Unit 9: Intravenous Solutions, Equipment, and  Route of Medication

9.1 Overview

Through the vein! A nurse must be able to perform calculations to determine the correct flow rate at which an enteral or intravenous solution will enter the body.  Infusion rates are measured in drops per minute (gtt/min) or milliliters per hour (mL/h). It is important to be able to convert each of these rates to the other and to determine how long a given amount will take to infuse (Gray Morris & Brown, 2017).

9.2 Learning Outcomes

After completing this unit, you will be able to

  1. Understand the scope of practice of registered nurses for intravenous therapy in Alberta;
  2. Acquire and apply knowledge regarding intravenous therapy and administration of intravenous medications;
  3. Acquire and employ psycho-motor skills needed for competency in intravenous therapy;
  4. Recognize complications regarding intravenous therapy;
  5. Identify common intravenous (IV) solutions and their abbreviations;
  6. Define the following terms:  peripheral line, central line, primary line, secondary line, IV piggyback, saline lock, IV push/direct and IV bolus; and
  7. Differentiate among various devices used to administer IV solutions.

9.3 Learning Resources

The following resources will assist you in achieving the learning outcomes for this unit. If a resource link does not function, use a search engine to locate the current link or alternative websites.

Note: Websites are provided for learning purposes only. Agency policies and procedures are updated on an ongoing basis. Always check for current agency policy and procedures when administering intravenous infusions.   

Alberta Health Services  (2016). Infusion pumps for medication & parenteral fluid administration.  Retrieved from https://extranet.ahsnet.ca/teams/policydocuments/1/clp-infusion-pumps-medication-parenteral-fluid-admin-ps-70-policy.pdf

Alberta Health Services (2015). Practice support document guideline. Independent double-check.  Retrieved from https://extranet.ahsnet.ca/teams/policydocuments/1/clp-provincial-med-mgmt-independent-double-check-guideline.pdf

Alberta Health Services (2014). Intravenous therapy a practical approach: An independent learning module for health care professionals. Retrieved from IV Module 2014.

Buchholtz, S. (2016).Henke's med-math: Dosage calculation, preparation, and administration(8th ed.). Philadelphia, PA: Wolters Kluwer.

Canadian Nurses Association (CNA) (2017). Code of ethics for registered nurses. https://www.cna-aiic.ca/en/nursing/regulated-nursing-in-canada/nursing-ethics

College of Registered Nurses of Alberta (CRNA). (2021) Scope of practice for registered nurses. https://nurses.ab.ca/media/ruwb0xql/scope-of-practice-for-registered-nurses-mar-2021.pdf

College of Registered Nurses of Alberta (CRNA). (2021). Medication management standards. https://nurses.ab.ca/media/3lfhdrrq/medication-management-standards-mar-2021.pdf

College of Registered Nurses of Alberta (CRNA). (2018). Guidelines for medication and vaccine injectin safety.  https://nurses.ab.ca/media/q5gn52kz/guidelines-for-medication-and-vaccine-injection-safety-acp-crna-cpsa-2018.pdf

Doyle, G.R. & McCutcheon, J.A. (2015). Clinical procedures for safer patient care.  BCcampus. Retrieved from https://opentextbc.ca/clinicalskills/
Gray Morris, D.C., & Brown, M. (2017). Calculate with confidence (1st Canadian ed.). Toronto, ON: Elsevier Canada.

Lippincott Williams & Wilkins (2018). Infusion therapy made incredibly easy! Hadaway, L. (Ed). 5th ed. Philadelphia, PA.  

Olsen, J.L., Giangrasso, A.P., & Shrimpton, D. (2016). Medical dosage calculations: A dimensional analysis approach(11th ed). New Jersey: Pearson Education.

Quizlet. (2019). IV therapy equipment and supplies.  Retrieved from https://quizlet.com/144894044/iv-therapy-equipment-and-supplies-flash-cards/

Quizlet. (2018). IV therapy and IV med administration. Retrieved from https://quizlet.com/77086776/iv-therapy-iv-med-administration-flash-cards/

RegisteredNurseRN. (2016.) Isotonic, hypotonic, hypertonic IV solutions made easy: Fluid electrolytes nursing students[Video File]. Retrieved from https://www.youtube.com/watch?v=51FkahHUBwc

UnityPoint Health – Meriter Nursing Education (2014).  Secondary Infusion. Retrieved from  https://www.youtube.com/watch?v=84B_94taIas

