A Practical Review of Infusion Therapy

The purpose of this module is to build on prior learning in infusion therapy. This learning resource was developed to facilitate a review of infusion therapy as you prepare for clinical courses in the Post LPN-BN program.

This is a self-study module. There is no tutor for this module.

All students perform clinical skills in accordance with policies and procedures of the health region/authority in which they are practicing.

Welcome Video

Overview

Infusion therapy is one of the most common interventions in health care. It is an efficient way to deliver medications and fluids to the acutely ill patient. The purpose of this module is to provide the student with a review of infusion therapy. Information specific to infusion pumps and equipment used in Calgary and Edmonton clinical placements is included. You will have the opportunity to practice priming an infusion line in your own home.

Learning Outcomes

Upon completion of A Practical Review of Infusion Therapy, the student will:

• Review content information related to infusion therapy;
• Understand the principles and purpose of infusion therapy including venipuncture, central line care, IV medications, spinal/epidural therapy and Smart pumps;
• Become familiar with the specific infusion pump that will be used on the assigned clinical unit of the clinical course;
• Develop psychomotor skills needed for competency in intravenous therapy.

Did you know? Some nurses may find it challenging to differentiate and identify the different types of infusion solutions. Knowing and understanding the various types of infusion solutions and supplies to administer them safely is integral to safe patient care.

1. Complete Section One: Purpose of Infusion Therapy, Solutions, and Supplies (pp. 8 – 21) in the following independent learning module, Peripheral Vascular Access Device (VAD) Insertion Learning Module (Alberta Health Services, 2014). http://charon.athabascau.ca/cnhsundergrad/401e5/activities/IVmodule.pdf

2. Read Chapter 8.3: IV Fluids, IV Tubing, and Assessment of IV System in Clinical Procedures for Safer Patient Care (Doyle & McCutcheon, 2015). https://opentextbc.ca/clinicalskills/chapter/8-2-types-of-iv-therapy/

3. Complete Unit 9: Intravenous Solutions, Equipment, and Route of Medication in the Medmath Module http://charon.athabascau.ca/cnhsundergrad/medmath/unit9.htm

4. View Video: Isotonic, Hypotonic, Hypertonic IV Solutions Made Easy to understand the different types of solutions (Registered Nurses RN, 2016). https://www.youtube.com/watch?v=51FkahHUBwc

5. Hignell (2018) listed supplies needed for a successful initiation of peripheral intravenous:

• Non-sterile glove
• IV catheter
• Start Pack kit/Insertion supplies:
  • Chlorhexidine 2% with Alcohol 70% swab
  • Single use tourniquet
  • Transparent securement dressing
  • Tape
  • Sterile 2x2 gauze
• IV catheter extension set with needleless connector
• Pre-filled 5 mL NS syringe
• IV solution as per order
• Electronic Infusion Device

---

Reflection

A doctor’s order is required for the insertion of a peripheral IV catheter. The order must include the type of IV solution, the rate of infusion, the most responsible health practitioner’s signature, and the date (Alberta Health Services, 2017).

Did you know? Intravenous initiation is a challenging procedure to perform for some nurses. Knowing and understanding the venous anatomy is an important first step for a successful venipuncture. Venipuncture requires a doctor’s order, skilled assessment, and patient preparation.

1. Complete Section Two: Selecting an Insertion Site (pp. 22 – 26) in the following independent learning module, Peripheral Vascular Access Device (VAD) Insertion Learning Module (Alberta Health Services, 2014). http://charon.athabascau.ca/cnhsundergrad/401e5/activities/IVmodule.pdf

2. Complete Section Three: Inserting a Peripheral Vascular Access Device (pp. 27 – 41) in the following independent learning module, Peripheral Vascular Access Device (VAD) Insertion Learning Module (Alberta Health Services, 2014). http://charon.athabascau.ca/cnhsundergrad/401e5/activities/IVmodule.pdf

3. View Video: IV Insertion from Nursing Skills Laboratory Online, University of Cincinnati, Blue Ash College (n.d.). http://hawknurse.weebly.com/iv-insertion.html

---

Reflection

Nurses provide safe, competent, and ethical care. Consult health region/authority policy and procedure prior to performing venipuncture. There should be no more than two attempts per clinician. Know your limitations. Do not attempt to place an access device into a patient when access is difficult. Patients with prominent veins are recommended for novice nurses, as this will increase both the confidence and skill level of the novice nurse.

