Practical procedures Flashcards
Infiltrating anaesthetic agents: advance and pull back
Whenever you inject anything, you should advance the needle and attempt to pull back the plunger at each step.
If you do not aspirate blood, you may then go ahead and infiltrate the anaesthetic.
Infiltrating anaesthetic agents: making a surface bleb
Take the syringe of anaesthetic (e.g. 1% lidocaine = 10mg/mL) and a small needle.
Pinch a portion of skin, insert the needle horizontally into the surface.
Withdraw (advance and pullback) and inject a small amount of the anaesthetic- you should see a wheal of fluid rise.
The area of skin will now be sufficiently anaesthetised to allow you to infiltrate deeper.
Infiltrating anaesthetic agents: risks
Injecting of a large amount of anaesthetic into a vein could lead to potentially fatal cardiac arrhythmias.
Damage to vessels.
Lidocaine and other LAs sting on initial infiltration so warn the patient.
Infiltrating anaesthetic agents: maximum dose of lidocaine
3mg/kg in an adult.
7mg/kg if mixed with adrenaline.
Hand hygiene: when?
Before patient contact. Before an aseptic task. After body fluid exposure risk. After patient contact. After contact with a patient's surroundings.
Hand hygiene: soap or alcohol gel?
Repeated washing with soap and water can cause skin dryness and can be time consuming.
Alcohol gel should not substitute soap and water if your hands are visibly soiled or if you are undertaking an aseptic procedure.
Alcohol gel is not effective against Clostridium difficile.
Aseptic technique: before
Wash hands with soap and water or alcohol gel.
Put on disposable apron and any other protective items.
Clean trolley/tray with wipes and dry with a paper towel.
Gather equipment and put on the lower shelf of the trolley.
Take trolley/tray to the patient.
Aseptic technique: during
Wash hands with alcohol gel.
Removed sterile pack outer packaging and slide the contents on to the top shelf of the trolley or into the tray, taking care not to touch the sterile pack.
Open the dressing pack using only the corners of the paper, taking care not to touch any of the sterile equipment.
Place any other required items on the sterile field ensuring the outer packaging does not come into contact with the sterile field.
Put a pair of non-sterile gloves on to remove any dressings on the patient and ensure that they are positioned appropriately.
Discard gloves and wash hands.
Put sterile gloves on.
Aseptic technique: after
Dispose of contaminated equipment in the rubbish bag from the dressing pack.
Dispose of all packaging.
Dispose of aprons and gloves in the appropriate waste as per local policy.
Wash hands.
Clean the trolley with detergent wipes and dry with a paper towel.
Aseptic technique: when to use?
Insertion, repositioning, or dressing invasive devices such as catheters, drains, and intravenous lines.
Dressing wounds healing by primary intention.
Suturing.
When sterile body areas are to be entered.
If there is tracking to deeper areas or the patient is immunocompromised.
Subcutaneous and intramuscular injections: contraindications
Infection at the injection site.
Oedema or lymphoedema at the injection site.
Contraindications regarding the drugs being injected will vary dependent upon drugs being administered.
Subcutaneous and intramuscular injections: risks
Incorrect drug and/or dosage administered. Allergy to drug(s). Haemorrhage, haematoma. Infection. Injection into a blood vessel. Injection into a nerve.
Subcutaneous and intramuscular injections: usual sites for subcutaneous injections
Upper arms
Abdomen- periumbilical region.
Subcutaneous and intramuscular injections: usual sites for intramuscular injections
Can be administered at any site with adequate muscle mass.
Deltoids.
Gluteal region (upper, outer quadrant of buttock).
Subcutaneous and intramuscular injections: equipment
Appropriate syringe. 25G (orange) needle, usually. Prescribed drug. Prescription chart. Antiseptic swab. Plaster.
Subcutaneous and intramuscular injections: before you start
Assess patient for drugs required (i.e. for pain relief, vomiting, etc.).
Refer to prescription chart, double checking the appropriate drugs and dosage to be given.
Always ensure you are fully aware of any possible side effects of any drugs you are due to administer.
Double check the prescription chart for date and appropriate route for administration.
Check administration of previous dose- not too soon after last dose?
Ensure that the drug to be given is within its use-by date.
Check patient and chart for any evidence of allergies, or reactions.
Once all above completed as per hospital policy, draw-up required drug and check appropriate needle size.
Complete appropriate documentation.
Once checked by suitably qualified staff, take drug and prescription chart to patient.
Subcutaneous and intramuscular injections: subcutaneous procedure
Introduce yourself, confirm the patient’s identity, explain the procedure and obtain informed consent.
Check with patient: name and DOB (or name band with another HCP).
Select appropriate site, and cleanse with the antiseptic wipe.
Grasp skin firmly between thumb and forefinger of your right hand.
