IV Insertions

IV Line Insertion & Maintenance: Starting and maintaining peripheral IV lines.

Apply tourniquet → pick a vein and clean with CHG → pull down skill to stabilize vein → hold IV bevel up → poke and see for blood return, then push slightly further → "thread" catheter in → apply pressure to cather → press down on safety button to remove needle → connect IV port w/flush → check for blood return → flush the IV (push/pause) → clamp port and apply blue cap → secure IV with biopatch + dressing → secure IV tubing with tape in J shape → initial and date


IV Blood Transfusions

Blood Transfusion: Donated blood is delivered at a controlled rate, monitored by medical staff.

First: Check for patent IV site, signed informed consent, MD order

Supplies: Blood tubing (Blood administration set AKA Y tubing - Blood tubing is indicated by red ports), normal saline bag

Steps: Take out blood tubing and roll the clamps of the Y tubing → take the spike and spike the normal saline, then hang it on IV pole → Open the red port closest to IV bag → prime the saline into a trash can (ensure stopper is opened) → once primed, connect to IV port of the patient → place IV tubing into pump → retrive bag of blood: check color, consistency. then that verify info between transfusion request slip, bag of blood label, and pt's blood bank bracelet matches with second RN: name, account and MR number, DOB, blood type, unit number, cross-match verification. → Once verified, sign the transfusion slip. → Set up blood by: Getting initial set of vital signs → Then open port on blood tubing and connect the spike → then hang blood on the pole → MAKE SURE saline is clamped → prime blood line by starting pump, setting it at a quick rate → watch until blood reaches the patient and note the time → then set to the appropriate rate → stay with pt for first 15 minutes and retake vital signs → retake vital signs q 30 min for 4 hours

keep in mind that blood can only be transfused within 4 hours.


PICC Line Dressing Change

Supplies: Dressing change kit, Stterile transparent dressing, gloves, alcohol wipes, mask

First, change all the caps with new caps w/every use → change the IV port itself every dressing change → Open dressing change kit, don mask → remove dressing while stabilizing the tubes → remove stabilization device and rest of dressing (use alcohol pads) → remove gloves → don sterile gloves → drop the stabilization device into kit → crack CHG and wipe insertion area on the pt and wait to dry → apply skin protectant to area → apply biopatch → apply stabilization device → apply dressing over the site, ensuring CHG is lined up over port of entry → Write initials and date


Blood sampling via central venous device, direct method

Supplies: Biohazard bag, lab tubes, stickers/labels, vacutainer, alcohol pads, tourniquet

Apply tourniquet → unclamp IV → flush → clean the hub → apply vacutainer → apply tubes to vacutainer until filled → disconnect and invert tubes 8-10 times → release tourniquet → release vacutainer → flush IV with saline → label the specimens → place them in biohazard bag → send them to lab. → make sure you've documented, labeled, and it has been scanned. → Wait for results.


Blood Sampling via PICC Line

Supplies: Gloves, 10 CC syringe, flush, alcohol pad, blood collection tubes and labels, blood transfer unit, biohazard bag, PPE,

Verify the order → Don PPE → Trace the lines and stop ALL IV fluids that are infusing → Remove protective cap, scrub the hub → Apply flush to connector → unclamp and aspirate for blood return slowly → If NO blood return, do not force, notify MD → If there is blood return, flush slowly → then obtain blood sample that you you will discard → clamp the line after disconnection → Scrub the hub → Insert collection tube (10 cc syringe?) and collect specimen → clamp the line and scrub the hub → flush with NS and disconnect. → Continue and IV Meds that were infusing → The blood specimen syringe can be transfereed to appropriate tube using blood transfer unit → place in biohazard bag → send to lab


CVC Blood Draw

Supplies: Alcohol pads, flush, 10 cc syringe, 22 G safety needle, blood collection tube, biohazard bag, Luer Connector

Verify MD Order → Don Gloves → check for signs of infection → turn off any infusing solutions → D/C IV tubing and scrub the hub → withdraw blood until it reaches the syringe but doesn't enter → flush → withdraw blood using same syringe to 10 cc → discard this syringe into biohazard container → attach new empty 10cc syringe to port → withdraw blood sample (10cc) → remove syringe → attach blood transfer device to syringe → fill blood tubes → discard syringe in biohazard container → get a new flush and flush line → discard in biohazard sharps container → connect new access cap → connect IV tubing to extension tube → label specimen with date, time, initials, site → place in biohazard bag → send to lab


