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Patient Group Direction For The Administration Of Sodium Chloride
0.9% w/v Solution For Injection For Flushing Intravenous
Catheters/Cannulae By Certified Healthcare Professionals Working
Within NHS Grampian
Co-ordinators:
Consultation Group:
Approver:
Deputy Director of
Pharmacy, Pharmacy and
Medicines Directorate
See relevant page in the
PGD
Medicine Guidelines and
Policies Group
Signature:
Signature:
Identifier:
Review Date:
Date Approved:
NHSG/PGD/NaClflush/
MGPG698
July 2017
July 2015
A Patient Group Direction is a specific written instruction for the supply or
administration of named medicines in an identified clinical situation. It is drawn
up locally by Doctors, Pharmacists and other appropriate professionals,
approved by the Employer and advised by the relevant professional advisory
committees. In most cases, appropriate clinical care is provided on an individual
basis by a specific prescriber to a specific individual patient. Patient Group
Directions should only be considered where they offer a benefit to patient care
without compromising patient safety in any way.
Uncontrolled when printed
Version 5
Title:
Patient Group Direction for the administration of sodium chloride 0.9%
w/v solution for injection for flushing intravenous catheters/cannulae
by certified healthcare professionals working within NHS Grampian
Identifier:
Replaces:
Across NHS
Boards
NHSG/PGD/NaClflush/MGPG698
NHSG/PGD/NaClflush/MGPG517
Organisation
Directorate
Clinical Service
Wide
Sub
Department
Area
Yes
This controlled document shall not be copied in part or whole without the express
permission of the author or the author’s representative.
Author:
Subject
Key word(s):
Deputy Director of Pharmacy, Pharmacy and Medicines
Directorate
Patient Group Direction
PGD patient group direction sodium chloride flush cannulation
nurse midwife radiographer
Policy application:
NHS Grampian
Purpose:
This Patient Group Direction (PGD) authorises appropriately
qualified and trained healthcare professionals to administer
sodium chloride 0.9% w/v solution for injection for flushing
intravenous catheters/cannulae to individuals without the
requirement for a patient specific prescription written by a
medical practitioner.
Responsibilities for implementation:
Organisational:
Corporate:
Departmental:
Area:
Hospital/Interface
services:
Operational
Management Unit:
Chief Executive and Management Teams
Senior Managers
Heads of Service/Clinical Leads
Line Managers
Deputy General Managers and Clinical Leads
Policy statement:
It is the responsibility of individual healthcare professionals and
their line managers to ensure that they work within the terms laid
down in this PGD and to ensure that staff are working to the most
up to date PGD. By doing so, the quality of the services offered
will be maintained, and the chances of staff making erroneous
decisions which may affect patient, staff or visitor safety and
comfort will be reduced. Supervisory staff at all levels must
ensure that staff using this PGD act within their own level of
competence.
This policy will be reviewed at least every two years or sooner if
current treatment recommendations change.
Review:
Unit Operational Managers
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This document is also available in large print and
other formats and languages, upon request.
Please call NHS Grampian Corporate
Communications on (01224) 551116 or (01224)
552245.
Responsible for review of this document:
Responsible for ensuring
Registration of this document on the NHS
Grampian Information/ Document Silo:
Deputy Director of Pharmacy, Pharmacy
and Medicines Directorate
Pharmacy and Medicines Directorate
Physical location of the original of this
document:
Pharmacy and Medicines Directorate
Job/group title of those who have control
over this document:
Pharmacy and Medicines Directorate
Responsible for disseminating document
as per distribution list:
Deputy Director of Pharmacy, Pharmacy
and Medicines Directorate
Revision History:
Date of
Approval
change
date of PGD
that is being
superseded
Nov 2014
Sept 2012
Nov 2014
Sept 2012
Nov 2014
Sept 2012
Nov 2014
Sept 2012
Summary of Changes
2 yearly update into new template
Precautions added
Additional information added
Removal of physiotherapists
Section
heading
2.4
3.1
Throughout
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Patient Group Direction for the administration of sodium chloride 0.9% w/v
solution for injection for flushing intravenous catheters/cannulae by certified
healthcare professionals working within NHS Grampian
Part A ......................................................................................................................... 2
1.
Introduction ....................................................................................................... 2
2.
Clinical Decision Making ................................................................................... 2
2.1. Patients who may be considered for the administration of sodium chloride 0.9%
(w/v solution for injection) flush................................................................................... 2
2.2. Patients who may receive the administration of sodium chloride 0.9% (w/v
solution for injection) flush .......................................................................................... 2
2.3. Contraindications .............................................................................................. 3
2.4. Precautions ....................................................................................................... 3
2.5. Action to be taken when a patient is excluded from treatment under this PGD 3
2.6. Action to be taken when a patient/parent/guardian or person with parental
responsibility does not wish the treatment to be received under this PGD ................. 3
3.
