The Royal Marsden Hospital Manual of Clinical Nursing Procedures - Lisa Dougherty [576]
Blood and blood products are administered via a blood administration set (Figure 13.26) which has a special filter. Platelets can be administered via blood sets (check with manufacturer) or specialist platelet administration sets. Some medications such as taxanes must be administered via special taxane administration sets as they have a filter.
Figure 13.26 Blood administration set.
Extension sets
Extension sets are used to add length (Hadaway 2010). The short extension sets tend to have a needle-free connector (Figure 13.27) and are attached directly to the VAD to provide a closed system and other equipment is then attached via the needle-free connector. The long (50–200 cm) extension sets are used to connect from syringe pumps or drivers to a VAD and usually have a back check or antisyphon valve. They can be single, double or triple and may contain a slide or pinch clamp but do not regulate flow (Hadaway 2010).
Figure 13.27 Extension set with needle-free injection cap.
Needle-free injection caps
These are caps that are attached to the end of a VAD or extension set (Figure 13.27) to provide a closed system and remove the need for needles when administering medications, thus removing the risk of needlestick injury. There are various types available and differences include the type of septum (split septum or mechanical valve) (Hadaway 2010). Some provide positive or neutral displacement (to reduce risk of blood reflux and occlusion) and others are coated with antimicrobial or antibactericidal solutions on external or internal parts to reduce the risk of infection (Hadaway 2010). These require regular changing in accordance with the manufacturer’s instructions as well as cleaning before and after each use (MHRA 2007, 2008).
It has been suggested that needle-free systems can increase the risk of bloodstream infections (Danzig et al. 1995). However, most studies have found no difference in microbial contamination when comparing conventional and needle-free systems (Brown et al. 1997, Luebke et al. 1998, Mendelson et al. 1998). It appears that an increased risk is only likely where there is lack of compliance with cleaning protocols or changing of equipment (Pratt et al. 2007).
Other equipment
Other IV equipment includes stopcocks (used to direct flow) usually three- or four-way devices. These tend to be used in critical care but are discouraged in the general setting due to misuse and contamination issues. If used, they should be capped off (Hadaway 2010).
Infusion devices
An infusion device is designed to accurately deliver measured amounts of fluid or drug via a number of routes (intravenous, subcutaneous or epidural) over a period of time. The infusion device is set at an appropriate rate to achieve the desired therapeutic response and prevent complications (Dougherty 2002, MHRA 2010b, Quinn 2000).
Gravity infusion devices
Gravity infusion devices depend entirely on gravity to deliver the infusion. The system consists of an administration set containing a drip chamber and a roller clamp to control the flow, which is usually measured by counting drops (Pickstone 1999). The indications for use are:
delivery of fluids without additives
administration of drugs or fluids where adverse effects are not anticipated and which do not need to be infused with absolute precision
where the patient’s condition does not give cause for concern and no complication is predicted (Quinn 2008).
The flow rate is calculated using a formula that requires the following information: the volume to be infused; the number of hours the infusion is running over; and the drop rate of