ALRIGHT. WE'RE GOING TO KEEP
ADDING ON TO STARTING IV'S
AND IV THERAPY.

SO IN YOUR MIND, I WANT
YOU TO BE THINKING

THAT YOU'VE STARTED YOUR IV
AND YOUR IV IS DRIPPING.

OKAY? SO WE'RE GOING TO HEAD
INTO OUR CLIENT'S ROOM

THAT HAS AN IV THAT
IS CURRENTLY RUNNING.

WHEN WE DO OUR MEDICATIONS AND
WHEN YOU ARE REVIEWING
YOUR BOOKS

FOR COMPATIBILITY ISSUES
AND ALLERGY ISSUES AND
THOSE KINDS OF THINGS,

I WANT YOU TO KEEP IN
MIND THESE CRITERIA.

YOU KNOW THAT ALLERGIES OF OUR
CLIENT IN THE LAB ARE WHAT?

- PENICILLIN.
- PENICILLIN, SULFA,
CODEINE, KEEP THAT MIND.

AND THEN, AS FAR AS
COMPATIBILITIES,
THE SOLUTIONS

THAT WE'RE GOING TO BE HANGING
ARE ALL GOING TO BE
SODIUM CHLORIDE.

JUST BECAUSE SUGAR SOLUTIONS
IN MY MANNEQUINS CAUSES MOLD.

SO, ALL MY SOLUTIONS ARE GOING
TO BE SODIUM CHLORIDE AND
NOBODY'S ALLERGIC TO THAT.

BUT I'M GOING TO HAVE
ADDITIVES IN ALL THE IV'S.

AND SO THEY'RE EITHER GOING
TO HAVE A MULTIVITAMIN

OR THEY'RE GOING TO HAVE
POTASSIUM CHLORIDE.

THE MOST COMMON, COMMON OF
ADDITIVES WHEN YOU'RE
IN THE HOSPITAL.

THOSE ARE WHAT YOU'RE GOING TO
BE SEEING IN YOUR IV'S
AS ROUTINE.

THERE'S OTHER MEDICATIONS AND
YOU CAN DEAL WITH THOSE
LATER IN PHARMACOLOGY.

YOU'VE GOT YOUR HEPARIN AND
INSULIN AND THOSE KINDS
OF THINGS.

SO, WHEN YOU START LOOKING --

THE DRUGS THAT WE'RE
GOING TO HANG BECAUSE --

OUR PLAN THIS NEXT WEEK IS DRUG
ADMINISTRATION, MEDICATION
ADMINISTRATION.

I WANT YOU TO BE LOOKING AT
COMPATIBILITY ISSUES
WITH THE DRUG

TO THE POTASSIUM AND THE
MULTIVITAMINS WHEN YOU'RE
LOOKING AT THEM. ALRIGHT?

SO YOUR FIRST ASSIGNMENT,

BASICALLY, YOU HAVE THREE
STATIONS YOU'RE GOING TO
GO TO NEXT WEEK.

AT ONE STATION, YOU'RE GOING
TO HANG A PIGGYBACK.

AT ONE STATION, YOU'RE GOING
TO GIVE AN IV PUSH MED.

AND AT ANOTHER STATION,
YOU'RE GOING TO GIVE MEDS
THROUGH A BURETROL.

SO MEDICATION ADMINISTRATIONS
THROUGH CONTINUOUSLY
DRIPPING IV'S.

THAT'S OUR THEME FOR
THE WEEK. ALRIGHT.

THIS FIRST STATION WHAT WE'RE
GOING TO DO IS GOING TO BE

OUR ANCEF IV PIGGYBACK STATION.

SO THE DOCTOR HAS WRITTEN
AN ORDER FOR ANCEF 1 GRAM,

IV PIGGYBACK, EVERY 8 HOURS.

SO, I WENT AHEAD AND WROTE
THE ORDER IN 100 CC'S
OF SODIUM CHLORIDE

BECAUSE THAT'S WHAT YOU'RE GOING
TO CREATE YOUR BAG TO BE.

SOMETIMES, THEY WRITE WHAT
IT'S TO BE DILUTED IN,

BUT MOST OF THE TIMES IT'S HOW
IT COMES FROM PHARMACY.

AND SO PHARMACY THEN,
WHEN THEY MAKE UP YOUR MARS,

THEY'LL SAY WHAT THE SOLU --
WHAT THE DRUG IS IN.

SO, THEY'LL SAY 50 CC'S OF D5W
OR 50CC'S OF SODIUM CHLORIDE

OR 100 CC'S OF SODIUM CHLORIDE
OR 100M CC'S OF D5W

HAS WHAT IT'S BEEN, YOUR
MEDICATION HAS BEEN MIXED IN.

SO FOR OUR PURPOSES, WE'VE
CHECKED OUR DOCTOR'S ORDERS,

ANCEF 1 GRAM Q8 HOURS IV
PIGGYBACK HAS BEEN ORDERED.
THAT'S HOW IT'S ORDERED.

ANCEF 1 GRAM IV PIGGYBACK
Q8 HOURS. THAT'S ALL
THE DOCTOR SAYS.

AT THIS PARTICULAR STATION,
YOUR IV IS GOING TO BE
RUNNING AT TKO.

WHAT IS TKO? WHAT'S THE RATE?

- IT'S ONE OR TWO?

- IT'S 25 CC'S PER HOUR,
25 MILLILITERS PER HOUR

TO 50 MILLILITERS PER HOUR,
DEPENDING ON YOUR HOSPITAL.

VERY, VERY SLOW, BUT ENOUGH TO
KEEP THE IV FROM CLOTTING OFF.

YOU HAVE TO HAVE A CONTINUOUSLY
RUNNING IV OR IT WILL CLOT OFF.

UNLESS IT'S AN IV LOCK AND IT'S
MAINTAINED WITH SALINE.

BUT FOR OUR PURPOSES,
WE HAVE A DRIPPING IV.

WE HAVE GOT TO KEEP IT DRIPPING.

WHENEVER YOU HAVE ADDITIVES,
WHENEVER THERE'S SUGAR CONTENT,

IF IT STOPS DRIPPING, IT CLOTS
OFF. YOU'VE GOT TO KEEP
IT DRIPPING.

SO WE'RE JUST GOING TO
MAINTAIN OURS AT A TKO,

BECAUSE ALL OUR CLIENT NEEDS
RIGHT NOW IS MEDICATION,

NOT REALLY FLUID VOLUMES,
FLUID SUPPORT.

SO WE'RE JUST KEEPING THE
VEIN OPEN, GIVING HIM A
LITTLE HYDRATION.

ALRIGHT. SO THE STANDING
ORDER, AND IT SAYS THAT
IN YOUR SYLLABUS.

IV IS RUNNING AT TKO.

AND THE SOLUTION WE HAVE RIGHT
NOW IS SODIUM CHLORIDE.

1000 CC'S OF SODIUM CHLORIDE
WITH 40 MIL EQUIVALENTS OF KCL
IN IT RUNNING AT TKO.

ALRIGHT. THE DOCTOR'S
ORDERED ANCEF,

SO I'M GATHERING
UP MY EQUIPMENT.

PHARMACY SENT ME UP
A PIGGYBACK OF ANCEF.

SO WHAT I WANT YOU TO DO IS, ON
THE PIGGYBACK THAT I GAVE YOU,

THAT'S YOUR SMALL VOLUME
BAG, 100 CC'S,

PUT A LABEL ON IT
AND CALL IT ANCEF.

IT'S ANCEF 1 GRAM. THERE YOU GO.

I'VE GATHERED IT UP. THE
SAME CRITERIA AS BEFORE.

WHEN YOU GATHER UP, GET IN
THE HABIT OF LOOKING FOR
EXPIRATION DATES.

THERE'S GOING TO BE
TWO EXPIRATION DATES.

ONE IS ON HERE THAT'S THE
MANUFACTURER'S, YOU CAN
HARDLY SEE IT,

BUT IT'S OCTOBER '04 ON HERE.
SO MY SOLUTION IS GOOD.