Description Of Treatment Available Under This Direction ................................. 3
3.1. Sodium Chloride 0.9% w/v solution for injection. .............................................. 3
3.2. Dose, route and frequency ............................................................................... 4
3.3. Concurrent medication ...................................................................................... 4
3.4. Adverse effects ................................................................................................. 4
3.5. Overdose .......................................................................................................... 5
3.6. Advice to patient ............................................................................................... 5
3.7. Follow up treatment .......................................................................................... 5
Part B ......................................................................................................................... 6
4.
Designated Staff Authorised To Administer Under This PGD ........................... 6
5.
Documentation.................................................................................................. 7
5.1. Authorisation of administration.......................................................................... 7
5.2. Record of administration ................................................................................... 7
5.3. Consent ............................................................................................................ 8
6.
Further Points ................................................................................................... 8
7.
Facilities And Supplies To Be Available At Sites For The Administration Of The
Drug Specified In The PGD ........................................................................................ 8
8.
Audit ................................................................................................................. 9
Part C ....................................................................................................................... 10
9.
Management And Monitoring Of Patient Group Direction ............................... 10
9.1. Consultative group .......................................................................................... 10
9.2. Professional advisory group approving PGD .................................................. 10
9.3. Authorising managers ..................................................................................... 10
10. References ..................................................................................................... 10
Appendix 1 .............................................................................................................. 11
Appendix 2 .............................................................................................................. 12
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Patient Group Direction For The Administration Of Sodium Chloride
0.9% w/v Solution for Injection for Flushing Intravenous
Catheters/Cannulae by Certified Healthcare Professionals Working
Within NHS Grampian
Part A
1.
Introduction
This patient group direction (PGD) will authorise certified healthcare professionals to
administer sodium chloride 0.9% w/v solution for injection for flushing intravenous
catheters/cannulae.
Sodium chloride 0.9% w/v solution for injection is indicated within the NHS Grampian
Policy For The Prescribing, Preparation And Administration Of Injectable
Medicines And Infusions In Near Patient Areas and for the flushing of intravenous
catheters/cannulae. Flushing should be performed before and after the
administration of compatible intravenous medicines and/or solutions to ensure and
maintain patency of intravenous catheters/cannulae. The use of sodium chloride
0.9% flushes between medicines prevents potential incompatibilities and ensures
that the full dose is received by the patient and not retained within the dead space of
the catheter. Sodium chloride 0.9% flush may also be administered to maintain
patency of intravenous catheters/cannulae and also to confirm placement and
patency of newly inserted catheters/cannulae.
This PGD should be used in conjunction with the recommendations in the current
British National Formulary and individual Summary of Product Characteristics.
2.
Clinical Decision Making
2.1. Patients who may be considered for the administration of sodium
chloride 0.9% (w/v solution for injection) flush
(i)
(ii)
All patients presenting for cannulation.
All patients presenting with intravenous catheters/cannulae in situ.
2.2. Patients who may receive the administration of sodium chloride 0.9%
(w/v solution for injection) flush
(i)
All patients in 2.1 above, where they, their parent, guardian or person with
parental responsibility does do not want specifically to consult with a doctor and are
willing to have treatment from the Certified Healthcare Professional.
(ii)
Patients, on initial cannulation, where placement and patency is to be
confirmed.
(iii)
Patients where the patency of existing intravenous catheters/cannulae needs
to be maintained.
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(iv)
Patients who are receiving intravenous medicines and/or solutions that are
compatible with sodium chloride 0.9% w/v solutions for injection.
2.3.
Contraindications
Patients may be administered sodium chloride 0.9% w/v solution for injection under
this PGD unless:
(i)
They are suffering from thrombophlebitis.
(ii)
The cannula insertion site is red and/or inflamed.
(iii)
Sodium chloride 0.9% w/v solution for injection is incompatible with the
intravenous medicine to be administered.
In any of the above cases the patient should be referred to a doctor.
2.4.
Precautions
Sodium chloride 0.9% w/v solution for injection should be administered with caution
to patients with congestive cardiac failure, pre-eclampsia, impaired renal function, or
oedema with sodium retention.
2.5. Action to be taken when a patient is excluded from treatment under this
PGD
If a patient is excluded from treatment under this PGD, medical advice should be
sought – refer to a doctor.
2.6. Action to be taken when a patient/parent/guardian or person with
parental responsibility does not wish the treatment to be received under this
PGD
The patient/parent/guardian or person with parental responsibility should be advised of
the risks of not receiving the administration of sodium chloride 0.9% w/v solution for
injection. The supervising doctor should be informed and actions documented in the
patient’s records.
