help with IV's!

Fiona59 · Jan 9, 2009

You are talking about the pump (aka IVAC, aka SMARTPUMP, or that ****machine).

Every unit should have a manual on how their pumps work. Find it and read up on their equipment. Usually orientation covers the use of whatever pumps you will meet.

The newer pumps can be very finicky. Miniscule airbubbles seem to collect over the sensor setting off the air in lines warning. Many times opening the cover and smacking it lightly will deal with the problem. Then there is the whole issue of having the right barcode on your ID to scan in and unlock the pump. We found out that kleenex boxes will scan.

My favourite message is "battery low, plug in" when the beast is already plugged in to a wall socket.

Find the manual, it will only be clearer to you with more exposure to the pump. Having said that, it's not rocket science.

sasha2lady · Mar 23, 2009

I hate iv pumps too! We use the ones from the ice age at my job. They always beep and say occluded etc.... but the only thing i hate more than the pumps is trying to start an actual iv line itself in a pt....I absolutely suck at it....we dont use alot of iv's unless we have to but in the past ive actually been successful at starting about 4 iv's.....elderly pts have awful veins....always too small or they roll all over the place.

DebanamRN, MSN, RN · Mar 27, 2009

Pumps can be evil. The last hospital I worked at had antiquated pumps. I had terrible luck w/them. The hospital I work at now has newer pumps that aren't so picky. We generally use dial-a-flow in the ER, but K, cardizem, heparin - that type of stuff goes on pumps. Also people w/really crappy veins get a pump.

Flush the IV line gently when beginning the shift, and before and after giving IVPB meds. You may also want to flush a line that isn't being used for patency during the middle of the shift. It helps to keep them clear.

As for starting IVs, it takes lots of practice. Its not easy, but gets easier as time goes on. I didn't get good at starting IVs until I came to the ER.

Hubby's girl · Mar 28, 2009

Expertise will come with time. Did you get an orientation to this hospital? At least ask someone to give you 5 minutes before you start your shift and go over the pumps. It might take too long to read the manual.

I think I'm actually better than some of the RN's we have- because I 've had to attempt so many. The RN's are usually in charge or team leading and you are expected to do your own. Give yourself time... someday it will be old hat to you.:redbeathe

chevyv, BSN, RN · Mar 29, 2009

I too have troubles with iv pumps. Can you backprime the pump to get the air out? I learned that and it's been better. I can't land iv's to save my life either. Squirrly veins and I never know which way they're going. I get so nervous, its horrible!

labvampire · Mar 29, 2009

To avoid a bunch of air bubbles, while I'm spiking the bag I pinch the resevoir so once the spike is in it sucks the IV fluid in and the air bubbles go through the line, then I open up the other end and let the air bubbles out and when they are gone I roll it shut. It's primed before I hook it up to the patient.

jadey1 · Apr 21, 2009

If the pump says "occlusion," check to make sure there aren't any sharp bends in the line, leading up to the patient. Normally, that means the patient moved and kinked the lines, somehow. Ask them to straighten their arm, if it's bent, and see if the occlusion fixes; especially in heavier patients, with bigger arms. It could be that the IV spine, itself is bent, within the arm. Sometimes, the roller controller is in closed position or the sliding clamp is still fastened.

If the pump says "air," open the pump box, unclamp the tubing and turn the lines upside down (so the patient's end is toward the ceiling) and strum it like a guitar string. That moves the air bubbles away from the pump mechinism part of the line. When there are no air bubbles in the section of tubing that snakes through the box, kink the line to keep the bubbles from going back and snake the lines back through the machine. Lock the box and press START.

There are different flush protocols, depending on your particular facility. In our facility, we flush with 5cc's NS and then 5cc's of Heparin, per shift or before and after hanging a bag. Normally, PICC lines don't need Heparin. NEVER use a 12cc syringe, for flushing, on a peripheral IV. The pressure might cause infiltration. Always flush slowly, with ANY syringe. Q shift flushes aren't necessary if it's a continuous flow. Always check for blood return before flushing an IV. Check your facility protocol regarding flushing (ie: what to flush with, amt. to flush with, what kind of IV needs which fluids, how often flushes are required).

When priming IV lines, make sure you have the little roller controller tight, so you have control of when to stop the priming, so you don't bleed too much of the med.

When you're hanging a med piggy back, spike the PB bag and hold it BELOW the larger bag so the larger bag's fluid will go down, toward the PB bag, and prime the lines. No bleeding necessary and no air bubbles! =)

Tops of hands are good for peripheral IV's, if forearm veins are hiding. The vein just over the ring finger is REALLY good....pretty straight. The distal part of the wrist (the dip just above the thumb where the wrist bone is) is good, too. That's a BIG vein. After placing the tournaquette, if you can't find a vein, make the patient pump their hand. Bevel up, poke, when you get the flash, pop the angio release button, and MAKE SURE you untie the tournaquette or when you try to aspirate for blood return, you'll get nothing and think you didn't get it.

Hope this is helpful. I LOVE IV's! Sure beats vital signs and charting. A little adrenaline rush always wakes me up. = D GOOD LUCK!