IVs - Scared Nursing Student

truern · Sep 10, 2005

I'm scared that it's so easy to hang an IV and not have it flowign at the proper rate and administering too much fluids to a pt.
Does anyone have any good references about Ivs that would help me?

I guess if you're not using a pump and don't know how to count drops in the chamber, it might be easy to give too much IVF, but I've never seen a patient with an IV that didn't have a pump in the hospitals where I've done clinicals.

Get I.V. Therapy made Incredibly Easy...it covers everything and makes it simple to understand

LeesieBug · Sep 10, 2005

I like "IV Therapy Made Incredibly Easy", also.

Have you done a junior level med/surg rotation yet? Eventually, you will start getting patients with a lot of IV meds. If you are able to chose your own patients for clinical, pick someone with a list of IV meds....if the instructor assigns them, ASK for someone with lots of IV meds...then just dive into it and ask for as much help as you need.

NONE of the classroom info helped me feel comfortable with doing IV meds. It was just something I had to do myself to learn about them and feel comfortable with them. I was terrified of them at the start of my junior year....as a first rotation senior it is one of my favorite things to do and it's a piece of cake!

AND, doing my senior preceptorship in PACU I have been doing some IV therapy with no pump....so even if you THINK you will never do them without a pump, pay ATTENTION in class when they discuss this. Yesterday I actually got to do the good old marking the bottle with a piece of masking tape and a pen! I told the nurse we went over that in class and we all said, "we'll never do THAT".

Good luck with everything.

gina72 · Sep 10, 2005

I'm a junior nursing student who is no stranger to these forums :) I'm nervous about IVS...I hear many times, this is one thing that isn't addressed that well in nursing school (I know it's BARELY been addressed at my school). I'm worried because IV therapy is obviously a huger part of nursing care. I'm scared that it's so easy to hang an IV and not have it flowign at the proper rate and administering too much fluids to a pt.
Does anyone have any good references about Ivs that would help me? How did you all learn abotu IVs? Did you ge talot of experience with them in clinicals? Someone please alleviate my fears, this has me really worried!

I'm qualified in may 2005 and like you was really scared of putting up ivs. I would always at the beginning ask someone to supervise me whilst putting up the iv and ask the nurse as much about the particular drug as possible.....you learn alot through experience. Now i can put up an iv without breaking out in a sweat but if unsure i always ask! Thats the smart thing to do. If iv not going through a pump, 15 drops equals 1ml of fluid...hope this helped!

Ifs_Wintery · Sep 11, 2005

You should ask your instructors about this. When I was in school we could optionally spend a 'day' in the day surgery unit doing nothing but starting IVs. Perhaps you could work something similar out with your instructors that would allow you to do an extra clinical type thing (or spend a regular clinical day) where you could hang IVs all day long. You would be surprised how they will try to work with you when asked.

If you have a clinical simulation center that has fluids and tubing you could have an instructor (or friend) write up med orders or senarios for you to practice with. All that it takes is practice and you don't really need a patient for that, just someone to check your math and help you with areas you feel are difficult (which was priming the tubing for me, I would get so nervous!).

I hung many many IVs in clinical. Once you do it a few times you'll find that it is not as difficult as you made it out to be :)

Happy-ER-RN, RN · Sep 12, 2005

As far as giving too much fluids goes, you really don't need to worry about it much unless they are elderly or have CHF. In the ER we usually put a bag of NS up on everyone, wide open if they are dehydrated and just barely dripping if they don't need fluids or are elderly/CHF. We use a pump for fluids on kiddos though and the Dr. will order how fast he wants it, then you just set the pump at what he orders. Same way on the floor--just set the pump.

If the IV is no longer working then the fluids will stop dripping. (or if on a pump the pump will start beeping usually) Then you flush the IV and if it has clotted off you will flush the clot out and it will start dripping again. If the IV is no good, usually they will start screaming when you flush it, or you will see the fluid bubble up under their skin, and the fluids will not drip (usually). If working on a floor you just need to check your patients IV sites regularly to make sure they aren't infiltrating, you will see redness or swelling or sometimes fluid oozing out of their arm in the elderly. D/C the IV and put a warm wash cloth over the site.

