Clinical Skills Team
Year 5 –How to administer IV medication via a syringe pump
EQUIPMENT
▪ Valid prescription chart ▪ Syringe driver/volumetric pump with power source/full battery ▪ Non sterile gloves ▪ Alcohol hand gel ▪ Needle and syringe for drawing up medication ▪ Needle and syringe for drawing up diluent ▪ Extra drawing up needles ▪ Appropriate size syringe for infusion through syringe driver ▪ Appropriate IV giving set ▪ Alcohol swabs ▪ Correct medication ▪ Correct diluent (sterile fluid to dissolve medication: NaCl 0.9% or sterile water) ▪ 10-20ml NaCl 0.9% flush ▪ Label for infusion ▪ Sharps bin ▪ Medical waste bin ▪ Medication preparation tray/trolley ▪ Syringe driver ▪ Drip stand
PROCEDURE
Preparation of the Patient: 1. Cleanse hands with alcohol gel 2. Check validity of prescription chart: patient identity, allergies recorded and doctor’s signature 3. Before giving any medications remember to check the prescription for: correct patient, correct drug, correct dose, correct route, correct time/frequency 4. Check the chart for other medications that have been given and for ‘prn’/as needed medications: be aware of drug interactions and repeating doses already administered 5. Introduce yourself to the patient 6. Check patient identity: name, surname and date of birth with identity on prescription chart (also check patient’s ID band to confirm hospital number) 7. Explain procedure to the patient and obtain consent 8. Check drug allergies with patient and also specific reactions to drug being given 9. Be familiar with the location of the ‘anaphylaxis kit’ before administering any drug to a patient
IV MEDICATION 1 Clinical Skills Team
Preparation of medication for infusion via a syringe pump: NB. Always prepare medication according to Trust Guidelines 1. Check the prescription chart as above 2. Check drug detail (name, strength and expiry date) and diluent/sterile solution used for mixing medication e.g. NaCl 0,9% ( name and expiry date) with another qualified person 3. Check the drug, dose, route and frequency are appropriate according to local guidelines/BNF 4. Go to drug preparation area: ensure a clean surface, sharps bin, clinical waste bin and equipment 5. Put on non-sterile gloves 6. Using the appropriate size needles and syringes, draw up the diluent and medication 7. Mix the diluent (e.g. sterile water) and the medication until fully dissolved: *See specific examples of mixing powders, liquids and pre-prepared medication 8. Calculate the appropriate dilution of the drug. Double check the volume and concentration (dilution) with another qualified person 9. Add medication and diluent to large syringe 10. Tilt the large syringe back and forth to mix the medication 11. Select correct brand and size syringe to fit the syringe pump (e.g. Plastipak 20/50ml) 12. Complete drug addition label, stick to the syringe: patient details, medication, dose, diluent, total volume, date and time of preparation and your signature as well as the signature of the person who checked with you 13. Calculate flow rate based on concentration/dilution and prescription (double check with qualified person) 14. Attach the giving set to the syringe and flush the line until no air is seen in the line 15. You are now ready to run the medication through the syringe driver 16. Remember before giving medication check cannula and flush
Using the ‘Graseby 3500’ syringe pump Plug in pump/ ensure battery is full Press the ‘on’ button Lift barrel clamp and slide syringe ‘wings/finger grips’ into slot Select ‘normal’ mode Select the units you are working with e.g. ml/hr or mg/hour etc. (adjust using the arrows) Press ‘Enter’ Using the keypad, type in the number you require e.g.6 ml/hr Take equipment to the patient See ‘Administering the infusion to the patient’ Attach the line as described Press ‘start’ when ready to administer the drug Make sure the screen flashes ‘infusing’ to show that the drug is now being infused
IV MEDICATION 2 Clinical Skills Team
Start
Stop
Off
On
A.
Alarm silence Screen Keypad Arrows to adjust settings
A + B. Images to show components of a ‘Graseby 3500’ syringe pump
Syringe ‘wings’/ finger tips
B.
