Intravenous (IV) Bag Preparation (Nursing)

00:00 Let's go ahead and get started in talking about the IV Therapy Preparation. Don't forget your hand hygiene first and foremost, then we want to take careful inspection of our equipment and supplies. One thing to note when you get your equipment and especially your solution, we want to make sure there's no damage to the bag, if it's a bottle no chips or cracks or breaks. One other key point to think about, look at the solution itself. Sometimes meds can be very expired or there may be some issues with it such as discoloration, maybe there's a weird cloudiness to the IV solution or weird abnormal particles in there. If this is the case, you need to stop before administration and examine this more closely. Here is a great example of that. There is a drug called mannitol for example. Sometimes in the bag you'll see these really cool crystals, they may look really cool but you do not want to administer that for your patient. Today I'm going to show you how to hang your primary IV fluids. Now earlier I spoke about sometimes those IV fluids are in glass bottles, now make sure you get the right equipment for that. But for this demonstration, I'm going to show you how to hang your primary IV fluids in a plastic bag. This is going to be your most common IV solution that you're going to hang. So before we get started, I'm going to do my hand hygiene. And then once we gather our equipment, we want to make sure we inspect this properly. Now if you remember earlier, any time you get any sort of IV solution, you really want to make sure you look at the solution itself. Is there any odd particles, any abnormal discoloration for example, or any sort of crystalling or anything else that's abnormal for your solution? So make sure you check that out. Next, we've got our primary IV tubing for those primary fluids that we're going to hang, and if you remember when I said primary that's going to be the continuous flowing fluid that you're going to administer your patient. So we've got our bag here, we've also got our tubing, and next don't forget about your label.

02:21 Now every facility is a little bit different, but IV labels for the tubing is really great because what it tells us is when that particular IV tubing was initiated for that patient. Most agencies will say about every 72 hours you need to change out the IV tubing to prevent infection.

02:40 Make sure you check with your agency. So once we've looked at our solution closely and gotten the right equipment, we want to make sure we close the clamp of the administration tubing. Really important to close the clamp before you spike it. We're going to remove the cap from the bag insertion port, remove the cap from the spike, and then we're going to insert that spike into the bag itself into the insertion port. Now we can hang the spiked bag on top of the IV pole and then we can squeeze that drip chamber until it's about half full.

03:20 So this is really important, we don't overfill here so we can see the small drips once the bag starts infusing. We're going to prime the administration tubing, and it's really important when you prime it that we make sure that we put the distal end of the tubing over maybe like a sink or trash bin because that's going to flow all the way through the tubing out the end of that. We're going to then open the roller clamp and make sure the slide clamp is open, and leave that clamp open until all of the air is gone and all of your IV solution has ran all the way through your tubing all the way to the end. We're going to then close that roller clamp so we can stop the dripping of the fluids and then we're going to attach this to whatever pump or flow control that your facility has. Next, we're going to label the tubing so the next nurse will know when that was hung. So first, I'm going to open this up. With our solution here, usually it's in a plastic bag like this and we're just going to tear this open and get to that. I've opened this up. Here's a little trick for you. One thing that I like to do just so I don't have to handle so many different pieces of equipment, sometimes I'll just go ahead and hang my solution. So we're hanging equipment like this, everything so far is capped. So we're good to go. Now what we don't want to do is once we uncap anything, we do not want to touch the ends to maintain sterility. So now that I've opened my IV solution, I'm going to open my tubing. Now when you're looking at IV tubing, you want to make sure for primary fluids we use what we call primary tubing. How you know it's a little bit different is that it's a little bit longer and typically you will have a specific one you use for your agency. So I'm going to open up my tubing and notice how long this is, and one thing before we start anything don't forget to close the clamp. Here, the roller clamp and when you close it instead, this is going up and see how nice and open this is. If you roll this down, what that does is pinch the tubing and keeps your solution from running all over the floor. So this is going to clamp it and this is what we call the roller clamp. And there's a little bit of variation on the order for this, it's whatever you're comfortable with as long as we maintain sterility.

06:21 Okay, so now that I've got that clamped, it's never a bad idea to take a look at this clamp as well. This is an extra clamp we have just for security. See how there's this large opening.

06:34 You can just push this tubing down and it will pinch it and it will clamp there as well. So this is an extra clamp for us. So now that we've got our tubing clamped, this is the spike and this is going to be the piece that goes for our patient. Now notice I've kept the cap on this just to make sure this stays sterile as well. So we're holding on to this. So now I've got my primary fluid and I've also now got my spike to my tubing. So first things first, you want to go ahead and undo the port to your tubing and everyone of this is a little bit different, but you're going to pull down and now that port is exposed. So now that's exposed, I do not want to touch this with my bare hands to make sure it stays sterile. Now, we're going to take the spike, we're going to remove the cap from the spike, we're going to hold on to our spike, and we're going to put the spike in to the medication port here. Now sometimes this takes a little bit of pushing so we're going to finagle this all the way. Now that we have this spiked, you can take the drip chamber and you want to squeeze this till it's about half full. Now you can just see I squeeze in the middle there, and then just kept squeezing until this is about half full. Now why is that important? This is important because once we infuse our fluids, we will see the drips and we want to make sure we see that. Now, before we go too much farther, let me show you something. What if we overfill that drip chamber like so? That's a little too full. Right? If we did that, we can simply take this upside down, squeeze this back into the chamber about half way, and then flip it back over. So now we can see our drips, just in case that happens. And it could from time to time. Okay, so now that we're spiked, if you remember now that we're clamped, I like to hang this first and spike it. The reason being as you noticed that way I'm not having to hold the bag and the spike together, just makes it a little bit easier for me to manipulate. The other thing to know is once you spike an IV bag, if I pull this out all the fluid's going to rush out. So make sure that stays intact. So now that I've spiked it, I'm going to take my roller clamp, I'm going to undo my blue clamp, and this is what's going to control how fast the IV solution is running. If I open this roller clamp all the way to the top, it's going to go full free flowing, but if I do it maybe about halfway it's going to go much slower and I can control it without losing so much my fluid. So this is what's going to control the flow and the rate of your IV fluid. So now for us to what we call prime AT, we want this solution to go all the way to the tubing all the way to the end, that way we're not infusing all air once we start it with our patient. So, I'm going to take this clamp and I'm going to gently unroll this and you can see my IV fluid moving and those air bubbles which we don't want and let it slowly go through my tubing, and if you want it to go a little faster I can just roll that up. And ideally you're over a trash can or maybe a sink, but this way you can see this. And see how it's going all the way to the end and then you will know it's all the way the end because you're going to see these drips. Right? Now we know we're good and primed. So once that's all the way to the end of the IV, what we want to do is close that roller clamp again, then we can close our second security blue clamp again, and now we're ready to hook it to our patient. So now that this is primed, don't forget to use your label per your agency policy and tag this and let us know what date that you hung your IV tubing.