Making up drugs for parenteral administration

Question 1

Equipment

Answer 1

• Patient’s drug chart
• Alcohol gel
• Clean receptacle
• Apron
• Gloves
• Sterile needle x1
• Syringes x3 (1 for drug, 2 for flush)
• 0.9% sodium chloride x2 (for flushes)
• Water for injection (for drug reconstitution) (can use saline)
• Medication prescribed
• Wipes (clinell swab) x2 (1 for drug vial, 1 for cannula bung)
• Sharps bin
• IV cannula

Question 2

Performance of task (making up drug)

Answer 2

• Check name, dose, route of prescribed drug and that the prescription is signed and dated. And hasn’t already been given
• Clean hands with alcohol gel
• Don glove and apron
• Collect drug and check it against chart and it’s expiry date
• Check name, dose and expiry date of diluent (water for injection)
• Open all the equipment for the drug making, aseptically - retain the packaging for the syringes as will use for transport
• Attach needle and syringe (aseptically)
• Take cap off diluent’s ampoule (don’t put needle down though)
• Insert needle into ampoule and draw up diluent into syringe.
• Remove protective cap (silver circle) from drug vial
• Clean the injectable bung with swab
• Inject diluent INTO vial (use this step to aid/begin mixing)
• Keeping needle in vial, let go of plunger (it will move backwards) holding syringe body (to equalise pressure)
• Place vial in palm, hold body of syringe in fingers. Move arm in circular motions to mix (takes ages so could state that would do this until mixed completely).
• Once all powder dissolved, inject air back into vial fully
• Invert syringe/vial
• Draw plunger back slowly (keep bevel within solution at all times)
• Fill syringe with solution completely before removing needle from vial
• Remove needle from vial
• Remove need from syringe and put needle and vial sharps bin
• Check for air bubbles
• Place capped-off syringe into its own packaging.

Question 3

Performance of task (flush preparation)

Answer 3

• Prepare two 0.9% Sodium Chloride flushes:
• Check name and expiry date of saline ampoule
• Break cap off of ampoule
• Insert syringe straight into ampoule
• Press down firmly to maintain tight seal
• Draw saline into 5ml syringe by moving plunger backwards
• Store flush syringe back in its own packaging for transport
• Leave the syringes in the ampoules for identification and transport

Question 4

Performance of task (administration of the drug solution)

Answer 4

• Take the 2 flushes (in their ampoules) and the drug (in the syringe packaging) and 2 Clinell wipes to the patient.
• Recheck identity of patient
• Check their cannula for signs of inflammation
• Wipe injectable bung (on cannula (from previous task)) with wipe and allow to dry
• Insert a flush into cannula
• Ask patient to inform you of any pain
• Insert drug syringe into cannula bung and inject slowly (some drugs have a prescribed rate)
• State that you are observing the patient for allergic reaction or discomfort at site
• Insert the second flush into cannula
• Ask patient to inform you of any pain

Question 5

Aftercare

Answer 5

• Complete drug chart (state that you would do this)
• Check welfare and ask patient to inform staff of pain, discomfort or swelling around site
• Ask patient to inform staff of specific symptoms of anaphylaxis (shortness of breath, itiching, tongue swelling)
• Remove apron and gloves
• Thank patient

Question 6

Complications

Answer 6

Anaphylaxis

Adverse drug reaction

Question 7

What would you say to inform the patient about the procedure?

Answer 7

‘I’ve been asked to put some drugs through your cannula today to hopefully make you feel a bit better. Firstly, I will flush the cannula with some saline to make sure it is working, I will then put the drugs through before flushing it with some more saline to make sure it has all gone through. It will not hurt but you may feel a bit of cold going up your arm. Stop me at any time if you are in pain or discomfort.’