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Intravenous injection

Intravenous injections are administered directly into the blood via a vein. They do not need to be absorbed and have an immediate action.

Introduction

  • Wash hands; Introduce self; Patient’s name, DOB and wrist band; Explain procedure and obtain consent
  • Cannula check: check when inserted, for signs of phlebitis and any pain
  • Allergy check: check for allergies with patient and on drug chart
  • Prescription check: check the prescription drug and dose, and confirm the name and DOB are correct (check with patient and their wristband)
  • Look up drug in Injectable Medicines book to determine volume of sterile water/saline required to reconstitute drug (if it is in powder form) and injection rate

Preparation 

  • Wash hands
  • Clean tray
  • Gather equipment around tray (think through what you need in order)

Equipment list

  • Gloves (+ extra pair and apron if you need to draw up drug/flush)
  • Drug – CHECK DATE, DOSE, PRESCRIPTION AND ALLERGIES
    • + if drug is in liquid form: blunt fill 18G drawing-up needle and syringe for drawing-up
    • + if drug is in powder form: blunt fill 18G drawing-up needle, syringe and vial of sterile water/saline for reconstituting drug and drawing-up – CHECK DATE
  • Alcohol 70%/chlorhexidine 2% device disinfection wipe
    • + if cannula does not have cannula IV extension set: sterile gauze and replacement bung
  • 2 x pre-prepared saline flushes (or 2 x: 10ml 0.9% saline + 10ml syringe + blunt fill 18G drawing-up needle) – CHECK DATE

  • Wash hands
  • Open packets and place neatly in tray, keeping items in plastic parts of packets (without touching the instruments themselves)
  • If flushes are not pre-prepared:
    • Wash hands, put on apron and extra pair of gloves
    • Snap top off 0.9% saline
    • Put green needle on syringe, hold saline upside-down and draw up 10ml saline
    • Dispose of needle in sharps bin
    • Expel air from syringe and place back into syringe packet in tray
    • Repeat the process for second flush
    • Discard waste; then discard gloves and apron; wash hands (if not drawing up drug)
  • If the drug is in powder form:
    • Wash hands, put on apron and extra pair of gloves (or leave on previous ones if you had to prepare flush)
    • Snap top off sterile water/saline vial
    • Put drawing-up needle on syringe, hold sterile water/saline vial upside-down and draw up required amount for reconstitution (plus a bit extra)
    • Expel air and some water from syringe to leave the exact amount needed for reconstitution
    • Flick top off drug vial
    • Insert needle and inject the sterile water/saline. Twist the vial back and forth on end of needle until drug powder is fully dissolved.
    • Draw up drug solution while the vial is upside-down
    • Remove and dispose of drawing-up needle in sharps bin
    • Expel air from syringe and place back into syringe packet in tray
    • Discard waste; then discard gloves and apron; wash hands
  • If the drug is in liquid form:
    • Wash hands, put on apron and extra pair of gloves (or leave on previous ones if you had to prepare flush)
    • Put drawing-up needle on syringe and fill with approximately the same volume of air as in the drug vial if drug vial contains a vacuum
    • Flick/snap top off drug vial
    • Insert needle into the vial, and inject the air into the airspace if drug vial contains a vacuum
    • Draw up drug solution while the vial is upside-down
    • Dispose of drawing-up needle in sharps bin
    • Expel air from syringe and place back into syringe packet in tray
    • Discard waste; then discard gloves and apron; wash hands
  • Walk to patient

Procedure

  • Wash hands
  • Put on gloves
  • If no cannula IV extension set on cannula:
    • Place gauze under back of cannula
    • Open back port of cannula while occluding the vein proximally
    • Clean cannula back port with device disinfection wipe
  • If cannula IV extension set on cannula:
    • Holding the proximal part of the administration port of the cannula IV extension set, clean the port with the device disinfection wipe
    • Unlock port
  • Flush 5-10mls flush 0.9% saline through the cannula’s back port/IV extension set slowly (in a pulsating manner)
  • Administer drug at rate stated in Injectable Medicines book
  • Administer 2nd 5-10ml flush through the cannula’s back port/IV extension set slowly (in a pulsating manner)
  • If no cannula IV extension set, place new cannula back port bung; if using cannula IV extension set, lock lumen

To complete

  • Thank patient and restore clothing
  • Discard waste and clean tray; then discard gloves; wash hands
  • Sign on the drug chart that the drug has been administered

Try an OSCE station

  1. Intravenous injection
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