Did you know? Specialized assessments are required to maintain peripheral infusion therapy and preventing complications.

1. Complete Section Four: Maintaining a Peripheral Vascular Access Device and Managing Complications (pp. 42 – 52) in the following independent learning module, Peripheral Vascular Access Device (VAD) Insertion Learning Module (Alberta Health Services, 2014). http://charon.athabascau.ca/cnhsundergrad/401e5/activities/IVmodule.pdf

2. Complete Section Five: Discontinuing a Peripheral Vascular Access Device (pp. 53 – 55) in the following independent learning module, Peripheral Vascular Access Device (VAD) Insertion Learning Module (Alberta Health Services, 2014). http://charon.athabascau.ca/cnhsundergrad/401e5/activities/IVmodule.pdf

3. View Videos:

• Priming a line by AU #1
• Priming a secondary line by AU #2
• Tegaderm IV Dressing 1683 Application and Removal ~ 3M Critical and Care Solutions. (2012). https://www.youtube.com/watch?v=wpS2mtvApDo
• Converting an IV to a Saline Lock. (Nursing File, 2011). https://www.youtube.com/watch?v=2CVHxXLYMU8
• Discontinuing an IV. https://www.youtube.com/watch?v=7c3iS-jURIM

4. Read: Chapter 8.3 IV Fluids, IV tubing, and Assessment of an IV System https://opentextbc.ca/clinicalskills/chapter/8-2-types-of-iv-therapy/ (Doyle & McCutcheon, 2015).

---

Reflection

Nurses provide safe, competent, and ethical care. It is always important to consult your health region/authority policy and procedure on the management of peripheral infusion therapy. 

Did you know? Several checks and assessments are required prior to and while administering IV medications and blood products to prevent complications.

1. Complete: The following independent learning module, Transfusion of Blood Components and Products (Alberta Health Services, 2017). https://www.albertahealthservices.ca/assets/wf/lab/wf-lab-clin-tm-manual-lm.pdf

2. View Videos:

• Top Tips for Blood Transfusions (NCLEX RN Review). NCLEX Study Guide (2016). https://www.youtube.com/watch?v=VyZD9scwCA8
• IV Regulating Infusion Flow Rate by Gravity Drip. NursingFile.com (2011). https://www.youtube.com/watch?v=-i5_v1AEGlo
• IV Therapy: Adding Medication to IV Solution Bag. NursingFile.com (2011). https://www.youtube.com/watch?v=yMOWBJ9FIoo
• Reconstituting IV Drugs. Medical Exam Tutor (2015). https://www.youtube.com/watch?v=w_MJ5ypOILM

3. Complete Unit 8: Reconstitution of Medication in the Medmath Module https://cnhs.lms.athabascau.ca/course/view.php?id=3192

4. Complete Unit 10: IV Flow Rate Calculations in the Medmath Module. https://cnhs.lms.athabascau.ca/course/view.php?id=3192

5. Read Chapter 7.6: Administering Intermittent Intravenous Medication (Secondary Medication) and Continuous IV Infusions (Doyle & McCutcheon, 2015). https://opentextbc.ca/clinicalskills/chapter/6-11-administering-intravenous-medications-by-piggyback-mini-bags-intermittent-infusion-sets-and-mini-infusion-pumps/

6. To safely reconstitute powdered drugs, review the following six steps to ensure a good quality mixture.

• Step One: Hand hygiene.
• Step Two: Draw up the correct dosage of the drug.
• Step Three: Scrub the rubber stopper of the drug vial or neck of an ampule.
• Step Four: Insert the needle device of diluent into the stopper at a 45° to 60° angle. Angling the needle minimizes coring or breaking off of the rubber stopper.
• Step Five: Inject the diluent.
• Step Six: Mix thoroughly. If the drug does not dissolve within a few seconds, let it stand for 10 minutes. Do not shake as this may cause frothing (Hadaway, 2018 p. 213).

