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(f) extravascular infusion.

Delivery parameters:

(a) infusion rate and volume required

(b) accuracy required (over a long or short period of time)

(c) alarms required

(d) ability to infuse into site chosen (venous, arterial, subcutaneous)

(e) suitability of device for infusing drug (e.g. ability to infuse viscous drugs).

Environmental features:

(a) ease of operation

(b) frequency of observation and adjustment

(c) type of patient (neonate, child, critically ill)

(d) mobility of patient.

Paediatric considerations

The MHRA classifies infusion devices into categories of infusion risk. Neonatal infusions are the highest risk category; high-risk infusions are typically the infusion of fluids in children where accuracy of the flow rate is essential (MHRA 2010b). Infusion therapy within the paediatric setting requires very specific skills (Frey and Pettit 2010). Competency in calculation of paediatric dosages, maintaining a stringent fluid balance, use of paediatric-specific devices and management of complications are paramount.

The MHRA has made recommendations on the safety and performance of infusion devices in order to enable users to make the appropriate choice of equipment to suit most applications (MHRA 2010b). The classification system is divided into three major categories according to the potential risks involved. These are shown in Table 13.10. A pump suited to the most risky category of therapy (A) can be safely used for the other categories (B and C). A pump suited to category B can be used for B and C, whereas a pump with the lowest specification (C) is suited only to category C therapies (MHRA 2010b) (Figure 13.29). Hospitals are required to label each infusion pump with its category and it is necessary to know the category of the proposed therapy and match it with a pump of the same or better category. A locally produced list of drugs/fluids by their categories will need to be provided to all device users (MHRA 2010b).

Table 13.10 Therapy categories and performance parameters

Procedure guideline 13.20 Medication: continuous infusion of intravenous drugs

This procedure may be carried out by the infusion of drugs from a bag, bottle or burette.

Essential equipment

Clinically clean receiver or tray containing the prepared drug to be administered

Patient’s prescription chart

Recording chart or book as required by law or hospital policy

Gloves

Protective clothing as required by hospital policy for specific drugs

Container of appropriate intravenous infusion fluid

2% chlorhexidine swab

Drug additive label

Preprocedure

Action Rationale

1 Explain and discuss the procedure with the patient. To ensure that the patient understands the procedure and gives their valid consent (Griffith and Jordan 2003, E; NMC 2008b, C; NMC 2008c, C).

2 Inspect the infusion in progress. To check it is the correct infusion 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 resited (NPSA 2007d, C).

3 Before administering any prescribed drug, check that it is due and has not already been given. To protect the patient from harm (NPSA 2007d, C).

4 Before administering any prescribed drug, consult the patient’s prescription chart and ascertain the following:

(a) Drug

(b) Dose

(c) Date and time of administration

(d) Route and method of administration

(e) Diluent as appropriate

(f) Validity of prescription

(g) Signature of doctor

(h) The prescription is legible.

To ensure that the patient is given the correct drug in the prescribed dose using the appropriate diluent and by the correct route. To protect the patient from harm (NMC 2008a, C; NPSA 2007d, C).

To comply with NMC (2008a) Standards for Medicines Management.

5 Wash hands with bactericidal soap and water or bactericidal alcohol handrub, and assemble the necessary equipment. To minimize the risk of infection