The Royal Marsden Hospital Manual of Clinical Nursing Procedures - Lisa Dougherty [582]
6 Prepare the drug for injection as described in Procedure guidelines 13.12–13.15 To ensure the drug is prepared (NPSA 2007d, C).
7 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 2008a, C; NPSA 2007d, C).
8 Check the expiry date of the fluid. To prevent an ineffective or toxic compound being administered to the patient (NPSA 2007d, C).
9 Check that the packaging is intact and inspect the container and contents in a good light for cracks, punctures, air bubbles. To check that no contamination of the infusion container has occurred (NPSA 2007d, C).
10 Inspect the fluid for discoloration, haziness and crystalline or particulate matter. To prevent any toxic or foreign matter being infused into the patient (NPSA 2007d, C).
11 Check the identity and amount of drug to be added. Consider:
(a) Compatibility of fluid and additive
(b) Stability of mixture over the prescription time
(c) Any special directions for dilution, for example pH, optimum concentration
(d) Sensitivity to external factors such as light
(e) Any anticipated allergic reaction.
To minimize any risk of error. To ensure safe and effective administration of the drug. To enable anticipation of toxicities and the nursing implications of these (NPSA 2007d, C).
If any doubts exist about the listed points, consult the pharmacist or appropriate reference works.
12 Any additions must be made immediately before use. To prevent any possible microbial growth or degradation (NPSA 2007d, C).
13 Wash hands thoroughly using bactericidal soap and water or bactericidal alcohol handrub. To minimize the risk of cross-infection (DH 2007, C; Fraise and Bradley 2009, E).
14 Place infusion bag on flat surface. To prevent puncturing the side of the infusion bag when making additions (NPSA 2007d, C).
15 Remove any seal present. To expose the injection site on the container. E
Procedure
16 Clean the site with the swab and allow it to dry. To reduce the risk of contamination (NPSA 2007d, C).
17 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 2007d, C).
(a) Avoid contamination of the needle and inlet port To minimize the risk of contamination (NPSA 2007d, C).
(b) Check that the correct quantity of fluid is in the chamber To ensure the correct dilution (NPSA 2007d, C).
(c) Switch the infusion off briefly
(d) Add the drug.
To ensure a bolus injection is not given (NPSA 2007d, C).
18 Invert the container a number of times, especially if adding to a flexible infusion bag. To ensure adequate mixing of the drug (NPSA 2007d, C).
19 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 2007d, C).
20 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 2007d, C).
21 Place the container in a clean receptacle. Wash hands and proceed to the patient. To minimize the risk of contamination (DH 2007, C).
22 Check the identity of the patient against the prescription chart and infusion bag. To minimize the risk of error and ensure the correct infusion is administered to the correct patient (NPSA 2007d, C).
23 Check that the contents of the previous container have been fully delivered. To ensure that the preceding prescription has been administered (NPSA 2007d, C).
24 Switch off the infusion. Apply gloves. Place the new infusion bag on a flat surface and then disconnect empty infusion bag. To ensure that the administration set spike will not puncture the side wall of the infusion bag (Finlay 2008, E; NPSA 2007d, C).
25 Push the spike in fully without touching it and hang the