Download Neonatal Unit Oral and Intravenous Drug Administration Workbook

Neonatal Unit
Oral and Intravenous Drug
Administration
Workbook & Competencies
Copyright  Royal United Hospital Bath NHS Trust. 2014 Version 5
For use in neonatal unit only
Neonatal Unit Oral and Intravenous Drug Administration Workbook 2014
Adapted from St Michael’s IV Drug workbook and Southmead NICU Drug Workbook
Neonatal Unit Oral and Intravenous Drug Administration Workbook 2014
Adapted from St Michael’s IV Drug workbook and Southmead NICU Drug Workbook
This book has been issued to.
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Date........................................................................................................................
Ward.
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Name(s) of assessor(s) – (please print).
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For audit and verification purposes, please complete the above section.
Neonatal Unit staff are required to complete the RUH NHS Trust’s Intravenous
Therapy Workbook and Competencies in addition to this specialist module.
You are reminded that only staff, who have completed the RUH NHS Trust’s
Intravenous Administration Train the Trainers Course and who are competent in oral
and intravenous drug administration in Neonatal Unit should assess you. Please refer
to the assessment criteria and process overleaf.
Competency forms should be kept in your portfolio when complete. Your manager may require a copy.
Neonatal Unit Oral and Intravenous Drug Administration Workbook 2014
Adapted from St Michael’s IV Drug workbook and Southmead NICU Drug Workbook
Safe administration of medicines and fluids to neonates.
Emma Trim – Practice Development Sister Neonatal Unit
The aim of the assessment process is to ensure a registered nurse/midwife becomes
competent in the safe administration of intravenous medication and the care and
management associated with the equipment. This must be relevant to the patient care
within the nurse/midwife’s current area of practice.
In order to achieve this aim the candidate must undergo final assessment of their
underpinning knowledge and their ability to safely administer drugs across a range of
circumstances.
Criteria for assessment:
(Experienced Neonatal staff from other trusts can complete assessment in 1st month,
and must achieve 100% pass in Neonatal Drugs assessment)
Assessment Process:
Before the final assessment of competence each candidate must:
Within 1 – 3 months:
1. Work through oral drug assessment section within 1st month
2. Complete the oral drug competency within the 1st month
3. Complete Volumat MC Agilia / Alaris and McKinley pump competencies within
1-3 months
Within 3 – 6 months:
4. Complete neonatal unit calculations test with practice development sister. Pass
mark is 100%
5. Work through IV drug assessments
6. Complete supervised practice with an IV trainer
7. Be familiar with ANTT and IV drug administration policies
8. Complete IV drug competencies & Gentamicin competency
9. Be assessed as competent by the PD Sister or IV trainer.
After 6 months of being competent at administering intravenous medicines to a
peripheral cannula candidates may undertake the competency assessment for
longlines.
After 6 months of competent practice at administering intravenous medicines to a
longline candidates may progress to undertake the competency assessment for
umbilical venous catheters.
Candidates who are qualified in speciality and who have completed all
competencies of Intravenous management may discuss with the PD sister about
arterial line sampling competency assessment.
Neonatal Unit Oral and Intravenous Drug Administration Workbook 2014
Adapted from St Michael’s IV Drug workbook and Southmead NICU Drug Workbook
Oral and topical drugs
Record of oral drug calculations
competency
You must complete the oral drugs questions and achieve 100%
Within the 1st month of being on neonatal unit.
Date Started:
Date completed and assessed as competent:
Neonatal Unit Oral and Intravenous Drug Administration Workbook 2014
Adapted from St Michael’s IV Drug workbook and Southmead NICU Drug Workbook
Calculating oral drugs
Qualified nurses
You may have come to neonates from a different area of nursing and should ensure you
are aware of how to calculate medicines and fluids for neonates.
Newly Qualified nurses awaiting registration.
The transition period from student to qualified nurse can be a difficult time, as you are
now accountable for your actions.
When you receive your NMC PIN number and
statement of entry, you can start checking and administering oral medication on the
neonatal unit with another registered nurse.
Here are some questions to help test your knowledge of the most common oral
medications used within the Neonatal unit and to help build your confidence with drug
calculations.
Remember the 5 R’s:
Right Patient
Right Medication
Right Dose
Right Time
Right Route
You should always check that the prescription is correct.
All drugs administered in the neonatal unit should be checked against Western Neonatal
Network Prescribing Group Monographs and the BNF for children. The critical care
nursery and the stabilisation bay each have a drug folder.
Formula for calculating medicines
Always remember this:
What you want
What you have got
x
What it is in
= Volume to be given
Neonatal Unit Oral and Intravenous Drug Administration Workbook 2014
Adapted from St Michael’s IV Drug workbook and Southmead NICU Drug Workbook
Vitamins and minerals supplementation and other drugs
1. List the indications for the below and how to administer:
Indication for use
How to administer
Breast Milk Fortifier
Gaviscon
Dalivit
Sodium Iron edetate (Sytron)
Sodium Chloride 30% oral solution
Glucose 30%
Duocal
Topical Drugs
1. List indications for the drugs below.
2. Check the prescription, drug and baby and administer the drug.
Eye Drops
Cyclopentolate 0.5%
Phenylephrine 2.5%
Chloramphenicol
Topical creams
Daktarin
Proshield
Cavilon barrier cream
Cavilon barrier film
Indications for use
Neonatal Unit Oral and Intravenous Drug Administration Workbook 2014
Adapted from St Michael’s IV Drug workbook and Southmead NICU Drug Workbook
Oral Drugs
Drug – Antibiotics and
Specific information
Dose / how to reconstitute
Specific Information
Dose / how to reconstitute
antifungal treatments
PO Flucloxacillin
PO Trimethoprim
PO Nystatin
Drug
PO Phenobarbital
PO Chloral hydrate
PO Spironolactone
PO Chlorothiazide
Oral Konakion (Vitamin K)
PO Furosemide
PO Ranitidine
PO Dexamethasone
PO Caffeine citrate
PO Paracetamol
Neonatal Unit Oral and Intravenous Drug Administration Workbook 2014
Adapted from St Michael’s IV Drug workbook and Southmead NICU Drug Workbook
Name:___________________
Date commenced:
/
/
Date completed:
Competency:
Oral drug administration in the neonatal unit
/
/
Aim:
The aim of this competency is to provide the individual with the knowledge and skills to
perform safe practice.
