The Royal Marsden Hospital Manual of Clinical Nursing Procedures - Lisa Dougherty [585]
37 Stop the infusion when all the fluid has been delivered. To ensure that all the prescribed mixture has been delivered and prevent air infusing into the patient (NPSA 2007d, C).
38 Put on non-sterile gloves. To protect against contamination with hazardous substances. E
39 Disconnect the infusion set and flush the device with 10 mL of 0.9% sodium chloride or other compatible solution for injection. (A ‘minibag’ may be used to flush the drug through the tubing but the cost implications of this as well as the risk to patients on restricted intake should be considered before this is adopted routinely.) To flush any remaining irritating solution away from the cannula. E
40 Attach a new sterile injection cap if necessary. To maintain a closed system (Hart 2008, E).
41 Flushing must follow. To maintain the patency of the device (Dougherty 2008, E).
42 Clean the injection site of the cap with 2% chlorhexidine swab. To minimize the risk of contamination (Hart 2008, E).
43 Administer flushing solution using the push- pause technique and ending with positive pressure. To maintain the patency of the device and if needle was used, to enable reseal of the injection site (Dougherty 2008, E).
44 If a peripheral device is in situ, cover the insertion site and cannula with a new sterile low-linting swab. Tape it in place. Apply a bandage. To minimize the risk of contamination of the insertion site. To reduce the risk of dislodging the cannula. E
45 Remove gloves. To ensure disposal. E
46 Assist the patient into a comfortable position. To ensure the patient is comfortable. E
Postprocedure
47 Record the administration on appropriate charts. To maintain accurate records, provide a point of reference in the event of any queries and prevent any duplication of treatment (NMC 2009, C).
48 Discard waste, placing it in the correct containers, for example sharps into a designated container. To ensure safe disposal and avoid injury to staff (DH 2005, C; MHRA 2004, C; NHS Employers 2007, C).
Procedure guideline 13.22 Medication: injection (bolus or push) of intravenous drugs
Essential equipment
Clinically clean receiver or tray containing the prepared drug(s) to be administered
Patient’s prescription chart
Protective clothing as required by hospital policy or specific drugs
Clean dressing trolley
Sterile needles and syringes
0.9% sodium chloride, 20 mL for injection, or compatible solution
Flushing solution, in accordance with hospital policy
2% chlorhexidine swab
Sterile dressing pack
Hypoallergenic tape
Sharps container
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 2006c, C; NMC 2008b, C).
2 Before administering any prescribed drug, check that it is due and has not been given already. Check that the information contained in the prescription chart is complete, correct and legible. To protect the patient from harm (NMC 2008b, C).
3 Before administering any prescribed drug, consult the patient’s prescription sheet 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 prescriber
(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 (NMC 2008a, C; NPSA 2007d, C).
To protect the patient from harm. To comply with NMC (2008a) Standards for Medicines Management.
Procedure
4 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 2007d, C).
5 Wash hands with bactericidal soap and water or bactericidal alcohol handrub, and assemble necessary