Intravenous infusion

Please note this information is for educational purposes only and procedures should not conducted based on this information. OSCEstop and authors take no responsibility for errors or for the use of any content.

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)

Drug preparation

NB: if infusing fluids without drug additives, skip this stage.

• Look up drug in Injectable Medicines book. Determine:
  • Volume of sterile water/saline required to reconstitute drug (if it is in powder form)
  • Type and volume of infusion fluid 
  • Infusion rate
• Wash hands 
• Clean tray
• Gather equipment around tray (think through what you need in order)

Equipment list

• Gloves
• Apron
• Drug vial – CHECK DATE, DOSE, PRESCRIPTION AND ALLERGIES
  • + if drug is in powder form: vial of sterile water/saline for reconstituting drug – CHECK DATE
• Syringe
• 2x blunt fill 18G drawing-up needles for drawing-up and injecting into bag
• ‘Drugs added to this infusion’ sticker
• Saline/dextrose infusion bag – CHECK DATE

• Wash hands
• Open packets and place neatly in tray, keeping items in plastic parts of packets (without touching the instruments themselves)
• Wash hands
• Put on gloves and apron
• If the drug is in powder form:
  • 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 to leave the exact amount needed for reconstitution
  • Flick top off drug vial
  • Insert the needle and inject the sterile water/saline. Twist the vial back and forth on end of needle until drug powder is fully dissolved.
• If the drug is in liquid form:
  • 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 top off drug vial
  • Insert needle into the vial, and inject the air into the airspace if drug vial contains a vacuum (stops a vacuum forming)
• Draw up drug solution while vial is upside-down
• Remove and replace the needle on the end of the syringe filled with the drug solution (put old one directly in sharps bin), expel the air, and inject the drug solution directly into the infusion bag
• Invert bag a few times to mix
• Fill in the details on the yellow sticker and stick it on the back of the infusion bag (expiry depends on drug, but is usually 24 hours)
• Dispose of sharps in sharps bin
• Discard waste and clean tray; then discard gloves and apron; wash hands

Infusion preparation 

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

Equipment list

• Gloves x 2
• Apron
• Giving set
• Infusion bag (with or without drug in) – CHECK DATE
• Sterile gauze
• Alcohol 70%/chlorhexidine 2% device disinfection wipe
• Pre-prepared saline flush (or 10ml 0.9% saline + 10ml syringe + green needle + bung) – CHECK DATE

• Wash hands
• Open packets and place neatly in tray, keeping items in plastic parts of packets (without touching the instruments themselves)
• Wash hands
• Put on 1^st pair of gloves and apron (2^nd if prepared drug)
• If flush is not pre-prepared:
  • Put drawing-up 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
• Preparing the giving set
  • Close roller clamp on giving set
• • Remove twist cap from infusion bag
• • Insert giving set spike into infusion bag 
• • Hang infusion bag up on a drip stand, squeeze chamber on giving set until it is just under half full
• • Fully open roller clamp and allow fluid to run all the way down the tubing (ensure no air bubbles at any point)
  • Close roller clamp, apply sterile cap and put bag with attached set back into tray
  • NB: This should all be done without touching the parts of equipment which will come into direct contact with the infusion fluid or patient – the ‘key parts’.
• Discard waste; then discard gloves and apron; wash hands
• Walk to patient

A patient presents to ED with chest pain and this trace. What would you do?

Interpretation management

Covered in OSCE Stations

Procedure

• Wash hands 
• Put on 2^nd pair of gloves (3^rd if prepared drug)
• 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
• Slowly flush 5-10mls flush 0.9% saline through the cannula back port/cannula IV extension set slowly (in a pulsating manner)
• Take cap off the giving set’s luer connector
• Attach it to the cannula’s back port/IV extension set 
• Hang up the infusion bag on the patient’s drip stand 
• Open the giving set’s roller clamp and adjust to give the correct amount of drops per minute (time it):

Example: a 1L (1000ml) bag of normal saline is prescribed over 8 hours (480 minutes). The giving set runs fluid through at 20 drops per ml and so the total drops in the bag are 1000 x 20, which is 20,000. To run the infusion over 8 hours, the rate required in drops per minute is 20,000 / 480, which is 42 drops per minute. This is approximately 10 drops in 15 seconds (42 / 4), and the giving set clamp can be adjusted to give that rate.

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
• Re-check flow rate regularly
• Return when finished: remove giving set and flush cannula