7. Learning how to read a parenteral monograph is important for infusion therapy medication administration and for patient safety. Completing the two case studies (located on the course home page) on the medications dimenhydrinate and pantoprazole will enhance your ability to read and understand parenteral monographs.

---

Reflection

To provide safe and ethical patient care, nurses should be competent in medication calculation and follow the rights of medication administration. A doctor’s order is required to infuse IV medications and blood products, and at times a second check must also be done. 

Did you know? IV therapy given centrally is infused directly into the superior vena cava. There are situations when this specialized intervention is required. For example, in an emergency, when a patient’s peripheral veins are difficult to access, when administering certain medications, or during long-term therapy.

1. Complete: The following independent learning module, Central Venous Access Device (CVAD) Learning Module (Alberta Health Services, 2019).

2. View Videos:

Central Line Dressing Change – Nursing Skills (EmpoweRN, 2015) https://www.youtube.com/watch?v=37d3wVulWcw

Central Lines /skills:  Flushing the line. (American College of Surgeons, 2016) https://www.youtube.com/watch?v=EwGXQ-CsZGU

---

Reflection

To minimize health and safety risks to patients, prior to procedures, consult health region/authority policy and procedure. Here is a link to Alberta Health Services, Clinical Policies and Procedures https://www.albertahealthservices.ca/info/Page7451.aspx

Did you know? Health care professionals monitoring patients with an epidural require additional knowledge pertaining to epidural pumps, analgesia and anesthesia to safely care for these patients.

1. Review: Grey Nuns and Misericordia Sites, Certification Module for Epidural/Spinal Analgesia/Anesthesia (Covenant Health, 2018) http://extcontent.covenanthealth.ca/Policy/vii-a-15%20Epidural%20Certification%20Package.pdf

• Section 1: pp. 1 – 9
• Section 2: pp. 10 – 12
• Section 4: pp. 15 – 21
• Section 5: pp. 24 - 27

Note: you may get a security error when you access this document. You can proceed without any concerns.

2. View Videos:

Epidural Sensory and Motor Assessment (Western Health, 2012). https://www.youtube.com/watch?v=ix5_Pwsuf2k

Alaris PCA (Nash-Arnold, 2013). https://www.youtube.com/watch?v=ecqouMRhORs

---

Reflection

As a student you will not be independently assessing these sites nor will you be administering medication through these sites. However, it is important to understand this restricted activity skill as you will care for patients receiving this therapy in your practicum.  Reflect and improve on your current knowledge of epidural infusions.

Did you know? Infusion pumps are getting smarter all the time. This means that with increased patient safety comes increased sensitivity to the pumps. Take the time needed to prime your lines properly and have the pumps positioned on the pole as per manufacturers guidelines. Taking your time to do these two steps will help decrease the likelihood of the pump alarm being triggered.

Before you begin: Focus your learning on the infusion pumps that will be used in your clinical area of practice. The smart infusion pumps differ between Calgary and Edmonton.

---

Smart Pumps for Clinical Practice in Calgary, AB

1. Watch videos, to learn about the pumps you will use in Calgary, AB.

• Baxter’s Sigma Spectrum Infusion System.  https://www.youtube.com/watch?v=oo5_GsK6tjk
• Sigma Spectrum Infusion Pump: Overview and Basic Infusion https://www.youtube.com/watch?v=sA5R0g7xar0
• Athabasca University Baxter Sigma Pump https://vimeo.com/manage/videos/585530795
• Athabasca University Sigma Pump Secondary line https://vimeo.com/manage/videos/583888308

2. Peruse Baxter’s Sigma Pump Operator’s Manual if you are interested in learning more (start on page 11).  https://infusystem.com/images/manuals/Sigma%20Spectrum.pdf

---

Smart Pumps for Clinical Practice in Edmonton, AB

1. Watch video, to learn about the pump you will use in Edmonton, AB. 

• Alaris 8100 Pump Module Training https://www.youtube.com/watch?v=Fyth0syNTP4
• Secondary Infusion by UnityPoint Health (2014). https://www.youtube.com/watch?v=84B_94taIas&t=123s

