Gather Supplies:

• (1) Bag of _______ (medication)
• (1) Pre-filled syringe of Saline
• Alcohol Prep Pads
• Curlin tubing

Procedure:

1. Wash hands thoroughly with liquid soap for at least 20 seconds and dry with paper towels
2. Open curlin tubing package (IV tubing good for 3 days)
3. Break off tab on yellow piece of tubing.
4. Remove tab from IV bag
5. Remove cap from spike on tubing (be sure not to bump this against anything)
6. Insert spike into IV bag by pushing and twisting until you reach lip on spike
7. Remove air from tubing by holding bag up and squeezing yellow piece on tubing until fluid reaches bottom of tubing.
8. Load tubing into pump by opening door on top of pump. Place pump on its side with the keypad facing towards you. Load blue piece on tubing into hole by the blue arrow in pump, then set pump upright and load yellow piece on tubing into hole by the yellow
   arrow in pump. Close door.
9. Prepare saline flush by removing cap, pulling plunger back to break seal, and then pushing up to remove air from syringe
10. Clean end of PICC line with alcohol swab for 10- 15 seconds
11. Attach saline flush to PICC line
12. Open clamp on PICC line
13. Flush PICC line with saline flush
14. Remove empty flush from PICC line and discard
15. Clean end of PICC line with new alcohol swab for 10-15 seconds
16. Remove cap from end of IV tubing and attach tubing to PICC line
17. Turn Pump On. Pump will go through self-test. Then show how full batteries are.
18. When pump reads “Program: – hit the YES button on the pump
19. When pump reads “Repeat Rx” – hit the YES button on the pump
20. Once pump reads through settings, hit the RUN button on the pump to start infusion
21. When infusion is complete – Pump will beep and read “Infusion Complete.”
22. Wash hands thoroughly with liquid soap for at least 20 seconds and dry with paper towels.
23. Change batteries. Batteries are changed in the back of pump. Slide door to unlock and then slide down. Pull batteries out and replace with (2) C batteries that face the same way.
24. Take tab off of new IV bag, remove spike of tubing from empty IV bag and immediately insert into new IV bag.
25. Turn pump on and follow steps 18-20.

Gather Supplies:

• (1) Bag of TPN
• (1) Pre-filled syringe of Saline
• Alcohol Prep Pads
• Curlin tubing

NOTE: If you have additives, refer to your nurse before starting.

Procedure:

1. Wash hands thoroughly with liquid soap for at least 20 seconds and dry with paper towels
2. Open curlin tubing package 
3. Break off tab on yellow piece of tubing.
4. Remove tab from IV bag
5. Remove cap from spike on tubing (be sure not to bump this against anything)
6. Insert spike into IV bag by pushing and twisting until you reach lip on spike
7. Remove air from tubing by holding bag up and squeezing yellow piece on tubing until fluid reaches bottom of tubing.
8. Load tubing into pump by opening door on top of pump, where it says “Lift to Open”. Place pump on its side with the keypad facing towards you. Load blue piece on tubing into hole by the blue arrow in pump, then set pump upright and load yellow piece on tubing into hole by the yellow arrow in pump. Close door. Door must be flush with top of pump.
9. Prepare saline flush by removing cap, pulling plunger back to break seal, and then pushing up to remove air from syringe
10. Clean end of PICC line with alcohol swab for 10 – 15 seconds
11. Attach saline flush to PICC line
12. Open clamp on PICC line
13. Flush PICC line with saline flush
14. Remove empty flush from PICC line and discard
15. Clean end of PICC line with new alcohol swab for 10-15 seconds
16. Remove cap from end of IV tubing and attach tubing to PICC line
17. Turn Pump On. Pump will go through self-test. Then show how full batteries are.
18. When pump reads “Program: – ensure “Program” is highlighted, then hit the YES button on the pump
19. When pump reads “Repeat Rx” – hit the YES button on the pump
20. Once pump reads through settings, hit the RUN button on the pump to start infusion
21. When infusion is complete – Pump will beep and read “Infusion Complete.”
22. Wash hands thoroughly with liquid soap for at least 20 seconds and dry with paper towels.
23. Change batteries. Batteries are changed in the back of pump. Slide door to unlock and then slide down. Pull batteries out and replace with (2) C batteries that face the same way.
24. Start at beginning.