Demonstrating competence in clinical and theoretical knowledge regarding safe practice,
technical skill required and rationale for the procedure.
Evidence of Competence
Individuals need to be able to provide evidence to support their competence.
♦ Have read the neonatal unit guidance to calculating
♦ Completion of the oral neonatal drug calculations test
♦ Learning log of practice and procedures undertaken
♦ Evidence of Direct supervision from a registered experience nurse within neonatal unit.
♦ Has read the relevant medicines management policies for the RUH trust.
I confirm that _________________________ has been supervised in practice and has completed the neonatal unit oral drugs test
and have read the written information for calculating oral medicine in the neonatal unit.
They have completed all relevant written documentation and understand the aim of this competency
Print name:
Signature of Supervisor:
Date:
I believe myself to be competent in this procedure and understand the competency aim
I have received relevant training and completed appropriate documentation successfully.
I accept full accountability for my own practice and have discussed this role with my supervisor.
Signature of individual:
Print name
Date:
Neonatal Unit Oral and Intravenous Drug Administration Workbook 2014
Adapted from St Michael’s IV Drug workbook and Southmead NICU Drug Workbook
Successful completion of oral drugs calculation test
Date
Individuals
signature
Practice
Development
sisters
signature
Individuals
signature
Nurse
observing
signature
Individuals
signature
Nurse
demonstrating
signature
Completion of oral
drugs calculations
test.
Observation of oral drug calculation
Date
Observation 1
Observation 2
Supervised Oral drug calculation and administration
Date
Observation 1
Observation 2
Neonatal Unit Oral and Intravenous Drug Administration Workbook 2014
Adapted from St Michael’s IV Drug workbook and Southmead NICU Drug Workbook
Childhood immunisations
Date Started:
Date completed and assessed as competent:
Neonatal Unit Oral and Intravenous Drug Administration Workbook 2014
Adapted from St Michael’s IV Drug workbook and Southmead NICU Drug Workbook
Childhood immunisations
1. List the vaccinations that maybe given while the baby is still on the Neonatal unit. (Though the doctors/ANNP’s administer vaccinations
you need to be aware of these).
Vaccination
Indication
Age it should be given
Method of administration
2. Check the prescription, drug, and dose are correct.
_____________________________
3. Can ensure that the necessary documentation and
_____________________________
Specific information
records are made.
Neonatal Unit Oral and Intravenous Drug Administration Workbook 2014
Adapted from St Michael’s IV Drug workbook and Southmead NICU Drug Workbook
Intravenous Drug Administration
in the Neonatal Unit
Intravenous drugs to a peripheral cannula
Intravenous Gentamicin competency
Date Started:
Date started :
Date completed and assessed as competent:
Date completed and assessed as competent.
Intravenous drugs to a neonatal long line
Intravenous drugs to a umbilical venous catheter
Date started :
Date started :
Date completed and assessed as competent.
Date completed and assessed as competent.
Neonatal Unit Oral and Intravenous Drug Administration Workbook 2014
Adapted from St Michael’s IV Drug workbook and Southmead NICU Drug Workbook
Risk Management issues relevant to IV drug therapy
Checking and administering drugs is a risky business. As qualified nurses we all have a duty to maintain professional standards and the
administration of IV drugs is no exception.
Obviously we are all responsible individually but we also have guidelines and policies to support our practice for example the 5Rs and the
NPSA Gentamicin prompt charts and the NPSA recommendations for the Prevention of over infusion of intravenous fluid and medicines in
neonates.
In the arena of risk management we are striving to put in place strategies to prevent errors occurring.
•
Ensuring prescriptions are correctly written
•
Having knowledge of drug therapies to ensure the correct dose is given e.g. using the WNNPG NICU Monograph, BNF for Children,
and local formularies.
•
Two trained nurses checking the prescription ensuring that two newly qualified nurses are not checking together, drawing up the
medication and then administering with minimum interruptions. (Red Aprons to be worn when checking drugs.)
•
Checking the drugs are being given to the right patient.
•
Ensuring documentation is done correctly e.g. both nurses/Dr signing that the medication has been given.
However sometimes mistakes occur and we need to consider the cause and effect and hopefully learn from the mistake. We try to encourage
reporting so we can monitor any errors and put in to place any changes to help minimise the risk of future mistakes.
Neonatal Unit Oral and Intravenous Drug Administration Workbook 2014
Adapted from St Michael’s IV Drug workbook and Southmead NICU Drug Workbook
What to do if an error occurs
•
Inform the senior nurse on duty that you have made or found an error.
•
Inform the Doctor on duty, making sure the baby is safe and if appropriate discontinue the medication or perform any action needed
e.g. levels to be taken.
•
Complete an Incident Reporting Form (IRFs) and also photocopy the relevant paperwork e.g. drug charts. Use the Datix reporting
system which is found on the desk top dashboard on any network computer.
•
An appropriate person should inform the parents an error has occurred.
•
If three IV errors occur in 12 month period then the individual involved will need to repeat the IV drug calculations test before being
allowed to continue to give IV drugs
The IRF’s will be sent to the line manager for investigation and also sent to the risk management department where they are logged. All of
the Incident Reports from the Neonatal unit are then discussed at the Paediatric Risk Forum.
The lead sister for the neonatal unit will aim to feedback any action to the individuals involved and to the unit as a whole via the
communication book and also through the practice development sister
Neonatal Unit Oral and Intravenous Drug Administration Workbook 2014
Adapted from St Michael’s IV Drug workbook and Southmead NICU Drug Workbook
Aseptic Non Touch Technique
Definition
An ‘Aseptic-non-touch- technique’ is achieved by preventing direct and indirect contact of key parts by a non-touch method and
other appropriate infective precautions.