2. Read the Directions for Use, Alaris System (2009) if you are interested in learning more.  http://static1.1.sqspcdn.com/static/f/1024263/13901185/1314646481840/Alaris_System_DFU_Model_8015_092009.pdf?token=6iRhSXm6HyLCZgbuD7%2B8tFYnpR0%3D

3. Athabasca University. Alaris Pump video (Coming Soon)

---

Additional Resources

Medication Safety and Calculation Module. (n.d.).  https://cnhs.lms.athabascau.ca/course/view.php?id=3192

Doyle, G. R., & McCutcheon, J. A. (2015). Clinical procedures for safer patient care. BC Campus. https://opentextbc.ca/clinicalskills/

Hignell, P. (2018). Peripheral intravenous initiation: Self-learning module (8th ed.).  Fraser Health. https://www.fraserhealth.ca/-/media/Project/FraserHealth/FraserHealth/Health-Professionals/Professionals-Resources/Acute-Care-Orientation/IV-Initiation-Self-Learning-Module-v8-June-2018.pdf?la=en&hash=320E955A6C95F3DB852E19EDA581864941EF06A1

---

Reflection

“Champions do not become champions when they win the event, but in the hours, weeks, months and years they spend preparing for it. The victorious performance itself is merely the demonstration of their championship character.”

Alan Armstrong (Goodreads, n.d.)

3M Health Care. (2015, December 1). I.V. port dressing.  Tegaderm Transparent Dressing 1668 Application [Video]. YouTube. https://www.youtube.com/watch?v=eOeVkphtSq8

Alberta Health Services. (n.d.). Clinical policy and procedures. https://www.youtube.com/watch?v=TnSmjDDRwkg

Alberta Health Services. (2014, December). Professional Development: Peripheral Vascular Access Device (VAD) Insertion Learning Module. http://charon.athabascau.ca/cnhsundergrad/401e5/activities/IVmodule.pdf

Alberta Health Services. (2017, January). Professional Development: Transfusion of Blood Components and Products. https://www.albertahealthservices.ca/assets/wf/lab/wf-lab-clin-tm-manual-lm.pdf

Alberta Health Services. (2019). Professional Development: Central Venous Access Device (CVAD) Learning Module.

Athabasca University (n.d.). Medication Math module, Unit 8. Reconstitution of medication. https://cnhs.lms.athabascau.ca/course/view.php?id=3192

Athabasca University (n.d.). Medication Math Module, Unit 9: Intravenous Solutions, Equipment, and Route of Medication http://charon.athabascau.ca/cnhsundergrad/medmath/unit9.htm

Athabasca University (n.d.). Medication Math Module, Unit 10.  IV flow rate calculations https://cnhs.lms.athabascau.ca/course/view.php?id=3192

Baxter. (2011). Sigma pump operator’s manual. https://infusystem.com/images/manuals/Sigma%20Spectrum.pdf

Baxter. (2012). SIGMA Spectrum infusion system receives best in KLAS award for second consecutive year.  https://www.youtube.com/watch?v=oo5_GsK6tjk

Baxter. (2012). Sigma Spectrum Infusion Pump: Overview and Basic Infusion https://www.youtube.com/watch?v=sA5R0g7xar0

CareFusion. (2009). Directions for use. Alaris system. http://static1.1.sqspcdn.com/static/f/1024263/13901185/1314646481840/Alaris_System_DFU_Model_8015_092009.pdf?token=6iRhSXm6HyLCZgbuD7%2B8tFYnpR0%3D

Covenant Health. (2018) Certification Module for Epidural/Spinal Analgesia/Anesthesia (http://extcontent.covenanthealth.ca/Policy/vii-a-15%20Epidural%20Certification%20Package.pdf

Doyle, G. R., & McCutcheon, J. A. (2015). Chapter 7.6: Administering intermittent intravenous medication (secondary medication) and continuous IV infusions Clinical procedures for safer patient care. BC Campus. https://opentextbc.ca/clinicalskills/chapter/6-11-administering-intravenous-medications-by-piggyback-mini-bags-intermittent-infusion-sets-and-mini-infusion-pumps/

