Intravenous administration of a medication using a syringe during an existing IV infusion

Authors:  Brikez J. I., Rednenko V.V., Poplavets E.V., Rednenko l.I.

Editor:.Rednenko V.V.

Clinical situation:

 You are a nurse at a hospital’s therapeutic department. The physician prescribed to the patient an antispasmodic intravenously. A client has an IV infusion. Inject an additional medication during the established intravenous infusion.

Equipment for the practical skill:

• workplace for injections and intravenous infusions (see PS1 - Preparing of the workplace for injections and intravenous infusions
•              Medications in glass (plastic) bottles or plastic IV fluid containers of 0,5 (0,4) or 1 litre volume
•              IV stand (bottle or bag holder)
•              IV set with a needle of appropriate size
• medication (antispasmodic)   in ampule or vial
• extra needle of size 0.8x 40 mm (green needle hilt, G21)
• 10 or 20 ml syringe with needle of size 0.8x 40 mm (green needle hilt, G21) 
• medical records

Order of the skill performance:

Preparatory stage:

• inform the patient about the injection, get verbal consent to giving it, ask if a patient allergic to medicines.
• withdraw the required medication into a syringe from an ampule (vial) and change the needle (see PS5 - Withdrawing of medicine from an ampule  into a syringe) or (PS6 - Withdrawing of medicine from a vial into a syringe)

Maine stage:

•  close the roller clamp of IV set
• remove the gauze from the puncture site
• place the used gauze in the container “Disinfection of dressings, PPE”
• take a swab, soaked it by disinfectant
• treat the injection site with a swab‚ fixing the tube of the system with the thumb of the non-dominant hand
• place the used swab in the container “Disinfection of dressings, PPE”
• take the syringe with a medication from the opened package with your dominant hand, place the second finger on the needle hilt, grasp the syringe barrel with others fingers
• place the package in the "Package" container
• remove a cap from the needle with your non dominant hand, holding the needle hilt with the index finger of your dominant hand
• place the cap in the "Plastic" container
• check the parallel position of the needle bevel and the syringe barrel scale
• fix the injection site by placing thumb of non-dominant hand on IV-system tube below the injection site  
• holding the injection needle with bevel by upward‚ pierce the injection site
• slowly enter the medicine
• carefully remove the needle‚ holding the tube with the thumb of non-dominant hand below the injection site
• slightly open the roller clamp on the system, adjust the rate of a solution administration
• cover the venipuncture site with gauze

Final stage:

• disinfect syringe and injection needle (see PS3 - Disinfection of disposable syringes and injection needles)
• take off the gloves, place it in the container “Disinfection of dressings, PPE” (see Removal contaminated gloves); 
• wash your hands (see Hygienic hand washing)
• register the medication administration in medical records;
• continue to observe the patient during IV infusion