Insert needle at 45 degree angle into the pinched skin, then release skin from your grip.
Draw syringe and plunger back, checking for any blood.
If none, inject drug slowly.
If any blood is noted on pulling the plunger back, withdraw and stop procedure- provide reassurance ad explanation to the patient.
Once the procedure is completed without complication, withdraw needle and discard into a sharps bin.
Monitor patient for any negative effects of the drug.
Subcutaneous and intramuscular injections: intramuscular procedure
Introduce yourself, confirm the patient’s identity, explain the procedure and obtain informed consent.
Check with patient: name and DOB (or name band with another HCP).
Select appropriate site, and cleanse with the antiseptic wipe. If using the deltoid muscle, feel the muscle mass and ensure there is enough muscle to take the needle.
Insert needle at 90 degree angle into the skin.
Draw syringe and plunger back, checking for any blood.
If none, inject drug slowly.
If any blood is noted on pulling the plunger back, withdraw and stop procedure- provide reassurance ad explanation to the patient.
Once the procedure is completed without complication, withdraw needle and discard into a sharps bin.
Monitor patient for any negative effects of the drug.
Subcutaneous and intramuscular injections: documentation
Drugs should always be signed for as per local policy.
Signature and time should be clearly recorded.
Site drug administered.
Reason for drug administration, time given, and any impact on the patient should be recorded.
Immediate vital signs should be recorded in notes.
Any causes for concern arising from administration of drugs should be clearly documented in the medical notes.
Signature, printed name, contact details.
Venepuncture: risks
Bleeding, haematoma.
Infection.
Accidental arterial puncture.
Venepuncture: inappropriate sites
Oedematous areas. Cellulitis. Haematomas. Phlebitis or thrombophlebitis. Scarred areas. Limb in which there is an infusion. Upper limb on the side of a previous mastectomy and axillary clearance. Limbs with arteriovenous fistulae or vascular grafts.
Venepuncture: equipment
Gloves. Sterile wipe (e.g. chlorhexidine or isopropyl alcohol). Cotton wool balls or gauze. Tape. Tourniquet. Needle (try 12G first). Syringe (size depends on amount of blood required), or vacutainer with holder. Collection bottles.
Venepuncture: procedure, needle and syringe
Introduce yourself, confirm the patient’s identity, explain the procedure, and obtain verbal consent.
Position the patient appropriately: sat comfortably with arm placed on a pillow.
Wash hands, put on your gloves and apply the tourniquet proximally.
Identify the vein, e.g. at the antecubital fossa. Palpable veins are ideal.
Clean the site with the tip, beginning centrally and moving outwards in concentric circles.
Whilst the sterilising solution dries, remove the needle and syringe from packaging and connect together.
Unsheathe the needle.
Using your non-dominant thumb, pull the skin taut over the vein in order to anchor it.
Warn the patient to expect a ‘sharp scratch’.
Insert the needle, bevel up, at an angle of 30 degrees until a flashback is seen within the hub of the needle.
Hold the syringe steady and withdraw the plunger slowly until the required amount of blood is obtained.
Release the tourniquet.
Venepuncture: procedure, vacuum device
Introduce yourself, confirm the patient’s identity, explain the procedure, and obtain verbal consent.
Position the patient appropriately: sat comfortably with arm placed on a pillow.
Wash hands, put on your gloves and apply the tourniquet proximally.
Identify the vein, e.g. at the antecubital fossa. Palpable veins are ideal.
Clean the site with the tip, beginning centrally and moving outwards in concentric circles.
Whilst the sterilising solution dries, remove the vacutainer needle from packaging and screw holder in place.
Unsheathe the needle.
Using your non-dominant thumb, pull the skin taut over the vein in order to anchor it.
Warn the patient to expect a ‘sharp scratch’.
Insert the needle, bevel up, at an angle of 30 degrees until a flashback is seen within the hub of the needle.
Once the needle is in place, vacuum collection bottles ar inserted into the holder over the sheathed needle in turn.
Bottles are self-filling.
Release the tourniquet before removing the last vacuum bottle, then remove the needle from the skin.
Venepuncture: documentation
Detailed documentation of the procedure is usually not required, but you should record that blood was taken and what tests it has been sent for.
Record any adverse incidents during the procedure or if multiple attempts were performed.
Signature, printed name, contact details.
Peripheral venous cannulation: contraindications
Cannulae should not be placed unless IV access is required.
Caution in patients with a bleeding diathesis.
Peripheral venous cannulation: risks
Infection, which could be local or systemic.
Peripheral venous cannulation: equipment
Gloves.
Sterile wipe (chlorhexidine).
Cannula of appropriate gauge.
Sterile saline for injection ('flush') and a 5mL syringe.
Cannula dressing.
Cotton wool balls/gauze.
Tourniquet.
