The Royal Marsden Hospital Manual of Clinical Nursing Procedures - Lisa Dougherty [587]
28 Observe the insertion site of the device throughout. To detect any complications at an early stage, for example extravasation or local allergic reaction (Dougherty 2008, E).
29 Blood return ‘flashback’ must be checked frequently throughout the injection (that is, every 3–5 mL) but other signs and symptoms must be taken into consideration. To confirm that the device is correctly placed and that the vein remains patent (Weinstein and Plumer 2007, E). Flashback alone is not an indicator that the vein is patent (Dougherty 2008, E).
30 Consult the patient during the injection about any discomfort, and so on. To detect any complications at an early stage, and ensure patient comfort (Dougherty 2008, E).
31 If more than one drug is to be administered, flush with 0.9% sodium chloride between administrations by restarting the infusion or changing syringes. To prevent drug interactions (NPSA 2007d, C).
32 At the end of the injection, flush with 0.9% sodium chloride by restarting the infusion or attaching a syringe containing 0.9% sodium chloride. To flush any remaining irritant solution away from the device site (NPSA 2007d, C).
33 Observe the insertion site of the cannula carefully. To detect any complications at an early stage. Extra pressure within the vein caused by both fluid flow and injection of the drug may cause rupture of the vessel (Dougherty 2008, E).
34 After the final flush of 0.9% sodium chloride, adjust the infusion rate as prescribed or open the fluid path of the tap/stopcock or administer the flushing solution using pulsatile flush and ending with positive pressure. To continue delivery of therapy. To maintain the patency of the cannula (Finlay 2008, E).
35 If a peripheral device is in situ, cover the insertion site with new sterile low-linting swab and tape it in place. To minimize the risk of contamination of the insertion site. E
36 Apply a bandage. To reduce the risk of dislodging the cannula. E
37 Assist the patient into a comfortable position. To ensure the patient is comfortable. E
Postprocedure
38 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).
39 Dispose of used syringes with needles, unsheathed, directly into a sharps container during procedure or place back on to plastic tray and then dispose of in a sharps container as soon as possible. Do not disconnect needle from syringe prior to disposal. Other waste should be placed into the appropriate plastic bags. To avoid needlestick injury (MHRA 2004, C; NHS Employers 2007, C).
Problem-solving table 13.2 Prevention and resolution (Procedure guidelines 13.20–13.22)
Postprocedural considerations
Ongoing care
Monitoring of the infusion while in progress includes monitoring of the patient’s condition and response to therapy, the VAD site, the rate and volume infused. It may also include the battery life and occlusion pressure. The frequency of monitoring is often based on the type of therapy and patient condition, for example 15 minutes after setting up infusion, at 1 hour and then 4 hourly. This information must be documented on the patient’s fluid balance chart or in their notes. The type and make of pump along with the serial number should also be documented (useful if any errors occur) (MHRA 2008a).
Complications
Allergic reaction
This is a complication associated with any medication administration but because it happens more rapidly when IV medication is administered, it is often considered as more of an issue.
An allergic reaction is a response to a medication or solution to which the patient is sensitive and may be immediate or delayed (Lamb and Dougherty 2008, Perucca 2010). Clinical features may start with chills and fever, with or without urticaria, erythema and itching. The patient could then go onto experience shortness of breath with or without wheezing, then angioneurotic oedema and in severe cases anaphylactic shock (Lamb and Dougherty 2008).