Buy Monitoring an IV Site and Infusion

Buy Monitoring an IV Site and Infusion
Buy Monitoring an IV Site and Infusion
1. Verify IV solution order on MAR/CMAR with the medical
order. Clarify any inconsistencies. Check the patient’s chart
for allergies. Check for color, leaking, and expiration date.
Know the purpose of the IV administration and medications
if ordered.
2. Monitor IV infusion every hour or per agency policy.
More frequent checks may be necessary if medication is
being infused.
3. Perform hand hygiene and put on PPE, if indicated.
4. Identify the patient.
5. Close curtains around bed and close door to room if possible. Explain what you are going to do to the patient.
6. If an electronic infusion device is being used, check
settings, alarm, and indicator lights. Check set infusion
rate. Note position of fluid in IV container in relation to
time tape. Teach patient about the alarm features on the
electronic infusion device.
7. If IV is infusing via gravity, check the drip chamber and
time the drops. (Refer to Guidelines for Nursing Care 40-3
to review calculation of IV flow rates for gravity infusion.)
8. Check tubing for anything that might interfere with flow.
Be sure clamps are in the open position.
9. Observe dressing for leakage of IV solution.
10. Inspect the site for swelling, leakage at the site, coolness,
or pallor, which may indicate infiltration. Ask if patient is
experiencing any pain or discomfort. If any of these symptoms are present, the IV will need to be removed and
restarted at another site. Check facility policy for treating
infiltration.
11. Inspect site for redness, swelling, and heat. Palpate for
induration. Ask if patient is experiencing pain. These
findings may indicate phlebitis. Notify primary care
provider if phlebitis is suspected. IV will need to be
discontinued and restarted at another site. Check facility
policy for treatment of phlebitis.
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