When giving medication drips you will also just set the pump at whatever the doctor orders. Antibiotics usually go in over an hour. Cardiac drugs you may have to titrate but you will be taught how to do that if necessary. These are just a few little tid bits that I can think of, some of them I am sure you already know. Good Luck!

sweetieann · Sep 12, 2005

As far as giving too much fluids goes, you really don't need to worry about it much unless they are elderly or have CHF. In the ER we usually put a bag of NS up on everyone, wide open if they are dehydrated and just barely dripping if they don't need fluids or are elderly/CHF. We use a pump for fluids on kiddos though and the Dr. will order how fast he wants it, then you just set the pump at what he orders. Same way on the floor--just set the pump.
If the IV is no longer working then the fluids will stop dripping. (or if on a pump the pump will start beeping usually) Then you flush the IV and if it has clotted off you will flush the clot out and it will start dripping again. If the IV is no good, usually they will start screaming when you flush it, or you will see the fluid bubble up under their skin, and the fluids will not drip (usually). If working on a floor you just need to check your patients IV sites regularly to make sure they aren't infiltrating, you will see redness or swelling or sometimes fluid oozing out of their arm in the elderly. D/C the IV and put a warm wash cloth over the site.
When giving medication drips you will also just set the pump at whatever the doctor orders. Antibiotics usually go in over an hour. Cardiac drugs you may have to titrate but you will be taught how to do that if necessary. These are just a few little tid bits that I can think of, some of them I am sure you already know. Good Luck!

thanks for the reply! I think I am just afraid of the unknown, because I haven't been exposed to them in clinicals yet. If you had to calculate "old school," like say...an order of IV to infuse over an hour, would you just calculate the flow rate and then from that, the drip rate and count that many drips going into the drip chamber? This is what I remember from my drug calculations bok, but it was very choppy.

Thanks for the feedback:)

NYNewGrad · Sep 12, 2005

I just graduated an accelerated BSN program and have had VERY little IV experience. Each rotation was 6 weeks, so every time we came to a floor nurses weren't interested in teaching us how to work that unit's pump. They figured we're here for 6 weeks so why bother. If you'd give me a bag to hang now I'd have no clue what to do. So sad... And this is considered a good education... Right now I'm focusing on passing the NCLEX and getting a job. Then I'll have to get my hands on as many nursing books as I can that teach practical skills. (In case you're wondering, I graduated in the top 5 of my class. Imagine what everyone else feels like.)

needs help · Sep 12, 2005

sweetie715--Congratulations for joining our wonderfull profession.

NYNewGrad--CONGRATULATIONS !!!! on your graduation.

First let me say that I am a VERY recently disabled/retired RN and went to a Wonderfull School. I remember being a little nervous about a lot of different things including IV's during my junior year (even though I was certified as a CNA & EMT beore I started nursing). As you go through classes you will probably be exposed to Pharmacology classes as well as 'clinical check-offs' (that's what we called them). It's where the instructor watches, in a lab at school, while you start & hang an IV. IV therapy IS a Very good resource, even AFTER you graduate. BUT, let me impart a little pearl of wisdom to both of you, as told to me by the head of the nursing department at my school. She said no matter how much classwork you have always remember, you will learn more in the first six months to a year on the job, than you did in school.

I found this to be true. I felt like a fish out of water at my first job after school. (Which was as a Nursing Supervisor in a 3-unit Nursing Home) I learned a lot there from both LPN's and the few other RN's that were there. Just be sure to pay attention in cllinicals, be willing to learn from everyone, no matter what level degree you have (you may be suprised to see how much you can learn from others that have a lesser degree. ie ADN's, LPN's, & even CNA's). Also remember the only dumb question is the one you didn't ask so ask for help whenever you are unsure. I hope this helps you both.

