[RNRabbit2be75]

Hi,
I'm in my second semester and I'm kinda confused about doing this set up, like the drip factor and all that. The instructor taught us, but I still don't get it. The paper I'm refering to study from doesn't make sense. Could somebody please explain to me, in easier terms(like what is a tubing and needless canula, etc). Thank you so much!

[suzanne4]

The tubing that you are talking about is called "secondary"-- it is used in conjunction with primary tubing. Secondary tubing is used for giving piggy back medications such as antibiotics.

In the recent past, we used needles on the end of the secondary tubing to insert into the primary tubing at the different ports, then usually put a piece of tape around it so that it would not get pulled out. Nurses would get stuck, etc. Now they have what is called the "needleless" system, where the tubing can attach directly without the needle.

Hope that this helps and good luck with your clinicals.

[crb613]

Originally Posted by tlcmel

Thank you.
Does anyone know of any good sites where I could view the parts and details of all this.

Do you have a skills book? It should be in there. We use Clinical Nursing Skills & Techniques 5th ed. by Perry & Potter.It's really good if you don't have one.

[VickyRN]

These links are excellent resources for IV therapy:

IV Therapy

IV calculation

ENW: I.V. Starts ---Improving Your Odds!

[purplemania]

also try www.ins1.org (Infusion Nurses Society)

[Daytonite]

Peripheral Venous Access Devices:

• https://nursing.advanceweb.com/Common/CE/Course.aspx?CourseID=562&CreditID=1 - Venous Access Devices. Click the link to read the article. There are two pages to the article. (link is good until November of 2008)
• http://www.guideline.gov/summary/summary.aspx?doc_id=8338&nbr=004666&string=central +AND+venous+AND+access+AND+devices - Access device guidelines: recommendations for nursing practice and education. Everything you wanted to know about the insertion, maintenance, complications, removal and more of peripheral and subcutaneous catheters, Midline catheters, PICCs, non-tunneled and tunneled central vascular lines, implanted ports, Apheresis/Hemodialysis Catheters, Arterial Access Devices, Intraventricular Access Devices, Epidural and Intrathecal Access Devices, Intraperitoneal Catheters, and Implanted Pumps
• http://www.childbirths.com/cypress/ivtherapy.htm - IV Therapy - discusses IV devices, IV fluid, vein selection, insertion technique, and solving IV flow rate calculations. Includes drawings/pictures.
• http://www.muw.edu/nursing/IV.htm
• http://www.mrprotocols.com/sset/iv.html - nice pictures of starting an IV!
• http://www.sh.lsuhsc.edu/Anesthesiology/piv/piv28.htm - how to start an IV. Includes a link to a video
• http://www.medtrng.com/blackboard/initiate_iv.htm - initiating and managing complications of an IV
• http://www.answers.com/topic/intravenous-therapy?cat=health - Intravenous Drip
• http://connection.lww.com/Products/timby-fundamentals8e/Ch35.asp - pictures of various types of IV devices and IV equipment
• http://employees.csbsju.edu/mbyrne/IVSite/abc_of_ivmain.htm - The ABC's of IV's. Click on links at left side of page to access information.
• http://en.wikipedia.org/wiki/Intravenous_therapy
• http://www.adhb.govt.nz/newborn/Guidelines/VascularCatheters/IVCannulationPreparation.htm - pediatric IVs; diagrams of veins in arms, hands, legs and feet
• http://www.adhb.govt.nz/newborn/Guidelines/VascularCatheters/IVInfiltrationInjuries.htm - Infiltration; clysis in pediatric patients
• http://connection.lww.com/Products/taylor5e/documents/Ch46/jpg/46_008.jpg - a picture of IV tubing with it's parts labeled
• http://connections.lww.com/products/evans-smith/RM_15.asp - pictures of labeled IV tubing and sites of IV insertion
• http://connections.lww.com/products/evans-smith/Ch15.asp - links to skill pictures related to IV procedures
  http://www.lhsc.on.ca/critcare/icu/procedures/bldwdrw.html - procedure for drawing blood from an IV line. Includes labeled photos
• http://www.guideline.gov/summary/summary.aspx?doc_id=3387&nbr=002613&string=Total+A ND+Parenteral+AND+Nutrition - Guidelines for the prevention of intravascular catheter-related infections
• http://community.nursingspectrum.com/MagazineArticles/article.cfm?AID=12209 - article on phlebitis and infiltration of peripheral IVs
• http://www.netwellness.org/healthtopics/anesthesiology/ivcomplications.cfm - complications of peripheral IV therapy
• http://www.infusionpartners.com/cc/q303.pdf - Preventing IV Therapy Complications, Part 2:
  Mechanical and Bacterial Phlebitis
• http://medi-smart.com/pitfalls.htm - Pitfalls of IV Therapy
• http://www.mccfl.edu/pages/2463.asp - Procedure: Initiating Intravenous Fluids into an Existing IV Site
  
