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This guide to setting up an intravenous fluid infusion provides a step-by-step approach to preparing and setting up an infusion of IV fluids, typically through a cannula, in an OSCE setting.
This should not be used as a guide to administering IV fluids to actual patients without first consulting your local medical school or hospital guidelines and undertaking the necessary training.
Gather equipment
Collect the equipment required for the procedure and place it within reach on a tray or trolley, ensuring that all the items are clearly visible:
- Clean procedure tray
- Non-sterile gloves
- Intravenous fluid bag
- Giving set
- Normal saline 0.9% (10 ml)*
- Syringe (10ml)*
- Alcohol wipe
- Infusion pump (If required)
- Drip stand
*These are not required if using a pre-filled flush (e.g. PosiFlush™)
Types of IV fluid
IV fluids can be categorised into 2 major groups:
- Crystalloids: solutions of small molecules in water (e.g. sodium chloride, Hartmann’s, dextrose)
- Colloids: solutions of larger organic molecules (e.g. albumin, Gelofusine)
For more information, see our guide to IV fluid prescribing.
Preparing the IV fluid infusion
Safety checks
Read the prescription chart and select a bag of fluids as appropriate.
- Carefully check the batch number and expiry date on the fluid bag.
Inspect the fluid bag for any damage.
Inspect the contents for any precipitate or cloudiness.
Double-check the prescription and any drug calculations with another registered health professional (e.g. nurse, doctor, pharmacist). You should also ask your colleague to inspect the bag for the expiration date, batch number, and other issues.
Record this check on the prescription chart.
Prepare a flush
If not using a pre-filled flush (e.g. PosiFlush™), prepare a flush:
1. Use an aseptic non-touch technique to assemble a 10ml syringe and a drawing up needle, then draw up 10mls of 0.9% saline.
2. Remove any air bubbles by gently flicking the syringe, then pulling back slightly and pushing air out of the syringe.
3. Dispose of the drawing up needle in the sharps bin and put the syringe back in the original packet to preserve the sterility of the tip of the syringe.
Prepare the infusion
Wash your hands using alcohol gel. If your hands are visibly soiled, wash them with soap and water.
Don non-sterile gloves.
Prepare the bag of fluids:
1. Open the bag of fluid using the provided perforations.
2. Open your giving set package and close the roller clamp.
3. Snap the square cover off the right-hand side port at the bottom of your fluid bag.
4. Remove the cap from the spike of your giving set, trying to avoid touching any of the key sites.
5. Stab the spike into the opening created by snapping off the cover of the right sided port on your fluid bag.
6. Holding the bag upwards, gently squeeze the chamber on your giving set to allow fluid to flow.
7. Slowly release the roller clamp and allow fluid to prime the giving set while keeping the bag upward.
8. Close the roller clamp again before placing the fluid bag on the clean trolley with your other equipment.
Final checks
Before proceeding, check the seven rights of medication administration.
1. Right person: ask the patient to confirm their details and then compare this to the patient’s wristband (if present) and the prescription. You should use at least two identifiers.
2. Right drug: check the labelled drug against the prescription and ensure the medication hasn’t expired.
3. Right dose: check the drug dose against the prescription to ensure it is correct.
4. Right time: confirm the appropriate time to administer the medication and check when the patient received a previous dose if relevant.
5. Right route: check that the planned route is appropriate for the medication you are administering.
6. Right to refuse: ensure that valid consent has been gained before medication administration.
7. Right documentation of the prescription and allergies: ensure that the prescription is valid and check the patient isn’t allergic to the medication you will administer.
Introduction
Wash your hands using alcohol gel. If your hands are visibly soiled, wash them with soap and water.
Don non-sterile gloves and other PPE if appropriate.
Introduce yourself to the patient including your name and role.
Confirm the patient’s name and date of birth and ensure that it matches with the prescription chart.
Briefly explain what the procedure will involve using patient-friendly language: “Today I need to give you some fluids that have been prescribed by the medical team through your cannula – the small plastic tube in your arm. This will involve connecting you to a bag of fluids via a long plastic tube, the tube will run through a pump that will make sure the fluids are delivered at the correct rate. This should not be painful but you may experience a strange sensation as the fluids start flowing into your vein.”
Check the patient’s understanding of the procedure and explain the indication for the treatment.
Check if the patient has any allergies (e.g. latex).
Gain consent to proceed with intravenous fluid administration.
Position the patient so that they are sitting comfortably.
Ask the patient if they have any pain before continuing with the procedure.
Check and flush the IV cannula
1. Adequately expose the patient’s cannula for the procedure.
2. Inspect the cannula site for any evidence of leakage, phlebitis or inflammation.
3. Clean the needle free port of your cannula with your alcohol wipe.
4. Connect the flush to the port and slowly inject the normal saline into the cannula.
The flush should be easy to administer with minimal resistance.
Observe for signs of swelling around the site or pain during administration and stop if this occurs.
Administer the fluids
1. Hang the primed bag on a drip stand.
2. Remove the cap from the end of your giving set and connect to the needle free port on the end of your cannula.
3. Set the drip rate or set up and use an infusion pump if required.
- Specific training is required to set up and operate infusion pumps; always follow your local guidelines.
4. When the bag is finished, disconnect the giving set, flush, and clamp the cannula.
To complete the procedure…
Explain to the patient that the procedure is now complete and that they should seek review if the cannulation site becomes painful or inflamed.
Thank the patient for their time.
Dispose of your PPE and other clinical waste into an appropriate clinical waste bin.
Wash your hands.
Document the details of the administration of IV fluids in the patient’s notes including:
- The patient’s details: full name, date of birth and unique identification number.
- The date and time that administration was performed.
- The type, expiry date and batch number of the bag of fluid administered.
- Your name, grade and contact details.
Remember to record any input on the patient’s fluid balance chart.
Editor
Dr Jess Speller
