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15.24 Medication: intermittent infusion of intravenous drugs

Essential equipment

  • Personal protective equipment
  • Patient's prescription chart
  • Recording chart
  • Electronic identity check equipment, where relevant
  • Container of appropriate intravenous infusion fluid
  • Drug additive label
  • Intravenous administration set
  • Intravenous infusion stand
  • Clean dressing trolley
  • Clinically clean tray
  • Sterile needles and syringes
  • 10 mL of a compatible flush solution (for injection), for example 0.9% sodium chloride or 5% dextrose
  • Flushing solution to maintain patency plus sterile injection cap
  • 2% chlorhexidine skin preparation
  • Sterile dressing pack
  • Hypoallergenic tape
  • Bandage
  • Sharps bin

Pre‐procedure

ActionRationale

  1. 1.
    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.
    Before administering any prescribed drug, check that it is due and has not been given already.
    To protect the patient from harm (NPSA [268], C; RPS [317] C).
  3. 3.
    Before administering any prescribed drug, look at the patient's prescription chart and check the following:
    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).
    1. the correct patient is being given the drug
     
    b. drug
     
    c. dose
    To protect the patient from harm. E
    d. date and time of administration
     
    e. route and method of administration
    To comply with RPS ([317]). E
    f. diluent as appropriate
    To comply with RPS ([317]). E
    g. validity of prescription
     
    h. signature of prescriber
     
    i. the prescription is legible.
     
    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.
    Wash hands with bactericidal soap and water or an alcohol‐based handrub.
    To prevent contamination of medication and equipment (DH [64], C).
  5. 5.
    Prepare the intravenous infusion and additive as described in Procedure guidelines 15.11, 15.12, 15.13 or 15.14.
    To ensure the drug is prepared correctly (NPSA [268], C).
  6. 6.
    Prime the intravenous administration set with infusion fluid mixture and hang it on the infusion stand.
    To ensure removal of air from the set and check that the tubing is patent. To prepare for administration (NPSA [268], C).
  7. 7.
    Draw up 10 mL of compatible flush solution for injection using an aseptic technique.
    To ensure sufficient flushing solution is available. E
  8. 8.
    Draw up solution (as advised by hospital policy) to be used to maintain patency, for example 0.9% sodium chloride. Add the additive drug label to the bag/syringe.
    To prepare for administration. E
  9. 9.
    Place the syringes in a clinically clean tray on the bottom shelf of the dressing trolley.
    To ensure the top shelf is used for the sterile dressing pack in order to minimize the risk of contamination. E
  10. 10.
    Collect the other equipment and place it on the bottom shelf of the dressing trolley.
    To ensure all equipment is available to commence the procedure. E
  11. 11.
    Place the sterile dressing pack on top of the trolley.
    To minimize the risk of contamination. E
  12. 12.
    Check that all necessary equipment is present.
    To prevent delays and interruption of the procedure. E
  13. 13.
    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.
    Proceed to the patient. Check the patient's identity against the prescription chart and prepared drugs. 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 drug is given to the correct patient (NPSA [268], C; RPS [317], C).