• http://www.mccfl.edu/pages/2478.asp - Procedure: Administering IVP (IV push) medication into an Existing IV Line
  
• http://www.mccfl.edu/pages/2479.asp - Procedure: Administering IVP (IV push) medication via INT (intermittent infusion device)/prn adapter/Lock device
  
• http://www.mccfl.edu/pages/2483.asp - Procedure: Administering IVPB (IV piggyback) Medication via INT (intermittent infusion device)/prn adapter/Lock device
  
• http://www.mccfl.edu/pages/2482.asp - Procedure: Administering IVPB (IV piggyback) Medications into Primary IV Lines
  

Central Venous Access Devices (CVADs):

• http://www.nlm.nih.gov/medlineplus/ency/imagepages/19861.htm - illustration of anatomical placement of a central venous catheter
• http://www.nlm.nih.gov/medlineplus/ency/imagepages/19868.htm - illustration of IV and central line sites used in babies
• http://www.gene.com/gene/products/education/vascular/cvads.jsp - an brief overview of the types of CVADs and the classifications of occlusions of central lines
• http://www.nursing-standard.co.uk/archives/ns/vol14-43/pdfs/4550w43.pdf - Central Venous Access Devices
• http://www.cancerhelp.org.uk/netscape/help/default_printer_friend.asp?page=302 - Chemotherapy given by intravenous injection. Has drawings illustrating a peripheral IV, a Hickman line, an implanted port and how it is accessed, and a PICC line
• http://www.mccfl.edu/pages/2653.asp - Procedure: Central Line Dressing Change
• http://www.unchealthcare.org/site/Nursing/nurspractice/procedures/procedures/procedurec32.pdf/ -one hospital's procedure for accessing an implanted port
• http://www.sjhlex.org/documents/Nursing/implanted_ports_mini_082607.pdf - Tips on Accessing, Assessing and Maintaining Implanted Ports with Non-Coring Huber needles

PICC lines:

• http://rnweb.com/rnweb/article/articleDetail.jsp?id=368379 - How to fine-tune your PICC care
• http://www.rnceus.com/course_frame.asp?exam_id=17&directory=picc - PICC Line Care and Maintenance: An Introduction
• http://www.bardaccess.com/nurse-grosh-picc.php - image of a Bard groshong P.I.C.C.
• Attachment 5740 - example of a Grosong PICC line care instruction sheet

TPN (Total Parenteral Nutrition):

• http://healthlinks.washington.edu/nutrition/index.html#table - Resource Book for Delivering Enteral and Parenteral Nutrition for Adults
• http://www.unchealthcare.org/site/Nursing/nurspractice/protocols/protocols_pdf/protocolt9.pdf - example of a facility nursing TPN policy protocol. Note that it includes required patient assessment, lab monitoring and reportable conditions, nursing care, safety concerns, patient teaching and required nursing documentation
• http://www.merck.com/mmpe/sec01/ch003/ch003c.html - TPN: indications, nutritional content, solutions, monitoring and complications – includes a table of the Basic Adult Daily Requirements for Total Parenteral Nutrition
• http://www.nhsgg.org.uk/content/default.asp?page=s862_1 - complications and management
• http://www.lhsc.on.ca/critcare/icu/protocols/tpn.pdf - sample pre-printed TPN order form. Note the nursing orders at the left side of the order page.
• http://www.guideline.gov/summary/summary.aspx?doc_id=3056&nbr=002282&string=Total+A ND+Parenteral+AND+Nutrition - American Gastroenterological Association medical position statement: parenteral nutrition
• http://www.guideline.gov/summary/summary.aspx?doc_id=8739&nbr=004851&string=Total+A ND+Parenteral+AND+Nutrition - Nutrition support in adults: oral nutrition support, enteral tube feeding and parenteral nutrition.