Gather Supplies:

• (1) Medication ball of ________ (removed from refrigerator 12 hours before use)
• (1) Pre-filled syringes of Saline
• Alcohol Prep Pads

Procedure:

1. Wash hands thoroughly with liquid soap for at least 20 seconds and dry with paper towels
2. Prepare saline flush by removing cap, pulling plunger back to break seal, and then pushing up to remove air from syringe
3. Clean end of PICC line with alcohol swab for 10-15 seconds
4. Attach saline flush to PICC line
5. Open clamp on PICC line
6. Flush PICC line with saline flush
7. Remove empty flush from PICC line and discard
8. Clean end of PICC line with new alcohol swab for 10-15 seconds
9. Remove cap from end of medication ball and attach tubing to PICC line
10. Open clamp on medication ball. (Check medication ball in a couple of hours – you should notice that medication ball is visibly getting smaller with some wrinkles and
    dimples in it)
11. When infusion is complete in 24 hours (medication ball should be flat)– Wash hands thoroughly with liquid soap for at least 20 seconds and dry with paper towels.
12. Disconnect medication ball tubing from the end of PICC line and discard
13. Repeat, starting at step 2.

Cyclic TPN:

            Gather Supplies:

• (1) Bag of TPN
• (2) Pre-filled syringes of Saline
• (1) Pre-filled syringe of Heparin
• Alcohol Prep Pads
• Curlin tubing

Procedure:

1. Wash hands thoroughly with liquid soap for at least 20 seconds and dry with paper towels
2. Open curlin tubing package
3. Break off tab on yellow piece of tubing.
4. Remove tab from TPN bag
5. Remove cap from spike on tubing (be sure not to bump this against anything)
6. Insert spike into TPN bag by pushing and twisting until you reach lip on spike
7. Remove air from tubing by holding bag up and squeezing yellow piece on tubing until fluid reaches bottom of tubing.
8. Load tubing into pump by opening door on top of pump. Place pump on its side with the keypad facing towards you. Load blue piece on tubing into hole by the blue arrow in pump, then set pump upright and load yellow piece on tubing into hole by the yellow arrow in pump. Close door.
9. Prepare saline flush by removing cap, pulling plunger back to break seal, and then pushing up to remove air from syringe
10. Clean end of PICC line with alcohol swab for 10- 15 seconds
11. Attach saline flush to PICC line
12. Open clamp on PICC line
13. Flush PICC line with saline flush
14. Remove empty flush from PICC line and discard
15. Clean end of PICC line with new alcohol swab for 10-15 seconds
16. Remove cap from end of IV tubing and attach tubing to PICC line
17. Turn Pump On. Pump will go through self-test. Then show how full batteries are.
    1. Make sure you change your batteries daily, you should always start with fresh batteries.
18. When pump reads “Program: – hit the YES button on the pump
19. When pump reads “Repeat Rx” – hit the YES button on the pump
20. Once pump reads through settings, hit the RUN button on the pump to start infusion
21. When infusion is complete – Pump will beep and read “Infusion Complete.” Turn pump OFF
22. Wash hands thoroughly with liquid soap for at least 20 seconds and dry with paper towels.
23. Disconnect tubing from the end of PICC line and discard
24. Prepare saline flush by removing cap, pulling plunger back to break seal, and then pushing up to remove air from syringe
25. Clean end of PICC line with new alcohol swab for 10-15 seconds
26. Attach saline flush to PICC line and flush PICC line with saline
27. Remove empty flush from PICC line and discard
28. Prepare heparin flush by removing cap, pulling plunger back to break seal, and then pushing up to remove air from syringe
29. Clean end of PICC line with new alcohol swab for 10-15 seconds
30. Attach heparin flush to PICC line and flush PICC line with heparin
31. Close clamp on PICC line
32. Remove empty heparin flush and discard

NOTE: If you have additives, refer to your nurse before starting

Gather Supplies:

• (1) Bag of __________ (medication)
• (2) Pre-filled syringes of Saline
• (1) Pre-filled syringe of Heparin
• Alcohol Prep Pads
• Dial-A-Flow tubing
• (1) Blue sterile cover

Procedure:

1. Wash hands thoroughly with liquid soap for at least 20 seconds and dry with paper towels
2. Open dial-a-flow tubing package (IV tubing is good to use for 3 days)
3. Pinch white clamp on tubing
4. Remove tab from IV bag
5. Remove cap from spike on tubing (be sure not to bump this against anything)
6. Insert spike into IV bag by pushing and twisting until you reach lip on spike
7. Hang bag, ensure this is above heart level (the higher the better)
8. Squeeze and fill drip chamber ½ way
9. Remove air from tubing by opening white pinch clamp on tubing until fluid reaches bottom of tubing
10. Pinch white clamp back off. Set IV tubing aside.
11. Prepare saline flush by removing cap, pulling plunger back to break seal, and then pushing up to remove air from syringe
12. Clean end of PICC line with alcohol swab for 10- 15 seconds
13. Attach saline flush to PICC line
14. Open clamp on PICC line
15. Flush PICC line with saline flush
16. Remove empty flush from PICC line and discard
17. Clean end of PICC line with new alcohol swab for 10-15 seconds
18. Remove cap from end of IV tubing and attach tubing to PICC line
19. Turn dial to rate of _______ ml/hr
20. Open white clamp and check chamber at top of tubing for drips
21. When infusion is complete – Pinch white clamp on tubing off
22. Disconnect tubing from the end of PICC line and immediately cap with new blue sterile cover.
23. Prepare saline flush by removing cap, pulling plunger back to break seal, and then pushing up to remove air from syringe
24. Clean end of PICC line with new alcohol swab for 10-15 seconds
25. Attach saline flush to PICC line and flush PICC line with saline
26. Remove empty flush from PICC line and discard
27. Prepare heparin flush by removing cap, pulling plunger back to break seal, and then pushing up to remove air from syringe
28. Clean end of PICC line with new alcohol swab for 10-15 seconds
29. Attach heparin flush to PICC line and flush PICC line with heparin
30. Close clamp on PICC line
31. Remove empty heparin flush and discard

NOTE: Leave empty medication bag on the IV tubing until the next dose, then change to a new bag when dose is due.

Gather Supplies:

• (1) Bag of __________ (medication)
• (2) Pre-filled syringes of Saline
• (1) Pre-filled syringe of Heparin
• Alcohol Prep Pads
• Gravity tubing
• (1) Blue sterile cover

Procedure:

1. Wash hands thoroughly with liquid soap for at least 20 seconds and dry with paper towels
2. Open gravity tubing package (IV tubing is good to use for 3 days)
3. Pull roller-clamp towards bottom of tubing, and close the roller-clamp by rolling it all the way to bottom.
4. Remove tab from IV bag
5. Remove cap from spike on tubing (be sure not to bump this against anything)
6. Insert spike into IV bag by pushing and twisting until you reach lip on spike
7. Hang bag
8. Squeeze and fill drip chamber ½ way
9. Remove air from tubing by rolling roller-clamp up on tubing until fluid reaches bottom of tubing
10. Close roller-clamp on tubing by rolling down to bottom. Set aside.
11. Prepare saline flush by removing cap, pulling plunger back to break seal, and then pushing up to remove air from syringe
12. Clean end of PICC line with alcohol swab for 10-15 seconds
13. Attach saline flush to PICC line
14. Open clamp on PICC line
15. Flush PICC line with saline flush
16. Remove empty flush from PICC line and discard
17. Clean end of PICC line with new alcohol swab for 10-15 seconds
18. Remove cap from end of IV tubing and attach tubing to PICC line
19. Open roller-clamp slowly until the desired number of drops as directed is achieved. Refer to IV label for drip rate. (If infusion is going too quickly – roll clamp down a little, if infusion is going too slowly – roll clamp up a little)
20. When infusion is complete – Roll roller-clamp to bottom to pinch off tubing.
21. Disconnect tubing from the end of PICC line and immediately cap with new blue sterile cover.
22. Prepare saline flush by removing cap, pulling plunger back to break seal, and then pushing up to remove air from syringe
23. Clean end of PICC line with new alcohol swab for 10-15 seconds
24. Attach saline flush to PICC line and flush PICC line with saline
25. Remove empty flush from PICC line and discard
26. Prepare heparin flush by removing cap, pulling plunger back to break seal, and then pushing up to remove air from syringe
27. Clean end of PICC line with new alcohol swab for 10-15 seconds
28. Attach heparin flush to PICC line and flush PICC line with heparin
29. Close clamp on PICC line
30. Remove empty heparin flush and discard