BUT WHAT YOU'RE EVEN
MORE CONCERNED ABOUT,

YOU WANT TO KNOW THE
BASE OF IT'S GOOD.

BUT WHEN DID PHARMACY MIX IT
AND HOW LONG IS THIS GOOD?

AND THIS IS ONLY GOOD FOR 24
HOURS MIXED IN SODIUM CHLORIDE.

HOW DO I KNOW THAT?
BECAUSE PHARMACY TOLD ME

AND OR YOU WOULD LOOK IN
YOUR BOOK OR THE LABEL,
DRUG LABEL

TO SEE HOW LONG IT'S
GOOD AFTER IT'S RECONSTITUTED.

ALRIGHT. SO PHARMACY HAS
ALREADY MIXED IT FOR ME.

THEY'VE TOLD ME MY MEDICATION,
THEY'VE GIVEN ME MY TIME
AND DATE ON HERE

SO I KNOW THAT
MY DRUG IS GOOD.

I ALSO KNOW THAT THIS IS
THE FIRST ANCEF THAT MY
CLIENT'S RECEIVED,

SO I WANT TO CHECK ALLERGIES
AND MAKE SURE MY CLIENT'S
NOT ALLERGIC TO ANCEF.

ANCEF IS CEPHALOSPORIN,

OR ANY OF THE ALLERGIES
WE HAVE IN THE LAB IS
CEPHALOSPORIN ALLERGIES.

- PENICILLIN?

CEPHALOSPORIN. PENICILLIN IS
ACTUALLY A CILLIN, NOT A SPORIN.

BUT THEY'RE VERY, VERY CLOSE
AND WE VERY SELDOM GIVE
BOTH TOGETHER.

SO IF YOU'RE ALLERGIC TO A
CILLIN, WE DON'T ALWAYS
SPORINS EITHER.

- BUT THAT'S WHY WE NEED TO
CHECK FOR PENICILLIN?

YEAH. SO CAUTION, BUT CHECK

WHEN YOU LOOK IN YOUR BOOKS,
LOOK UNDER THE DRUG ALLERGIES,

WHO IS THIS CONTRAINDICATED FOR.

IT'S NOT A PROBLEM WITH SULFA,

IT'S NOT A PROBLEM WITH CODEINE.

OKAY?

AMPICILLIN WOULD BE
OUR BIGGER ONE.

SO, SOMETIMES YOU'LL GIVE A
SPORIN WITH THE CILLIN
DEPENDING ON --

WITH A CILLIN ALLERGY, DEPENDING
ON WHAT THEIR ALLERGY
REALLY IS. SO.

- THE COMPATIBILITY CHART
TOO?

- NO. IT'S GOING TO HAVE TO DO
WITH CONTRAINDICATIONS.

COMPATIBILITIES IS, IS ANCEF
COMPATIBLE WITH SODIUM CHLORIDE?

IS ANCEF COMPATIBLE WITH
POTASSIUM CHLORIDE?

SO THAT, WHEN THESE TWO
START RUNNING TOGETHER

AM I GOING TO GET A
PRECIPITATE IN THE TUBING?

SO NOW YOU WANT TO LOOK
FOR Y-SITE COMPATIBILITY

OR SYRINGE COMPATIBILITY.
AND I LOOK IN BOTH.

THIS I GOING TO ACTUALLY
BE A Y-SITE.

WE'RE GOING TO COME TOGETHER
HERE WITH TWO TUBINGS.

SYRINGE, WOULD BE PUSHING
IT THROUGH THE TUBING. BUT
WHAT'S THE DIFFERENCE?

THEY'RE BOTH GOING TO BE MIXED
IN THE TUBING.

SO I LOOKED IN BOTH OF THESE,
TO SEE WHAT THEY'RE
COMPATIBLE WITH.

AND THEN IT'LL LIST
INCOMPATIBILITIES AS WELL.

BUT I LIKE TO LOOK FOR
COMPATIBILITIES.

SO, WHICH WOULD LEAD US
RIGHT TO COMPATIBILITIES.

I CHECKED ALLERGIES, I DON'T
THINK I HAVE A PROBLEM HERE
WITH MY CLIENT.

COMPATIBILITIES, I KNOW I'M
COMPATIBLE WITH EVERYTHING,
OKAY, FOR MIXING.

I'VE ALSO -- FOR GATHERING
UP MY EQUIPMENT, I NEED
ANOTHER TUBING.

I HAVE THIS TUBING, BUT I
NEED A SECONDARY TUBING.

SO NOW YOU'RE GOING TO GET
YOUR SECONDARY TUBING WHICH
IS A SHORT TUBING.

LET ME SEE IF IT HAS
THE INCHES ON HERE.

NO, IT DOESN'T. BUT THEY'RE
SHORTER AND THEY DON'T HAVE
INJECTION PORTS.

IT'S JUST A LITTLE SHORT
STRAIGHT TUBING

THAT'S GOING TO GO DIRECTLY
TO THE LINE.

SO, I WASHED MY HANDS PRIOR
TO GETTING MY MED READY.

AND I'M GOING TO GO AHEAD
AND GET IT SET UP HERE
IN THE NURSING STATION.

SO YOU CAN PRACTICE WITH YOURS.
YOU CAN GET YOURS LABELED.

AND YOU CAN HOOK UP YOUR
PIGGYBACK THROUGH YOUR TUBING,

BEFORE YOU COME TO THE STATION.

- DO WE HAVE THAT?
- YOU HAVE THIS.

SO HERE YOU HAVE YOUR
SECONDARY TUBING.

WHAT ARE WE LOOKING
FOR IN THE PACKAGE?

DROP FACTOR. DROP FACTOR
IS 15. OKAY.

INSIDE YOU'RE GOING
TO HAVE TUBING.

NOTHING SPECIAL ABOUT THE
TUBING, IT HAS THE SPIKE,
HAS THE VENT,

IT HAS THE DROP CHAMBER,
IT HAS THE ROLLER CLAMP.

THIS IS REALLY SHORT TUBING,
SO THIS IS REALLY IMPORTANT
THAT YOU TURN THE CLAMP DOWN.

IF I FORGET THE CLAMP ON THE
LONG TUBING, I USUALLY CAN CATCH
IT BEFORE IT ALL RUNS OUT.

BUT IF I DON'T ON THE SHORT
TUBING,

IT'S SQUIRTING ON MY SHOE
BEFORE I'VE GOT IT.

SO, REAL IMPORTANT TO GET
THAT ONE CLAMPED DOWN.

THERE'S A LITTLE CLIP. WE DO
NOT NEED THIS ADAPTOR CLIP.

THIS IS FOR AN INTERLINK SYSTEM
OR A PRECUT, PRE-SLIT MED PORT.

OURS IS NOT A PRECUT, IT DOES
NOT NEED ADAPTORS, THIS
IS A DIAPHRAGM.

IT'S A DEPRESSIBLE DIAPHRAGM IN
HERE THAT WE'RE GOING TO USE.

IF WE STICK NEEDLES IN TO
THESE, WE BREAK THEM.

ALTHOUGH THIS ISN'T A NEEDLE,

IT'S AN ADAPTOR FOR A
PRECUT RUBBER STOPPER.

I'LL SHOW YOU ONE LATER.
YOU JUST DON'T NEED THAT.

ALRIGHT. YOU HAVE TWO PORTS.

AND I DON'T KNOW WHICH ONE'S
WHICH HERE. ONE'S FOR MEDICATION
ADMINISTRATION, ADDITIVE.

AND I GUESS THE ONLY WAY TO
KNOW HERE IS TO SPLIT IT OFF.

IT'S NOT THIS ONE. THIS ONE'S
YOUR RUBBER STOPPER

AND THAT'S WHAT YOU WOULD
PUT MEDICATION IN.

SO, THE ONE I NEED IS THIS ONE
THAT GIVES ME THE OPEN HOLE

SO I COULD PUT THE SPIKE IN IT.

ALRIGHT. TAKE YOUR SPIKE OFF.

