Intravenous administration of the drug using a device for infusion into small veins "butterfly needle"

Authors: Brikez J. I., Rednenko V.V., Poplavets E.V., Tolyaronok D.A.

Editor: Rednenko V.V.

Equipment for the practical skill:

• medical manipulation table
• disinfection table
• medicine in an ampoule (vial) as prescribed by a doctor
• infusion solution in a vial as prescribed by a doctor with a volume of 200, 400 ml
• skin antiseptic
• emergency chemical disinfectant  
• sterile disposable medical instruments:
• the butterfly needle device
• system
• 5 ml, 10 ml, 20 ml syringes with a needle size of 0.8x40 mm
• sterile dressings in individual packaging (balls, gauze napkin) 
• ampoule knife
• medical tripod
• anatomical tweezers in a container with a disinfectant solution
• PPE: medical robe, cap, gloves (non-sterile), mask, glasses or protective screen
• working solution of a chemical disinfectant in containers:
• "Disinfection of sharp medical devices" 
• "Disinfection of syringes and other medical devices"
• "Disinfection of dressings and PPE"
• "Rinsing of syringes and other medical devices"
• medical waste containers:
• "Empty ampoules"
• "Empty vials"
• "Plastic"
• "Packaging"
• scissors in a container with a disinfectant solution
• medical tripod for intravenous infusions
• medical documentation (treatment list)

 Level of assistance:

• Hospital and outpatient health care facilities

Clinical situation:

•  Perform intravenous administration of the drug using a device for infusion into small veins "butterfly needle" as prescribed by a doctor

Order of the skill performance:

Preparatory stage:

• inform the patient about the upcoming intravenous administration of the drug
• get verbal consent to giving it
• ask him to take the required position
• compare:

• the name and dose of the drug on the ampoule (vial) and the infusion solution on the vial with an entry in the treatment list
  • check:
• the integrity of the ampoule (vial) and the infusion solution
• their appearance, expiration date
• the integrity of the packaging of sterile medical items and sterile dressings, their expiration date

• indicate on the vial with the infusion solution the date and time of opening the vial, the name and initials of the patient
• perform hygienic hand antiseptics
• open the package with the balls
• prepare a vial with an infusion solution (see the practical skill above)
• fill the system with an infusion solution (see the practical skill above)
• enter the medicine into a vial with an infusion solution (if necessary)
• cut three or four strips of adhesive tape 10 cm long with scissors
• place them on a manipulative table or on a tripod

• take the package with the butterfly needle device from the manipulation table with your right hand, open the package, remove the butterfly needle device with your left hand, place the package into the "Packaging" container

• take the system by the connector with the first and second fingers of the right hand, place the connector between the third and fourth fingers of the left hand
• place the first and second fingers of the right hand on the needle cannula, separate the injection needle with a cap by rotating it and place it in the container "Disinfection of sharp medical devices"
• remove the protective cap with the fingers of your right hand from the connection at the distal end of the tube of the butterfly needle, place the protective cap in the container "Plastic"
• take the system coupling at the base of the connector with the first and second fingers of your right hand
• connect the connector of the system to the distal end of the butterfly needle, fix the connection point with a rotational movement
• take the butterfly needle device by the wings with the first and second fingers of your left hand, remove the fingers of your right hand from the connection point of the system with the butterfly needle 
• open the roller clip on the system with your right hand
• fill the butterfly needle device with infusion solution until a drop of infusion solution appears on the needle slice
• close the roller clamp on the system with your right hand
• make sure visually that there is no air in the tube of the butterfly needle device, leave the system with the attached butterfly needle device on the tripod
• perform hygienic hand antiseptics
• put on gloves
• open the packages with balls, gauze napkins.     

Main stage:

• place a pad under a patient's shoulder
• put a tourniquet on patient's shoulder and treat the skin at the injection site with antiseptic (see the practical skill above)
• take the butterfly needle device by the wings with the first, second and third fingers of your right hand, holding the needle with the cut up
• open the roller clip on the system with your left hand until a drop of infusion solution appears on the needle slice, without removing the cap from it
• close the roller clamp on the system with your left hand
• remove the cap from the needle with your left hand, place the cap in the container «Plastic»
• fix the vein by pulling the skin in the venipuncture area with the first finger of the left hand
• holding the needle with the cut up, pierce the skin at a slight angle (no more than 15 degrees) place the needle parallel to the vein
• continuing to fix the vein, slightly change the direction of the needle, pierce the anterior wall of the vein with the needle and carefully move the needle along the vein
• untie the tourniquet with your left hand, invite the patient to unclench his fist
• 
• open the roller clip on the system with your left hand, make sure there is no infiltration in the venipuncture area
• straighten the wings of the butterfly needle device, holding them with the fingers of your right hand
• fix the butterfly needle device and the system with strips of adhesive tape with your left hand: one strip — for wings, the other — for a tube rolled into a ring, the third is for the system below the injection coupling (the second and third strips of adhesive plaster can be fixed with the right hand)
• adjust the speed of drug administration with the right hand using the roller clip on the system according to the doctor's prescription
• cover the venipuncture site and the connection point of the system with the butterfly needle device with gauze napkins
• remove the gloves, put them in a container «Disinfection of dressings and PPE»
• wash your hands
• observe the patient's condition during the infusion

After the end of the infusion:

• perform hygienic hand antiseptics
• put on clean gloves
• open the package with the balls
• take the ball with your right hand, moisten it with antiseptic, place it in the palm of your left hand, holding it with the fourth and fifth fingers
• close the roller clamp on the system with your right hand
• remove the gauze napkins with your right hand from the connection point of the system with the butterfly needle device and from the venipuncture site
• place them in a container «Disinfection of dressings and PPE» 
• holding the wings of the butterfly needle device with the first and second fingers of the left hand, peel off the strips of adhesive plaster with your right hand at the fixation points, place them in a container «Disinfection of dressings and PPE» 
• place the first and second fingers of the right hand on the connector of the system, at the same time remove the fingers of the left hand from the connector
• attach a ball moistened with antiseptic to the venipuncture site, take the wings of the butterfly needle device with the first and second fingers of your right hand and remove the needle with a quick movement, press the ball for 3-5 minutes. When puncturing the ulnar vein, ask the patient to bend his arm at the elbow joint.

Final stage:

• disconnect the butterfly needle device from the system
• place it in a container «Disinfection of sharp medical devices», place the ball in a container «Disinfection of dressings and PPE», system — in a container «Disinfection of syringes and other medical devices»
• remove the gloves, put them in a container «Disinfection of dressings and PPE»
• wash your hands
• register the introduction of drugs in the medical documentation

Используемые источники:

Приказ МЗ РБ №1355 от 27.11.2017 "Об утверждении инструкций по выполнению инъекций и внутривенных инфузий"

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