Procedure

  1. 15.
    Open the sterile dressing pack.
    To minimize the risk of cross‐infection (DH [64], C; Fraise and Bradley [98], E).
  2. 16.
    Open the 2% chlorhexidine skin preparation packet and empty it onto the pack.
    To ensure the correct cleaning swab is available (DH [64], E).
  3. 17.
    Wash hands with bactericidal soap and water or an alcohol‐based handrub.
    To minimize the risk of cross‐infection. (DH [64], C; Fraise and Bradley [98], E).
  4. 18.
    If a peripheral device is in situ, remove the patient's bandage.
    To observe the insertion site (Dougherty [77], E).
  5. 19.
    Inspect the insertion site of the device.
    To detect any signs of inflammation, infiltration and so on. If present, take appropriate action (see Problem‐solving table 15.14) (DH [62], C).
  6. 20.
    Wash and dry hands.
    To minimize the risk of contamination (DH [64], C).
  7. 21.
    Put on gloves.
    To protect against contamination with hazardous substances, for example cytotoxic drugs (NPSA [268], C).
  8. 22.
    Place a sterile towel under the patient's arm.
    To create a sterile area on which to work. E
  9. 23.
    Clean the needle‐free cap with the 2% chlorhexidine skin preparation.
    To minimize the risk of contamination and maintain a closed system (Loveday et al. [176], C).
  10. 24.
    Gently inject 10 mL of 0.9% sodium chloride for injection.
    To confirm the patency of the device. E
  11. 25.
    Check that no resistance is met, no pain or discomfort is felt by the patient, no swelling is evident, no leakage occurs around the device and there is a good backflow of blood on aspiration.
    To ensure the device is patent (Dougherty [77], E).
  12. 26.
    Connect the infusion to the device.
    To commence treatment. E
  13. 27.
    Open the roller clamp and/or insert the tubing into an infusion pump and start the pump.
    To check the infusion is flowing freely. E
  14. 28.
    Check the insertion site and ask the patient whether they are comfortable.
    To confirm that the vein can accommodate the extra fluid flow and that the patient experiences no pain. E
  15. 29.
    Adjust the flow rate as prescribed.
    To ensure that the correct speed of administration is established (NPSA [268], C).
  16. 30.
    Tape the administration set in a way that places no strain on the device, which could in turn damage the vein.
    To reduce the risk of mechanical phlebitis or infiltration (Dougherty [77], E).
  17. 31.
    Remove gloves.
    To ensure disposal. E
  18. 32.
    If the infusion is to be completed within 30 minutes, bandaging is unnecessary and the patient may be instructed to keep the arm resting on the sterile towel. Otherwise apply a new bandage.
    To reduce the risk of dislodging the device. E
  19. 33.
    The equipment must be cleared away and new equipment only prepared when required at the end of the infusion.
    To ensure that the equipment used is sterile prior to use. E
  20. 34.
    Monitor flow rate and device site frequently.
    To ensure the flow rate is correct and the patient is comfortable, and to check for signs of infiltration (NPSA [268], C).
  21. 35.
    When the infusion is complete, wash hands using bactericidal soap and water or an alcohol‐based handrub, and recheck that all the equipment required is present.
    To maintain asepsis and ensure that the procedure runs smoothly (DH [64] C; Finlay [94], E).
  22. 36.
    Stop the infusion when all of the fluid has been delivered.
    To ensure that all of the prescribed mixture has been delivered and prevent air infusing into the patient (NPSA [268], C).
  23. 37.
    Put on non‐sterile gloves.
    To protect against contamination with hazardous substances. E
  24. 38.
    Disconnect the infusion set and flush the device with 10 mL of 0.9% sodium chloride or another compatible solution for injection. (A ‘minibag’ may be used to flush the drug through the tubing but the cost implications of this as well as the risk to patients on restricted intake should be considered before this is adopted routinely.)
    To flush any remaining irritating solution away from the cannula. E
  25. 39.
    Attach a new sterile injection cap if necessary.
    To maintain a closed system (Hart [120], E).
  26. 40.
    Flush the device.
    To maintain the patency of the device (Dougherty [77], E).
  27. 41.
    Clean the injection site of the cap with 2% chlorhexidine skin preparation.
    To minimize the risk of contamination (Hart [120], E).
  28. 42.
    Administer flushing solution using the push–pause technique and ending with positive pressure.
    To maintain the patency of the device and, if a needle was used, to enable resealing of the injection site (Dougherty [77], E).
  29. 43.
    Reapply bandage.
    To reduce the risk of dislodging the cannula. E
  30. 44.
    Remove gloves.
    To ensure disposal. E
  31. 45.
    Assist the patient into a comfortable position.
    To ensure the patient is comfortable. E

Post‐procedure

  1. 46.
    Discard waste, placing it in the correct containers, for example sharps into a designated container.
    To ensure safe disposal and avoid injury to staff (EASHW [84], C; HWR [137], C; MHRA [201], C; NHS Employers [227], C).
  2. 47.
    Record the administration on the appropriate charts.
    To maintain accurate records, provide a point of reference in the event of any queries and prevent any duplication of treatment (NMC [257], C; RPS [317], C).
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