THESE ARE SO STIFF.

BUT YOU WANT TO GET THAT
ALL IN. ALRIGHT.

PULL YOUR DROP CHAMBER HALFWAY
AND THAT'S ALL YOU NEED FOR NOW.

ACTUALLY, I DON'T EVEN
REALLY NEED TO DO THAT.

WHAT IF YOU FILL IT UP
ALL THE WAY BY ACCIDENT?

- TURN IT OVER.
- TURN IT OVER AND YOU CAN
SQUIRT IT BACK IN. OKAY?

ALRIGHT.

THE SAME RULE FOR THIS TUBING
IS FOR YOUR OTHER TUBINGS.

THEY'RE GOOD 48 TO 72
HOURS DEPENDING ON YOUR
HOSPITAL POLICY.

THE INS, INTRAVENOUS NURSING
SOCIETY HAS ACTUALLY CHANGED
THE CRITERIA

FOR TUBINGS THAT HAVE MEDICATION
AND THEY THINK

THEY SHOULD BE RUN FOR
A SHORTER PERIOD OF TIME.

SO YOU'RE GOING TO HAVE TO FALL
IN LINE WITH YOUR HOSPITAL
POLICY ON THIS WHETHER IT'S --

SOME MAY BE EVEN 24,
BUT 48 TO 72.

WE'RE GOING TO GO AHEAD WITH
THE 72 HOUR POLICY

JUST BECAUSE IT'S
AN IN-HOUSE POLICY.

BUT DO WHAT THEY WANT.
SO I'M GOING TO GO AHEAD
AN TAG THIS LABEL.

YOU CAN SEE THAT
IF THE DOCTOR ORDERED

AN IV MEDICATION THE SECOND DAY
THEY WERE IN THE HOSPITAL

AND THEN SWITCHED BECAUSE IT
WASN'T RESPONDING WELL
TILL THE THIRD DAY.

YOU CAN HAVE TUBINGS WITH ALL
KIND OF TAGS AND LABELS ON THEM.

AND SO YOU JUST NEED
TO PAY ATTENTION.

YOU DON'T JUST CHANGE THEM ALL
ON WEDNESDAYS OR SOMETHING.

SO, YOU HAVE TO KEEP
TRACK OF IT.

ALRIGHT. WE DO NEED THIS
ADAPTOR HOOK HERE, AND
SO WE'LL KEEP THAT.

AND I HAVE MY ALCOHOL SWAB, I'M
GOING TO GET RID OF MY TRASH.

AND I'M GOING TO GO HERE.

BEFORE WE GO TO THE
NURSE'S STATION,

OR TO THE PATIENT'S ROOM,
YOU NEED A PLAN.

SO WHEN YOU GO TO GIVE YOUR MED,
YOU'RE GOING TO NEED TO --

I WANT MED CARDS ON ALL OF
THE MEDS THAT WE GIVE
FOR IV THERAPY.

AND YOU COULD BE BUILDING ON
THE MED CARDS YOU DID
LAST SEMESTER.

SO KEEP THEM AND JUST ADD TO
NOW, BUT ADD IV CRITERIA.

EVERYTHING WE DID LAST SEMESTER
WAS PO, SO, NOW IT'S IV.

THE MED IS GOING TO BE THE SAME
AS FAR AS WHAT IT DOES.

IT'S JUST HOW DOES IT
REACT INTRAVENOUSLY?

NOW YOU HAVEN'T DONE AN ANCEF
CARD, SO THIS WILL BE ALL NEW.

ON YOUR ANCEF, YOU GO AHEAD
AND YOU FIND THE SAME
THINGS YOU DID BEFORE.

BUT THERE'S SOME DIFFERENT
CRITERIA THAT WE NEED TO KNOW.

I ALREADY TALKED TO YOU ABOUT
ANCEF AS AN ANTIBIOTIC,
IT'S CEPHALOSPORIN,

I KNOW THAT IT'S SPECIFIC
FOR -- IT'S THE BACTERIA.

IT'S FIRST GENERATION
CEPHALOSPORIN AND SO FORTH
AND YOU CAN READ ALL THAT.

AND IT'S -- IT BINDS TO
BACTERIAL CELLS, GOOD FOR
STREPTOCOCCUS AND SO ON.

THE ROUTES AND DOSAGES, YOU
CAN LOOK FOR SIDE EFFECTS.

IN PARTICULAR, I JUST WANT TO
POINT OUT THAT AN UNDERLINED

WHICH IS MOST FREQUENT ADVERSE
REACTION IS PHLEBITIS.

OK, SO IT'S VERY IRRITATING
TO THE VEINS.

YOU'RE GOING TO WANT TO WATCH
THE VEINS OF THE CLIENT THAT'S
RECEIVING THIS MEDICATION

TO SEE IF THEY'RE HAVING
PAIN, REDNESS, STREAKING

RELATED PARTICULARLY TO
THIS DRUG.

SO PAIN, LOCALIZED PAIN AT
THE SITE.

OKAY. THEN WHAT YOU WANT TO DO
IS YOU WANT TO COME OVER
HERE TO CEFAZOLIN,

WHICH IS ITS GENERIC NAME

AND SEE IF THE DOSE THAT
I'VE PRESCRIBED,

FALLS WITHIN A SAFE AND
THERAPEUTIC RANGE.

AND IT SAYS HERE,
FOR MOST INFECTIONS,
250 MILLIGRAMS TO 1.5 GRAMS

EVERY SIX TO
EIGHT HOURS IS COMMON.

SO MY ONE GRAM EVERY
EIGHT HOURS, FINE.

ALRIGHT, MOVING ALONG IT TELLS
YOU HOW IT'S AVAILABLE
AND SO FORTH.

WHAT YOU WANT TO DO NOW IS YOU
WANT TO COME OVER HERE

INTO THE IMPLEMENTATION SECTION.

IMPLEMENTATION.
AND IN IMPLEMENTATION,

IT TALKS ABOUT PO, IM, IV
AND SO FORTH.

WHEN YOU COME OVER TO CEFAZOLIN,

IT TALKS TO YOU ABOUT WHAT YOU
CAN DILUTE IT WITH.

THIS IS WHERE I FOUND OUT MY
SYRINGE INCOMPATIBILITIES

AND COMPATIBILITIES OVER HERE,

BUT I'M ALSO LOOKING FOR SOME
OTHER PIECE OF INFORMATION.

HOW FAST DO YOU GIVE ANCEF?

DOCTOR DIDN'T SAY,
DID HE? SHE, WHOEVER.

THEY JUST SAID, ANCEF 1 GRAM,
IV PIGGYBACK EVERY EIGHT HOURS.

AND THAT'S ALL THEY'LL EVER SAY.

YOU HAVE TO GO TO THE BOOK
AND YOU HAVE TO FIND SAFE
ADMINISTRATION TIMES

FOR YOUR DRUG SO THAT YOU
GIVE IT AT A SAFE TIME.

THERE'S TWO WAYS TO GIVE ANCEF.

YOU CAN GIVE A DIRECT IV WHICH
IS THROUGH A SYRINGE AND PUSH IT

OR YOU CAN GIVE IT INTERMITTENT.

MOST OF THE TIME WE GIVE
OUR DRUGS INTERMITTENT

BECAUSE IT'S IN A LARGER
SOLUTION AND IT'S NOT
QUITE AS IRRITATING

AND WE TEND TO NOT BLOW UP
THE VEINS.

SO WE GIVE THEM AS A DRIP.

IT MAINTAINS A SIMILAR PRESSURE
IN THE VEIN

AND THEY TEND TO
RESPOND BETTER TO IT.

YOU CAN GIVE A PUSH
IF YOU'RE IN A HURRY.

THEY NEED TO GO TO SURGERY,
YOU'RE GIVING A PRE-OP,

IT'S GOOD TO KNOW THAT
YOU CAN MIX THIS IN 10 CC'S

AND GIVE IT OVER FIVE MINUTES
AND JUST PUSH IT IN, SPEED-WISE.

