IV Bag Attachment (Spiking) and Flushing
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As an EMT you may be called upon to prepare an IV bag for a paramedic. This consists of attaching the IV tubing to the bag (spiking), and flushing the tubing to prime it. IV tubing must be primed with IV solution to remove air from the tubing to prevent air from entering the circulatory system. An air embolism is a potential complication of IV therapy and can enter a patient’s blood system through cut tubing, unprimed IV tubing, access ports, and drip chambers with too little fluid.
- Perform hand hygiene and don appropriate PPE.
- Gather supplies. You will need sterile IV solution, primary IV tubing, time label, change label, and alcohol swab.
- Verify the IV solution to be used is: a) The proper solution b) Clean, without particulate matter c) Not outdated d) Not leaking e) Warmed or cooled as indicated
- Select the proper administration set: Primary IV tubing can be macro-drip or micro-drip tubing. a) Macro drip chamber for trauma b) Micro drip chamber for medical conditions and drug administration
- Prepare the IV bag and administration set using an aseptic technique to prevent contamination.
- Remove IV bag from its protective envelope and gently squeeze to detect any punctures or leakage.
- Steady the port of the IV bag with one hand, and remove the protective cap by pulling smoothly to the right to keep it sterile.
- Remove the IV tubing from its protective wrapping or box
- Move the roller clamp about 3 cm below the drip chamber and close the clamp.
- Remove the protective cover on the IV solution port and keep sterile. Remove the protective cover on the IV tubing spike. Be careful and do not contaminate the spike.
- Invert the IV bag.
- Without contaminating the solution port, carefully insert the IV tubing spike into the port, gently pushing and twisting.
- Hang bag on IV pole. The IV bag should be approximately one meter above the IV insertion site.
- Invert all access ports and backcheck valve to prevent air bubbles remaining in the line during flush.
- Fill the drip chamber one-third to one-half full by gently squeezing the chamber. Remove protective cover on the end of the tubing and keep sterile. Filling the drip chamber prevents air from entering the IV tubing.
- With distal end of tubing over a basin or sink, slowly open roller clamp to prime the IV tubing. Invert backcheck valve and ports as the fluid passes through the tubing. Tap gently to remove air and to fill with fluid. Inverting and tapping the access ports and backcheck valve helps displace and remove air when priming the IV tubing.
- Once IV tubing is primed, check the entire length of tubing to ensure no air bubbles are present. This step confirms that air is out of the IV tubing.
- Close roller clamp. Cover end with sterile dead-ender or sterile protective cover. Hang tubing on IV pole to prevent from touching the ground. Keep the distal end sterile prior to connecting IV to patient.
- Label tubing and IV bag with date, time, and initials.
- Perform hand hygiene.