Doyle, G. R., & McCutcheon, J. A. (2015). Chapter 8.3: IV fluids, IV tubing, and assessment of an IV system. Clinical procedures for safer patient care. BC Campus. https://opentextbc.ca/clinicalskills/chapter/8-2-types-of-iv-therapy/

F.A. Davis (2015). Davis’ nursing skills videos for RNs. Discontinuing a peripheral IV [Video]. Vimeo. https://vimeopro.com/fadavis/wilkinson-skills-videos-3e/video/121281010

GoodReads (n.d.). Preparation Quotes. https://www.goodreads.com/quotes/tag/preparation

Hadaway, L. (Ed.). (2018). Infusion therapy made incredibly easy! (5th ed.). Wolters Kluwer.

Hignell, P. (2018). Peripheral intravenous initiation: Self-learning module (8th ed.).  Fraser Health. https://www.fraserhealth.ca/-/media/Project/FraserHealth/FraserHealth/Health-Professionals/Professionals-Resources/Acute-Care-Orientation/IV-Initiation-Self-Learning-Module-v8-June-2018.pdf?la=en&hash=320E955A6C95F3DB852E19EDA581864941EF06A1

Mann, J. (2019). Personal photos, India

Medical Exam Tutor. (2015). Reconstituting IV drugs. https://www.youtube.com/watch?v=w_MJ5ypOILM

Med One Group (2019, March 7). Alaris 8100 Pump Module Training [Video]. YouTube. https://www.youtube.com/watch?v=Fyth0syNTP4

Nash-Arnold, N. (2013). Brisbane Northside Emergency.  Alaris PCA [Video]. YouTube. https://www.youtube.com/watch?v=ecqouMRhORs

NCLEX Study Guide. (2016). Top tips for blood transfusion (NCLEX RN Review). https://www.youtube.com/watch?v=VyZD9scwCA8

NursingFile (2011). Changing and flushing a central line access cap.  https://www.youtube.com/watch?v=TnSmjDDRwkg

NursingFile (2011). Intravenous (IV) therapy:  Converting an IV to a saline lock [Video]. YouTube. https://www.youtube.com/watch?v=2CVHxXLYMU8

NursingFile. (2011). IV Regulating Infusion Flow Rate by Gravity Drip. https://www.youtube.com/watch?v=-i5_v1AEGlo

NursingFile. (2011). Adding medication to IV solution bag. https://www.youtube.com/watch?v=yMOWBJ9FIoo

Porth, C.M. (2015). Essentials of pathophysiology: Concepts of altered health states (4th ed.). Wolters Kluwer.

Registered Nurses RN (2016, January 11). Isotonic, hypotonic, hypertonic IV solutions made easy/Fluid electrolytes nursing students [Video]. YouTube.  https://www.youtube.com/watch?v=51FkahHUBwc

Sigma Spectrum (n.d.). Operator’s manual. https://infusystem.com/images/manuals/Sigma%20Spectrum.pdf

Teleflex (n.d.). The history of the arrow vascular access brand [Image]. https://www.teleflex.com/usa/en/product-areas/vascular-access/timeline/index

Unity Point Health, Meriter Nursing Education (2014, June 26).  Secondary infusion [Video]. YouTube. https://www.youtube.com/watch?v=84B_94taIas

University of Alberta (2012, February 9). Teaching and Learning, University of Alberta Nursing. Flushing a central line [Video]. YouTube.  https://www.youtube.com/watch?v=mPOwY6-kX-8&list=PL579C06EADD54801C&index=3&t=0s

University of Alberta Nursing (2014, December 18). Teaching and Learning, University of Alberta Nursing. Central venous access dressing change and injection cap change [Video]. YouTube.  https://www.youtube.com/watch?v=b1AgE8gdPEA&t=16s

University of Cincinnati, Blue Ash College (n.d.). Nursing Skills Laboratory Online. IV insertion [Video]. http://hawknurse.weebly.com/iv-insertion.html

Western Health (2012, Jul 6). Epidural sensory and motor assessment [Video]. YouTube. https://www.youtube.com/watch?v=ix5_Pwsuf2k

Wordcloud. (n.d.). https://www.wordclouds.com