ALRIGHT, WE'RE GOING TO GIVE
OURS PIGGYBACK. SO YOU'RE
GOING TO COME UP HERE

TO INTERMITTENT AND YOU'RE GOING
TO LOOK AT THE SAFE RATE
OF ADMINISTRATION.

AND IT SAYS THAT IT SHOULD
BE ADMINISTERED OVER
30 TO 60 MINUTES.

ALRIGHT, THAT'S WONDERFUL.

SO WE NEED A PLAN.

YOU HAVE 100 CC'S OF FLUID,

WITH A 15 DROP FACTOR THAT
YOU NEED TO INFUSE OVER
30 TO 60 MINUTES.

30 BEING THE FASTEST,
AN HOUR BEING THE SLOWEST.

IF IT GOES FASTER THAN 30.
WHAT MIGHT HAPPEN?

- MIGHT HAVE ADVERSE
DRUG REACTION.

- IRRITATION.

IT ACTUALLY TALKS ABOUT
SEIZURES IN THERE.

SO LOOK AND SEE. WELL,
WHY COULDN'T I GO FASTER?

ASK WHYS WHENEVER YOU'RE
GIVING MEDICATION.

I KNOW IT'S NOT THERAPEUTIC
COMMUNICATION TO ASK
YOUR CLIENT THAT,

BUT IT'S THE BEST QUESTION
YOU CAN EVER ASK YOURSELF.

WHY AM I DOING IT THIS WAY?
FIND THE ANSWER.

ALL RIGHT, WHY WOULDN'T WE WANT
TO GIVE IT OVER AN HOUR AND A
HALF OR TWO HOURS?

- WOULDN'T WORK?

- IT'S NOT AS EFFECTIVE.
IT'S NOT AS POTENT.

AND YOU NEED IT
TO BE CONCENTRATED
ENOUGH FOR THE CLIENT TO

EFFECTIVELY ATTACK THOSE --
THE BACTERIA THAT WE'RE
TRYING TO GET TO.

SO, YOU'VE GOT TO STAY WITHIN
THOSE SAFE PARAMETERS.

I USUALLY TRY TO GO
IN THE MIDDLE,

IN CASE THE IV IS RUNNING SLOW,
THEN I DON'T GET TOO,
BUT -- BEHIND.

AND IF THE IV'S OFF A LITTLE,
AND IT GOES TOO FAST,

AND I DON'T GO TOO FAST,
I JUST KIND OF AIM FOR
IN THE MIDDLE.

ALRIGHT, LET'S GO
WITH EASY MATH HERE AND START.

YOU HAVE 100 CC'S TO PUT
IN AN HOUR. WHAT'S
YOUR RATE?

- 100 CC'S OVER AN HOUR.

- YES, THAT'S IT.
100 CC'S PER HOUR, OKAY.

THAT WASN'T A TRICK QUESTION.

OKAY, OUR RATE IS
100 CC'S PER HOUR.

WE WANT TO GET IN THIS
100 CC'S IN ONE HOUR.

IF OUR DROP FACTOR IS 15,

AND I'LL LET YOU WORK
WITH YOUR DROP FACTOR ON
THIS ONE, AT THIS STATION.

HOW MANY DROPS PER MINUTE TO
ADMINISTER 100 CC'S IN ONE HOUR?

- 25.
- 25.

- 25 DROPS PER MINUTE.

AND THEN YOU CAN BREAK IT
DOWN INTO

A FIFTEEN SECOND OR A FIVE
SECOND INTERVAL, OKAY?

WHAT IF I WANT MY 100 CC'S TO
GO IN, IN 30 MINUTES.
WHAT'S THE RATE?

- 25.

- BE BRAVE.

200 CC'S PER HOUR, RIGHT?

IT WOULD HAVE TO RUN AT 200 CC'S
AN HOUR TO GET 100 CC'S IN,
IN 30 MINUTES.

HOW DID I FIGURE THAT OUT?

-- RATIO IS DOUBLED THERE?

- YOU HAVE TO TAKE 100
AND DIVIDE IT BY 30.

- NO.
- YOU HAVE TO TAKE
100 CC'S IN HALF THE TIME.

- UH-HUH. THAT'S TWICE AS FAST.

IT'S MADE AN EQUAL -- WHICH MADE
AN EQUAL RATIO.

YEAH, 100 CC'S GOES IN,
IN ONE HOUR,

THEN HOW MANY CC'S PER 0.5
HOURS?

AND IT WOULD BE 200.

SO 200 CC'S PER HOUR WILL GET
THIS IN, IN 30 MINUTES.

YOU DON'T WANT TO SAY
50 CC'S PER HOUR,

RIGHT. BECAUSE THEN
IT WOULD TAKE TWO HOURS.

AND THAT'S OUR TENDENCY IS
WE'RE DOING IT HALF AS FAST,

SO PEOPLE TEND TO
GO BACKWARDS WITH IT, OKAY, SO.

IF YOUR RATE IS 200 CC'S
PER HOUR,

AND YOU DROP FACTOR IS 15.
HOW MANY DROPS PER MINUTE?

- 50.
- 50, YOU DIVIDE BY 4, RIGHT?

BECAUSE 15 TIMES 4 IS 60,
SO OUR DIVISOR IS A 4.

DIVIDE YOUR RATE BY 4.

AND THAT'S ALL THERE IS TO IT.
THERE'S OUR PLAN.

ALRIGHT, LET'S SAY, OUR IV WAS
INFUSING AT 125 CC'S AN HOUR.

I KNOW RIGHT NOW IT'S TKO.

BUT LET'S SAY THE DOCTOR ORDERED
THIS IV, 1000 CC'S WITH

40 MIL EQUIVALENTS OF KCL TO
INFUSE CONTINUOUSLY AT
125 CC'S AN HOUR.

AND WE'RE GOING TO
HANG OUR PIGGYBACK

WOULD YOU CHANGE THE RATE FOR
YOUR PIGGYBACK TO BE

THE 30 MINUTE OR AN HOUR RATE

OR WOULD YOU LEAVE IT AT
125 CC'S PER HOUR?

- IS THIS CASE BY CASE BASIS,
I MEAN?

IT IS FINE, BUT YOU COULD LEAVE
IT AT 125 CC'S PER HOUR

TO MAINTAIN THE SAME FLUID
VOLUME FOR YOUR CLIENT
ON THAT HOURLY RATE,

HOW LONG WOULD IT TAKE THE
MEDICATION TO GO IN AT
125 CC'S AN HOUR?

IF 100 CC'S GOES IN,
IN ONE HOUR, 125 CC'S WILL GO
IN,

AND YOU CAN DO IT IN
A SIMPLE PROPORTION,

IN ABOUT 50 MINUTES, 45-50
MINUTES. IS THAT ACCEPTABLE?
YES.

ANYTHING BETWEEN 30 AND
60 MINUTES IS ACCEPTABLE.

SO YOU CAN LEAVE YOUR IV
RUNNING AT ITS PRIMARY RATE

OR YOU CAN CHANGE IT TO GET IT
IN SLOWER OR FASTER DEPENDING ON
HOW YOUR CLIENT'S TOLERATING IT.

LET'S SAY, THEY COMPLAIN OF
BURNING WHEN YOU PUT
THIS MED IN.

WELL, THEN DO IT SLOW. DO IT AS
SLOW AS YOU CAN, BECAUSE THEN
THERE WILL BE LESS BURNING.

IF THEY NEED TO GO TO SURGERY,
AND YOU NEED TO HAVE
YOUR MED IN,

IT'S A PRE-OP MED, YOU GET IT IN
IN 30 MINUTES. GET ON WITH IT.

SO YOU HAVE ROOM TO PLAY AROUND,
YOU'RE IN CHARGE.

YOU CAN DECIDE WHAT'S
BEST FOR YOUR CLIENT.

ALRIGHT, SO OUR PLAN,

YOU WORK IT, YOU CAN HAVE
ANY PLAN YOU WANT.

BECAUSE THE IV IS
RUNNING AT TKO,

YOU'RE GOING TO GET THIS IN
A SAFE ADMINISTRATION TIME.

