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Sodium Chloride 0.9% for IV Flush Staff Characteristics Clinical Details Registered Midwife Clinical Situation for which medicine is to be used To maintain the patency of an intravenous device and act as a buffer solution between different IV medicines Clinical Criteria for inclusion Women ≥16 years who have indwelling iv cannulae. Clinical Criteria for exclusion • • • Known hypersensitivity to any component of the medicine. Individuals < 16 years of age. When prescribed IV therapy that is incompatible with sodium chloride 0.9%. Management of excluded women and those not wishing to receive care • • Refer to medical staff as appropriate. Document action / refusal in woman’s maternity handheld record. Use in pregnancy or lactation May be used in pregnancy and lactation. Cautions and/or reasons for seeking further advice from a doctor • • • • Woman fits exclusion criteria. Woman suffers an adverse drug reaction. Chronic dosing is required. Woman declines medication. Cautions and action that will be taken if a caution applies • • Check for and document any allergies. Check and document past medical and drug history and current medication to ascertain potential for overdose. If a caution applies consult with a doctor. Document consultation in woman’s maternity handheld record. Refer to current BNF for latest information on interactions. • • • Description of Treatment Name / Form / Strength of Medicine Sodium Chloride / Injection / 0.9% Dosage 5-10ml Route of administration Intravenous Frequency of administration • • Twice daily to maintain patency where no infusion or bolus injections are being used (unless prescribed otherwise). If bolus injections or intermittent infusions are being administered the flush should be given before giving a bolus injection; in between two different IV medicines, as a buffer; and after the administration of the bolus injection or intermittent infusion. Duration of treatment As per local Trust guidelines. Legal Status • POM – midwife may administer as medicine is on midwives exemption list. Storage requirements • Should be stored at room temperature and protected from excessive heat and freezing. Warnings • Do not use excessive force when attempting to flush an IV device as this may risk a thrombus being pushed into the circulation. To minimise coldness/ pain on injection: give slowly. • Follow –up • • • • Refer if cannula is blocked then it must be resited. Refer if prescribed IV therapy is incompatible with sodium chloride. Refer if woman develops side/adverse effects or if there is an inadequate response. Refer immediately in case of overdose. Undesirable effects Injudicious intravenous saline therapy may cause hypernatraemia. • If a serious adverse reaction is suspected please report to the MHRA Yellow Card Scheme http://yellowcard.mhra.gov.uk/ Overdose Injudicious intravenous saline therapy may cause hypernatraemia. General adverse effects of sodium chloride excess in the body include: nausea, vomiting, diarrhoea, abdominal cramps, thirst, reduced salivary and lachrymal secretions, sweating, fever, hypotension, tachycardia, renal failure, peripheral and pulmonary oedema, respiratory arrest, headache, dizziness, restlessness, irritability, weakness, muscular twitching and rigidity, convulsions, coma and death. Excess chloride in the body may cause a loss of bicarbonate, with an acidifying effect. • Immediate assessment / treatment is essential – refer to medical staff. • Manage in accordance with established treatment guidelines or see BNF overdose section. • For further advice contact National Poisons Centres 0844 892 0111. Advice to be given to the woman Monitoring arrangements during and after treatment and follow-up required. Records to be kept • • • • Explain treatment and course of action. Side effects explained. Verbal consent obtained before administration. It is good practice to offer the woman the manufacturer’s Patient Information Leaflet to support any verbal advice provided. If the woman suffers a serious adverse drug reaction, seek immediate medical assistance. • Monitor for side effects and effectiveness. • To be reviewed by doctor if inadequate response. Must be written in the once only medicines and pre-medications section of the medicine kardex. The person who writes up the medication must write their designation after their signature e.g. Midwife Band (*). Also record the administration, date, time and name of practitioner in the relevant section of the woman’s maternity handheld record. • References • • Sodium Chloride 0.9% SPC Hameln Pharmaceuticals Ltd 2nd February 2010 www.medicines.org.uk Intravenous Therapy in Nursing Practice Second Edition edited by Lisa Dougherty, Julie Lamb