Practising ANTT
There are four stages to performing an ANTT
1. Identification of key Parts
2. Assessing the risk of contaminating the key-parts
3. Choosing appropriate infective precautions.
4. Performing the Procedure
1. Identifying the Key Parts
•
The practitioner must know the definition of a key part
•
The practitioner must be able to identify all key parts in any procedure
2. Assessing the risk of contaminating the Key Parts
•
Simply the practitioner must ask, can I perform the procedure without touching/ contaminating the key parts either directly or
indirectly`?
This will depend on factors such as the technical difficulty of the procedure, the number of key parts, and how long the procedure should
take and the cleanliness of the environment.
Neonatal Unit Oral and Intravenous Drug Administration Workbook 2014
Adapted from St Michael’s IV Drug workbook and Southmead NICU Drug Workbook
3. Choosing appropriate infective precautions
•
The Practitioner will now tailor the infective precautions to the risks to the risks identified. Essentially, infective precautions can be
broken down into 5 components- only two of these actually involve a choice
1. Pre hand wash
-compulsory
2. Glove Wearing
- sterile compulsory
3. Aseptic Field
- simple or involved
4. Non- touch technique
- compulsory
5. Post hand wash
- compulsory
e.g. The preparation of multiple drugs and multiple IV lines for an experienced practitioner would involve a pre hand wash, sterile gloves
(multiple key parts can be exposed and protected one at a time in an organised fashion), a large sterilised paper towel on a work surface
to hold and organise all the components safely, a non- touch- technique and a post hand wash.
4. Performing the procedure
This is self-explanatory but here are some good practice guidelines: 1. DON’T confuse your practice. For example, by trying to keep one hand clean and the other dirty. This will make things more
difficult.
2. Important- TOUCH non-key parts with confidence - this will make the procedure easier for you.
3. Concentrate on the key parts. As long as they are not touched or contaminated by you or anything else, you are practising
safely.
4. Think ahead. Gather your equipment before starting. Organise your working area, especially your IV tray.
5. Always wait for alcohol cleaned equipment to dry (to become aseptic) before using (usually 30 seconds or so)
Neonatal Unit Oral and Intravenous Drug Administration Workbook 2014
Adapted from St Michael’s IV Drug workbook and Southmead NICU Drug Workbook
ANTT gloves in the Neonatal Unit
PROCEDURE
Peripheral line drugs ± TPN
(without disconnecting line)
Central line drugs ± TPN
(without disconnecting line)
Disconnecting peripheral line
or central line with TPN (e.g.
to add extra port)
Disconnecting central line
with clear fluids
Disconnecting peripheral line
with clear fluids
Running through non-TPN
fluids / infusions – peripheral
or central (if preparation time
less than 5 minutes)
All babies less than 1.5 kg or
ITU babies with peripheral /
central lines
STERILE
GLOVES







Neonatal Unit Oral and Intravenous Drug Administration Workbook 2014
Adapted from St Michael’s IV Drug workbook and Southmead NICU Drug Workbook
Your responsibilities:
• As a registered nurse you will have met one of the Intravenous trainers for the neonatal unit or the practice
development sister and arranged to complete the Royal United Hospital, Intravenous Therapy Workbook.
• You will have been assessed by someone with the RUH NHS Trust Intravenous Medicines Administration Trainers
course.
• You will have fully completed this package.
• If you have come from another trust you will show evidence of IV competence/certification. You will read the RUH
relevant policies and workbook and self certificate your competence
• You will complete the Neonatal Unit workbook and the Intravenous Drugs calculations test before being signed off
to give intravenous drugs in the neonatal unit.
Neonatal Unit Oral and Intravenous Drug Administration Workbook 2014
Adapted from St Michael’s IV Drug workbook and Southmead NICU Drug Workbook
Commonly used abbreviations and units
Abbreviations
Units
mg
milligram
1 kilogram (kg)
=
1000 grams
kg
kilogram
1 gram (g)
=
1000 milligrams
ml
millilitre
1 milligram (mg)
=
1000 micrograms
IV
intravenous
1 microgram
=
1000 nanograms
IM
intramuscular
1 nanogram
=
1000 picograms
SC
subcutaneous
IO
intraosseous
ET
endotracheal
Remember the 5 R’s:
Right Patient
Right Medication
Right Dose
Right Time
Right Route
You should always check that the prescription is correct. Resources for this on the unit include drug folder found in the clean utility that has
the Western Neonatal Network Prescribing Group Monographs and the BNF for children.
Neonatal Unit Oral and Intravenous Drug Administration Workbook 2014
Adapted from St Michael’s IV Drug workbook and Southmead NICU Drug Workbook
Basic Calculations and Formulas
What you want in
divided by
What you have got
x
What it is in
=
Volume needed
(mg/microgram/nanogram)
(mg/microgram/nanogram)
(ml of fluid drug is suspended in)
(ml)
_________________________________________________________________________________________________________________
You want to give 10 microgram/kg/hour of Morphine to a 2.5kg baby
Morphine infusion labeled as
Morphine Sulphate
(5mg in 5ml)
added to
5% glucose
2.5mg
2.5ml
USE WNPIG DRUG FORMULARY
2.5mg of Morphine Sulphate = 2500 microgram
2500 microgram is in 50ml of infusion solution
2500 microgram ÷ 50ml = 50 microgram per ml of infusion solution
47.5ml
2.5kg baby x 10 microgram = 25 microgram per hour
25 microgram ÷ 50 microgram per ml of infusion solution = 0.5 ml/hour
Calculation to work out how many micrograms per kg an infusion is running at.
Amount in mgs x 1000 (to change to mcg) divide by weight, divide by amount in syringe (50) x rate = mcg/kg/hour
_________________________________________________________________________________________________________________
You want to give 20 microgram/kg/minute of Dopamine to a 1.8 kg baby
Dopamine infusion labeled as
Dopamine
216mg
(40mg in 1ml) 5.4ml
added to
5% glucose
44.6ml
USE WNPIG DRUG FORMULARY
216mg of Dopamine = 216000 microgram
216000 microgram is in 50ml of infusion solution
216000 microgram ÷ 50ml = 4320 microgram per ml of infusion
solution
1.8kg baby x 20 microgram = 36 microgram x 60 (minutes) = 2160 microgram per hour
2160 microgram in 1 hour ÷ 4320 microgram per ml of infusion solution = 0.5ml/hour
Remember when calculating for kg/minute you need to multiply by 60 MINUTES to make 1 HOUR infusion pumps run in ml per HOUR.