NOTE: Leave empty medication bag on the IV tubing until the next dose, then change to a new bag when dose is due.

Gather Supplies:

• (1) Bag of __________ (medication)
• (2) Pre-filled syringes of Saline
• (1) Pre-filled syringe of Heparin
• Alcohol Prep Pads
• Curlin tubing
• (1) Blue sterile cover

Procedure:

1. Wash hands thoroughly with liquid soap for at least 20 seconds and dry with paper towels
2. Open curlin tubing package (IV tubing is good to use for 3 days)
3. Break off tab on yellow piece of tubing.
4. Remove tab from IV bag
5. Remove cap from spike on tubing (be sure not to bump this against anything)
6. Insert spike into IV bag by pushing and twisting until you reach lip on spike
7. Remove air from tubing by holding bag up and squeezing yellow piece on tubing until fluid reaches bottom of tubing.
8. Load tubing into pump by opening door on top of pump. Place pump on its side with the keypad facing towards you. Load blue piece on tubing into hole by the blue arrow in pump, then set pump upright and load yellow piece on tubing into hole by the yellow arrow in pump. Close door.
9. Prepare saline flush by removing cap, pulling plunger back to break seal, and then pushing up to remove air from syringe
10. Clean end of PICC line with alcohol swab for 10- 15 seconds
11. Attach saline flush to PICC line
12. Open clamp on PICC line
13. Flush PICC line with saline flush
14. Remove empty flush from PICC line and discard
15. Clean end of PICC line with new alcohol swab for 10-15 seconds
16. Remove cap from end of IV tubing and attach tubing to PICC line
17. Turn Pump On. Pump will go through self-test. Then show how full batteries are.
    1. If batteries are less ¼ full, change these before starting. Batteries are changed in the back of pump. Slide door to unlock and then slide down. Pull batteries out and replace with (2) C batteries that face the same way.
18. When pump reads “Program: – hit the YES button on the pump
19. When pump reads “Repeat Rx” – hit the YES button on the pump
20. Once pump reads through settings, hit the RUN button on the pump to start infusion
21. When infusion is complete – Pump will beep and read “Infusion Complete.” Turn pump OFF
22. Disconnect tubing from the end of PICC line and immediately cap with new blue sterile cover.
23. Prepare saline flush by removing cap, pulling plunger back to break seal, and then pushing up to remove air from syringe
24. Clean end of PICC line with new alcohol swab for 10-15 seconds
25. Attach saline flush to PICC line and flush PICC line with saline
26. Remove empty flush from PICC line and discard
27. Prepare heparin flush by removing cap, pulling plunger back to break seal, and then pushing up to remove air from syringe
28. Clean end of PICC line with new alcohol swab for 10-15 seconds
29. Attach heparin flush to PICC line and flush PICC line with heparin
30. Close clamp on PICC line
31. Remove empty heparin flush and discard

NOTE: Leave empty medication bag on the IV tubing until the next dose, then change to a new bag when dose is due.

