The Royal Marsden Hospital Manual of Clinical Nursing Procedures - Lisa Dougherty [584]
10 Collect the other equipment and place it on the bottom shelf of the dressing trolley. To ensure all equipment is available to commence procedure. E
11 Place a sterile dressing pack on top of the trolley. To minimize risk of contamination. E
12 Check that all necessary equipment is present. To prevent delays and interruption of the procedure. E
13 Wash hands thoroughly using bactericidal soap and water or bactericidal alcohol handrub before leaving the clinical room. To minimize the risk of cross-infection (DH 2007, C; Fraise and Bradley 2009, E).
14 Proceed to the patient. Check patient’s identity against prescription chart and prepared drugs. To minimize the risk of error and ensure the correct drug is given to the correct patient (NMC 2008a, C; NPSA 2007d, C).
Procedure
15 Open the sterile dressing pack. To minimize the risk of cross-infection (DH 2007, C; Fraise and Bradley 2009, E).
16 Open the 2% chlorhexidine swab packet and empty it onto the pack. To ensure the correct cleaning swab is available (DH 2007, E).
17 Wash hands with bactericidal soap and water or with a bactericidal alcohol handrub. To minimize the risk of cross-infection. (DH 2007, C; Fraise and Bradley 2009, E).
18 If peripheral device is in situ remove the patient’s bandage and dressing. To observe the insertion site (Dougherty 2008, E).
19 Inspect the insertion site of the device. To detect any signs of inflammation, infiltration, and so on. If present, take appropriate action (DH 2003c, C).
20 Wash and dry hands. To minimize the risk of contamination (DH 2007, C).
21 Put on gloves. To protect against contamination with hazardous substances, for example cytotoxic drugs (NPSA 2007d, C).
22 Place a sterile towel under the patient’s arm. To create a sterile area on which to work. E
23 Clean the needle-free cap with 2% chlorhexidine swab. To minimize the risk of contamination and maintain a closed system (Pratt et al. 2007, C).
24 Inject gently 10 mL of 0.9% sodium chloride for injection. To confirm the patency of the device. E
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 2008, E).
26 Connect the infusion to the device. To commence treatment. E
27 Open the roller clamp or insert the tubing into an infusion pump and start pump. To check the infusion is flowing freely. E
28 Check the insertion site and ask the patient if they are comfortable. To confirm that the vein can accommodate the extra fluid flow and that the patient experiences no pain. E
29 Adjust the flow rate as prescribed. To ensure that the correct speed of administration is established (NPSA 2007d, C).
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 2008, E).
31 If a peripheral device is in situ, cover it with a sterile topical swab and tape it in place. To maintain asepsis (Dougherty 2008, E).
32 Remove gloves. To ensure disposal. E
33 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 reapply bandage. To reduce the risk of dislodging the device. E
34 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
35 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 2007d, C).
36 When the infusion is complete, wash hands using bactericidal soap and water or bactericidal alcohol handrub, and recheck that all the equipment required is present. To maintain