What is the longest period of time that one IV bag or solution can be infused...

KelRN215, BSN, RN · Jan 22, 2013

Without producing untoward effects?
- I got an answer of 7 days but another student got 1 day. All we have on IV insertion is a packet and it is rather confusing.

Where did you get your answer from? In my experience, facilities have varying policies on this. When I worked in the hospital, our IV bags/IV tubing were good for 96 hours before they needed to be changed. Other places have different timelines

Also, some other questions I need some help with:
1) If an intermittent IV antibiotic is incompatible with potassium in the primary IV bag, what actions should be taken?
A couple answers I've come up with include:
- Start new IV site
- use multilumen
- slow down infusion
- keep vein open

What do you mean "use multilumen"? If the patient had a multilumen line, using the other lumen would be an option but I don't see this as an option in your question. The question doesn't tell you what kind of access the patient has and if he has a multilumen line, this would be a non-issue.

What would slowing down the infusion do? If you slow down the primary infusion then you've A) changed the rate to a rate which is not ordered (which may or may not be allowed depending on your facility, in my hospital we often cut the IV rate in half to get the patient to drink and then either hep-locked if he took good POs or increased it back to maintenance if he didn't) and B) you still have incompatible fluids running with the antibiotic. Why would it make them less incompatible if it were going slower?

KVO- same as above. KVO just means running the fluid at 5-10 mL/hr to keep the vein open. Why would this help with incompatible fluids?

Starting a new IV site is a good idea if the patient has good veins and other places to go. When I worked in the hospital, it was pediatrics so we usually didn't want more IVs than we needed in the kids... Kids in the hospital are miserable if they can't play. When you run an IV antibiotic as a piggyback, most pumps pause the primary infusion until the antibiotic is complete. In this case, I would simply pause the primary infusion, flush the line and run the antibiotic as its own primary set then flush the line and reconnect the fluids when the infusion is complete. Again, every facility seems to have its own way of doing things.

2) What is the priority nursing action when an IV cannula is suspected of shearing off in a vein?

Is this how the question was worded? Because I'm not sure what the question is referring to when they say a cannula is "shearing off" in a vein. Are they talking about if the catheter actually breaks while in the vein or that it goes through the vein and slips out/infiltrates?

3) What is the general procedure for discontinuing an IV? Is this something nurses can do without a doctors order or not? I have got conflicting answers in class.
Thanks in advance for any and all help!

What do you think for this one? Have you ever had an IV? Seen one removed? Removing an IV is quite simple... many elderly and pediatric patients do it themselves... multiple times/day.

Regarding whether or not you need a doctor's orders... if you have an IV that infiltrates or you notice phlebitis, do you wait to contact the doctor or do you remove it right away? What about if an IV isn't working... if it doesn't work it needs to come out.

In these situations, I simply take the IV out and then text page or find the MD and say "Pt Jones in room 1 lost her IV, does she need a new one?" Depending on why the IV was in in the first place, the answer may be no.

Esme12, ASN, BSN, RN · Jan 22, 2013

It depends....Are you up-to-date with the infusion nursing standards? : Nursing2013

nurseprnRN, BSN, RN · Jan 22, 2013

Generally speaking, we like to know what you've already found out or thought of. You gave us some of that, but you need to have looked around a bit more. KelRN215 has been exceptionally generous in completely answering your questions. Esme has given you a reference to use on similar ones in the future.

Now, what WOULD you do if an IV cannula broke off in the vein?

pacionne · Jan 23, 2013

Thanks everybody! I think for my title question, our answer in the text is every 24 hours. However, according to the CDC it seems to be every 96 hours (4 days)

1) I believe the answer now is hold the solution and contact the doctor.

2) I think by shearing off in the vein they either mean blowing off the vein or infiltrating surrounding tissue. I am not sure and still haven't been able to find the answer.

3) I am just not sure if a nurse is allowed to discontinue the IV or not.

HM-8404, BSN, RN · Jan 23, 2013

I would assume shearing off is meaning part of it came off and was left in the vein when the cath was removed.

HM-8404, BSN, RN · Jan 23, 2013

I would assume shearing off is meaning part of it came off and was left in the vein when the cath was removed.

iluvivt, BSN, RN · Jan 23, 2013

1. I am assuming you are talking about the solution in the IV bag. No solution should be hanging more than 24hours. There are some that are actually less and these are often fat based drugs and other speciality IV medications. In addition to this no one should spike and pre-prime an IV bag while waiting for a patient for any length of time. For example, some surgery centers spike and prime multiple bags for the day or next day. Tubing will have different change times depending upon the the IV medication, nutrients etc and how it used (primary vs intermittent). One place was even doing this on Fri for their patients with Monday surgeries..(very unsafe practice)

3 It depends upon how this happens. If the nurse thinks she has sheared it off when she or he is trying to insert it and you discover that quickly you do not want that piece to be embolized. So you apply a tourniquet above that point enough to restrict venous flow and not arterial flow. Of course this will not be very comfotable so you have to work fast. Call the MD ...get an order for an X ray ( it is radiopaque)to see if it in the arm and while you at it get a CXR to make sure it has not traveled to the lung. The patient will then need to go somwhere to get that retained part retrieved. If it is in the venous system usually ir can get it with a snare. If in the lung they may have to got to OR.

2 If an abx can not be hung as a secondary because it is incompatable with KCL in a primary IVF there are several choices you can do and that all depends upon a few things.

a. if you have a multilumen CVC/PICC you can give it as a primary intermittent in one of the available lumens

b you can start another peripheral IV and give it that way as a primary intermittent.

c. if you have a small extenasion set or a dual extension set or a T extension set you can give it at that site. Do not give it at a Y -site on the IVF with the KCL b/c that is too much mixing

d You can always stop the IVF with the KCL and hang the abx with primary intermiitent tubing..sometimes you have no other choice..it's late at night and you cannot get another IV in....you are going to do this rather than hold the abx

4. Sure you can in most places. I am sure there are some places that make you get an order BUT IMO this makes the patient wait when they may be having symptoms and be uncomfortable. Generally, you get an order for peripheral IV therapy and all that it entails. So you place it,monitor it and replace as needed. If the patient has a phlebitis just geting the catheter out right away will relieve some of the pain. They are way more painful than they look! INS has changed their recommendation on routine site changes. They now say base an IV site change on your assesment and emphasize frequent assesment. It is several pages long that it a very simple explanation.