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
   Inspect the infusion in progress.
   To check the correct infusion is being administered at the correct rate and that the contents are due to be delivered on time in order for the next prepared infusion bag to be connected. To check whether the patient is experiencing any discomfort at the site of insertion, which might indicate the peripheral device needs to be re‐sited (NPSA [268], C).
3. 3.Show
   Before administering any prescribed drug, check that it is due and has not already been given.
   To protect the patient from harm (NPSA [268], C).
4. 4.Show
   Before administering any prescribed drug, look at the patient's prescription chart and check the following:

   1. the correct patient is being given the drug
   2. drug
   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 drug 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).
   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
5. 5.Show
   Wash hands with bactericidal soap and water or an alcohol‐based handrub, and assemble the necessary equipment.
   To minimize the risk of infection (DH [64], C; Fraise and Bradley [98], E).
6. 6.Show
   Prepare the drug for injection as described in Procedure guidelines 15.11, 15.12, 15.13 or 15.14.
   To ensure the drug is prepared (NPSA [268], C).
7. 7.Show
   Check the name, strength and volume of intravenous fluid against the prescription chart.
   To ensure that the correct type and quantity of fluid are administered (NMC [257], C; NPSA [268], C).
8. 8.Show
   Check the expiry date of the fluid.
   To prevent an ineffective or toxic compound being administered to the patient (NPSA [268], C).
9. 9.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).
10. 10.Show
    Inspect the fluid for discoloration, haziness, and crystalline or particulate matter.
    To prevent any toxic or foreign matter being infused into the patient (NPSA [268], C).
11. 11.Show
    Check the identity and amount of drug to be added. Consider:

    1. compatibility of fluid and additive
    2. stability of mixture over the prescribed duration of the infusion
    3. any special directions for dilution, for example pH or optimum concentration
    4. sensitivity to external factors, such as light
    5. any anticipated allergic reaction.

    If any doubts exist about the listed points, consult the pharmacist or appropriate reference works.
    To minimize the risk of error. To ensure safe and effective administration of the drug. To enable anticipation of toxicities and the nursing implications of these (NPSA [268], C).
12. 12.Show
    Any additions must be made immediately before use.
    To prevent any possible microbial growth or degradation (NPSA [268], C).
13. 13.Show
    Wash hands thoroughly using bactericidal soap and water or an alcohol‐based handrub.
    To minimize the risk of cross‐infection (DH [64], C; Fraise and Bradley [98], E).
14. 14.Show
    Place the infusion bag on a flat surface.
    To prevent puncturing the side of the infusion bag when making additions (NPSA [268], C).
15. 15.Show
    Remove any seal present.
    To expose the injection site on the container. E

Procedure

1. 16.Show
   Clean the site with a swab and allow it to dry.
   To reduce the risk of contamination (NPSA [268], C).
2. 17.Show
   Inject the drug (using a new sterile needle) into the bag, bottle or burette. A 23 or 25 G needle should be used. If the addition is made into a burette at the bedside:
   To minimize the risk of contamination. To enable resealing of the latex or rubber injection site (NPSA [268], C).
   1. avoid contamination of the needle and inlet port
    

   b.	check that the correct quantity of fluid is in the chamber

   To minimize the risk of contamination (NPSA [268], C).

   c.	switch the infusion off briefly

   To ensure the correct dilution (NPSA [268], C).

   d.	add the drug.

   To ensure a bolus injection is not given (NPSA [268], C).
3. 18.Show
   Invert the container a number of times, especially if adding to a flexible infusion bag.
   To ensure adequate mixing of the drug (NPSA [268], C).
4. 19.Show
   Check again for haziness, discoloration and particles. This can occur even if the mixture is theoretically compatible, thus making vigilance essential.
   To detect any incompatibility or degradation (NPSA [268], C).
5. 20.Show
   Complete the drug additive label and fix it on the bag, bottle or burette.
   To identify which drug has been added, when and by whom (NPSA [268], C).
6. 21.Show
   Place the container in a clean receptacle. Wash hands and proceed to the patient.
   To minimize the risk of contamination (DH [64], C).
7. 22.Show
   Check the identity of the patient against the prescription chart and infusion bag. 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 infusion is administered to the correct patient (NPSA [268], C).
8. 23.Show
   Check that the contents of the previous container have been fully delivered.
   To ensure that the preceding prescription has been administered (NPSA [268], C).
9. 24.Show
   Switch off the infusion. Apply gloves. Place the new infusion bag on a flat surface and then disconnect the empty infusion bag.
   To ensure that the administration set spike will not puncture the side wall of the infusion bag (Finlay [94], E; NPSA [268], C).
10. 25.Show
    Push the spike in fully without touching it and hang the new infusion bag on the infusion stand. Insert tubing into the infusion pump where appropriate.
    To reduce the risk of contamination (DH [64], C).

    To ensure accuracy of delivery (Quinn [293], E).
11. 26.Show
    For gravity infusion, restart the infusion and adjust the rate of flow as prescribed. If using an infusion pump, start the pump and set the rate.
    To ensure that the infusion will be delivered at the correct rate over the correct period of time (NPSA [268], C).
12. 27.Show
    If the addition is made into a burette, the infusion can be restarted immediately following mixing and recording, with the infusion rate adjusted accordingly.
    To ensure that the infusion will be delivered correctly (NPSA [268], C).
13. 28.Show
    Ask the patient to report any abnormal sensations.
    To ascertain whether there are any problems that may require nursing care and to enable referral to medical staff where appropriate. E.

Post‐procedure

1. 29.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. To prevent reuse of equipment (EASHW [84], C; HWR [137], C; MHRA [201], C).
2. 30.Show
   Complete the patient's recording chart and other hospital and/or legally required documents.
   To maintain accurate records. To provide a point of reference in the event of any queries. To prevent any duplication of treatment (NMC [257], C; RPS [317], C).