Amount in mgs x 1000 (to change to mcg) divide by weight, divide by amount in syringe (50), divide by 60 (change to minutes) x rate = mcg/kg/minute
Neonatal Unit Oral and Intravenous Drug Administration Workbook 2014
Adapted from St Michael’s IV Drug workbook and Southmead NICU Drug Workbook
Intravenous Volumetric Infusion pumps and syringe pumps used within the Neonatal Unit
Volumat MC Agilia infusion pump - commonly used for administration of maintenance fluids, TPN and exchange transfusions
Alaris Asena GH Syringe pump – commonly used for administration of Intravenous medicines such as Morphine, Inotropes and Heparinised
saline infusions. Blood and Blood products
McKinley T34 Ambulatory Syringe pump – can be used for delivery of small drug quantities, such as Vancomycin, Metronidazole etc.
Competencies are available through the Intranet and are to be completed prior to assessment.
No other Infusion devices should be used
within the Neonatal Unit or borrowed from other departments.
Neonatal Unit Oral and Intravenous Drug Administration Workbook 2014
Adapted from St Michael’s IV Drug workbook and Southmead NICU Drug Workbook
The following are drugs that are likely to be used on the Neonatal Unit
Complete the table below (specific information should include things such as specific nursing care, main side effects, levels, administration
method, frequency etc.)
Drug - Antibiotics
IV Aciclovir
IV Amoxicillin
IV Amphotericin
IV Benzyl penicillin
IV Ceftazidime
IV Cefotaxime
IV Cefuroxime
IV Erthromycin
IV Flucloxacillin
IV Fluconazole
Specific information
Dose / how to reconstitute
Neonatal Unit Oral and Intravenous Drug Administration Workbook 2014
Adapted from St Michael’s IV Drug workbook and Southmead NICU Drug Workbook
Drug - Antibiotics
Specific Information
Dose / how to reconstitute
Specific Information
Dose / how to make up
IV Gentamicin
IV Meropenem
IV Metronidazole
IV Rifampicin
IV Teicoplanin
IV Vancomycin
Drug - Infusions
Dopamine
Dobutamine
Noradrenaline
Morphine
Vecuronium
4.2% Sodium Bicarbonate
Neonatal Unit Oral and Intravenous Drug Administration Workbook 2014
Adapted from St Michael’s IV Drug workbook and Southmead NICU Drug Workbook
IV Calcium gluconate
IV Midazolam
IV 30% Sodium Chloride
IV 20% Potassium Chloride
Intubation Drugs
IV Atropine
IV Suxamethonium
IV Morphine
Specific Information
How to make up / administer
Neonatal Unit Oral and Intravenous Drug Administration Workbook 2014
Adapted from St Michael’s IV Drug workbook and Southmead NICU Drug Workbook
Intravenous Infusion Information for Staff on the Neonatal Unit
Intravenous infusions (IVI) are routinely used in the care on neonates in the neonatal Unit. An IVI is used when a baby is nil by mouth, this
may be due to their clinical condition or prematurity or gastric instability.
Maintaining an accurate fluid balance is important when caring for a sick neonate. Under or over hydrating a baby can be extremely
detrimental to the babies’ condition therefore it is very important to check the fluid prescription chart very carefully at the beginning of each
shift.
All staff will adhere to the NPSA recommendations for intravenous medicines and fluids and follow the chart below. All staff will have read the
report for neonates on the prevention of over infusion of intravenous medicines and fluids. Three way taps are not used in the administration
set up. Fluids given by syringe pumps are drawn up into the appropriate size syringe and connected to the main IV access or to secondary IV
access as indicated by the nature of the fluid/drug to be infused.
Neonatal staff will follow the Neonatal Intravenous Fluid Administration Guideline:1. Sterile Aseptic Non Touch Technique should be used in any activity involving the setting up or administration of intravenous (IV) drugs
or infusions.
2. Disposable plastic red drug aprons should be worn during the performance of infusion procedures.
3. Clear IV Fluids will be run though a clear IV administration set and have a 96 hour endotoxin filters in the line, the set and filter will be
changed every 96 hours.
4. TPN (Vamin) will be run though a light sensitive IV administration set and have a 96 hour endotoxin filter in the line, the set and filter
will be changed every 96 hours
5. Clear IV Fluids and TPN: administration sets used must be changed immediately upon suspected contamination or when the integrity
of the product or system has been compromised.
6. All IV fluids/drugs (rate and total volume) must be independently checked by two registered nurses (at least one of whom has
completed the Neonatal Intravenous Administration competency) prior to administration.
Neonatal Unit Oral and Intravenous Drug Administration Workbook 2014
Adapted from St Michael’s IV Drug workbook and Southmead NICU Drug Workbook
7. Check that the appropriate route is available for infusion/drug. i.e. central line or peripheral line.
8. Check that the percent of dextrose to be infused is compatible with the baby’s blood glucose level.
9. All IV infusion rates and type of solution must be checked and signed prior to commencement of infusion and at each rate change.
10. The total fluid volume/kg/24 hours, the IV infusion rates, type and concentration of solution must be double checked as part of the
handover of each shift.
11. Electronic infusion devices (syringe pumps/infusion pumps) must be used for continuous infusions due to the need for pressure
monitoring and rapid occlusion alarms.
12. The IV infusion site must be observed and the assessment site score to be documented hourly (see guideline).
13. The total volume infused must be documented hourly and checked that the correct volume has been administered.
14. All clamps on IV administration sets must be closed before removing the administration set from the infusion pump, or switching the
pump off.
15. When using a syringe pump to administer IV fluids or drugs, a bag of fluid should not be left connected to the syringe.