SO, I JUST THINK I'LL PUT MINE
IN, IN OVER AN HOUR.

ALRIGHT, I HAVE A PLAN,
I HAVE MY SUPPLIES,
I HAVE MY MAR,

I CHECKED MY DRUG TO MY MAR,
I CHECKED MY ALLERGIES,
MY COMPATIBILITIES,

I THINK I'VE JUST DONE ALL
I COULD POSSIBLY DO.

SO, I AM GOING INTO
MY CLIENT'S ROOM.

YOU WILL BE DOING CLIENTS
AT BED STATIONS,

I DON'T KNOW WHICH BEDS
YOU'RE GOING TO GET

BECAUSE IT'LL ALL BE
FAIR GAME, SO.

ALL I SAID ON HERE IS
ADULT CLIENT.

SO, YOU'RE JUST GOING TO HAVE TO
TAKE YOUR MAR TO YOUR
ADULT CLIENT.

GOOD MORNING, WHOEVER ARM.

AND I'M DIANE. I'LL BE
YOUR NURSE TODAY.

AND I HAVE YOUR IV
ANTIBIOTIC FOR YOU.

SO I JUST NEED TO
CHECK YOUR NAME BAND.
COULD YOU TELL ME YOUR NAME?

ADULT CLIENT, AND I CHECK
MY MAR TO THE NAME BAND
AND ALL IS WELL HERE.

I WOULD AGAIN CHECK
THE ALLERGY BAND

AND THIS WILL BE YOUR LAST
CHECK FOR ALLERGIES

BECAUSE YOU'LL KNOW
WHEN YOU GET TO THE BED
WHICH ALLERGY THEY REALLY HAVE,

WHETHER IT'S INDICATED FOR
THEM OR NOT.

ALRIGHT, BEFORE I HANG THIS
I'M JUST GOING TO DO MY
THIRD CHECK HERE

AND MAKE SURE AGAIN THAT I HAVE
THE RIGHT MED FOR THE CLIENT

I'VE JUST IDENTIFIED
AND I DO ANCEF.

SO, I'M GOING TO COME OVER HERE,
AND THE FIRST THING I WANT TO DO
REALLY EVEN BEFORE

I HANG THIS MED IS
I WANT TO ASSESS MY IV SITE.

WE'RE ALWAYS CHECKING THE
IV SITE, EVERY HOUR.

YOU TALKED ABOUT --
WHEN AFTER YOU STARTED YOUR IV.

WELL, HERE'S WHERE
IT COMES INTO PLAY.

AND WE'RE GOING TO LOOK AT YOUR
IV SITE PRIOR TO HANGING THIS

AND MAKE SURE ITS NOT
INFILTRATED, MAKE SURE
THAT THERE'S NO SIGNS OF...

..SWOLLEN, HARD, PAINFUL SKIN,
NO REDNESS, NO STREAKS.
LOOK FOR LEAKING.

SOMETIMES THE IV MAY NOT BE
INFILTRATED BUT THE SITE
IS JUST OLD

AND IT'S JUST NOT DOING WELL,
AND FLUID IS JUST LEAKING OUT.

THE SITE'S NOT GOOD.
CHECK YOUR DRESSING,

MAKE SURE YOUR DRESSING'S
INTACT, THAT THIS IS STABLE,
THAT THE IV IS DRIPPING,

THAT IT'S RUNNING THE RATE
YOU WANT IT TO RUN,

IT'S FLOWING WITHOUT ANY
DIFFICULTY, IT'S NOT
AN OLD SITE.

YOU HAVE TO CHANGE THIS
EVERY THREE DAYS TO KEEP
PHLEBITIS DOWN.

I GAVE YOU TWO WONDERFUL
ARTICLES ON PHLEBITIS

AND MEDICATIONS THAT
CAUSE PHLEBITIS.

IT TALKS ABOUT MECHANICAL
PHLEBITIS.

I FIND IT INTERESTING THAT WOMEN
ARE MORE PRONE TO PHLEBITIS
THAN MEN.

INTERESTING.

MECHANICAL PHLEBITIS.

WE CAN CAUSE PHLEBITIS BY JUST
PUTTING IN TOO LARGE
A CATHETER.

SO THAT'S WHERE WE GOT
OUR RECOMMENDATION

TO PUT ALWAYS THE
SMALLEST CATHETER IN
SO THAT...THE CATHETER

ITSELF ISN'T CAUSING
PHLEBITIS AND IRRITATION.

AS WELL AS HOW WE STUCK THE
VEIN] AND HOW WE PUNCTURED IT.

BUT WE CAN ALSO CAUSE
MEDICINAL PHLEBITIS,

AND SO OUR MEDICATIONS CAN
BE IRRITATING TO THE VEINS
AND CAUSE THE SAME THING.

SO IF OUR CLIENT'S BEEN
ON ANCEF FOR A WHILE,

YOU WANT REALLY BE WATCHING THIS
VEIN TO SEE HOW IT'S HOLDING UP.

ALRIGHT. SO OUR SITE LOOKS GOOD.
MY IV TUBINGS, MY VEINS,

EVERY THING IS BEAUTIFUL.
THIS WAS JUST HUNG TODAY.

MY TUBING'S GOOD FOR A
WEEK -- FEW MORE DAYS.

THIS HAS JUST BEEN HUNG TODAY,
SO EVERYTHING LOOKS GOOD
ON THIS CLIENT.

ALRIGHT. I NEED TO NOW
GET MY PIGGYBACK GOING,

SO WHAT I NEED TO DO
IS SET UP A SYSTEM

THAT WILL ALLOW THE
PIGGYBACK TO GO IN.

SO, THE FIRST THING I WANT
TO DO IS I WANT TO HANG

MY PRIMARY BAG ON THIS HOOK,

SO THAT IT'S HANGING LOWER
THAN WHAT MY SECONDARY
BAG IS GOING TO HANG.

YOU WANT YOUR SECONDARY BAG,

YOU CAN HANG IT ON THE SAME
HOOK, YOU CAN PUT IT OVER HERE.

YOU WANT IT TO HANG HIGHER

SO THAT THIS IS GOING TO BE
DRIPPING AND OVERRIDE THIS ONE.

ALRIGHT. HAVE YOU NOTICED THAT
I HAVEN'T PRIMED MY TUBING IN,

IS THAT WORRYING ANYONE YET?
OKAY, DON'T WORRY, YET.

OKAY, THE FIRST THING I WANT
TO DO IS I WANT TO CONNECT
MY TUBING TO MY --

MY SECONDARY TUBING TO MY
PRIMARY TUBING BEFORE
I PRIME IT.

AND THIS IS WHY. LET ME JUST
SHOW YOU HOW TO CONNECT
HERE FIRST.

YOU'RE GOING TO CLEAN YOUR PORTS
JUST LIKE YOU WOULD A
MEDICATION VIAL,

TAKE THE CAP OFF. SAVE THESE
BLUE CAPS BECAUSE THEY'LL
KEEP YOUR ENDS STERILE

AND YOU CAN SIMULATE STERILITY.

TO MAKE THESE WORK, NOTICE
RIGHT NOW THAT NO FLUID IS
PASSING BACK AND FORTH.

BUT MY TUBING NOW IS
GOING TO GO IN HERE

AND IT'S GOING TO PUSH
THE DIAPHRAGM DOWN,

SQUEEZE IN AND NOW I
HAVE A PATENT SYSTEM.

AND THAT'S AS SIMPLE
AS IT IS. I LOVE IT.

IT'S MY FAVORITE ONE. NO
NEEDLES, NO ADAPTORS, NO PARTS.

YOU JUST HOOK UP TO TUBING.

ALRIGHT. WHAT I WANT TO
DO NOW IS I WANT TO TAKE

MY SECONDARY TUBING AND I
WANT TO PRIME IT WITH
MY PRIMARY TUBING.

IT'S CALLED BACK FILLING.

