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IV Solutions: Primary & Secondary Solutions for Adult & Pediatric Patients (102.052)

IV Solutions: Primary & Secondary Solutions for Adult & Pediatric Patients (102.052) - Policies, Clinical, UWMF Clinical, UWMF-wide, Clinical Policies and Procedures, IV and Fluids



Primary & Secondary Solutions for Adult & Pediatric Patients

Effective Date: September 2012 Approval: See Authorization
Supersedes Protocol: None Contact: Clinical Staff Education


PURPOSE: To provide guidelines for hanging IV solutions for peripheral intravenous (PIV) lines at UWMF
and DFM Clinics.

POLICY: The R.N. staff will utilize the following guidelines to initiate the appropriate IV solutions for
primary and secondary PIV lines.
The L.P.N., under the direction of the R.N. or provider, will utilize the following guidelines to properly initiate
the appropriate IV solution for primary and secondary PIV lines, only after being certified in IV skills.
However, the responsibility for the procedure remains with the supervising R.N. or provider.

Pediatrics – those patients weighing less than or equal to 50kg/110lbs, or 14 years of age or younger

Primary IV solution – used to initiate IV therapy; initial solution hung and attached to IV insertion device.

Secondary IV solution – also referred to as tandem or piggyback, is used when giving drugs with a small
volume of dilute solutions. A shorter (secondary) PIV tubing attached to the medication/solution bag is inserted
into an access port on the primary infusion tubing. Administering medications by this method reduces risk of
rapid drug-dose infusion and provides greater comfort for the patient.

Hanging of an IV solution - selecting the appropriate solution (based on the provider’s order), attaching the IV
solution to the patient and other appropriate equipment.

SUPPLIES: IV solution, IV tubing (primary or secondary, as indicated), IV pole and/or infusion pump
Provider’s order, Patient record

Primary IV Solutions

1. Check provider’s order and clarify any inconsistencies. Verify:
Type of solution
Rate of infusion
duration of therapy

2. Wash hands and gather supplies.

3. Identify patient, include patient’s full name and date of birth & verify allergies.

4. Prepare the IV solution using the “5 Rights of Drug Administration”
Right – drug, dose, time, route, patient
Check the expiration date of the IV solution

5. Inspect IV bag for tears, leaks, discoloration, cloudiness, particulate matter or other signs of contamination.
If ANY of these signs appear, discard solution, get new bag.

6. Remove IV tubing from packing and close off roll-clamp on the IV tubing.

7. Remove caps from both the end of IV solution container and spike of IV tubing. Maintain sterility of both

8. Insert spike into port of IV solution, (1 to 2 inches) holding the neck of the port tightly to prevent slipping
and possible contamination.

9. Hang IV solution on pole and squeeze the drip chamber until chamber is 1/2 filled with solution.

10. Open clamp and let fluid clear tubing of air.

11. Once tubing is filled with fluid, close clamp.

12. Provide Patient Education:
reason for the IV solution administration
desired effect
expected/common side effects
potential adverse reactions
when to call for assistance

13. Connect tubing to IV access device, as applicable.

14. Adjust infusion rate per physician order. This may be accomplished by counting drops, use of an infusion
pump, or addition of a Dial Meter to the IV tubing.

15. Monitor patient first 5 to 10 minutes of infusion.
NOTE: If reaction occurs:
Close IV line and immediately flush with saline
Contact provider and call 911 (if reaction is anaphylaxis in nature)
Complete PSN (patient safety net)

NOTE: If solution becomes contaminated with particulate matter during infusion:
Stop infusion and clamp IV line
Change IV solution immediately and flush with saline
Alert pharmacy, monitor patient, complete PSN
Document in chart

16. Documentation (Progress Notes in HealthLink)
Dosage, rate of infusion, and time started
Patient education
How patient tolerated procedure, i.e., desired effect, adverse reaction.

Secondary IV Solutions

1. Follow above steps 1 through 12 using secondary IV solution and secondary IV tubing.

2. Locate IV port closest to patient and cleanse IV port with alcohol swab. Connect secondary IV tubing to the
IV port.

3. Adjust drip rate per physician order.

4. Monitoring and Documentation
Dosage, rate of infusion, and time started and discontinued
Patient education
How patient tolerated procedure, i.e., desired effect, adverse reaction.

NOTE: If secondary solution contains medication, refer to UWMF/DFM policy: Medication Administration via
a Peripheral Intravenous (PIV) Line

WRITTEN BY: Ronnie Peterson, R.N., M.S., Manager of Clinical Support

REVISED BY: Carol Decker, RN, MSN, Clinical Staff Educator
REVIEWED BY: LaVay Morrison, RN, BSN, Clinical Staff Educator
Rebecca Harrison, RN, TL, East Towne Urgent Care

Infusion Nurses Society. (2006). Policies and procedures for infusion nursing. (3rd ed.). Infusion Nurses
Kowalak, J. P. (Ed.). (2009). Lippincott’s nursing procedures (5th ed.). Ambler, PA: Lippincott Williams &
Perry, A.G. & Potter, P.A. (2002). Clinical nursing skills & techniques. (5th ed.). St. Louis, MO: Mosby.
Perry, A.G. & Potter, P.A. (2009). Fundamentals of nursing. (7th ed.). Hall, A. & Stockert, P.A. (Eds.). St.
Louis, MO: Mosby Elsevier.

AUTHORIZED BY: Richard Welnick, MD, Medical Director, UWMF Ambulatory Clinic Operations
Sandra A. Kamnetz M.D., Vice Chair, Department of Family Medicine

Medical Director, UWMF

Vice Chair, Department of Family Medicine