The Royal Marsden Hospital Manual of Clinical Nursing Procedures - Lisa Dougherty [586]
6 Prepare the drug for injection as Procedure guidelines 13.12–13.15. To prepare the drug correctly. E
7 Prepare a 20 mL syringe of 0.9% sodium chloride (or compatible solution) for injection, as described, using aseptic technique. To use for flushing between each drug (NPSA 2007d, C).
8 Draw up the flushing solution, as indicated by local hospital policy. To prepare for administration. E
9 Place syringes in a clinically clean receptacle on the bottom shelf of the dressing trolley, along with the receptacle containing any drug(s) to be administered. To ensure top shelf is used for sterile dressing pack in order to minimize the risk of contamination. E
10 Collect the other equipment and place it on the bottom of the trolley. To ensure all equipment is available to commence procedure. E
11 Place a sterile dressing pack on top of the trolley. To minimize the 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. To minimize the risk of infection (DH 2007, C; Fraise and Bradley 2009, E).
14 Proceed to the patient and check identity with prescription chart and prepared drug. To minimize the risk of error and ensure the correct patient (NPSA 2007d, C).
15 Open the sterile dressing pack and 2% chlorhexidine swab and empty onto pack. To gain access to equipment and to ensure there is a cleaning swab available (DH 2007, C).
16 Wash hands with bactericidal soap and water or with bactericidal alcohol handrub. To reduce the risk of infection (DH 2007, C; Fraise and Bradley 2009, E).
17 If a peripheral device is in situ, remove the bandage and dressing (if appropriate). To observe the insertion site. E
18 Inspect the insertion site of the device. To detect any signs of inflammation, infiltration, and so on. If present, take appropriate action (see Problem-solving table 13.2) (DH 2003c, C).
19 Observe the infusion, if in progress. To confirm that it is infusing as desired (NPSA 2007d, C).
20 Check whether the infusion fluid and the drugs are compatible. If not, change the infusion fluid to 0.9% sodium chloride to flush between the drugs if necesary. To prevent drug interaction. Some manufacturers may recommend that the drug is given into the injection site of a rapidly running infusion (NPSA 2007d, C). A compatible fluid must be used to remove the medication and prevent precipitation or drug incompatibility if medications mix in the tubing (Whittington 2008, E).
21 Wash hands or clean them with an alcohol handrub. To minimize the risk of infection (DH 2007, C; Fraise and Bradley 2009, E).
22 Place a sterile towel under the patient’s arm. To create a sterile field. E
23 Clean the injection site with a 2% chlorhexidine swab and allow to dry. To reduce the number of pathogens introduced by the needle at the time of the insertion. To ensure complete disinfection has occurred (Pratt et al. 2007, C).
24 Switch off the infusion. To prevent excessive pressure within the vein. To prevent contact with an incompatible infusion fluid. To allow the nurse to concentrate on the site of insertion and injection (NPSA 2007d, C).
25 If a peripheral device is in situ, gently inject 0.9% sodium chloride. This may not be necessary if the patient has a 0.9% sodium chloride infusion in progress. To confirm patency of the vein. To prevent contact with an incompatible infusion solution (NPSA 2007d, C).
26 Open the roller clamp of the administration set fully. Inject the drug at a speed sufficient to slow but not stop the infusion and inject the drug smoothly in the direction of flow at the specified rate. To prevent backflow of drug up the tubing. To prevent excessive pressure within the vein. To prevent speed shock (NPSA 2007d, C).
27 Ensure used needles and syringes are disposed of immediately into appropriate sharps container (or are returned to tray). Do not leave any sharps on opened sterile pack. To reduce the risk of needlestick injury and to prevent