Gather Supplies:

• (1) Medication ball of ________ (removed from refrigerator 12 hours before use)
• (2) Pre-filled syringes of Saline
• (1) Pre-filled syringe of Heparin
• Alcohol Prep Pads

Procedure:

1. Wash hands thoroughly with liquid soap for at least 20 seconds and dry with paper towels
2. Prepare saline flush by removing cap, pulling plunger back to break seal, and then pushing up to remove air from syringe
3. Clean end of PICC line with alcohol swab for 10-15 seconds
4. Attach saline flush to PICC line
5. Open clamp on PICC line
6. Flush PICC line with saline flush
7. Remove empty flush from PICC line and discard
8. Clean end of PICC line with new alcohol swab for 10-15 seconds
9. Remove cap from end of medication ball and attach tubing to PICC line
10. Open clamp on medication ball. (Check medication ball in approximately 15 minutes. You should notice that medication ball is visibly getting smaller and developing wrinkles and dimples along outside)
11. When infusion is complete (medication ball should be flat)– Disconnect medication ball tubing from the end of PICC line and discard
12. Prepare saline flush by removing cap, pulling plunger back to break seal, and then pushing up to remove air from syringe
13. Clean end of PICC line with new alcohol swab for 10-15 seconds
14. Attach saline flush to PICC line and flush PICC line with saline
15. Remove empty flush from PICC line and discard
16. Prepare heparin flush by removing cap, pulling plunger back to break seal, and then pushing up to remove air from syringe
17. Clean end of PICC line with new alcohol swab for 10-15 seconds
18. Attach heparin flush to PICC line and flush PICC line with heparin
19. Close clamp on PICC line
20. Remove empty heparin flush and discard

Gather Supplies:

• (1) syringe of __________ (medication)
• (2) Pre-filled syringes of Saline
• (1) Pre-filled syringe of Heparin
• Alcohol Prep Pads

Procedure:

1. Prepare saline flush by removing cap, pulling plunger back to break seal, and then pushing up to remove air from syringe
2. Clean end of PICC line with alcohol swab for 10- 15 seconds
3. Attach saline flush to PICC line
4. Open clamp on PICC line
5. Flush PICC line with saline flush
6. Remove empty flush from PICC line and discard
7. Clean end of PICC line with new alcohol swab for 10-15 seconds
8. Attach medication syringe to PICC line
9. Push medication slowly over _____ minutes or _____ mL per ___________.
10. When medication syringe is empty, remove from PICC line and discard.
11. Prepare saline flush by removing cap, pulling plunger back to break seal, and then pushing up to remove air from syringe
12. Clean end of PICC line with new alcohol swab for 10-15 seconds
13. Attach saline flush to PICC line and flush PICC line with saline
14. Remove empty flush from PICC line and discard
15. Prepare heparin flush by removing cap, pulling plunger back to break seal, and then pushing up to remove air from syringe
16. Clean end of PICC line with new alcohol swab for 10-15 seconds
17. Attach heparin flush to PICC line and flush PICC line with heparin
18. Close clamp on PICC line
19. Remove empty heparin flush and discard

In the event of an emergency where you are unable to contact us within 24 hours, please be prepared to initiate the following:

1. Notify your physician
2. Stay with a family member or friend
3. Proceed to an emergency room if you require additional medication or immediate care
4. Notify the Agency of your location as soon as possible

Potential emergencies may include:

1. Severe weather (blizzard, tornado, ice storm, etc.)
2. Agency is inoperable (fire, flood, etc.)
3. County emergency
4. Civil disturbance

If unable to reach our office, contact our answering service directly at 315-475-1601.

• Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it.
• Wash your hands often with soap and water, especially after you cough or sneeze. Alcohol-based hand cleaners are also effective.
• Avoid touching your eyes, nose or mouth.
• Stay home if you get sick
• Follow public health advice regarding school closures and avoiding crowds.
• Develop a family emergency plan as a precaution.
• Call 1-800-CDC-INFO for more information

Do You Know??

Hand hygiene (cleansing)

Washing your hands

• Removal of jewelry is recommended for the best result
• Wet your hands with warm running water
• Apply liquid soap, rub hands together to make lather and scrub all surfaces
• Continue rubbing for 15-20 seconds (the time it takes to sing Happy Birthday twice!
• Rinse hands well under running water
• Dry hands with paper towel; then use towel to turn off the faucet
• Always wash with soap and water if your hands are visibly dirty

Alcohol based hand sanitizer for between washes or if no soap & water are available!

• Wet hands thoroughly using a palm full of hand sanitizer – must have at least 60% alcohol content.
• Rub all surfaces of hands and fingers together until dry- at least 15 seconds

If your nurse has not performed hand hygiene, Speak Up!!