9.4 Learning Activities

  1. Review the following IV Therapy Equipment and Supplies located at https://quizlet.com/144894044/iv-therapy-equipment-and-supplies-flash-cards/. https://quizlet.com/144894044/iv-therapy-equipment-and-supplies-flash-cards/
  2. Review the video on Isotonic, hypotonic, hypertonic IV solutions made easy: Fluid electrolytes nursing students https://www.youtube.com/watch?v=51FkahHUBwc
  3. Watch the following video by Teaching and Learning, University of Alberta, (2012). Priming an IV line.  https://www.youtube.com/watch?v=Glw-nxlVMxQ&t=72s
  4.   Watch the following video by Teaching and Learning, University of Alberta, (2014). IV medication administration:  hanging a minibag.  https://www.youtube.com/watch?v=md9FpRg6zJc

    SAFETY ALERT! It is important to pay close attention to the abbreviations used for IV solutions. The letters indicate the solution components, whereas numbers indicate the solution strength (Gray Morris & Brown, 2017, p. 512).

  5. Watch the following video by Teaching and Learning, University of Alberta, (2014). IV medication administration:  Reconstituting an IV medication.  https://www.youtube.com/watch?v=ZTLB3Trr3bM
  6. Review Chapter 8 Intravenous Therapy in the open education resource provided by BCcampus titled Clinical Procedures for Safer Patient Care. https://opentextbc.ca/clinicalskills/chapter/8-1-introduction/
  7. Complete the following learning module by Alberta Health Services (2014) Intravenous Therapy Learning Module for professional development by Alberta Health Services (2014) IV Module 2014.

    Did you know? 
    To safely reconstitute powdered drugs this can be done in 6 easy steps.

    Step #1 hand hygiene
    Step #2 draw up the correct dosage of the drug
    Step #3 scrub the rubber stopper of the drug vial or neck of an ampule
    Step #4 inserts the needless device of diluent into the stopper at a 45o to 60o angle.Angling the needle minimizes coring or breaking off of the rubber
    Step #5 inject the diluent
    Step #6 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 (Lippincott, Williams & Wilkins, 2018 p. 213).

  8. Get to know your infusion pump prior to clinical by reviewing the following videos used in your chosen clinical practice city (Calgary or Edmonton, AB). You are not expected to read the whole manual but you are expected to be familiar with what the pump looks like and how it operates at a very basic level. Know where you want to go before investing in learning about the pump! 

    Calgary Placement:

    Operators Manual for the Baxter Sigma Infusion Pump  https://infusystem.com/images/manuals/Sigma%20Spectrum.pdf

    Sigma Spectrum Infusion Pump – Overview and Basic Infusion https://www.youtube.com/watch?v=sA5R0g7xar0

    NEMS Sigma Spectrum Pump in Basic Mode - https://www.youtube.com/watch?v=GnPK2TJco-0

    Edmonton Placement: 

    Operators Manual for the Carefusion Alaris  Infusion Pump http://static1.1.sqspcdn.com/static/f/1024263/13901185/1314646481840/Alaris_System_DFU_Model_8015_092009.pdf?token=6iRhSXm6HyLCZgbuD7%2B8tFYnpR0%3D

    Med One Group Alaris Pump Module Training https://www.youtube.com/watch?v=Fyth0syNTP4

    UnityPoint Health – Meriter Nursing Education (2014).  Secondary Infusion.  https://www.youtube.com/watch?v=84B_94taIas

  9. Watch the following video from Alberta Health Services on Independent Double-checks. Be prepared to evaluate yourself!  https://www.youtube.com/watch?v=Jbhwg1p8cCs&feature=youtu.be
  10. You have the opportunity to acquire and employ psycho-motor skills needed for competency in intravenous therapy prior to the start of your clinical. If you are interested in practicing priming lines and reconstituting medications in the convenience of your own home simply place an order using the following instructions. Before you order you must know where you plan on doing your NURS 401 clinical as the supplies for the pumps differ quite a bit. 

    Calgary Placement:

    Call 780-675-6366. You will need to provide your ID number, name, address and a payment method.