AND WE'RE GOING TO TAKE AND LET
THE AIR FROM THIS TUBING
GO UP INTO THE BAG

AND ACTUALLY PUT A LITTLE
MORE PRESSURE IN THE BAG

SO THAT IT WILL FLOW. IT'S
IMPORTANT FOR A GRAVITY SETUP.

YOU'RE GOING TO NEVER SEE NURSES
DO IT THIS WAY TO HOOK IT
UP TO A PUMP

BECAUSE A PUMP PULLS
THE FLUID OUT.

BUT WHEN WE'RE JUST
DOING IT BY GRAVITY,

WE NEED A LITTLE EXTRA PRESSURE
IN THERE TO OVERRIDE
THIS BIG BAG.

SO, WE'RE JUST GOING
TO OPEN UP THE CLAMP.

I LIKE TO KEEP MY
SETUP... FACING UP.

IF I TURN IT UPSIDE DOWN,
THEN I TEND TO OVERFILL
THE DROP CHAMBER.

PUT IT BELOW, OPEN UP
THE CLAMP ALL THE WAY,

AND THEN THE FLUIDS COME IN.
YOU CAN SEE THE AIR BUBBLE IN,

UNTIL IT COMES UP AND IT
STARTS FILLING UP YOUR
DRIP CHAMBER HALFWAY.

AND THEN CLOSE IT DOWN.

SO NOW I AM PRIMED AND
I HAVE A LITTLE BIT MORE
PRESSURE IN MY BAG.

ALRIGHT.

- I'M SORRY. THIS MAY SOUND
DUMB, BUT WHAT JUST HAPPENED?

DID SOME OF THE PRIMARY
IV FLUID GO BACK INTO --

- YEAH, BECAUSE THEY'RE TOTALLY
COMPATIBLE, THAT'S NO PROBLEM.

WE JUST DON'T WANT IT TO FILL
UP THIS BAG AND DILUTE IT OUT

BECAUSE THEN YOU DON'T KNOW HOW
MUCH FLUID IS IN THERE

AND IT'S HARD TO MAKE SURE
THAT THAT 100 CC'S COMES
OUT IN AN HOUR.

BUT AS LONG AS YOU JUST KEEP AN
EYE ON IT, AND THEN YOU JUST
PRIME TO YOUR DROP CHAMBER,

IT DOESN'T CHANGE YOUR VOLUME
AT ALL IN YOUR BAG.

BUT IT PUT THAT LITTLE BIT
OF AIR UP HERE, TO GIVE US
A LITTLE MORE PRESSURE.

KIND OF, THE SAME AS
PUTTING AIR IN A VIAL

SO THAT YOU CAN GET
THE FLUID OUT.

- AND THAT LOWER POSITION
CAUSES IT?

- UH-HUH. YEAH, BELOW
THE MAIN LINE.

ALRIGHT. MY MAIN LINE IS STILL
DRIPPING BECAUSE I DON'T
WANT TO --

YOU JUST DON'T TURN IV'S OFF.

IF YOU DO, THEY CLOT OFF.
YOU GOT TO KEEP THEM --

DON'T MESS WITH
THIS PART RIGHT NOW.

ALRIGHT, I'M GOING TO OPEN
THIS UP THIS NOW...TOTALLY.

OKAY? THIS IS TOTALLY OPEN.

AND I'M GOING TO REGULATE MY
DROP BY THE PRIMARY LINE CLAMP.

AND THAT'S REALLY IMPORTANT. YOU
DON'T REGULATE IT BY THIS ONE

BECAUSE YOU CAUSE
A PRESSURE IN HERE,

AND I CAN'T EXPLAIN IT
TO YOU PHYSIOLOGICALLY.

ALL I KNOW IS THAT IF YOU DON'T
OPEN THIS ALL THE WAY,

AND YOU REGULATE BY
HERE, BOTH DRIP,

AND EVENTUALLY THIS
QUITS DRIPPING BECAUSE
THE PRESSURE'S EQUALIZED,

AND THIS NEVER EMPTIES
AND THIS TAKES OVER.

YOU HAVE TO OPEN
THIS ALL THE WAY

AND YOU HAVE TO REGULATE
YOUR DRIP BY THIS ONE.

SO, WE'RE GOING TO COME UP HERE,
AND ARE RUNNING IT AT
100 CC'S PER HOUR,

SO 25 DROPS PER MINUTE DIVIDED
BY 12 IS GOING TO GIVE ME TWO,

ALMOST MAYBE THREE, MOSTLY
TWO EVERY FIVE SECONDS.

ONE..

TWO. BEAUTIFUL.

HERE. OKAY, NOTICE THAT
THIS ONE'S DRIPPING.

ALWAYS LOOK AT YOUR SYSTEM
AND MAKE SURE THAT THIS
OF THIS IS DRIPPING.

THIS ONE IS NOT.

IT TOOK OVER. BECAUSE IF
I HAVE THIS ONE DRIPPING
AT 100 CC'S PER HOUR,

AND THIS ONE DRIPPING
AT 100 CC'S AN HOUR,

THEN THEY'RE GETTING
200 CC'S AN HOUR.

AND NOBODY ORDERED THAT.

SO, ONLY ONE THING SHOULD
DRIP AT A TIME.

IF YOU HAVE IT REGULATED
BY THIS CLAMP,

THEN WHEN THIS ONE EMPTIES,
THIS ONE TAKES OVER

AND IT WILL START DRIPPING
AT 100 CC'S AN HOUR.

AND THAT WAY YOUR LINE NEVER
GOES DRY AND IT DOESN'T
CLOT OFF.

SO IT JUST KEEPS DRIPPING,
DRIPPING, DRIPPING.

SO I CAN GET IT DRIPPING.
I CAN LOOK AT MY CLIENT

AND I CAN SAY
EVERYTHING'S GOING OKAY.

I CAN COME OVER HERE,
I CAN SIGN MY MED OUT.

AND I CAN GO ON MY MERRY WAY
AND THEN KNOW

THAT IN AN HOUR OR SO,
THIS MED SHOULD BE IN.

ALRIGHT.

WE NEED TO TALK ABOUT
DOCUMENTING BUT IN
AN HOUR OR SO --

WASH MY HAND, GO DOCUMENT.

I'LL COME BACK, I'LL LOOK UP,

I'LL SEE THAT THE MED IS
ALL IN, IN AN HOUR.

THIS, WHAT HAPPENS IS, IT COMES
DOWN TO ABOUT HERE AND IT STOPS.

SO THEY ACTUALLY DON'T GET MAYBE
2 CC'S OF WHAT'S IN THE TUBING,

BECAUSE ONCE IT EQUALIZES
WITH THIS BAG, IT QUITS.

THIS BAG TAKES OVER.

WHEN YOU COME BACK
IN THE ROOM,

THEN YOU'RE GOING
TO TURN THIS ONE OFF.

YOU'RE GOING TO HOOK THIS
ONE BACK UP HERE,

YOU'RE GOING TO JUST LEAVE
THIS CONNECTED

FOR THE NEXT TIME
THE MED IS DUE.

AND THEN YOU'RE GOING TO RESET
YOUR RATE OF THE PRIMARY BAG
FOR WHAT YOU WANT IT.

SO NOW I WANTED IT TKO,
WHICH IS...
- 25.

- 25 CC'S PER HOUR DIVIDED BY 4.

6 DROPS PER MINUTE.

IT'S LIKE HARDLY DROPPING.
SO I'LL PROBABLY DO 50.

SO ABOUT A DROP EVERY
FIVE TO 10 SECONDS.

AND THERE I AM. I'M HAPPILY
DRIPPING IT TKO.

AND THEN THAT'S
HOW YOU LEAVE IT.

SO NOW WHEN THE MED
IS DUE IN EIGHT HOURS,

YOU'RE GOING TO GO
TO THE MED ROOM

AND PHARMACY IS GOING TO
HAVE ANOTHER BAG FOR YOU.

YOU'RE GOING TO GET THE NEW BAG,

COME IN HERE,
DO ALL YOUR CHECKS,

TAKE OFF THE OLD BAG,
PUT ON THE NEW BAG,

HANG IT ON THE SAME TUBING.

