit, Justin Patrick W.

Date: 12/15/2021

Evaluator/Signature: Queenie Jane Ramel RN, MAN Grade: _____________

CHANGING AN IV SOLUTION CONTAINER AND ADMINISTRATION SET

Description: Primary and secondary IV tubing and add-on devices (extension tubing) must be primed with IV solution to remove air from the tubing. Priming refers to placing IV fluid in
IV tubing to remove all air prior to attaching the IV tube to the patient. IV tubing is primed to prevent air from entering the circulatory system. An air embolism is a potential
complication of IV therapy and can enter a patient’s blood system through cut tubing, unprimed IV tubing, access ports, and drip chambers with too little fluid (Perry et al., 2014).

Purpose:

Provide fluid and electrolyte maintenance, restoration and replacement.

Equipment:

- Sterile IV solution
- IV tubing
- Label for the tubing
- Transparent site dressing
- Nonallergenic tape
- Cleaning swabs
- Clean gloves
- PPE, as indicated
 PERFORMED
ACTION RATIONALE REMARKS
YES NO
1. Verify IV solution order on the patient’s chart IV solutions are considered as a medication and must be checked using the
with the medical order. Clarify any seven rights x3 as per policy. Baseline data is essential to provide the right
inconsistencies. Check the patient’s chart for nursing care for the patient. It is important to take note if there are any
allergies. Check for color, leaking, and notable changes in color in the IV set especially its expiration date.
expiration date. Know the purpose of the IV
administration and medications if ordered.

2. Gather all equipment and bring to bedside. To promote efficiency and facilitate easy flow of procedure

3. Perform hand hygiene and put on PPE, if To prevent the transmission of microorganisms
indicated. To prevent the spread of germs and protect the health workers from
infections especially when exposed to blood and other body fluids.

4. Identify the patient by asking the patient’s To verify if you are doing the procedure to the right patient and make sure
name, or reading the identification band. that the patient is not confused. To help ensure that a correct match is made
between the service or treatment and the individual. This process will help
eliminate errors and enhance patient care

5. Close curtains around bed and close the door To provide privacy for the patient. Explaining the procedure will help alleviate
to the room, if possible. Explain what you are the patient’s anxiety therefore facilitating cooperation. Checking if there are
going to do and why you are going to do it to any allergies will help the nurse assess what procedure to do and provide the
the patient. Verify the patient’s allergies as right interventions for the patient. This will provide an enhanced patient care.
reflected in the chart.
6. Compare IV container label with the doctor’s
order. Remove IV bag from outer wrapper, if To ensure that the IV to be given to the patient is the right one and checking
indicated. Check expiration date of the IV the IV container label will lessen the incidence of error. Removing the IV bag
solution. Prepare and label the IV tag with the from the outer wrapper to ensure that the correct IV solution is used.
 name of the patient, room number, IV Label is very essential to make sure that the IV to be administered will not be
number, name and type of IV solution, drop interchanged with another patient. Also, the IV number will indicate if the IV
rate, additives, time of follow-up, estimated to be administered is the patient’s 1st, 2nd or 3rd one. It is also important
date & time to be consumed, and name of that the name and type of IV is seen so that the nurse can take note of what
nurse who followed - up the IV. to look at in case there are any complications. Also it is important to take
note of the drop rate so that the nurse will be able to estimate the date and
time the IV solution will be fully consumed and check the chart if there are
any to follow IV solution.
PERFORMED
ACTION RATIONALE REMARKS
YES NO
7. Maintain aseptic technique when opening Aseptic technique is practiced to avoid introducing microorganisms directly to
sterile packages and IV solution. Remove the patient through the IV line.
administration set from package. Apply label
to tubing reflecting the day/date for next set Application of the label reflecting date and time also will help the nurse
change, per facility guidelines. estimate how long the IV will last and know the time when to give the next
set of IV, as ordered.

8. Carefully remove the cap on the entry site of So that the nurse can maintain the sterility of the entry site and for the nurse
the new IV solution container and expose the to not introduce microorganisms to the patient
entry site, taking care not to touch the
exposed entry site.