Barrel Clamps
IV MEDICATION 3 Clinical Skills Team
Administering the infusion to the patient via the syringe pump: 1. Wash your hands and put on nonsterile gloves 2. Take the infusion connected to pump, a 10ml saline flush and alcohol swab to the patient’s bedside 3. Again check patient identity and drug allergies with the prescription chart before connecting the infusion 4. Again confirm patient consent and understanding of the procedure 5. Check the IV cannula site for any signs of infection/phlebitis: any redness, pain or swelling around the cannula site (do not connect the infusion if infection/phlebitis is suspected- the cannula may need to be removed and sited elsewhere) 6. Check the patency of the IV cannula: clean the hub with alcohol swab for 30 seconds and let dry for 30 seconds/remove the cap using aseptic technique, connect the syringe with saline flush, clamp off any other infusion that may be running, inject the saline into the cannula making sure it injects easily with no resistance and doesn’t cause the patient any pain nor cause any redness or swelling to surrounding tissues (do not give the infusion if in doubt about the patency of the IV cannula) 7. Check the compatibility of the infusion you are about to start with any other infusions running through the same cannula (stop any other infusion that is not compatible with the medication you are about to infuse or wait for the infusion already connected to be completed- if this is not possible, a second IV cannula may need to be inserted at a different location) 8. Using aseptic non touch technique, remove the cap from the end of the infusion line, ensuring that the exposed end is not contaminated 9. Elevate the patient’s arm and remove the cap from the cannula or clean existing hub with an alcohol swab for 30 seconds and let dry for 30 seconds and attach infusion line. 10. Make sure the volume to be infused and the infusion rate are set correctly as prepared 11. Secure the pump to the trolley/drip stand 12. Start the infusion running 13. Check the patient’s comfort and for any immediate effects / signs of an adverse reaction 14. Record on the drug chart: the date, the time of commencing infusion, your signature AND the signature of qualified person who checked the drugs with you earlier
Remember practice makes perfec t –as well as work
in the independent learning room , you must look
for opportunities to practice on the wards
Your notes:
IV MEDICATION 4 Clinical Skills Team
Year 5 -M ixing intravenous medication
MIXING A POWDER E.G. ANTIBIOTIC
PREPARATION
▪ A clean surface ▪ Gloves ▪ Valid prescription ▪ A syringe and drawing up needle ▪ Two extra drawing up needles ▪ Large syringe for syringe pump e.g. 50ml syringe ▪ An alcohol swab ▪ Vial containing medication powder ▪ Appropriate diluent to mix with the medication ▪ Appropriate diluent for the large infusion syringe ▪ A label for the infusion syringe ▪ Sharps container
PROCEDURE
1. See section on ‘Preparation of medication for infusion’ and follow correct procedure 2. Wash hands and put on gloves 3. Draw up correct diluent and discard the needle into the sharps container 4. Break open the vial containing powder/break seal off the top of vial 5. Inject diluent into the powder. Mix the medication together gently 6. Draw up medication into small syringe 7. Draw up appropriate diluent to correct volume into the large syringe 8. Double check with qualified staff correct drug, dose and dilution calculation 9. Add medication into large syringe using clean needle. 10. Discard needles in the sharps container 11. Remember to always double check prescription, medication, diluent, concentration, volume and flow rate with another qualified person 12. Label the infusion syringe as described previously 13. See section on ‘Administering infusion to the patient’ and follow correct procedure
IV MEDICATION 5 Clinical Skills Team
MIXING A PRE-PREPARED LIQUID E.G. PROPOFOL
PREPARATION
▪ Clean surface ▪ Gloves ▪ Valid prescription ▪ Drawing up needle ▪ Large syringe for syringe pump e.g. 50ml syringe ▪ An alcohol swab ▪ Pre prepared medication vial ▪ Sharps container
PROCEDURE
1. See section on ‘Preparation of medication for infusion’ and follow correct procedure 2. Wash hands and put on gloves 3. Break open the medication vial or clean the rubber injection port with alcohol swab for 30 seconds and allow to dry for 30 seconds 4. Draw up the correct volume of medication into the large infusion syringe 5. Discard needle in sharps container 6. Label the infusion syringe as described earlier 7. Remember to always double check prescription, medication, concentration, volume and flow rate with another qualified person 8. See section on ‘Administering infusion to the patient’ and follow correct procedure
Remember practice makes perfect –as well as work in the independent learning room, you must look for opportunities to practice on the wards
IV MEDICATION 6 Clinical Skills Team
MIXING A LIQUID MEDICATION IN A LIQUID E.G. PREPARING 50 UNITS ACTRAPID INSULIN IN 50ML NACL 0.9% FOR INFUSION THROUGH SYRINGE PUMP
PREPARATION
▪ Valid prescription chart ▪ Clean working surface ▪ Gloves ▪ Alcohol hand gel ▪ Sharps container ▪ Insulin syringe ▪ Actrapid vial ▪ 50ml NaCl 0.9% (often best to use 100ml NaCl bag) ▪ 50ml syringe for syringe pump ▪ Drawing up needle ▪ Alcohol swabs ▪ Label for 50ml infusion syringe
PROCEDURE
1. See section on ‘Preparation of medication for infusion’ and follow correct procedure 2. Wash hands and put on gloves 3. Draw up 50ml NaCl 0.9% from infusion bag into 50ml syringe for infusion pump 4. Remove needle from 50ml syringe and discard in sharps container 5. Clean rubber injection port on Actrapid vial with alcohol swab for 30 seconds and allow to dry for 30 seconds 6. Draw up 50 Units Actrapid insulin into INSULIN SYRINGE. 7. Double check with qualified staff correct drug, dose of both syringes. 8. Add Actrapid into the 50 ml syringe with NaCl 0.9% 9. Tilt the syringe back and forth to mix the insulin with the NaCl 0.9% 10. Label the syringe as described earlier 11. You will now have a concentration of 1ml = 1 unit of insulin (50 units Actrapid insulin in 50ml NaCl 0.9%) therefore 6 Units/hour = 6ml/hour etc. 12. Remember to always double check prescription, medication, concentration, volume and flow rate with another qualified person 13. See section on ‘Administering infusion to the patient’ and follow correct procedure
IV MEDICATION 7 Clinical Skills Team
Your notes:
IV MEDICATION 8