IV Flow Rate and Calculation Problems:

• http://www.m2hnursing.com/MedCal/index.php - Module 3 has IV flow rate tutorials and problems - you do not have to login to access the tutorial
• http://www.testandcalc.com/quiz/testiv.htm -- practice IV flow rate quiz and answers
• http://go.dbcc.edu/hhps/nursing/Nur_1201_nur_1260C_nur1213.html - a wonderful site for practice problems with answers on IV calculations. Just click on the links provided
• http://www.geocities.com/Heartland/Valley/3049/iv/clcltns.html
• http://classes.kumc.edu/general/IVPump/IVSimulation.html -- a cool interactive IV pump simulator!

Blood Transfusion:

• http://www.guideline.gov/summary/summary.aspx?doc_id=9850&nbr=005274&string=blood+A ND+transfusion - Blood Transfusion: Indications and Administration
• http://campbellteaching.co.uk/lesson%20notes/nursing/BLOOD%20TRANSFUSIONS.htm
• http://library.med.utah.edu/WebPath/TUTORIAL/BLDBANK/BLDBANK.html - tutorial on blood banking and blood transfusion. Includes discussion on compatibility, cross matching and transfusion reactions
• http://www.muw.edu/nursing/IV.htm - the last half of this document has information about the procedure of blood transfusion and transfusion reactions
• http://www.nhlbi.nih.gov/health/prof/blood/transfusion/transfin.htm - indications for the use of Red Blood Cells, Platelets and Fresh Frozen Plasma from the National Heart Lung and Blood Institute.
• http://rnweb.com/rnweb/article/articleDetail.jsp?id=310561 - Your guide to safe transfusions. From RNWeb. Includes a blood compatibility chart at the very bottom of the page.
• http://www.redcross.org/services/biomed/profess/pgbtscreen.pdf - Practice Guidelines for Blood Transfusion
• http://labtestsonline.org/lab/bloodbank.html - blood banking-scroll through the series of pages that explains what this is
• http://www.upmc.com/HealthManagement/ManagingYourHealth/HealthReference/Procedures/?chunkiid=14773 - blood transfusion - a teaching document for patients
• Attachment 5812 - Chart of Commonly Transfused Blood Products, what they consist of, why they are used, how they are administered and nursing considerations

IV Infusion Devices/Pumps

• http://www.rnweb.com/rnweb/article/articleDetail.jsp?id=254828 - " Technology today: Smart IV pumps". Includes photos of some of these pumps.

Table of Commonly Used IV Solutions

• Table of Commonly Used IV Solutions.doc - most commonly used IV solutions; includes tonicity, pH, the ingredients of the solutions, its uses and complications

IV Tips & Tricks:

• http://allnurses.com/forums/f18/iv-tips-tricks-3793.html - this thread over on the Emergency Nursing Forum has an immense amount of good information from experienced nurses on starting IV's

[VickyRN]

Another GREAT resource:

http://www.icufaqs.org/

[carlita]

Does anyone know any good website that explains about syringes and how to mix and dilute different types of drugs? I am having my test-off in four days and I have no clue how to proceed. I'd really appreciate any help.

[Daytonite]

Hope this is what you are looking for. The only drugs I can think of that you want to dilute would be IV drugs. You can find some of that information on the chart I've linked you into below. If you are looking for the re-constitution directions for some of the antibiotics and steroids you can get that information from www.drugs.com by looking up the professional's information about a specific drug at their site.

http://www.musc.edu/pharmacyservices/PnP/f23.pdf - I'm not sure that this is what you are looking for. This is a chart from a pharmacy policy manual that directs nursing how to administer IV push medications with the specific instructions for certain IV push medications. You might want to keep this list around somewhere, however, because these kinds of charts are often hard to come across when you need one!

[VickyRN]

IM Injection Sites - great resource!