Speak to the patient – do the usually introduction, consent, and explanation of the procedure. If they already have a cannula in:
Check how long the cannula has been in
Check for phlebitis / general soreness / signs of infection
Clean out the blue tray with soap and water. Make sure you clean the underneath of the tray too. After soap and water also use a sterile swab.
Wash your hands with alcohol gel and then put on gloves. Remember that the gloves on the ward are not completely sterile as they are just lying around in a box. They tend to act as more of a barrier between you and the patient, rather than as something completely sterile.
Check you have the right solution! Check its expiry date and batch number (write this in the notes), and also ask another member of staff to check, just to cover your back. Also, check the expiry date on the giving set.
Get a colleague to double check the expiry date and batch number, and to co-sign for this in the notes.
Also remember to get 5ml of saline solution and a syringe – to flush the cannula with. When you flush the cannula you are checking it is patent.
Open up the giving set and the solution. Try not to touch them as you open them, just rip open the packets and drop them into the blue tray.
Hang up the drip. Check the tube in the giving set isn’t tangled and close of the valve thing in the giving set. Make sure there are not kinks or knots.
Jab the giving set into the drip. You need to first twist off the bit on the bottom of the drip, and then whilst holding the chamber of the giving set, twist the sharp part of the giving set into the drip.
Squeeze the drip to fill the chamber. Fill it roughly to near the line (i.e. make sure there’s a decent amount in there). Never ever squeeze the chamber – you may cause tiny cracks that could leak, or allow antigens into the drip.
Pull the cap off the giving set and slowly open the valve to allow the liquid to flow through the tube. Make sure there are not bubbles in the tube (some small ones are okay and they can be difficult to get rid of). It’s ok if you spill some of the liquid, but better practice if you don’t. Close off the valve. Once you have bled all the liquid through the tube, don’t put it down anywhere! Clip the end of the tube to the little loop thingy on the valve.
Work out how many drops per minute you need. On the back of the drip packet, it tells you how many drops/ml this particular drip provides. To work out the total number of drops in a drip packet:
Total volume x drops/ml = total no. of drops.
You will have been told how long a period to give this drip for (e.g. over 6 hours), so convert this to minutes. Then you can work out how many drops per minute:
Total no. of drops / time (minutes) = Drops/min.
Once the drip is all set up (you will have done this in a separate room), you should go and see the patient. Check they are the right patient! (You need at least the patient’s name and DOB to do this). Make sure you check the patient’s wrist band. Tell the patient who you are what you are going to do etc.
Wash your hands again, and put the gloves back on. Wheel the drip to the patient, and put the tube into the needle thing. Then set it up to be the right number of drops per minute
Dr Tom Leach MBChB DCH EMCert(ACEM) currently works as a GP Registrar and an Emergency Department CMO in Australia. He is also a Clinical Associate Lecturer at the Australian National University. After graduating from his medical degree at the University of Manchester in 2011, Tom completed his Foundation Training at Bolton Royal Hospital, before moving to Australia in 2013. He started almostadoctor whilst a third year medical student in 2009.
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