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Intravenous Therapy: IV Bag and Tubing Preparation

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What is the purpose of the IV solution during intravenous therapy?

The IV solution corrects and prevents the client’s fluid and electrolyte imbalances.

Different IV solutions are prescribed to different clients who required intravenous therapy such as:

  • those with acute illness
  • those required to have nothing per orem
  • those with severe burns

What are the most common IV tubings?

These are IV tubings a nurse must be familiar with:

  • Primary Tubing – have no ports or multiple ports
  • Secondary Tubing – used when another solution is added to the primary tubing
  • Filtered Tubing – used in blood transfusion to filter the blood

Aside from the type, what must the nurse need to know about IV tubing?

The nurse must be familiar with the size of the tubing to be able to accurately count the IV flow rate.

Macrodrop IV tubing can vary from 10, 15, or 20 gtts per milliliter.

Microdrop IV tubing has a rate of 60 gtts per milliliter.

Materials needed:

  • Gloves
  • IV solution in a bag
  • IV tubing as order
  • Sterile 2 x 2 gauze

IV Bag and Tubing Preparation 

1. Check health care provider’s order for the IV solution. Ensures accurate administration of the solution.
2. Wash hands. Reduces transmission of microorganisms.
3. Check client’s identification bracelet. Ensures medication is given to the correct client.
4. Prepare new bag by removing protective cover. Check the expiration date on the bag and assess for cloudiness or leakage. Allows for quick, smooth preparation. Ensures that the solution is sterile.
5. Open new infusion set. Unroll tubing and close roller clamp. Prevents fluid from leaking after IV bag is spiked.
6. Spike bag with tip of new tubing and compress drip chamber to fill halfway. Promotes rapid flow of solution through new tubing without air bubbles.
7. Open roller clamp, remove protective cap from the end of the tubing, and slowly flush solution completely through tubing. Removes air from tubing. Prevents entry of air into the venous system, a cause of air embolus. If fluid enters tubing too rapidly air bubbles occur.
8. Close roller clamp and replace cap protector. Prevents fluid from leaking and maintains sterility of tubing.
9. Apply clean gloves. Reduces the transmission of microorganisms
10. Remove old tubing and replace with new tubing:

  • Place sterile 2 × 2 gauze under IV catheter or heparin lock.
  • Stabilize hub of catheter or needle and gently pull out
  • old tubing.
  • Quickly insert new tubing into hub of catheter or
  • needle.
  • Open roller clamp to establish flow of IV solution.
  • Reestablish drip rate.
  • Apply new dressing to IV site.
  • Absorbs fluids that may drip during the procedure, preventing contamination of surrounding areas.
  • Prevents accidental dislodging of catheter or needle.
  • Prevents backflow of blood or the entrance of air into the vein.
  • Prevents catheter occlusion and maintains IV flow at prescribed rate.
  • Maintains IV flow at prescribed rate.
  • Provides protection from infection and accidental dislodgement.
11. Discard old tubing and IV bag. Prevents accidental transmission of microorganisms.
12. Remove gloves and dispose with all used materials. Reduces transmission of microorganisms.
13. Apply a label with date and time of change to tubing. Calculate intravenous drip rates and begin infusion at prescribed rate. Allows for planning of next change.
14. Wash hands. Reduces transmission of microorganisms.

Note. Adapted from Fundamental and Advanced Nursing Skills. Third Edition, p. 1030-1032, by G. B. Altman, 2010,
Delmar: Cengage Learning.

What to document?

Document the following:

  • Date, time and name IV solution was started
  • Date and time IV tubing was changed

Key Considerations:

  • Before administering medications through IV, ensure its compatibility with the IV solution to prevent untoward reactions.
  • Always check the temperature of the IV solution so that it’s not too warm or too cold before administering it to the client.
  • Teach client to alert the nurse before the solution in the IV bag runs out so that the appropriate replacement will be given in due time.
  • If the IV tubing gets contaminated by needle piercing during the IV piggyback injection, stop the medication administration. Remove the needle and replace cap of the needle to maintain its sterility.  Stop IV flow, obtain a new tubing and change existing tubing using proper aseptic technique. Discard contaminated tubing and place a new IV tubing and solution and finally administer the IV piggyback medication.