9. Lift empty container off IV pole and invert it. Ensure IV tubing spike remains sterile during removal to avoid contaminating
Quickly remove the spike from the old IV the IV tube.
container, being careful not to contaminate it.
Discard old IV container. Removing old solution from IV pole and inverting it prevents spilling the
solution

10. Using a twisting and pushing motion, insert Essential to make sure that the spike will be in contact with the entry site of
the administration set spike into the entry site the next solution set to maintain its sterility and avoid introducing foreign
of the IV container. Hang the container on the microorganisms to the patient.
IV pole.
 Hanging the container will facilitate the flow of medication from the IV
solution container to the patient

11. Alternately, hang the new IV fluid container Make sure that when the cap is removed avoid touching it with bare hands to
on an open hook on the IV pole. Carefully avoid introducing microorganisms to the sterile field.
remove the cap on the entry site of the new
IV solution container and expose the entry Remove the spike carefully and ensure that it does not touch anything
site, taking care not to touch the exposed unsterile. This is to ensure that the principles of asepsis technique is
entry site. Lift empty container off the IV pole followed. This is to avoid introducing microorganisms to the patient.
and invert it. Quickly remove the spike from
the old IV container, being careful not to Removing old solution from IV pole and inverting it prevents spilling the
contaminate it. Discard old IV container. solution
Using a twisting and pushing motion, insert
the administration set spike into the entry port Twisting motion will help the spike go through the entry site
of the new IV container as it hangs on the IV
pole.
PERFORMED
ACTION RATIONALE REMARKS
YES NO
12. If using gravity infusion, slowly open the roller Slowly opening the clamp will ensure the IV solution is infusing at the correct
clamp on the administration set and count the rate.
drops. Adjust until the correct drop rate is
achieved. Adjusting to the correct drop rate will help the nurse estimate the date and
time on when to change the IV solution container.
13. Hang the IV container on an open hook on Closing the clamp stop prevents air bubbles forming in the IV tubing
the IV pole. Close the clamp on the existing
IV administration set. Also, close the clamp
on the short extension tubing connected to
the IV catheter in the patient’s arm.
14. Put on gloves. Remove the current infusion Proper disinfection of equipment decreases bacterial load and prevents
tubing from the access cap on the short infections
extension IV tubing. Using an antimicrobial
swab, cleanse access cap on extension
tubing. Remove the end cap from the new
 administration set. Insert the end of the
administration set into the access cap. Loop
the administration set tubing near the entry
site, and anchor with tape (non-allergenic)
close to site.
15. Open the clamp on the extension tubing. To let the solution flow from the IV set to the patient
Open the clamp on the administration set.

16. If using gravity infusion, slowly open the roller Slowly opening the clamp will ensure the IV solution is infusing at the correct
clamp on the administration set and count the rate.
drops. Adjust until the correct drop rate is
achieved. Adjusting to the correct drop rate will help the nurse estimate the date and
time on when to change the IV solution container.
17. Remove equipment. Ensure patient’s comfort. To avoid any contact or spillage from the previous medication given.
Remove gloves. Lower bed, if not in lowest
position.
18. Remove additional PPE, if used. Perform To avoid spreading or introducing microorganisms to the next patient or
hand hygiene. directly to oneself.

PERFORMED
ACTION RATIONALE REMARKS
YES NO
19. Return to check flow rate and observe IV site Checking the flow rate will make sure that the patient is receiving the right
for complications 30 minutes and at least an amount of fluids therefore reducing the risk of experiencing fluid overload/
hour thereafter. Complications would include
infiltration (cool skin, swelling, blanching and Check the patency and evidence of complications to provide immediate
decreased or stopped flow rate), and phlebitis interventions.
(swelling, redness, warmth burning, and/or
tightness). Ask the patient if he or she is IV site should be free from redness, swelling, pain and leaking. Transparent
experiencing any pain or discomfort related to semipermeable dressing on IV site should be dry and intact.
the IV infusion.
20. Document the type of IV solution and the rate Timely and accurate documentation promotes patient safety
of infusion; and the presence of redness,
 swelling, or drainage. Record the patient’s
reaction to the procedure and pertinent
patient teaching, such as alerting the nurse if
the patient experiences any pain from the IV
or notices any swelling at the site. If
necessary, document the IV fluid solution on
the intake and output record.

Learner’s Reflection: (What did you learn most of the activity? What is its impact to you?) Instructor’s Comments:
I learned how to properly perform changing an IV set. In actual setting, I was able to terminate
an IV and also change the IV of the patients so the procedure is not that new to me. While I
was watching the videos provided, I learned how to properly perform the procedure and what to
take note. It feels like a long procedure while reading the looseleaf, but it was just a smooth
flowing procedure. The only limitation I could think of is not being able to practice or perform it
because of online class.

References:
Lynn, P. (2011). Taylor's Clinical Nursing Skills: A Nursing Process Approach. 3rd Edition. Philadelphia: LWW
Smith-Temple, J & Johnson, J.Y. (2006). Nurses’ Guide to Clinical Procedures. 5th Edition. Philadelphia: LWW.
Hilton, P.A. (2004). Fundamental of Nursing Skills. Philadelphia: Whurr Publishers Ltd.
Mills, E. J. (2004). Nursing Procedures. 4th Edition. Philadelphia: LWW
https://opentextbc.ca/clinicalskills/chapter/8-4-iv-assessment-maintenance-troubleshooting-and-discontinuation/