3.
Description Of Treatment Available Under This Direction
3.1.
Sodium Chloride 0.9% w/v solution for injection.
Sodium chloride 0.9% w/v solution for injection is available in ampoules of 2mL, 5mL
or 10mL.
Store at room temperature and protect from excessive heat and freezing.
Sodium chloride injection 0.9% w/v solution for injection is a Prescription-only
Medicine (PoM).
There are various strengths of sodium chloride solution for injection, ensure only
0.9% ampoules are used.
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Before use, ensure that the ampoule is undamaged and the contents clear in
appearance. After use, discard any remaining solution according to local procedures.
3.2.
Dose, route and frequency
(i) To be administered before and after administration of compatible intravenous
medicines.
(ii) To be administered to confirm placement and patency of newly inserted
catheters/cannulae.
(iii) The catheter/cannula should be flushed at established intervals to maintain
patency.
Adults:
Up to 10mL via an intravenous catheter.
The volume of the flush should be equal to at least twice the volume of the catheter and
add-on devices, usually 5-10mL (for adults).
Children:
2-10mL depending on the age, size and condition of patient.
Standard Flushing Technique
(i) Administer over 3-5 minutes, or if a flush after a medicine, at the same prescribed
rate of the medicine.
(ii) 10mL syringes must be used when flushing.
(iii) The flush should be administered using a push-pause and positive pressure
method.
(iv) The pulsated flush creates turbulence within the catheter lumen, removing debris
from the internal catheter.
(v) Positive pressure within the lumen of the catheter should be maintained to prevent
reflux of blood.
3.3.
Concurrent medication
It is the responsibility of the healthcare professional to check the compatibility of the
medicine with sodium chloride 0.9% injection. For other checks, refer to the document,
“Policy For The Prescribing, Preparation And Administration Of Injectable Medicines
And Infusions In Near Patient Areas”.
3.4.
Adverse effects
Adverse events are unlikely due to the small volume use.
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3.5.
Overdose
Overdose is unlikely due to the small volume use.
3.6.
Advice to patient
(i)
The reason for using a sodium chloride 0.9% flush should be explained to the
patient.
(ii)
The patient information leaflet contained in the medicine(s) should be made
accessible to the patient/parent/guardian or person with parental responsibility. Where
this is unavailable, or unsuitable, sufficient information should be given to the
patient/parent/guardian or person with parental responsibility in a language that they can
understand.
3.7.
Follow up treatment
No follow up treatment is required.
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Part B
4.
Designated Staff Authorised To Administer Under This PGD
The following staff are authorised to administer the drug specified in this PGD without an
individual medical prescription providing the patient falls into one of the categories listed
in 2.2 of this PGD. Staff must be employed either directly by NHS Grampian, or
contracted to provide NHS services, or providing services in partnership with NHS
Grampian under the direction of this authorised PGD.
(i)
A registered nurse or midwife as recognised by the Nursing and Midwifery Council.
(ii)
Registered Radiographer as recognised by the Health Professions Council.
In addition the following requirements are necessary. Staff must:
(i)
agree to be professionally accountable for their work (Appendix 1).
(ii) be competent to assess the patient’s capacity to understand the nature and
purpose of the administration in order for the patient to give or refuse consent.
(iii) be aware of current treatment recommendations and be competent to discuss
issues about the drug with the patient.
(iv) have been trained and assessed as being competent in the administration of the
drug. All staff will have access to the current PGD.
(v) have completed a period of practice based learning under the guidance of a named
supervisor and achieved a level of competence as recognised by NHS Grampian.
(vi) maintain their skills, knowledge and their own professional level of competence in
this area according to their individual Code of Professional Conduct.
(vii) agree to work within the terms of the NHS Grampian PGD.
Professional Managers/Nurse managers/Lead nurses will be responsible for:
(i)
Ensuring that the current PGD is available to staff providing care under this direction.
(ii) Ensuring that the staff have access to all relevant Scottish Government Health
Directorate advice, including any relevant CMO letter(s).
(iii) Ensuring that staff have received adequate training in all areas relevant to this PGD
and meet the requirements above.
(iv) Maintaining a current record of all staff authorised to administer the drug specified in
this PGD.
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5.
Documentation
5.1.
Authorisation of administration
Nurses and Midwives working within NHS Grampian can be authorised to administer the
drug specified in this PGD by their nursing/midwifery manager, NHS Grampian.
Radiographers working within NHS Grampian can be authorised to administer the drug
specified in this PGD by their radiography manager, NHS Grampian.
A certificate of authorisation (Appendix 2) signed by the authorising doctor/manager
should be supplied. This should be held in the individual staff records or as agreed
locally.
5.2.
