INTRAVENOUS HYDRATION

Effective Date: 
Wed, 02/01/2012
Reviewed: 
Wed, 02/01/2012
Revised: 
Wed, 05/09/2012
Policy: 

IV hydration is indicated when patients are significantly dehydrated and unable to orally rehydrate. Diarrhea and vomiting can lead to severe electrolyte derangement that may present with symptoms of dehydration including syncope, arrhythmias, and other serious disturbances.   Timely diagnosis is critical for optimal management, as the implementation of IV therapy can prevent shock and severe damage to many internal organs such as the kidneys, liver, and brain. For this reason, all patients having an IV started for dehydration at the Student Health Center will routinely have blood drawn to measure in house STAT electrolyte panel.

Procedure: 
  1. The clinician orders the initiation of IV therapy, to include rate, blood draw if indicated via the EMR
  2. The Nurse explains the procedure to the patient and gathers equipment:
    • IV solution 0.9% NS, IV tubing, primary and extension, IV pole, IV start kit, alcohol swabs, clean gloves, Blood specimen tubes: green, tiger, purple top, 10 c syringe
  3. The Nurse hangs solution from IV pole and checks solution for clarity. Connect tubing to solution container and clear air from the line, close clamp
  4. Start IV: Identify appropriate vein for cannulation, using the appropriate catheter size required for the size of the vein. Use a tourniquet to distend the vessel. Prepare the skin with alcohol followed by providone iodine cleansing the site in a circular manner; the cleansing agent is allowed to dry on the skin. Introduce the needle at a 10-30 degree angle with the bevel up, following the appropriate instructions for the advancement of the catheter according to the manufacturers IV catheter instructions. Withdraw 10cc of blood, with syringe, set aside.   Release the tourniquet within 1 minute. Connect the catheter to IV tubing and open clamp. Fill the blood specimen tube according to the labs ordered; apply the patient label to each. Apply a sterile dressing to the IV site, and initiate the prescribed flow rate as directed by the clinician.
  5. Stat Electrolytes: The Nurse starting the IV will be responsible for labeling and collecting the in-house blood specimen tube for electrolyte measurement. The Clinical Laboratory Scientist (CLS) will be responsible for running the electrolyte analysis STAT upon receiving the specimen in the laboratory. The clinician caring for the patient is responsible for ordering the IV via the Nursing Orders section of the EMR specifying IV composition and rate of infusion as well as ordering the STAT in-house electrolyte measurement. In the event the CLS receives a blood specimen used for in-house electrolytes without a clinician order; the CLS will run the specimen under a standing order from the Medical Director. Additional electrolyte measurements are at the discretion of the clinician managing the patient and are not routinely performed.
  6. The Nurse starting the IV: Charts the IV catheter size and location, the number of attempts, IV solution, and time IV therapy initiated. The time and solution will also be charted for each additional bag hung, as well as documenting the additional bag charges.  It is best practice to attempt to start the IV no more than two times per nurse.
  7. Maintain the IV:  Inspect the patency of the IV tubing and catheter. Inspect the insertion site for fluid infiltration. Monitor the patency of the IV frequently. Maintain solution container 3 feet above the IV site. Inspect the tubing for kinks or obstructions. Ensure tight connections to prevent leakage. Discontinue the solution and remove the access device if there is no blood return and you are unable to establish an acceptable drip rate.
  8. IV medication administration: IV medication must be infused via a secondary infusion set, never as a primary IV line.  Prepare the medication per insert instructions. Draw into a syringe, clean the injection port with an alcohol swab and allow to dry for 30 seconds .Remove the needle cap from syringe, insert the needle through the center of the injection port,  Add the medication to a 100 cc NS solution, mix the medication and solution by gently rotating the bag. Complete and attach a medication label to the solution, with the name and dose of the medication and the nurse s initials. Once the primary line is determined patent, attach the secondary line into the Y port of a continuously running infusion, after cleansing the infusion port of the continuous line with an alcohol swab, using a securely taped needle. Hang the existing primary infusion set lower than the piggyback secondary set. Maintain the existing IV roller clamp position, and regulate the piggyback rate using the roller clamp on the secondary tubing: the piggyback solution will infuse first, and when complete, the existing IV will resume the original rate. Chart the medication added, the time started, and the IV solution.
  9. Discontinue the IV: Clamp off the IV, withdraw the catheter; apply a pressure dressing, ensuring the bleeding has stopped. Chart the time discontinued, catheter intact, pressure applied, total IV solution intake.
Key Points: 
  • IV solution should be visually checked for clarity before flushing of tubingAll patients having an IV started for dehydration at the Student Health Center will routinely have blood drawn to measure in house STAT electrolyte  panel
  • Always use Normal Saline 1000 cc bags to back up intermittent infusions
  • IV medication must be infused via a secondary infusion set, never as a primary IV line
  • It is best practice to make no more than two attempts at starting an IV per nurse.