AND THEN OPEN, DROP, REGULATE.

OKAY?

QUESTION?

- AFTER THE SECOND,
THE NEW MEDICATION,

THEY'LL ALSO BE RE-PRIMED BY
LOWERING AND FILLING
THE AIR IN --

- OKAY, IT'LL BE HALF FULL.

SO, THEY'LL GET SOME
OLD STUFF IN THERE.

BUT YOU DO THE SAME THING,

BACKFILL, GET THAT AIR OUT.

GET IT.

WHAT WE DON'T DO IS WE DON'T
PUT DIFFERENT MEDS ON
THE SAME TUBING.

SO, IF THEY'RE GETTING LIKE
A MYCIN, LIKE A TOBRAMYCIN

A GENTAMICIN AND A
CEPHALOSPORIN, THEY EACH
HAVE THEIR OWN TUBINGS.

SO, IF THEY WERE
GETTING THEIR --

MYCIN OR TOBRAMYCIN
EVERY EIGHT HOURS,

AND IT'S LIKE IN TWO MORE HOURS,
SO I COME,

I'M GOING TO DISCONNECT
THIS AND PUT A CAP ON IT.

THEN I'M GOING TO HOOK MY
TOBRAMYCIN UP HERE, RUN IT,
LEAVE IT CONNECTED

AND THEN WHICHEVER MED COMES
UP NEXT IS HOW I'M GOING
TO SWITCH IT BACK.

BUT YOU DON'T JUST KEEP
LOADING UP MEDS TOGETHER.

THEY'RE NOT USUALLY COMPATIBLE,

THE DIFFERENT MEDS TOGETHER.

OKAY, SO THAT'S WHY YOU'LL
SEE TWO OR THREE BAGS SOMETIMES

HANGING FROM ONE PERSON'S POLE
BECAUSE THEY'RE GETTING
DIFFERENT THINGS.

WHAT I DON'T WANT TO SEE
EVER AND IF YOU SEE IT,
IT'S JUST BAD PRACTICE.

IS YOU'LL SEE, I HOPE YOU WON'T
SEE IT, I'VE SEEN IT.

YOU'LL SEE A CAP TAPED ON HERE

SO THAT YOU CAN KEEP HOOKING
ON YOUR PIGGYBACK. SO --

- I'M LOST.

YOU'LL SEE A CAP,
THIS IS TURNED OFF.

I NEED A NEW PIGGYBACK,
SO THEY'LL TAKE THIS
AND THEY'LL GO...

..AND THEY'LL STICK IT IN HERE.

NOW, HOW STERILE IS THIS?

IT'S BEEN SITTING HERE ON
A POLE TAPED FOR TWO DAYS.

ABSOLUTELY HORRIBLE,
HORRIBLE PRACTICE.

IT'S WRONG, IT'S JUST WRONG.
YOU SHOULD WRITE THEM UP,

PULL THOSE OFF, WRITE IT AGAINST
YOUR REPORT AND MOVE ON. OKAY,
IT'S JUST BAD PRACTICE.

AND THEN THEY PUT THE NEW ONE ON
AND THEN THEY TAKE THE NEXT
ONE OFF AND THEY HOOK IT.

IT'S NONSENSE.
YOU CAN'T DO THAT.

YOU HAVE TO MAINTAIN
THESE ENDS AS STERILE.

YOU HAVE TO GET SOME
KIND OF ADAPTOR,

AND THAT'S WHEN THIS MIGHT
FALL INTO PLACE.

YOU GET A CLEAN STERILE
NEEDLE OR ADAPTOR HERE
TO PROTECT THE END.

AND THIS IS ALL STERILE,
AND YOU HOOK IT ON.

AND THEN IT CAN HANG.

BUT YOU JUST CAN'T KEEP USING
THE SAME THING.

AND I KNOW IT'S STERILE, BECAUSE
I HAVE A CAP ON HERE.

BUT SOMETHING STERILE HAS
TO BE ON THE ENDS OF
ALL THESE TUBINGS.

OKAY?

BUT IF IT'S JUST ONE MED,
JUST LEAVE IT CONNECTED
FOR ALL DOSES.

WE HUNG OUR ANCEF
AT 13:40.

DB. MY NAME.

AND THAT'S ALL THERE IS TO IT.

TIME, AND YOUR INITIALS.

YOU DON'T HAVE TO PUT A SITE
BECAUSE THE SITE IS IV

AND IT'S ALREADY SPECIFIED ON
YOUR ROUTE OF ADMINISTRATION.

SO ALL YOU NEED IS TIME AND
INITIALS AND YOU SIGN IT
WHEN YOU HANG IT.

YOU DON'T SIGN IT AFTER
IT'S BEEN HUNG.

SO LET'S SAY IT INFILTRATES
HALFWAY THROUGH. RIGHT?

YOU GO IN, IT'S NOT DRIPPING.
THEY DON'T GET IT.

THEN YOU WOULD CIRCLE IT AND
SAY INFILTRATED AND DEAL
WITH THAT LATER.

AFTER YOU RESTART, MAYBE YOU
CAN GET IT GOING BEFORE THE
HOUR'S UP OR WHATEVER.

BUT FOR THE MOST PART,
WHEN WE HANG IT,

WHEN IT'S DRIPPING,
WE SIGN IT OUT. OKAY.

YOU'RE ALSO GOING TO DO
I&O AT THIS STATION.

ALRIGHT, SO YOU'RE GOING TO GET
A SHEET THAT LOOKS LIKE THIS.

THAT'S BEEN FILLED OUT
FOR THE DAY.

YOU'RE THE AFTERNOON SHIFT,
RIGHT?

SO THIS IS WHAT HAPPENED
IN THE MORNING.

THEY ACTUALLY HAD AN IV
OF D5 OR GOING.

1000 CC'S WENT IN.

BUT THE DOCTOR DECIDED
TO CHANGE --

WELL, A COUPLE OF
THINGS HAPPENED.

WE GAVE OUR ANCEF THIS
MORNING AT 6 O'CLOCK,

100 CC'S OF 0.9% OF SODIUM
CHLORIDE, ANCEF 1 GRAM
AND 100 CC'S WENT IN.

AND THEN AT 12 O'CLOCK, THE
DOCTOR SWITCHED THE IV SOLUTION

TO SODIUM CHLORIDE WITH
40 MIL EQUIVALENTS KCL.

ALRIGHT, THE DAYSHIFT.

SO JUST FIGURE THAT YOU'RE
COMING IN AT 1 O'CLOCK,
WHICH YOU ARE.

1 O'CLOCK, YOU'RE
THE AFTERNOON SHIFT.

AT 1 O'CLOCK, WHEN WE COLLECTED
I&OS, THIS IS WHAT HAPPENED.

AT 1 O'CLOCK, THEY HAD HUNG THIS
BIG BAG OF 1000 CC'S AT NOON.

AT 1 O'CLOCK, 100 CC'S
HAD GONE IN.

SO THEY'RE GIVING YOU A --
100 CC'S WENT IN FOR THEM.

SO ACTUALLY, FOR THIS SHIFT
1200 CC'S HAS GONE IN.

BUT THEY HAD TO GIVE
YOU A CREDIT.

REMEMBER I TALKED ABOUT LEFT IN
BAG, THE LIB FOR YOUR SHIFT,

YOU'RE COMING ON AT 1 O'CLOCK,
HOW MUCH FLUID IS IN THE BAG
FOR YOUR SHIFT?

HOW DO YOU KNOW HOW MUCH
WENT IN OR WILL HAVE GONE
IN ON YOUR SHIFT?

SO THEY LEFT YOU A CREDIT.

IF 100 CC'S WENT IN OF A 9 --
1000 CC'S, HOW MUCH IS LEFT?

900. SO AT 1 O'CLOCK,
OF THE SECOND BOTTLE,

900 CC'S IS HANGING OF SODIUM
CHLORIDE 40 MIL EQUIVALENTS
OF KCL.

OKAY, SO YOUR CREDIT FOR
YOUR SHIFT IS 900.