16. The baby must be monitored and observations recorded as indicated by their condition; continuous or intermittent.
17. All discontinued infusions must be disconnected from the baby.
18. All staff must complete infusion device equipment competencies.
Neonatal Unit Oral and Intravenous Drug Administration Workbook 2014
Adapted from St Michael’s IV Drug workbook and Southmead NICU Drug Workbook
Immediate checks at time of clinical handover between the nurse going off duty and the nurse coming on duty.
•
Fluid prescription chart and drug chart
•
Check correct fluid is being infused
•
Check fluid is in date
•
Check infusion calculations are correct and labelled correctly
•
Chart is signed and dated
•
Check amount per kg is correct for babies’ age in days (if different from recommended amount find out why).
•
Review last blood glucose
•
Check NESS score
•
Lines all labelled
•
Chart intravenous and arterial lines on chart.
•
Sign the back of the critical care /special care chart as evidence that this procedure has been adhered to.
Neonatal Unit Oral and Intravenous Drug Administration Workbook 2014
Adapted from St Michael’s IV Drug workbook and Southmead NICU Drug Workbook
Neonatal Unit Oral and Intravenous Drug Administration Workbook 2014
Adapted from St Michael’s IV Drug workbook and Southmead NICU Drug Workbook
Intravenous infusion information for staff on the neonatal unit
Pressure limits:
Check limits are appropriate. All infusions whether they are longlines or peripheral lines should be set 25 mmHg above the resting pressure.
The neonatal unit uses the Volumat MC Agilia infusion pump, the pumps are configured for special care, critical care and 1 for exchange
transfusion.
Pressure limits for Volumat MC AgiliaSpecial Care pressure limits –
• Minimum Pressure set = 50mmhg
• Maximum Pressure Set = 300mmhg
• Maximum Pressure set when delivering a bolus only = 750mmhg
Critical Care Pressure limits –
• Minimum Pressure set = 50mmhg
• Maximum Pressure Set = 450mmhg
• Maximum Pressure set when delivering a bolus only = 750mmhg
Exchange transfusion
• Minimum Pressure set = 50mmhg
• Maximum Pressure Set = 500mmhg
A peripheral cannula should not exceed 50mmhg without the certainty that the line is patent, flushes well and there is a clinical indication for
the need of pressures greater than 50 mmHg .
The Alaris Asena pump is capped at a pressure limit of 400mmhg. This is L4 on the pump pressure bar.
L0 = 50mmhg
L1 = 100mmhg
L2= 200mmhg
L3=300mmhg
L4=400mmhg
Neonatal Unit Oral and Intravenous Drug Administration Workbook 2014
Adapted from St Michael’s IV Drug workbook and Southmead NICU Drug Workbook
Volume to be Infused (VTBI):
This method is routinely used to safe guard against accidental over infusing of fluids
Set the volume to be infused at your 4 hourly rate, if your rate was 5 ml hourly; then your volume to be infused would be 20 ml hourly.
Pumps need to be read hourly. Check the amount infused and record; check the IV site hourly observing any changes using NESS
assessment tool. Pumps should be zeroed at 07:00
Changing fluids:Fluids should be changed in the early evening when possible. (TPN & Lipids come from pharmacy at approximately 16:30 onwards Mon -Fri
there should be emergency TPN and Lipid in the fridge (standard bags) for new admissions. This does not apply when changing from
prescribed 10% Dextrose to 10% Dextrose and electrolytes when the baby is 24 hours old.
IV Lines for clear fluids (10% Dextrose / Vamin (TPN) must be changed every 96 hours (remember to label the filters when they are set up).
The lipid line and lipid filter must be changed every 24 hours.
NB:- When putting up a bag of TPN (48-hour bag) check the date of the line change. If it needs changing the next day (i.e. 24 hours into the
48-hour bag) then you need to change the line a day before it was due to be changed so as not to interrupt the infusion.
If a baby commences oral feeds then you have to deduct the amount from the hourly rate of the intravenous infusion.
Neonatal Unit Oral and Intravenous Drug Administration Workbook 2014
Adapted from St Michael’s IV Drug workbook and Southmead NICU Drug Workbook
ACCOUNTABILITY
Objective – To be able to demonstrate an understanding of:
I. The relevant Royal United Hospital Bath policies and hospital standards
II. The NMC Scope of Professional Practice
Describe / outline the Trust’s policies on IV administration
How should the NMC Code of Conduct influence the nurse’s attitude to the administration of IV drugs?
What resources are available to help you when administering IV drugs?
Neonatal Unit Oral and Intravenous Drug Administration Workbook 2014
Adapted from St Michael’s IV Drug workbook and Southmead NICU Drug Workbook
ANATOMY AND PHYSIOLOGY
Objective – To know the reason why the IV route will be chosen / prescribed and the advantages / disadvantages of IV therapy.
State 3 reasons why the intravenous route might be chosen in preference to another route of administration.
1.
2.
3.
State 3 disadvantages of using the intravenous route
1.
2.
3.
List the types of intravenous lines currently used in the neonatal unit
Discuss the rational for the decision to use central or peripheral venous access.
Neonatal Unit Oral and Intravenous Drug Administration Workbook 2014
Adapted from St Michael’s IV Drug workbook and Southmead NICU Drug Workbook
INFECTION CONTROL
Objective: To understand the principles, and importance of Infection Control in IV drug administration.
List 5 methods of preventing / reducing infection risks when administering intravenous therapy:
1.
2.
3.
4.
5.
What are the principles of the ANTT?
What is the definition of a key-part?
Is it possible to achieve a true sterile IV technique in a typical ward setting?
YES / NO
Is it possible to achieve an aseptic technique in a typical ward setting?
YES / NO
Neonatal Unit Oral and Intravenous Drug Administration Workbook 2014
Adapted from St Michael’s IV Drug workbook and Southmead NICU Drug Workbook
Which types of venous-access-device should it be used for?
What kind of patients should we use ANTT and when should we use a sterile technique?
When should hands be washed?
Why is a ‘non-touch-technique’ important even when practitioners wash their hands and wear sterile gloves?
Are sterile gloves required for all procedures?
What are the four stages in performing ANTT?
What stages are compulsory for all procedures?
