in this video we're going to talk about iv sets the main thing we're going to look at are primary line secondary lines the difference between between peripheral lines and central ivy lines we're going to talk a little bit about drip chambers which is going to come up a little bit later in the next unit a lot we're going to look at roller clamps and how they work slide clamps and a few different pump types that you might see in the hospitals now the iv route is one of the big ways that we give medications and fluids in the hospital if you go to work in the hospital you will absolutely see these every day of your working life there are some components that you have to look at um typically it starts at the top with the iv bag an iv line iv pump down to the iv decathlon or catheter let's start with the iv bags that contains the fluid or medicine that the patient has been ordered to receive ivy lines are what transports the fluid from the bags to the patients we have different kinds of iv lines but let's talk a little bit about this one first this is typically what you'll see beside the bedside of a patient the one that is in green is the primary line this is what you basically spike into the iv bag the main bag fluid will start to drip down through a drip chamber some of them have a back check valve that keeps fluid from running back up not all of them have it the primary lines typically have ports on them where things can be connected or injected they have slider clamps roller clamps and that's typically what you'll see on primary lines secondary lines the one that just highlighted in pink you have a secondary bag we call these piggybacks usually these are medications that need to be given you can see this one has a little injection port on it that medicine can be injected into the fluid it has a little drip chamber and a smaller tube that goes down and connects into the primary line this one typically has a roller clamp or a slide clamp on it too but it's a lot shorter and it typically doesn't have ports to inject things in we're going to take a second and talk about drip chambers because this is going to be really big when we start calculating drops per minute the drip chamber is the little part that's at the very top of the primary ivy line it has a basically a big plastic needle that's a spike that we push into a port on the ivy bag once that's done fluids will start dripping down from the iv bag through the drip chamber and travel down through the rest of the tubing to get to the patient what we'll do is in this one you can kind of see that it's half full it's kind of a soft plastic that you could squeeze and when you do and it fills back up it pulls fluid down so that it can partly fill the drip chamber that's what we want us to be at halfway up when we're doing iv administrations we count the drills or the drops to see how fast we can give something we can actually calculate uh how many milliliters a person is getting based on the drops that are going and that's going to be in the next unit that we talk about we don't do it a whole lot on the floors but we need you to know how to do it now when we're talking about drip factors um there are numbers that you'll see on the iv tubing labels on the one on the left you see this is 60 that means that there are 60 drops in one milliliter the next one's on the right 15 drops per milliliter that doesn't mean anything right now but just remember because it'll come up again a lot later and again it's always listed on the iv tubing bag the drop factor tells you how many drops are in one milliliter so again we'll talk about this when we start getting into the drops per minute so iv lines let's talk a little about that we have two basic types of them we have the primary line and the secondary line it's listed as a piggyback line here the primary line it runs from the primary bag usually the big bag down to the patient it has sets of rollers and clamps and ports on it the secondary line the shorter one it runs from the secondary bag the pig backpack it's typically a medication that's being administered it usually has roller clamps on it to adjust drip rate roller clamps are these little things the little blue part you roll with your thumb and it's important because we can use that to partly squeeze the tubing if you look at the circle we'll say that's a wide open lumen of an iv tube and on the right hand side you can actually roll that lock up so it's partly closed so you can change the speed that the iv fluid is running at just by that again you do it by rolling the lorem part up and down now what it does is when it's completely open you have iv fluid running full speed you can roll it partially closed and you can watch this by looking at the drip chamber because when you partly close it the drips should slow down you can even completely close it and it stops all the iv fluid from running through the tube and the way you'd look at this is just look at the drops if they stop then a clamp is closed now there's a simpler kind of clamp it's called a side slot clamp if you look at the little green one on the right there's a wide spot that's completely open and the bottom part when you squeeze it the tube through it it's completely closed so this is either either or either running or not running and this is an example of one that's been closed you can see that it's in the little narrow part of the opening and it you can see that it's clamped shut so no iv fluid will run through that now after telling you that about the drops typically we don't count drops anymore but it's something you have to know just in case typically in the hospital we use iv pumps that tell us or that we can set to deliver certain amounts of fluid over a certain time so this is a lot more common than counting the drips in the drip chamber now when you're setting an iv pump you have two things that you have to look at you have to tell the pump how much fluid is going to be infused that's how much is in the bag that you want to run into the patient and you need to tell it how fast you want the fluid to run and over so how do you determine those depends on a couple of things you'll usually see doctor's orders say infuse normal saline at a rate of 100 milliliters an hour that's typically an ongoing thing that until the doctor says stop it we'll keep running that fluid so we know from this that