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Policy Type: Clinical C li

Clinical Policy
Definition:
Owner Group:
Policy
Operations
n ic
al
Gu
id e
lin
e

Policy for The Administration of


Intravenous Fluids at John Taylor
Hospice

Applicable To: Nursing and Therapy Staff


Communication Method: Line Manager
Consequence of Non Adherence: Disciplinary

Policy Author/Source: Clinical Lead, John Taylor Hospice


Trust Policy and Procedure Number: 2.3
Version Number: 1

Approval Body: Clinical Policy and Procedures


Group, EBPCT June 2005
Date Approved: Adopted by BENPCT, October
2006
Review Date: May 2007
CONTENTS

Page No

Diversity Statement 3

Subject 4

Rationale 4

BEN PCT Responsibility 4

Manager Responsibility 4

Staff Responsibility 4
Knowledge of Policy

Principles 4
Rationale for Administration of Intravenous Fluids

Exclusions 5

Training 5

Audit 5

Guidelines/Procedures 5
Prior to Administration of the Infusion

Prescribing 6

Administration 7

After Care 7

References 9

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Diversity Statement for Clinical Policies

This policy endeavours to deliver care in such a way as to treat patients fairly and
respectfully regardless of age, gender, race, ethnicity, religion/belief, sexual
orientation and/or disability.

The care and treatment provided will respect the individuality of each patient.

BEN PCT is caring, committed and competent in its core values and these will be
developed to ensure equality and fairness becomes the working culture.

In line with the PCT’s strategy and plans for race and equality all clinical policies
and protocols are reviewed against the values, standards and targets contained
within the strategy for fairness and equality.

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1.0 SUBJECT

The rationale for prescribing intravenous fluids, the management of


administration of intravenous fluids, the addition of drugs to intravenous
infusions, and aftercare of patients receiving intravenous fluids, at John Taylor
Hospice In Patient Unit.

2.0 RATIONALE

To ensure the highest standards, and a consistent, evidence based approach


for the safe administration of intravenous fluids and drugs, and management
of patients’ aftercare.

3.0 BEN PCT RESPONSIBILITY

 To provide a Policy, which is current, evidence based and accessible.

 Provide Training.

4.0 MANAGER RESPONSIBILITY

To ensure Staff have knowledge of and access to the Policy

To ensure Staff attend Trust Training which is competency based, and ensure
Staff are given opportunities to maintain competencies

5.0 STAFF RESPONSIBILITY

Knowledge of Policy
To Practice within Policy guidelines
To ensure updated knowledge by attending Training and maintaining
competency

6.0 PRINCIPLES

6.1 Rationale for Administration of Intravenous Fluids


Intravenous fluids are administered at John Taylor Hospice;

 as a required preparation for patients undergoing blood transfusion. For


Criteria for Transfusion see: Policy for the Safe Administration of Blood at
JTH

 as a therapy for Hypercalcaemia

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6.2 The decision to administer Intravenous fluids under any other circumstances
will be a clinical decision made by the Doctor attending the patient, whose
final decision will be made, in discussion with the patient, based on the
patients symptoms and disease progression.

6.3 Patient’s privacy and dignity will be maintained at all times during the
consultation and administration process.

7.0 EXCLUSIONS

7.1 Patients will not receive Intravenous Fluids therapy in cases of

 Patients religious/cultural objections

 Not having gained patient’s informed consent – refer to BEN PCT Consent
Policy

8.0 TRAINING

8.1 Any nurse administering intravenous drugs must be competent in all clinical
aspects of intravenous therapy and have validated competency. The nurse
must practice in accordance with the NMC Code of Conduct.

8.2 Attendance and completion of training in administration of intravenous fluids


and drugs must be recorded in the personal training record of members of
staff. A record of staff training will also be provided to BENPCT Training and
Education Department by John Taylor Hospice Manager.

9.0 AUDIT

9.1 Audit of clinical activity will be via the BENPCT Incident Reporting procedure
and any adverse events should be reported by the nurse, via the yellow card
system.

10.0 GUIDELINES / PROCEDURE

10.1 Prior to Administration of the Infusion

10.2 The patient will be cannulated using an aseptic technique by the


Doctor/practitioner attending John Taylor Hospice, in the morning prior to
commencement of the infusion. An appropriate discussion will take place
between the multi-disciplinary team where consent will be obtained from the
patient.

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10.2 The cannula should be secured using clean tape. Non-sterile tape should not
cover the insertion site, and taping must enable the site to remain visible and
the cannula stable. A transparent IV dressing will be used to secure the
cannula in place. A bandage must not be used, as visibility and moisture
permeability are obscured.