Neonatal Unit Oral and Intravenous Drug Administration Workbook 2014
Adapted from St Michael’s IV Drug workbook and Southmead NICU Drug Workbook
HEALTH AND SAFETY
Objective: To be aware of relevant policies and know what course of action to take regarding:
o Safe disposal of sharp objects
o Infection risks from body fluids
o Accidents, injuries and near misses
o Accidental injury from a sharp object
Describe how you would ensure the safe disposal of sharp objects that are used in the administration of IV’s
List seven different administration errors
1.
5.
2.
6.
3.
7.
4.
List the 5 R’s
1.
2.
3.
4.
5.
What is the Trust policy when a needle stick injury has occurred?
Neonatal Unit Oral and Intravenous Drug Administration Workbook 2014
Adapted from St Michael’s IV Drug workbook and Southmead NICU Drug Workbook
PRACTICE
Objective: To have knowledge of the practical aspects and considerations required for IV administration.
Outline the considerations required when preparing a drug for IV administration
Describe what is meant by the term displacement.
Describe what is meant by the word incompatibility.
Name two of the problems caused by incompatibility reaction:
1.
2.
If a precipitation occurs what should you do?
Neonatal Unit Oral and Intravenous Drug Administration Workbook 2014
Adapted from St Michael’s IV Drug workbook and Southmead NICU Drug Workbook
Why is thorough mixing of drugs into IV fluids important?
Give an example of drugs which might be given by the following methods and why?
Continuous Infusion
Bolus Injection
Slow (intermittent) infusion
What checks should be made of the peripheral site and line prior to the administration of IV drugs / infusions?
What is the life expectancy of an IV line with a filter in situ?
What actions can you take to prevent being interrupted when checking IV drugs / infusions?
Neonatal Unit Oral and Intravenous Drug Administration Workbook 2014
Adapted from St Michael’s IV Drug workbook and Southmead NICU Drug Workbook
Name:___________________
Date commenced:
/
/
Date completed:
/
/
Competency:
Intravenous drug administration to a Peripheral Cannula
Aim:
The aim of this competency is to provide the individual with the knowledge and skills to
perform safe practice.
Demonstrating competence in clinical and theoretical knowledge regarding safe practice,
technical skill required and rationale for the procedure.
Evidence of Competence
Individuals need to be able to provide evidence to support their competence.
♦ Completion of RUH Intravenous & Subcutaneous Therapy Workbook
♦ Completion of Neonatal Drug Calculations
♦ Learning log of practice and procedures undertaken
♦ Has read the RUH trusts Administration of Intravenous Drugs policy
I confirm that _________________________ has been supervised in practice and has
completed the RUH Trusts Intravenous & Subcutaneous Therapy workbook and has also completed the Intravenous Drug
Administration in the Neonatal Unit. They have completed all relevant written
documentation and understand the aim of this competency
Print name:
Signature of Supervisor:
Date:
I believe myself to be competent in this procedure and understand the competency aim
I have received relevant training and completed appropriate documentation successfully.
I accept full accountability for my own practice and have discussed this role with my supervisor.
Signature of individual:
Print name
Date:
Neonatal Unit Oral and Intravenous Drug Administration Workbook 2014
Adapted from St Michael’s IV Drug workbook and Southmead NICU Drug Workbook
Supervised drug administration to peripheral intravenous cannula IV boluses
No of
attempt
Drug Preparation and
administration
Adherence to
correct
procedure
Action/Side
effect
discussed
Assessee’s
Signature
Assessor’s
Signature
Comments
You must have completed 5 supervised drug administrations before being signed off for this competency
Supervised drug administration to peripheral intravenous cannula when IV infusions in situ
No of
attempt
Drug Preparation and
administration
Adherence to
correct
procedure
Action/Side
effect
discussed
Assessee’s
Signature
Assessor’s
Signature
Comments
You must have completed 5 supervised drug administrations before being signed off for this competency
Neonatal Unit Oral and Intravenous Drug Administration Workbook 2014
Adapted from St Michael’s IV Drug workbook and Southmead NICU Drug Workbook
Competency certificate for the administration of intravenous fluids and medicines to Peripheral Intravenous
Cannula
Nurse demonstrating
competency signature
Date
Individuals
signature
Bolus medicines
Fluids and Infusions
Candidates must be able to answer and demonstrate competence
Performance Criteria
1.State intended use of Intravenous Therapy
2. Discuss the hazards & precautions with IV therapy & take the appropriate action
3. Demonstrate how to calculate rates of infusions in commonly used infusions
4. Demonstrate the appropriate checks to ensure a cannula is adequately & safely secured when a cannula is in situ
5.Demonstrate and explain the different signs and symptoms of impending or actual extravasation injury
6.Discuss pressures limits set on pumps & the significance of changes in the pressure
7. Maintains clear and accurate documentation
8. Demonstrates an understanding of the trust policy and unit guidelines on care of infusions/cannula – including 5R’s
9. Discuss and demonstrate the principles of ANTT
10.Demonstrate running through IV fluids
Neonatal Unit Oral and Intravenous Drug Administration Workbook 2014
Adapted from St Michael’s IV Drug workbook and Southmead NICU Drug Workbook
Care and management of long lines
Neonatal Unit Oral and Intravenous Drug Administration Workbook 2014
Adapted from St Michael’s IV Drug workbook and Southmead NICU Drug Workbook
Care of a neonate with a longline
1. List three reasons why a neonate may require a longline.
2. List 5 items a doctor / ANNP may require when inserting a longline.
3. Name two common sites for insertion of a long line.
4. Give two reasons why it is important to confirm by X-ray the position of the tip of the long line before commencing fluids?
5. Why do some longlines require radio opaque dye to be administered immediately prior to X-ray?
6. Describe two potential complications for neonates with a long line in situ.
7. What observations would you make when caring for a baby with a long / central line in situ and how frequently would you carry them
out?
