Changing an IV Solution Container and Administration Set

Goal: The prescribed IV infusion continues without interruption and with infusion complications identified.

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. Gather all equipment and bring to bedside.

3. Perform hand hygiene and put on PPE, if indicated.

4. Identify the patient.

5. Close curtains around bed and close the door to the room, if possible. Explain what you are going to do and why you are going to do it to the patient. Ask the patient about allergies to medications or tape, as appropriate.

6. Compare IV container label with the MAR/CMAR. Remove IV bag from outer wrapper, if indicated. Check expiration dates. Scan bar code on container, if necessary. Compare patient identification band with the MAR/ CMAR. Alternately, label solution container with the patient’s name, solution type, additives, date, and time. Complete a time strip for the infusion and apply to IV container.

7. Maintain aseptic technique when opening sterile packages and IV solution. Remove administration set from package. Apply label to tubing reflecting the day/date for next set change, per facility guidelines.

To Change IV Solution Container
8. If using an electronic infusion device, pause the device or put on “hold.” Close the slide clamp on the administration set closest to the drip chamber. If using gravity infusion, close the roller clamp on the administration set.

9. Carefully remove the cap on the entry site of the new IV solution container and expose the entry site, taking care not to touch the exposed entry site.

10. Lift empty container off IV pole and invert it. Quickly remove the spike from the old IV container, being careful not to contaminate it. Discard old IV container.

11. Using a twisting and pushing motion, insert the administration set spike into the entry site of the IV container. Alternately, follow the manufacturer’s directions for insertion. Hang the container on the IV pole.

12. Alternately, hang the new IV fluid container on an open hook on the IV pole. Carefully remove the cap on the entry site of the new IV solution container and expose the entry site, taking care not to touch the exposed entry site. Lift empty container off the IV pole and invert it. Quickly remove the spike from the old IV container, being careful not to contaminate it. Discard old IV container. Using a twisting and pushing motion, insert the administration set spike into the entry port of the new IV container as it hangs on the IV pole.

13. If using an electronic infusion device, open the slide clamp, check the drip chamber of the administration set, verify the flow rate programmed in the infusion device, and turn the device to “run” or “infuse.”

14. If using gravity infusion, slowly open the roller clamp on the administration set and count the drops. Adjust until the correct drop rate is achieved.

To Change IV Solution Container and Administration Set
15. Prepare the IV solution and administration set. Refer to Skill 15-1, Steps 7–11.

16. Hang the IV container on an open hook on the IV pole. Close the clamp on the existing IV administration set. Also, close the clamp on the short extension tubing connected to the IV catheter in the patient’s arm.

17. If using an electronic infusion device, remove the current administration set from device. Following manufacturer’s directions, insert a new administration set into infusion device.

18. Put on gloves. Remove the current infusion tubing from the access cap on the short extension IV tubing. Using an antimicrobial swab, cleanse access cap on extension tubing. Remove the end cap from the new administration set. Insert the end of the administration set into the access cap. Loop the administration set tubing near the entry site, and anchor with tape (nonallergenic) close to site.

19. Open the clamp on the extension tubing. Open the clamp on the administration set.

20. If using an electronic infusion device, open the slide clamp, check the drip chamber of the administration set, verify the flow rate programmed in the infusion device, and turn the device to “run” or “infuse.”

21. If using gravity infusion, slowly open the roller clamp on the administration set and count the drops. Adjust until the correct drop rate is achieved.

22. Remove equipment. Ensure patient’s comfort. Remove gloves. Lower bed, if not in lowest position.

23. Remove additional PPE, if used. Perform hand hygiene.

24. Return to check flow rate and observe IV site for infiltration 30 minutes after starting infusion, and at least hourly thereafter. Ask the patient if he or she is experiencing any pain or discomfort related to the IV infusion.