Oxygen Tanks

Indications: COPD, pulmonary fibrosis

Use dial to adjust flow of O@ based on MD order → connect tubing by placing one end over the nozzle on the tanks regulator. Reognize when humidifier bottle fluid is too high or too low


Blood sampling, direct

Supplies: appropriate tubes, appropriate needle size, vacutainer,

How to anchor veins(?): find a straight vein that is easily visible → create tension on the vein → position thumb 1-2 inches below insertion site and hold the vein down and in place →

Place tourniquet → palpate for vein on AC (medial or cephalic veins in the middle of the elbow) → cleanse site with alcohol pad → apply needle to vacutainer while keeping cover on the needle → hold vacutainer assembly and remove the needle cover (you should be holding it with thumb on top and fingers on the bottom) → anchor the vein by stretching skin downards → with bevel up, and needle parallel to vein, insert with quick and smooth motion at 15-20 deg angle → hold in place and steady → push lab collection tube to the vacutainer needle while keeping needle in the vein → allow tube to fill to maximum capacity → remove tube → invert the tube mix gently 8-10 times → continue filling tubes and inverting until order is filled → as last tube begins filling, release tourniquet → remove last tube → place gauze over puncture site and remove needle → dispose of the needle assemply in sharps container. → complete lab requisiton form and send lab → document procedure


IV Admixture

Supplies: medication, alcohol pads, correct size empty syringe, correct size needle, IV bag solution (based on order). Ensure med vial is compatible with IV solution

Remove cap from med vial and scrub with alcohol pad → Assemble needle to empty syringe → inject air (depending on dosage) into syringe, and then into vial → draw up right dose from med vial → remove air bubbles from syringe → locate med port on site of IV bag, scrub with alcohol pad → add drug into IV bag med port and dispose of needle into sharps container → gentle invert bag to mix med. Apply label w/name, dosage and med, date, time, initials


Malignant Hyperthermia


MRSA Screening BRN Protocol Competency


Restraints


Sigma Spectrum Infusion Pump


Type & Crossmatch, Obtaining Specimen


TB Test


Seizures

Recognizing seizures, ensuring safety, and administering anticonvulsants.


Wound Drains

Drain Management (JP, Hemovac, Chest Tubes): Monitoring and emptying surgical drains as needed.


Sepsis

Sepsis Protocols: Identifying early signs of sepsis, initiating fluid resuscitation, administering antibiotics.


Foley Catheter Insertion


Straight Catheter Insertion


IV Piggyback Infusion


Central Venous Catheter Dressing Change


Code Blue

Performing CPR, using defibrillators, administering emergency cardiac medications.

Code Blue Response: Performing BLS/ACLS protocols, assisting in intubations, and medication administration.


NG Tube Insertion


Stroke Emergency

Monitoring stroke patients, performing NIH Stroke Scale evaluations, recognizing changes in neurological status.


EKG Monitoring / Arrhythmias

Interpretation of cardiac rhythms, recognition of dysrhythmias, and appropriate interventions. Recognizing normal and abnormal rhythms (e.g., atrial fibrillation, ventricular tachycardia).


Heart Failure Management


Pain Management

Evaluating pain levels using scales and administering appropriate pain relief.


Tracheostomy Care


Fluid Management


Oxygen Management


Crash Cart


Vital Signs Monitoring

Frequent assessment of blood pressure, heart rate, oxygen saturation, and temperature.


Chest Tube Management

Monitoring output, maintaining patency, and preventing complications.


Discharge Planning & Teaching

Post-Discharge Instructions: Ensuring patients understand home care, follow-up appointments, and red flags.


Sterile Wound Dressing Change

Wound Dressing Changes: Using sterile technique to prevent infection.


Pressure Injury Prevention

Pressure Injury Prevention: Repositioning patients, using specialty beds or cushions, applying barrier creams.


Post-Op Monitoring

Post-Operative Monitoring: Assessing for signs of infection, dehiscence, or complications.


SBAR Reports

SBAR Communication: Using Situation, Background, Assessment, and Recommendation for clear handoffs and physician communication.


SubQ, IM, and ID Injections


Ampules & Vials


Applying Electrodes for 12-Lead ECG


Emptying & Changing Ostomy Bag


Enema Administration


Lab Value Interpretations / Electrolyte Management


5 Lead Electrode Placement