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 drug, check that it is due and has not been given already.
   To protect the patient from harm (RPS [317], C).
3. 3.Show
   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 2019, C).

   To protect the patient from harm (DH [61], C).
   1. the correct patient is being given the drug
    

   b.

   drug

    

   c.

   dose

    

   d.	date and time of administration

   To protect the patient from harm. E

   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.Show
   Select the required medication and check the expiry date.
   Treatment with medication that is outside the expiry date is dangerous. Drugs deteriorate with storage. The expiry date indicates when a particular drug is no longer pharmacologically efficacious (NPSA [268], C).
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 prepare the drug correctly. E
7. 7.Show
   Prepare a 20 mL syringe of 0.9% sodium chloride (or another compatible solution) for injection using aseptic technique.
   To use for flushing between each drug (NPSA [268], C).
8. 8.Show
   Draw up the flushing solution, as indicated by local hospital policy.
   To prepare for administration. E
9. 9.Show
   Place the syringes in a clinically clean receptacle on the bottom shelf of the dressing trolley, along with the receptacle containing any drug(s) to be administered.
   To ensure the top shelf is used for the sterile dressing pack in order to minimize the risk of contamination. E
10. 10.Show
    Collect the other equipment and place it on the bottom of the trolley.
    To ensure all equipment is available to commence the procedure. E
11. 11.Show
    Place a sterile dressing pack on top of the trolley.
    To minimize the risk of contamination. E
12. 12.Show
    Check that all necessary equipment is present.
    To prevent delays and interruption of the procedure. E
13. 13.Show
    Wash hands thoroughly.
    To minimize the risk of infection (DH [64], C; Fraise and Bradley [98], E).
14. 14.Show
    Proceed to the patient and check their identity and the prepared drug against the prescription chart. 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 drug is given to the correct patient (NPSA [268], C).

Procedure

1. 15.Show
   Open the sterile dressing pack, and open the 2% chlorhexidine skin preparation and empty it onto the pack.
   To gain access to the necessary equipment and to ensure there is a cleaning swab available (DH [64], C).
2. 16.Show
   Wash hands with bactericidal soap and water or an alcohol‐based handrub.
   To reduce the risk of infection (DH [64], C; Fraise and Bradley [98], E).
3. 17.Show
   If a peripheral device is in situ, remove the bandage.
   To observe the insertion site. E
4. 18.Show
   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).
5. 19.Show
   Observe the infusion, if in progress.
   To confirm that it is infusing as desired (NPSA [268], C).
6. 20.Show
   Check whether the infusion fluid and the drugs are compatible. If not, change the infusion fluid to 0.9% sodium chloride to flush between the drugs if necessary.
   To prevent drug interaction. Some manufacturers recommend that the drug is given into the injection site of a rapidly running infusion (NPSA [268], C). A compatible fluid must be used to remove the medication and prevent precipitation or drug incompatibility if medications mix in the tubing (Whittington [368], E).
7. 21.Show
   Wash hands with bactericidal soap and water or an alcohol‐based handrub.
   To minimize the risk of infection (DH [64], C; Fraise and Bradley [98], E).
8. 22.Show
   Place a sterile towel under the patient's arm.
   To create a sterile field. E
9. 23.Show
   Apply gloves. Clean the injection site with a 2% chlorhexidine skin preparation and allow to dry.
   To reduce the number of pathogens introduced by the needle at the time of the insertion. To ensure complete disinfection has occurred (Loveday et al. [176], C).
10. 24.Show
    Switch off the infusion.
    To prevent excessive pressure within the vein. To prevent contact with an incompatible infusion fluid. To allow the nurse to concentrate on the site of insertion and injection (NPSA [268], C).
11. 25.Show
    If a peripheral device is in situ, gently inject 0.9% sodium chloride. This may not be necessary if the patient has a 0.9% sodium chloride infusion in progress.
    To confirm patency of the vein. To prevent contact with an incompatible infusion solution (NPSA [268], C).
12. 26.Show
    Open the roller clamp of the administration set fully. Inject the drug at a speed sufficient to slow but not stop the infusion and inject the drug smoothly in the direction of flow at the specified rate.
    To prevent backflow of drug up the tubing. To prevent excessive pressure within the vein. To prevent speed shock (NPSA [268], C).
13. 27.Show
    Ensure the needles and syringes are disposed of immediately into appropriate sharps containers (or are returned to the tray). Do not leave any sharps on the opened sterile pack.
    To reduce the risk of needle stick injury and to prevent contamination of the pack (RCN [295], C).
14. 28.Show
    Observe the insertion site of the device throughout.
    To detect any complications at an early stage, for example extravasation or local allergic reaction (Dougherty [78], E).
15. 29.Show
    Frequently check for blood return and/or ‘flashback’ throughout the injection (i.e. every 3–5 mL), but other signs and symptoms must be taken into consideration too.
    To confirm that the device is correctly placed and that the vein remains patent (Weinstein and Hagle [363], E).

    Flashback alone is not an indicator that the vein is patent (Dougherty [77], E).
16. 30.Show
    Consult the patient during the injection about any discomfort.
    To detect any complications at an early stage and ensure patient comfort (Dougherty [77], E).
17. 31.Show
    If more than one drug is to be administered, flush with 0.9% sodium chloride between administrations by restarting the infusion or changing syringes.
    To prevent drug interactions (NPSA [268], C).
18. 32.Show
    At the end of the injection, flush with 0.9% sodium chloride by restarting the infusion or attaching a syringe containing 0.9% sodium chloride.
    To flush any remaining irritant solution away from the device site (NPSA [268], C).
19. 33.Show
    After the final flush of 0.9% sodium chloride, adjust the infusion rate as prescribed, open the fluid path of the tap/stopcock, or administer the flushing solution using pulsatile flush and ending with positive pressure.
    To continue delivery of therapy. To maintain the patency of the cannula (Finlay [94], E).
20. 34.Show
    Apply a bandage.
    To reduce the risk of dislodging the cannula. E
21. 35.Show
    Assist the patient into a comfortable position.
    To ensure the patient is comfortable. E

Post‐procedure

1. 36.Show
   Dispose of used syringes (with the needle unsheathed) directly into a sharps container during the procedure, or place them back onto the plastic tray and then dispose of them in a sharps container as soon as possible. Do not disconnect needles from syringes prior to disposal. Other waste should be placed into the appropriate plastic bags.
   To avoid needle stick injury (EASHW [84], C; MHRA [201], C; NHS Employers [227], C).
2. 37.Show
   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).