we have to set the pump to run 100 milliliters an hour the other thing you have to know is the amount to be infused so the iv bags you see in the hospital they're typically a thousand milliliters but they do have different sizes so you have to know that before you can set this so you can set the pump to infuse a thousand milliliters at 100 milliliters an hour but as a real life practice note you usually don't do that you'll usually set it to something like 950 milliliters or 975 milliliters to infuse the reason is you don't want the drip chamber and the iv tubing to run down if it gets too far down uh or what i mean is that if air gets in the tubing and it goes so far down then you can't run air into the patient because it could cause a lot of problems so you'd have to replace the tubing so the little side goal is you don't want the tubing to run empty or you'll have to change it all okay that's one way of doing it doctors write other orders like roceph and one gram iv twice a day so this is usually the little piggyback medicines the 50 milliliter bag or 100 milliliter bag and the pharmacy typically pre-mixes those before they send them up to the hospital floor the nice thing is they also stick a label on it that gives you instructions so if you have rocephin that's been sent up as 1000 milligrams in 100 milliliters it and it instructs you to infuse over one hour well right there you have 100 milliliters to infuse at 100 milliliters an hour so that you get all of the medicine in an hour now bags aren't the only type of pumps that we have we have a few other things that are used and i just want to touch on them so that you'll know what they are if you see them we have syringe pumps and if you'll look at the kind of magenta purplish circled part you can see that it's a syringe instead of an iv bag these are used to administer small doses over time so if you have a medicine that has to be given extremely slowly this is one that you could set it to give on and here's another example this one just has two syringes to it the last type i want to talk to you about is uh pca pump patient controlled analgesia analgesia you can see that this one on the left hand side there's a little hand piece with a rectangular blue button the patient gets that and when they're feeling pain they can press that button and the pump will give them a little extra dose of medicine now the pump is usually set to give a small amount continuously anyway just real slow to help control the pain but if the patient feels like they're having some breakthrough pain or it's getting worse they can hit that blue button and it'll give them an extra dose typically it limits them though that they might be able to get one dose every 10 minutes that they push so they can't just empty the thing out in two minutes if they wanted to all right let's move on down to down the iv line to the insertion site here we see an iv catheter that's been inserted into looks like the left and a cubital area so this is uh something that again you're going to be seeing pretty common that when we insert ivs we typically have what's called a catholon that we have a needle with a little sheath over it so when you stick the needle in to the vein you'll get a blood return then you pull the metal needle out and it leaves the little sheath inside if you look on the left hand side the one that is kind of pinkish in the middle and you can see the white tip of it the white part is left in the vein and that's what the medicine goes through we have different sizes of these catheters we have 14 gauge which is a really thick one and they go every two to we see 20 which is kind of pink 22 which is the blue and 24 the smallest on the right which is a real small gauge which one we pick depends on the patient's condition and what they're receiving if they're going to be receiving something really thick or if they're getting blood then they need at least a 20 or an 18. you wouldn't want to use the smaller ones like a 22 or 24. so those are for peripheral ivs we have another kind called central ivs and what those are they go deeper the tip of the insertion line is close to the heart so what they do is they will do uh usually in the chest that they start inserting the catheter tube and the tip of it ends close to the heart this is uh for people who either we have trouble getting ivs in in the arms or legs or other places and uh or if they're getting some powerful medicines that will just burn up the little veins out in the body this is typically what a central line looks like you have uh either on the left or right hand side of the chest it goes down into the skin it's covered with a plastic or a little clear dressing so that we can look at it and if you'll look up at the tubes that come out up at the shoulder you'll see that there are three lines there that's called a triple lumen catheter the colors on this one are a little different but it's the same thing really you have three lines that you can inject medicines into now we have another type called a peripherally inserted central catheter that is where we take a long tube and insert it usually into the arm and the tube is a lot longer so it travels up to the heart where you can see on this example so it's a peripherally inserted central catheter so types of iv fluids that we have just to talk briefly about them one of the ones you see very common is normal saline we abbreviated ns you'll also see on the bags it'll say 0.9 percent sodium chloride that means there's 9 grams of sodium chloride in one thousand milliliters of sterile water another type is you might see five percent dextrose we write it as d5 sometimes that's basically a mix of glucose which is really just sugar in sterile water you might also see like the label on the right hand side that this one is it has the five percent dextrose the d5 and 0.45 sodium chloride so d5 one half normal saline it's a mix of glucose and salt in sterile water the last one is lactated ringers abbreviated lr this is a mix of electrolytes and sterile water has a lot of little things in it so i'm not going to name each one off to you but this is one that has a bunch of little things mixed in okay that's all for this section the next section we'll start talking about drip factors and infusion times so go ahead look in your books if you bought them to that and it'll be uploaded soon thank you