Record of administration
An electronic or paper record for recording the screening of patients and the subsequent
administration of the drug specified in this PGD must be completed in order to allow
audit of practice.
When given pre and post administration of an intravenous medicine and for patency, the
medicine should be written on the Main Prescription Sheet in the “As Required Therapy”
section and administration recorded against the entry by staff signed up to the PGD.
The name of the drug should be written as “Sodium Chloride 0.9%” with “Sodium
Chloride 0.9% Flush PGD” in the signature box. Using the “as required” section allows
recording of administration at non standard times.
In situations where the Main Prescription Sheet is not available, the administration of the
drug specified in this PGD may be recorded in the patient’s
nursing/midwifery/radiography notes or within the patient’s care plan.
Please refer to the Instructions for NHS Grampian Staff on the In-Patient Prescribing
and Administration of Medicines using the NHS Grampian Prescription and
Administration Record, 2011 (Paragraph 2.4).
http://intranet.grampian.scot.nhs.uk/foi/files/NHSGPaAR.pdf
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Any adverse effects should be documented in the patient’s
nursing/midwifery/radiography notes or patient’s care plan and also in the patient’s
medical notes.
These records should be retained:
For children and young people, retain until the patient's 25th birthday or 26th if the
young person was 17 at the conclusion of treatment.
For 17 years and over retain for 6 years after last date of entry.
Or for 3 years after death, or in accordance with local policy, where this is greater than
above.
5.3.
Consent
Prior to the administration of the drug, consent must be obtained, preferably written,
either from the patient, parent, guardian or person with parental responsibility and
documented either in the patient’s medical records/notes or on an administration form
(see Section 5.2). Consent must be in line with current NHSG “Staff Policy for Obtaining
Consent for Clinical Procedures and Healthcare Interventions”. See link below.
http://intranet.grampian.scot.nhs.uk/ccc_nhsg/15692.html?pMenuID=460&
6.
Further Points
The manufacturers leaflet inside boxes of drug should be read and advice from them
taken into consideration.
7.
Facilities And Supplies To Be Available At Sites For The Administration
Of The Drug Specified In The PGD
The following should be available at sites where the drug is to be administered:
(i)
(ii)
(iii)
(iv)
(v)
(vi)
Appropriate needles and syringes (10mL).
Access to medical support (this may be via telephone).
Safe storage areas for medicines and equipment.
Approved equipment for the disposal of used materials.
Clean and tidy work areas.
Copies of the current PGD for the drug specified in the PGD
Minimum Standards for Facilities for Preparation of Injections in Near Patient
Areas
(i)
Clinical areas should have a multipurpose room with a designated area for
preparation of injections, separate from patient care area to avoid distractions.
(ii)
The room must have adequate lighting to ensure safe preparation of injections.
300lux at bench height, the standard used for treatment rooms, should provide the
required amount of light.
(iii)
The room must not have a sluice or hold dirty waste.
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(iv)
The sink must be used for hand washing purposes only.
(v)
The surfaces must be smooth, free from cracks and easily cleaned.
(vi)
The area designated for preparation of injections must allow adequate space and
have a clear uncluttered surface.
(vii) The area must be cleaned before and after preparation of injections as per local
policy.
(viii) There must be no food or drink in the area.
8.
Audit
All records of administration of the drug specified in this PGD will be filed with the
normal records of medicines administration in each practice/service. A designated
person within each HSCP/practice/service will be responsible for auditing completion of
drug forms and collation of data.
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Appendix 1
Health Care Professional Agreement To Administer Medicines Under Patient
Group Direction
I:
(Insert name)
Working within:
e.g. HSCP, Practice
Agree to administer medicines under the direction contained within the following Patient
Group Direction
Patient Group Direction for the administration of sodium chloride
0.9% w/v solution for injection for flushing intravenous
catheters/cannulae by certified healthcare professionals working
within NHS Grampian
I have completed the appropriate training to my professional standards enabling me to
administer medicines under the above Patient Group Direction. I agree not to act
beyond my professional competence nor outwith the recommendations of the Patient
Group Direction.
Signed:
Print Name:
Date:
Professional Registration No:
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Appendix 2
Certificate Of Authorisation To Administer Medicines Under Patient Group
Direction
This authorises:
Working within:
e.g. HSCP, Practice
To administer medicines under the following Patient Group Direction
Patient Group Direction for the administration of sodium chloride
0.9% w/v solution for injection for flushing intravenous
catheters/cannulae by certified healthcare professionals working
within NHS Grampian
The above named person has satisfied the training requirements and is authorised to
administer medicines under the above Patient Group Direction. The above named
person has agreed not to act beyond their professional competence nor outwith the
recommendations of the Patient Group Direction
Signed:
Authorising Manager/Doctor
Print Name:
Date:
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