Pre‐procedure

ActionRationale

1. 1.Show
   Introduce yourself to the patient, explain and discuss the procedure with them, and gain their consent to proceed.
   To ensure that the patient feels at ease, understands the procedure and gives their valid consent (NMC [257], C).
2. 2.Show
   Before administering any prescribed fluid, check that it is due and has not already been given.
   To protect the patient from harm (NPSA [268], C).
3. 3.Show
   Before administering any prescribed fluid, look at the patient's prescription chart and check the following:

   1. the correct patient is being given the drug
   2. drug/fluid
   3. dose
   4. date and time of administration
   5. route and method of administration
   6. diluent as appropriate
   7. validity of prescription
   8. signature of prescriber
   9. the prescription is legible.
   To ensure that the correct patient is given the correct fluid in the prescribed dose using the appropriate diluent and by the correct route (DH [61], C; RPS [317], C).

   To protect the patient from harm (DH [61], C; NMC [257], C).
   If any of these pieces of information are missing, unclear or illegible, do not proceed with the administration. Consult with the prescriber.
   To prevent any errors occurring. E
4. 4.Show
   Wash hands with bactericidal soap and water or an alcohol‐based handrub, and assemble the necessary equipment.
   To minimize the risk of infection (Fraise and Bradley [98], E; NHS England and NHSI [233], C).

Procedure

1. 5.Show
   Check the name and volume of the infusion fluid against the prescription chart.
   To ensure that the correct type and quantity of fluid are administered (NPSA [268], C; RPS [317], C).
2. 6.Show
   Check the expiry date of the infusion bag.
   To prevent an ineffective or toxic compound being administered to the patient (NPSA [268], C).
3. 7.Show
   Check that the packaging is intact and inspect the container and contents in good light for cracks, punctures and air bubbles.
   To check that no contamination of the infusion container has occurred (NPSA [268], C).
4. 8.Show
   Inspect the fluid for discoloration, haziness, and crystalline or particulate matter. If this is found, discard.
   To prevent any toxic or foreign matter being infused into the patient (NPSA [268], C).

   To detect any incompatibility or degradation (NPSA [268], C).
5. 9.Show
   Establish the correct drip rate setting using the correct calculation.
   To monitor rate and ensure fluid is infused safely (Pickstone [284], E).
6. 10.Show
   Place the infusion bag and administration set in a clean receptacle. Wash hands and proceed to the patient.
   To minimize the risk of contamination (Loveday et al. [176], C; NHS England and NHSI [233], C).
7. 11.Show
   Check the identity of the patient against the prescription chart, and with the patient. If an electronic identity check system for patient and/or medicine identification is in place, then use in accordance with hospital policy and procedures.
   To minimize the risk of error and ensure the correct fluid is administered to the correct patient (NPSA [268], C).
8. 12.Show
   Place the infusion bag on a flat surface, remove the seal and insert the spike of the administration set fully into the infusion bag port.
   To prevent puncturing the side of the infusion bag and to reduce the risk of contamination (DH [64], C).
9. 13.Show
   Hang the infusion bag from a drip stand.
   To allow flow due to gravity. E
10. 14.Show
    Open the roller clamp and allow the fluid through the set to prime it. Close the clamp.
    To remove air from the set. E
11. 15.Show
    Apply an apron and assist the patient into a comfortable position.
    To ensure patient comfort during the procedure. E
12. 16.Show
    Expose the chosen site for infusion.
    To expose the area. E
13. 17.Show
    Apply gloves and clean the chosen site with a swab saturated with 70% isopropyl alcohol. Wait until the alcohol evaporates.
    To reduce the risk of infection and prevent a stinging sensation on insertion of the needle (Fraise and Bradley [98], E; Loveday et al. [176], C).
14. 18.Show
    Pinch a fold of skin firmly.
    To elevate the subcutaneous tissue. E
15. 19.Show
    Insert the infusion needle into the skin at an angle of 45°, bevel up, and release the grasped skin. (If using a cannula, remove the stylet.)
    To gain access to the subcutaneous tissue (Walsh [361], E).
16. 20.Show
    Connect the administration set to the device.
    To commence the infusion. E
17. 21.Show
    Apply a transparent dressing to secure the infusion device.
    To prevent movement and reduce the risk of mechanical phlebitis and infection (Fraise and Bradley [98], E; Loveday et al. [176], C; Weinstein and Hagle [363], E).
18. 22.Show
    Open the roller clamp and adjust until the flow rate is achieved. The rate is usually 1 mL/min per site by gravity.
    To ensure the correct rate is set. E

Post‐procedure

1. 23.Show
   Complete the patient's prescription chart and other hospital and/or legally required documents.
   To comply with local drug administration policies and provide a record in the event of any queries, and to prevent any duplication of treatment (RPS [317], C).
2. 24.Show
   Monitor the patient for any infusion‐ or site‐related complications and document these in the patient's notes.
   To detect complications promptly (Sasson and Shvartzman [321], E).
3. 25.Show
   Ask the patient to report any pain or tenderness at the infusion site.
   To ascertain whether there are any problems that may require nursing care and to enable referral to medical staff where appropriate. E
4. 26.Show
   Discard waste, making sure that it is placed in the correct containers, for example sharps into a designated receptacle.
   To ensure safe disposal and avoid injury to staff, and to prevent reuse of equipment (HWR [137], C; MHRA [201], C).