    The following Calgary clinical lab supplies are available as a kit for $27.97 + shipping 

    Shipping costs:  Alberta $12.60, BC, SK, MB $13.65, ON $16.80, and Atlantic Canada $21.00

    Each kit contains: 

    CLEARLINK CONTINU-FLO LF ~ 1
    CLEARLINK SECONDARY MED LF ~ 1
    NEEDLE, BLUNT FILL 18GX1.5" ~ 1
    LABEL,"MEDICATION ADDED" ~ 1
    SOLN, MINIBAG, NACL .9% USP 250ML ~ 1
    SOLN, SALINE.9% MINIBAG 50ML ~ 1
    PRACTI-POWDER, YELLOW ~ 1
    SODIUM CHLORIDE.9% 10ML ~ 1 vial
    LINE LABEL ~ 2

    Edmonton Placement:

    Call 780-675-6366. You will need to provide your ID number, name, address and a payment method.

    The following Edmonton lab supplies are available as a kit for $35.06 + shipping

    Shipping costs:  Alberta $12.60, BC, SK, MB $13.65, ON $16.80, and Atlantic Canada $21.00

    Each kit contains: 

    INFUSION SET W/ CHECK VALVE ~ 1
    SMART SITE, VENT/NON-VENT SEC ~  1
    SOLN, MINIBAG, NACL .9% USP 250ML ~  1
    SOLN, SALINE.9% MINIBAG 50ML ~ 1
    PRACTI-POWDER, WHITE 10ML ~ 1
    SODIUM CHLORIDE.9% 10ML VL 1
    LINE LABELS ~1 2
    NEEDLE, BLUNT FILL 18GX1.5" ~ 1
    LABEL, "MEDICATION ADDED" ~ 1

    When your order arrives open this Step-by-Step Instructions for IV Infusion Home Kit document to help guide you.  Before you start this psychomotor skill have you watched the entire "how to" video's on this?  If your answer is yes, proceed to the skill of priming and reconstituting intravenous lines.  We are always open to constructive feedback for this learning activity.  Please email Jacquelinemann@athabascau.ca your thoughts on this activity.  What did you like about it?  Were the supplies adequate enough?  Did the step-by-step document help in any way? 

    Did you know?  That as a clinician, registered nurses provide safe, competent, ethical, compassionate, and evidence-informed care across the lifespan in response to client needs (CARNA, 2019 p. 5) Be in the know when it comes to infusion therapy! 

Evaluation ~ Test yourself aim to achieve 100%.

1. Morphine 2 mg – 4 mg IV q4H prn for pain is ordered for Mr. Murray.  The nurse (based on a comprehensive assessment and discussion with Mr. Murray) decides to administer morphine 2 mg IV at 1400.  After one hour, the client continues to have pain.  Can the nurse give the other 1 – 2 mg to a maximum of the ordered 4 mg?

Answer: The nurse cannot administer another 1-2 mg of Morphine an hour later based on this same order as the order identified the timeframe as q4h, not q1h.  The nurse needs to contact the authorized prescriber for further medication orders to address the client's pain. 

If you did not receive a correct response, please re-read the article titled Medication Guidelines: Range Doses by CARNA (2019).  

2. True or False? Managers and educators only need to ensure at a minimum that health care professionals receive one-time training on all infusion pumps used within their practice environment? 

Answer:  False  ~ Managers and staff educators shall ensure that health care professionals receive ongoing training on all infusion pumps used within their practice environment. 

If you did not receive a correct response, please re-read the policy on Infusion pumps for medication and parenteral fluid administration by Alberta Health Services (2016).

3.  Which seven indicators found under "Clinician" in the following document from CARNA's entry-to-practice competencies do you think relates to infusion therapy? https://www.nurses.ab.ca/docs/default-source/document-library/standards/entry-to-practice-competencies-for-the-registered-nurses-profession.pdf?sfvrsn=15c1005a_12

Answer:  1.4, 1.7, 1.8, 1.10, 1.11, 1.12, and 1.13

4.  In your own words define "Emergency Situation" as per Alberta Health Services document titled Independent Double-Check (2015.)

Emergency Situation: "means a situation which requires health care that is necessary to preserve life, prevent serious physical or mental harm, or to alleviate severe pain" (AHS, 2015 p.4)

5.  True or False? An emergency situation is happening, you are alone, and you must hang IV high alert medication STAT.  Are you able to perform this skill without an independent double check?  Explain your answer

True, you may hang the high alert medication without access to another health care professional however, you must step away after you have performed your checks and perform another task (delaying self-verification); then return and repeat your checks.

If you did not receive a correct response, please re-read the policy on Independent Double-Check by Alberta Health Services (2015 2.3).

Last updated: April 11, 2022 © Copyright Athabasca University
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