Intravenous injection

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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

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

Interpretation management

Covered in OSCE Stations

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

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