Mommy2Katiebaby · Sep 12, 2005

Look at the drip factor number (usually 10 or 15) on your IV tubing set package. That's the number of drops per mL that flow through that tubing. So if you are running an IV at 100 mL per hour (just to make it easy on myself, LOL) on tubing with a drip factor of 10 drops / mL, you need to run 1000 drops per hour. Which is 1000/60 or about 16 drops per minute. You can count it out by watching it drip and setting the rate so it drips about four times in fifteen seconds, and you'll have it.

So the formula is rate x drip factor = hourly drops

Hourly drops / 60 = drops per minute

Drops per minute / 4 = number of drops you want in 15 seconds.

Eventually you learn it by rote - 100 mL / hr will be four drops in 15 seconds, 150 will be 6 drops, etc. (At least on 10-drop tubing.) Whatever tubing type your hospital uses, you won't have to do all the conversions for each IV because you'll just know. So you put your tape on the bag, mark it with your Sharpie, watch it closely, and set it right and you'll be fine.

sweetieann · Sep 12, 2005

Look at the drip factor number (usually 10 or 15) on your IV tubing set package. That's the number of drops per mL that flow through that tubing. So if you are running an IV at 100 mL per hour (just to make it easy on myself, LOL) on tubing with a drip factor of 10 drops / mL, you need to run 1000 drops per hour. Which is 1000/60 or about 16 drops per minute. You can count it out by watching it drip and setting the rate so it drips about four times in fifteen seconds, and you'll have it.
So the formula is rate x drip factor = hourly drops
Hourly drops / 60 = drops per minute
Drops per minute / 4 = number of drops you want in 15 seconds.
Eventually you learn it by rote - 100 mL / hr will be four drops in 15 seconds, 150 will be 6 drops, etc. (At least on 10-drop tubing.) Whatever tubing type your hospital uses, you won't have to do all the conversions for each IV because you'll just know. So you put your tape on the bag, mark it with your Sharpie, watch it closely, and set it right and you'll be fine.

So, you just calculate the flow rate and then from that, the drip rate and count that many drips going into the drip chamber? And allow it to infuse for the given number of hours (I know there is another formula to calculate when you will have to hang another bag when the first runs out, if say, the infusion to be over 8 hours where more than one bag will need to be hung)?

Happy-ER-RN, RN · Sep 12, 2005

thanks for the reply! I think I am just afraid of the unknown, because I haven't been exposed to them in clinicals yet. If you had to calculate "old school," like say...an order of IV to infuse over an hour, would you just calculate the flow rate and then from that, the drip rate and count that many drips going into the drip chamber? This is what I remember from my drug calculations bok, but it was very choppy.
Thanks for the feedback:)

I am a new grad, but I have never actually seen someone count drops in real life. If it is that important it needs to be on a pump. If it needs to go in over an hour, then look at your bag, if it's 100 ml bag then set the pump at 100 ml/hr, a 250 ml bag then set the pump at 250 ml/hr. It's that easy (sometimes), nursing school just makes things seem difficult! Maybe they teach us how to count drops just in case the world is coming to an end and we have no electricity. :) You do need to know how to do drug calcultions, but just pick one formula that works for you and memorize it. Like, the doc might order 1 liter of NS to go in over an hour and half and you have to figure out how many ml/hr to set the pump at. Also remember there will always be someone there to help you. I was having a brain fart the other day and could not figure out how much of a pediatric drug to give--the amount in the bottle was strange and I had to give .2 ml to get 35 mg or something... so I figured it out then had an older nurse double check me to be sure.

I can completely relate to your fear of the unkown, even if something is very simple I am scared of it just because I am not familiar with it. I used to get sick to my stomach before my first day of clinicals at a new site just because I didn't know what to expect, but once I was there I was always fine. I always look back and see how worked up I was about something so simple. I guess that's just part of learning.