23.7 Checklist for Secondary IV Solution Administration
23.7 Checklist for Secondary IV Solution Administration
Use the checklist below to review the steps for completion of “Secondary IV Solution Administration.” This checklist is used when fluids are already being administered via the primary IV tubing and a second IV solution is administered.
View an instructor demonstration of Secondary IV Solution Administration[1]:
Steps
Disclaimer: Always review and follow agency policy regarding this specific skill.
- Gather supplies: secondary IV fluid/medication, secondary IV tubing, alcohol wipe/scrub hubs, and tubing labels.
- Verify the provider order with the medication administration record (eMAR/MAR).
- Perform the first check of the rights of medication administration while withdrawing the IV solution and tubing from the medication dispensing unit. Check expiration dates on the fluid and the tubing and verify allergies.
- Verify compatibility of the secondary IV solution with the other IV fluids the patient is currently receiving.
- Remove the IV solution from the packaging and gently apply pressure to the bag while inspecting for tears or leaks. Check the color and clarity of the solution.
- Perform the second check of the rights of medication administration.
- Perform safety steps:
- Perform hand hygiene.
- Check the room for transmission-based precautions.
- Introduce yourself, your role, the purpose of your visit, and an estimate of the time it will take.
- Confirm patient ID using two patient identifiers (e.g., name and date of birth).
- Explain the process to the patient and ask if they have any questions.
- Be organized and systematic.
- Use appropriate listening and questioning skills.
- Listen and attend to patient cues.
- Ensure the patient’s privacy and dignity.
- Assess ABCs (airway, breathing, circulation).
- Perform the third check of the rights of medication administration at the patient’s bedside.
- If the patient is receiving the medication for the first time, teach the patient and family (if appropriate) about the potential adverse reactions and other concerns related to the medication.
- Remove the secondary IV tubing from the packaging.
- Place the roller clamp to the “off” position.
- Remove the protective sheath from the IV spike and the cover from the tubing port of the IV solution.
- Insert the spike into the IV bag while maintaining sterility.
- Prime the secondary IV tubing. Back priming is considered best practice and is performed using an infusion pump or gravity with primary fluids attached:
- Vigorously cleanse the Y port closest to the drip chamber with an alcohol pad/scrub hub (or the agency required cleansing agent) for at least five seconds and allow it to dry.
- Connect the secondary tubing to the port closest to the drip chamber. Lower the secondary bag below the primary bag and allow the fluid from the primary bag to fill the secondary tubing. Fill the secondary tubing until it reaches the drip chamber, and then raise the secondary bag above the primary line.
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