8. What size syringe should be used to flush central lines and why?
Neonatal Unit Oral and Intravenous Drug Administration Workbook 2014
Adapted from St Michael’s IV Drug workbook and Southmead NICU Drug Workbook
9. What would you do if you found a central line difficult or impossible to flush?
10. When would you wear sterile gloves when handling central lines and why?
11. What would make you suspect an infant has a line infection?
12. What are some of the indications for removing a central venous line?
13. Whilst you are supervising the administration of IV drugs you become aware of practices you feel are unsafe. What do you do?
14. The syringe disconnects as you are injecting a drug and it sprays into the bedding. What would you do?
15. When you check the IV insertion site you observe that the area is grossly swollen with blisters. What action would you take?
16. Why must a longline always have fluid running through it until it is safely removed from the infant?
Neonatal Unit Oral and Intravenous Drug Administration Workbook 2014
Adapted from St Michael’s IV Drug workbook and Southmead NICU Drug Workbook
Name:___________________
Date commenced:
/
/
Date completed:
/
Competency:
Intravenous drug administration to neonatal longline
/
Aim:
The aim of this competency is to provide the individual with the knowledge and skills to
perform safe practice.
Demonstrating competence in clinical and theoretical knowledge regarding safe practice,
technical skill required and rationale for the procedure.
Evidence of Competence
Individuals need to be able to provide evidence to support their competence.
♦ Completion of RUH Intravenous & Subcutaneous Therapy Workbook
♦ Competency of Neonatal Drug Calculations and administration to a peripheral cannula
♦ Learning log of practice and procedures undertaken
♦ Evidence of Direct supervision from RUH NHS Trust Intravenous Medicines Administration Trainers.
♦ Has read the RUH trusts Administration of Intravenous Drugs policy
I confirm that _________________________ has been supervised in practice and has
completed the RUH Trusts Intravenous & Subcutaneous Therapy workbook and has also completed the Intravenous Drug
Administration in the Neonatal Unit. They have completed all relevant written documentation and understand the aim of
this competency.
Print name:
Signature of Supervisor:
Date:
I believe myself to be competent in this procedure and understand the competency aim
I have received relevant training and completed appropriate documentation successfully.
I accept full accountability for my own practice and have discussed this role with my supervisor.
Signature of individual:
Print name
Date:
Neonatal Unit Oral and Intravenous Drug Administration Workbook 2014
Adapted from St Michael’s IV Drug workbook and Southmead NICU Drug Workbook
Supervised drug administration to a neonatal longline IV boluses
No of
attempt
Drug Preparation and
administration
Adherence to
correct
procedure
Action/Side
effect
discussed
Assessee’s
Signature
Assessor’s
Signature
Comments
You must have completed 5 supervised drug administrations before being signed off for this competency
Supervised drug administration to longline when setting up IV infusions
No of
attempt
Drug Preparation and
administration
Adherence to
correct
procedure
Action/Side
effect
discussed
Assessee’s
Signature
Assessor’s
Signature
Comments
You must have completed 5 supervised drug administrations before being signed off for this competence
Neonatal Unit Oral and Intravenous Drug Administration Workbook 2014
Adapted from St Michael’s IV Drug workbook and Southmead NICU Drug Workbook
Competency certificate for the administration of intravenous fluids and medicines to a neonatal longline
Nurse demonstrating
competency signature
Date
Individuals
signature
Bolus medicines
Fluids and Infusions
Candidates must be able to answer and demonstrate competence
Performance Criteria
1.State intended use of Intravenous Therapy
2. Discuss the hazards & precautions with IV therapy & take the appropriate action
3. Demonstrate how to calculate rates of infusions in commonly used infusions
4. Demonstrate the appropriate checks to ensure a longline is adequately & safely secured when a longline is in situ
5.Demonstrate and explain the different signs and symptoms of impending or actual extravastion injury
6.Discuss pressures limits set on pumps & the significance of changes in the pressure
7. Maintains clear and accurate documentation
8. Demonstrates an understanding of the trust policy and unit guidelines on care of infusions/longline – including 5R’s
9. Discuss and demonstrate the principles of ANTT and longlines
10.Demonstrate running through IV fluids
Neonatal Unit Oral and Intravenous Drug Administration Workbook 2014
Adapted from St Michael’s IV Drug workbook and Southmead NICU Drug Workbook
Care and management of umbilical Venous lines (UVC)
Neonatal Unit Oral and Intravenous Drug Administration Workbook 2014
Adapted from St Michael’s IV Drug workbook and Southmead NICU Drug Workbook
1
List three reasons why a neonate may require a UVC?
2
Name two things you may do to prepare your patient prior to the insertion of a UVC?
3
Name at least five pieces of equipment a doctor / ANNP will require when inserting a UVC
4
List the two ways in which a UVC can be secured and illustrate the one you may be required to help with.
5
What special precautions in terms of skin integrity may you advocate when helping a doctor secure a UVC?
6
Why is it important to await x-ray confirmation of the position of the UVC prior to commencing infusion fluids?
7
What positions can a baby with a UVC be nursed?
8
If both a UAC and a UVC are in situ, how should the lines be positioned for X-ray?
Neonatal Unit Oral and Intravenous Drug Administration Workbook 2014
Adapted from St Michael’s IV Drug workbook and Southmead NICU Drug Workbook
9
Name two potential complications of having a UVC in situ
10
What would you do if you spotted an air bubble in the line?
11
What specific observations would you make when a baby has a UVC in situ and how often would you carry them out?
12
What would be the consequence of a loose connection or a leak in the line and what would be your immediate management?
13
Describe the route the UVC takes when entering the abdomen
14
Where is the recommended position for the tip to lie internally?
15
Describe the two different types of UVC and what situations they are most likely to be used.
16
On X-ray how would you distinguish between a UAC and a UVC?
Neonatal Unit Oral and Intravenous Drug Administration Workbook 2014
Adapted from St Michael’s IV Drug workbook and Southmead NICU Drug Workbook
17
Describe why it is important that an aseptic technique is used when changing giving sets and administering drugs and via long/ central
venous lines.
18
How often would you change a giving set carrying:
19
•
Maintenance fluids?
•
Drug infusions?
Describe two potential complications of administrating drugs / infusions via a UVC and how you would manage it.