ALRIGHT. LET'S JUST
SAY IT'S 2 O'CLOCK.

AT 2 O'CLOCK, I HUNG MY 100 CC'S
OF 0.9 SODIUM CHLORIDE --

SO HARD TO READ, SORRY.

WITH 40 OF KCL.

HOW MUCH WENT IN?

100 BECAUSE MY BAG IS DONE.

REMEMBER I SAID IT WAS DONE.

SO YOU CAN PRETEND THAT
YOUR BAG HAS ALL GONE IN.

YOU HAVE TO PUT ON THE I&O WHAT
YOU HUNG AND HOW MUCH WENT IN.

AND THAT'S WHAT WOULD
HAPPEN ON YOUR SHIFT.

OKAY. THAT'S NICE.

THEN WE'RE GOING TO SAY TO YOU,
"ALRIGHT, IT'S THE END
OF YOUR SHIFT.

IT'S 9 O'CLOCK AT NIGHT,
COMPLETE THE I&O."

ARE YOU WITH ME SO FAR?

OKAY, YOU'VE GOTTEN THE CREDIT
FOR YOUR SHIFT AT 1 O'CLOCK.

DRIP TIME GOES BY FAST, AND
NOW IT'S 9 O'CLOCK AT NIGHT.

WE'RE GOING TO COME TO THE BAG.

AND OUR 100 CC'S HAS ALREADY
GONE IN, WE'VE TAKEN
CREDIT FOR THAT.

BUT NOW, WHAT YOU NEED
TO DO IS COME UP HERE,

AND LOOK AND SEE HOW MUCH IS
LEFT IN THE BAG RIGHT NOW.

I ALWAYS START WITH
WHAT'S LEFT IN THE BAG.

AND I START COUNTING
FROM THE BOTTOM UP.

AND HOW MUCH IS LEFT IN MY BAG?

- THAT'S ABOUT --
- HARD TO SEE. YEAH.
1000 WILL BE UP HERE.

- NO, BUT I MEAN,
IT IS 1000 BAG.
- IT'S 1000 CC BAG.

IT'S ON THE 2 MARK,
EACH MARK IS 100,

SO ABOUT 800 CC'S
IS LEFT IN THE BAG.

THAT'S THE CREDIT
FOR THE NEXT SHIFT.

THAT'S THE LIB IS WHAT
I'M GIVING THEM.

OKAY. SO LOOK AND SEE
WHAT'S IN THE BAG.

WHEN YOU'RE CALCULATING
AND WHEN YOU'RE ESTIMATING,

I MEAN, HOW ACCURATE
CAN YOU BE ON THESE THINGS?

GO TO THE NEAREST 25 CC'S
AND JUST GUESS.

IF IT'S BETWEEN THE 50 MARK,
THEN GUESS 25.

BUT DON'T GUESS 37 OR --
THERE'S JUST NO WAY.
SO JUST GUESS 25.

BUT OURS LANDED PRETTY CLOSE
TO A WHOLE NUMBER.

SO, I'M GOING TO COME DOWN HERE

AND AT 21:00, I HAVE 800 CC'S

LEFT IN THE BAG OF
0.9% SODIUM CHLORIDE...

..WITH 40 OF K.
HOW MUCH WENT IN?

THAT'S THEIR PROBLEM, HOW
MUCH WENT IN, IN MY SHIFT?

- 100 CC'S.
- IF 900 WAS WHAT WAS MY
CREDIT,

SUBTRACT WHAT I HAVE LEFT

AND YOU SHOULD HAVE
100 CC'S THAT WENT IN.

THE TOTAL THAT WENT
IN FOR MY SHIFT, 200 CC'S.

FOR I&O.

AND THAT'S IT.

IT WOULD SEEM SO SIMPLE AS
I DISCUSSED THIS WITH YOU.

THIS HAS TO BE THE WORST GRADE
THAT EVERYONE GETS EVERY
SEMESTER, EVERY SEMESTER.

I MEAN, WE'RE TALKING,
LIKE, 20S, 40S.

EVERY STEP IS ASTERISKED
ON THIS ONE.

BECAUSE I KNOW, IF YOU GET
THE LEFT END BOTTLE WRONG,

IF YOU GET THE NUMBER WRONG,

IF YOU DON'T GET YOUR SOLUTIONS
ON THE RIGHT LINE,

EVERYTHING'S MESSED UP.

IT'S DOCUMENTATION, EVERY SINGLE
STEP OF THIS IS ASTERISKED.

SO YOU GOT TO APPRECIATE WHAT
YOU'RE DOING, PRACTICE
WITH A COUPLE.

YOU'LL HAVE THIS EXACT SAME
SHEET, WE'LL HAVE DRIPPING IV'S.

NO ONE WILL HAVE THE SAME LIB,

AS THE DAY GOES ON, YOU KNOW,

THE 1 O'CLOCK PEOPLE
WILL HAVE. LIKE, 850,

BUT BY THE TIME IT GETS
TO 4:00 IN THE AFTERNOON,

THEY'LL HAVE 500 IN THE
BAG, I DON'T KNOW,

BECAUSE IT'S GOING TO KEEP
DRIPPING CONTINUOUSLY
ALL AFTERNOON.

AND YOUR IV -- LEFT-IN BAGS WILL
CHANGE AS THE DAY GOES ON.

SO YOU'RE GOING TO
TAKE RESPONSIBILITY
FOR YOUR PIGGYBACK,

YOU'VE GOT YOUR CREDIT FOR
YOUR SHIFT, JUST ASSUME
IT'S 2 O'CLOCK.

WHETHER YOU COME IN AT 1:00 OR
4:00, THAT'LL MAKE IT EASY.

AND THEN AFTER YOU'VE HUNG,
YOU'VE DOCUMENTED
YOUR PIGGYBACK,

THEN WE'LL SAY, "IT'S 9:00
AT NIGHT, COMPLETE THE I&O.

GIVE THE CREDIT
TO THE NEXT SHIFT

AND TOTAL OUT HOW MUCH
WENT IN FROM YOUR SHIFT."

YOUR CREDIT WILL BE 900.

OKAY.

- SO YOU STARTED OUT UP THERE,
THAT'S 1200, RIGHT, WHERE
YOU HAVE THE CIRCLE?

- THAT'S HOW MUCH WENT IN.

AND I ALWAYS CIRCLE THE TOTALS,

BECAUSE IF YOU DON'T,
SOMETIMES THEY GET ADDED UP

INTO THE NEXT SHIFT'S AMOUNT.

SO, CIRCLE THE
EIGHT-HOUR TOTALS,

BECAUSE AT THE END OF
THE DAY, THEY HAVE TO
TOTAL UP EVERYTHING.

AND SO, THEY'RE GOING TO TOTAL
UP THE THREE EIGHT HOURS

TO COME UP WITH A 24 HOUR
TOTAL OF WHAT WENT IN

BECAUSE WE'VE GOT TO START
MATCHING IT NOW TO
WHAT CAME OUT.

SO, YOU'RE GOING TO GET --
YOU'RE GOING TO HANG
YOUR PIGGYBACK.

IT DOESN'T TAKE
ANY TIME AT ALL,

YOU HOOK THE THING UP AND PUT IT
IN, GET IT DRIPPING.

YOU DECIDE, IT'S YOUR DECISION
HOW FAST YOU'RE GOING TO RUN IT

ACCORDING TO THE CRITERIA
IN THE BOOK.

WE ALREADY TALKED ABOUT 30 TO
60 MINUTES, YOUR DROP FACTOR.

THE IV'S RUNNING AT TKO,
MAKE IT HAPPEN.

THEN YOU'RE GOING TO CALCULATE
I&O AT ANOTHER STATION.

YOU GO OVER THERE AND
WORK OUT YOUR MATH.

AND, THAT'S IT, OKAY.
SO, TWO STATIONS

THAT YOU'RE GOING TO HIT.
ALRIGHT.