Intravenous injection

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.

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 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
  • 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 2^nd 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
2. Find lots more procedure stations here