10.3 The nurse administering medications and solutions should have knowledge of
indications for therapy, side effects and potential adverse reaction, and
appropriate interventions, particularly related to the management of
anaphylaxis. Refer to the Anaphylaxis Policy 2005

10.4 Prior to administration of medications and solutions, the nurse should


appropriately label all containers, vials, and syringes; identify the patient; and
verify contents, dose, rate, route, expiry date, and integrity of the solution.

10.5 inspection of fluids, drugs, equipment and their packaging must be undertaken
to detect any points where contamination may have occurred during
manufacture and/or transport. This intrinsic contamination may be detected as
cloudiness, discolouration or the presence of particles.

10.6 The date of insertion and date of removal of the device will be documented, in
the clinical record as a matter of routine.

10.7 The number of lines, lumens and stopcocks will be kept to the absolute
minimum consistent with clinical need.

11.0 PRESCRIBING

All details of the infusion and any drug additions should be prescribed, by the
prescriber at John Taylor Hospice, on the Drug Administration sheet IV Drugs
section, and in the patient’s records.

11.1 All drug additions to intravenous infusions are made by the Doctor or
prescriber attending John Taylor Hospice.

11.2 When adding drugs to a continuous infusion, only one addition should be
made to each bag or bottle of fluid after the compatibility has been
ascertained.

11.3 The additive and fluid must be mixed well, by means of inverting the container
several times, to prevent a layering effect and a bolus injection of the drug
being delivered.

11.4 Details of the prescription, dose, route of administration, rate of


administration, time period of administration, all calculations, and patient’s
details, must be checked by the Doctor/presciber and Registered nurse prior
to commencement of the infusion.

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12.0 ADMINISTRATION

12.1 The number of lines, lumens and stopcocks will be kept to the absolute
minimum consistent with clinical needs.
Winnings Ways 2003

12.1 The Nurse is accountable for evaluating and monitoring the effectiveness of
the prescribed therapy; documenting patient response, adverse events, and
interventions; and achieving effective delivery of the prescribed therapy.

12.2 Aseptic technique must be adhered to throughout all intravenous procedures.


The Nurse must employ good hand washing and drying techniques using a
bactericidal soap or bactericidal alcohol hand rub in order to prevent local
infection, septic phlebitis or septicaemia. Refer to the infection control policy
2002.

12.3 The insertion site should be inspected at least once a day for complications
such as infiltration, phlebitis or any indication of infection, e.g. redness at the
insertion site of the device or pyrexia. These problems will necessitate the
removal of the cannula and further investigations e.g. wound swab in the
presence of exudate.

12.4 Replace all tubing when the cannula is replaced.

12.5 Replace solution administration sets and stopcocks used for continuous
infusions every 72 hours. Research has indicated that routine changing of
administration sets every 48-72 hours instead of every 24 hours is not
associated with an increase in infection and could result in considerable
savings for hospitals.

12.6 Infusion bags should not be left hanging for longer than 24 hours. After being
added to an infusion bag, a medication or solution should be infused within 24
hours or discarded, via the Clinical Waste disposal system.
Nice Guidelines 2003

13.0 AFTER CARE

13.1 On completion of the prescribed regime, tubing and the infusion bag will be
disposed of in the appropriate Clinical Waste disposal system.

13.2 The nurse will remove the cannula from the patient following an aseptic
procedure.

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13.3 The cannula should be removed using a slow steady movement and pressure
should be applied using a non-woven gauze swab until haemostasis is
achieved. The pressure should be firm and not involve any rubbing
movement. The site should be inspected to ensure bleeding has stopped, and
should then be covered with a sterile dressing, such as Mepore or a similar
dressing. The cannula integrity should be checked to ensure the complete
device has been removed.

13.4 Fluid charts and prescription charts will be filed in patient’s records on
completion of treatments. The episode of care and treatment should be
documented in the patients records according to the Trust Record Keeping
Policy.

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REFERENCES

The Royal Marsden Hospital Manual of Clinical Nursing Procedures (6th Edition) The
Royal Marsden NHS Foundation Trust 2004

Royal College of Nursing. Standards for Infusion Therapy 2003

Infection Control Prevention of Health-Associated infection in Primary and


Community Care. June 2003 N.I.C.E

Winning ways. Woking together to reduce Healthcare Associated Infection in


England. December 2003

Infection Control Policy and Procedure Manual 2002

Policy for Consent to Examination or Treatment. BEN PCT 2003

The NMC Code of Professional Conduct: Standards for conduct, performance and
ethics. November 2004

Policy adopted from Sandwell and West Heath Birmingham Hospitals NHS Trust
Incorporating Local Procedures for John Taylor Hospice for the safe administration
of Blood Transfusion 2004

Guidelines for Record keeping BEN PCT 2006

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