Neonatal Unit Oral and Intravenous Drug Administration Workbook 2014
Adapted from St Michael’s IV Drug workbook and Southmead NICU Drug Workbook
Name:___________________
Date commenced:
/
/
Date completed:
/
/
Competency:
Intravenous drug administration to a Umbilical Venous Catheter.
Aim:
The aim of this competency is to provide the individual with the knowledge and skills to
perform safe practice.
Demonstrating competence in clinical and theoretical knowledge regarding safe practice,
technical skill required and rationale for the procedure.
Evidence of Competence
Individuals need to be able to provide evidence to support their competence.
♦ Completion of RUH Intravenous & Subcutaneous Therapy Workbook
♦ Competency of Neonatal Drug Calculations and administration to a peripheral cannula and neonatal longline
♦ Learning log of practice and procedures undertaken
♦ Evidence of Direct supervision from RUH NHS Trust Intravenous Medicines Administration Trainers.
♦ Has read the RUH trusts Administration of Intravenous Drugs policy .
I confirm that _________________________ has been supervised in practice and has
completed the RUH Trusts Intravenous & Subcutaneous Therapy workbook and has also completed the Intravenous Drug
Administration in the Neonatal Unit. They have completed all relevant written documentation and understand the aim of
this competency.
Print name:
Signature of Supervisor:
Date:
I believe myself to be competent in this procedure and understand the competency aim
I have received relevant training and completed appropriate documentation successfully.
I accept full accountability for my own practice and have discussed this role with my supervisor.
Signature of individual:
Print name
Date:
Neonatal Unit Oral and Intravenous Drug Administration Workbook 2014
Adapted from St Michael’s IV Drug workbook and Southmead NICU Drug Workbook
Supervised drug administration to a Umbilical Venous Catheter IV boluses
No of
attempt
Drug Preparation and
administration
Adherence to
correct
procedure
Action/Side
effect
discussed
Assessee’s
Signature
Assessor’s
Signature
Comments
You must have completed 5 supervised drug administrations before being signed off for this competency
Supervised drug administration to Umbilical Venous Catheter when setting up IV infusions
No of
attempt
Drug Preparation and
administration
Adherence to
correct
procedure
Action/Side
effect
discussed
Assessee’s
Signature
Assessor’s
Signature
Comments
You must have completed 5 supervised drug administrations before being signed off for this competency
Neonatal Unit Oral and Intravenous Drug Administration Workbook 2014
Adapted from St Michael’s IV Drug workbook and Southmead NICU Drug Workbook
Competency certificate for the administration of intravenous fluids and medicines to a Umbilical Venous
Catheter.
Nurse demonstrating
Date
Individuals
signature
Bolus medicines
Fluids and Infusions
Candidates must be able to answer and demonstrate competence
Performance Criteria
1.State intended use of Intravenous Therapy
2. Discuss the hazards & precautions with IV therapy & take the appropriate action
3. Demonstrate how to calculate rates of infusions in commonly used infusions
4. Demonstrate the appropriate checks to ensure a UVC is adequately & safely secured when a UVC is in situ
5.Demonstrate and explain the different signs and symptoms of impending or actual extravastion injury
6.Discuss pressures limits set on pumps & the significance of changes in the pressure
7. Maintains clear and accurate documentation
8. Demonstrates an understanding of the trust policy and unit guidelines on care of infusions/UVC – including 5R’s
9. Discuss and demonstrate the principles of ANTT and UVC’s
10.Demonstrate running through IV fluids
Neonatal Unit Oral and Intravenous Drug Administration Workbook 2014
Adapted from St Michael’s IV Drug workbook and Southmead NICU Drug Workbook
Name:___________________
Date commenced:
/
/
Date completed:
Competency:
Safer administration of intravenous Gentamicin
/
/
Aim:
The aim of this competency is to provide the individual with the knowledge and skills to perform safe practice.
Demonstrating competence in clinical and theoretical knowledge regarding safe practice, technical skill required
and rationale for the procedure.
Evidence of Competence
Individuals need to be able to provide evidence to support their competence.
♦ Completion of RUH Intravenous & Subcutaneous Therapy Workbook
♦ Competency of Neonatal Drug Calculations and administration to a peripheral cannula
♦ Learning log of practice and procedures undertaken
♦ Evidence of Direct supervision from RUH NHS Trust Intravenous Medicines Administration Trainers.
♦ Has read the RUH trusts Administration of Intravenous Drugs
♦Has read the NPSA Safe use of Gentamicin in Neonates (02/2010)
I confirm that _________________________ has been supervised in practice and has completed the RUH Trusts
Intravenous & Subcutaneous Therapy workbook and has also completed the Intravenous Drug Administration in
the Neonatal Unit. They have completed all relevant written documentation and understand the aim of this
competency; to provide consistency in conjunction with a high standard of knowledge and adherence to the NPSA
requirements for the Administration of Gentamicin in the Neonatal Unit
Print name:
Signature of Supervisor:
Date:
I believe myself to be competent in this procedure and understand the competency aim
I have received relevant training and completed appropriate documentation successfully.
I accept full accountability for my own practice and have discussed this role with my supervisor.
Signature of individual:
Print name
Date:
Neonatal Unit Oral and Intravenous Drug Administration Workbook 2014
Adapted from St Michael’s IV Drug workbook and Southmead NICU Drug Workbook
Candidate’s signature
and candidates
answers.
1.How frequent should gentamicin be given for:
Babies <32 weeks gestation
Babies >32 weeks gestation
2. How many mg/kg should be prescribed (according to local policy)?
3. Where should the prescription be prescribed on the drug chart?
4. Which other documentation should be present with the drug chart?
5. With which dose should blood levels be monitored?
6.What is the timing for:
The pre level?
7. What is the purpose for monitoring blood levels?
8.What is the correct level for:
Pre gentamicin level
9. How may the levels affect future dosage?
10. What are the potential side effects of a Gentamicin overdose?
11. Show evidence of application of the 5 R’s prior to administration
Taken from: NPSA Safe use of intravenous Gentamicin for neonates (02/2010)
Date
Competency
achieved
Signature of
Assessor