Injections, Infusions & NG Tubes

Question 1

Indications of cannula

Answer 1

• IV medications
• IV fluids
• blood products

Question 2

Step before cannulation procedure

Answer 2

• wash hands
• prepared cannulation pack & cannula

Question 3

Equipment for cannulation

Answer 3

• sterile sheet
• gauze
• tourniquet
• clinical waste bag
• chlorhexidine wipe
• cannula dressing
• flush
• connector
• review day sticker
• cannula
• sharps bin

Question 4

What cannula information should be filled out and placed within the patient’s records?

Answer 4

• date of insertion
• size of cannula
• when to review
• problems with insertion

Question 5

Steps of cannulation: 1

Answer 5

• wash hands, PPE (non-sterile gloves), introduce (name & role)
• confirm pt details
• gain informed consent
• check allergies
• adequate exposure & positioning
• ask if any pain

Question 6

Steps of cannulation: 2

Answer 6

• find suitable site (non-dominant hand preferable)
• not in area of lymphoedema & AVfistula
• tourniquet 4-5cm above cannulation site to palpate suitable vein
• remove tourniquet to prep site
• flush cannula with saline solution

Question 7

Steps of cannulation: 3

Answer 7

• remove air from pre-prepared flush & prime extension set
• unclamp tubing & insert fluid to remove residual air in extension set
• clamp and replace ext set to packaging
• apply tourniquet
• inspect cannula for faults & prime until click
• remove sheath, bevel up
• stabilise vein, insert cannula 10-40 degree angle
• Watch for flashback then level cannula
• hold needle in one hand then push cannula in
• remove tourniquet
• withdraw needle and watch for second flashback (pressure on site reduces blood)
• connect extension set
• flush cannula through extension set to check for patency (too much resistance/pain = not patent, remove)
• apply dressing
• add date sticker
• document insertion

Question 8

Indications for IV infusion

Answer 8

patient’s needs cannot be met by oral intake alone:
- NBM
- severe vomiting/diarrhoea
- hypovolaemia (blood/fluid loss)

Question 9

Types of fluid

Answer 9

Colloids
- larger organic molecules in solution (proteins, albumin)
- small risk anaphylaxis
- human albumin solution, gelofusine

Crystalloids
- solution of small molecules in water
- resus & maintenance
- no risk anaphylaxis, used more often
- NaCl (saline), dextrose, Hartmann’s

Question 10

Steps for infusion

Answer 10

• wash hands, introduce self
• explain procedure, gain consent, check ID (x3), check allergies
• PPE
• check fluid bag (leaks, tampering, contaminants, exp date)

Question 11

Steps for infusion (2)

Answer 11

• remove fluid & giving set from casing, close valve of giving set
• remove cap from fluids
• insert giving set spike
• place fluid on drip stand
• squeeze giving set chamber until half filled
• prime line (slowly open valve to allow fluid no bubbles to fill)
• close valve

Prime cannula:
- wipe port, flush with 10ml saline

Question 12

Steps to infusion (3)

Answer 12

• connect giving set to cannula, open valve, set drip rate
• remove PPE
• document date, time, batch number
• ask pt to inform of discomfort

Question 13

How to calculate rate of infusion

Answer 13

• infusion pump
  OR
• drop factor of giving set (often 14 drops = 1ml)
  ie - 1L infusion over 8hrs = 14k drops over 480 mins = 29 drops/min (adjust valve and time for 1 minute)