Spike and Prime IV Lab 2021

SPIKE AND PRIME IV LAB NUR 111

• Instructor: Elizabeth Biggs, MSN, RN

Initiating Primary Intravenous Fluids

1. Verify physician orders.

2. Collect necessary supplies.

3. Verify PIV (Peripheral Intravenous) patency.

4. Assess primary IV tubing.

5. Spike the IVF (Intravenous Fluid) bag.

6. Prime the IVF.

7. Connect IV tubing.

8. Set the pump.

9. Assess the patient frequently.

Spiking the IV Bag

• Components:

  • Primary IV tubing

  • IV fluid bag (e.g., 0.9% Sodium Chloride injection USP 1000 mL)

  • Roller clamp

  • Drip chamber

  • Medication port

  • IV tubing port (Upper and Lower Y-sites)

  • Needle adaptor

Priming the Fluid

Step-by-Step Process:

1. Using aseptic technique, carefully remove the protective cover from the bag or bottle while maintaining sterility.

2. Remove the cap from the spike and insert it into the insertion site without contamination.

3. Hang the solution container on the IV pole.

4. Partially fill the drip chamber with the solution.

5. Priming the tubing:

   • Flush the tubing to remove air.

   • Hold the tubing over a source to prime the fluid while maintaining sterility.

   • Release the clamp to allow fluid flow until bubbles are cleared.

   • Re-clamp the tubing and replace the tubing cap.

Key Points to Remember

• Maintain sterility of the port on the bag and spike.

• Avoid spiking through the bag.

• Ensure all tubing is clamped until ready to prime.

• Vent cap management depends on fluid container type.

• Compliance with facility policy for changing fluid and tubing every 24 hours is crucial. Make proper labels.

• Scan fluids as medications to ensure correct rates.

IVF Tonicity

• Definition: Tonicity refers to the ability of an extracellular fluid to influence the intracellular water level, affecting osmosis and fluid movement.

Isotonic Fluids

• Characteristics: Has the same osmotic pressure as the inside of cells; does not promote osmosis.

• Purpose: Used to increase extracellular fluid volume.

• Types:

  • Lactated Ringer's (LR)

  • 0.9% NaCl in Water (NS)

  • Dextrose 5% in Water (D5W)

• Effects: No net osmotic flow; water transport into cells equals water transported out.

Nursing Considerations for Isotonic Fluids

• Monitor IV sites for inflammation or pain.

• Watch for hypervolemia and electrolyte imbalances.

• Assess vital signs and hemoglobin levels frequently.

Hypertonic Fluids

• Definition: Higher concentration of NaCl outside the cell, promoting fluid movement out of the cell.

• Types:

  • Dextrose 5% in Lactated Ringer’s (D5LR)

  • Dextrose 5% in half normal saline (D51/2NS)

  • Dextrose 5% in normal saline (D5NS)

Nursing Considerations for Hypertonic Fluids

• Monitor IV site for inflammation/pain and fluid overload.

• Keep an eye on electrolyte levels.

Hypotonic Fluids

• Definition: Lower NaCl concentration outside the cell, causing water to enter the cell.

Nursing Considerations for Hypotonic Fluids

• Check IV site for inflammation/pain.

• Monitor electrolytes and avoid administration to patients at risk for increased ICP.

Complications of Intravenous Therapy

Local Complications:

1. Infiltration

2. Phlebitis

3. Thrombosis

4. Thrombophlebitis

5. Venous Spasm

6. Local Infection

7. Extravasation

8. Hematoma

Systemic Complications:

1. Septicemia

2. Fluid Overload and Pulmonary Edema

3. Air Embolism

4. Catheter Embolism

5. Speed Shock

Infiltration

• Definition: Inadvertent administration of a non-vesicant solution into surrounding tissue.

• Signs/Symptoms:

  • Coolness of skin around the IV site

  • Taut skin, dependent edema

  • Absence of blood return

  • Slowed infusion rate

Phlebitis

• Definition: Inflammation of the vein, leading to irritation and complications.

• Sources: Mechanical, chemical, bacterial, or post-infusion.

• Signs/Symptoms:

  • Redness at the site

  • Warmth and swelling

  • Palpable cord along the vein

Documentation for Phlebitis

• Include site assessment, phlebitis rating, and interventions performed (like IV removal and notification of the physician).

Hematomas

• Causes: Nicking the vein, improper IV removal, overly tight tourniquets.

• Signs/Symptoms: Skin discoloration, swelling, discomfort.

Thrombosis

• Definition: Catheter-related obstruction categorized into mechanical and thrombotic causes.

• Signs/Symptoms: Slowed infusion rate, catheter flush difficulties, fever, malaise.

Extravasation

• Definition: Inadvertent administration of a vesicant solution into surrounding tissue.

• Signs/Symptoms: Pain or burning, swelling, tight skin, slowed infusion.

Local Infection

• Definition: Microbial contamination of the cannula or site.

• Signs/Symptoms: Increased white blood cell count, possible exudate, redness, swelling.

Venous Spasm

• Definition: Sudden involuntary contraction causing diminished blood flow.

• Signs/Symptoms: Sharp pain, slowing infusion rate.

Septicemia (Sepsis)

• Definition: A febrile disease from microorganisms or their toxins in the bloodstream.

• Signs/Symptoms: Fluctuating fever, malaise, altered mental status, tachycardia.

Air Embolism

• Causes: Air in central veins due to various factors like changing IV bags.

• Signs/Symptoms: Palpitations, drop in blood pressure, pulmonary symptoms.

Speed Shock

• Definition: A systemic reaction from rapid drug administration reaching toxic levels.

• Signs/Symptoms: Dizziness, flushing, headache, chest tightness, hypotension.

Catheter Embolism

• Definition: A piece of the catheter breaks off and travels through the vascular system.

• Signs/Symptoms: Sharp pain at the IV site, minimal blood return, chest pain.