cazrella

No, I don't have access as I am no longer on placement. The "do not bolus" labels were mentioned pg. 10 https://www.nuh.nhs.uk/handlers/downloads.ashx?id=61025 As you mentioned, IV lines (for continuous infusions?) should be labelled with the name of the drug. I wonder what the rationale for NHS was for implementing a "do not bolus" label in addition to a label with the drug name on the IV line. Okay, so CVC line patency does not need to be checked 8 hourly (or per shift) if there is an infusion running through it. And, if I was to titrate the noradrenaline down and end treatment, then I aspirate blood out and flush with NS after. What other medication should we also aspirate blood out (to prevent a drug bolus) when that lumen of the CVC is used again? All potent continuous IV infusions (high-alert drugs e.g. insulin infusions)? I have heard of cases in the literature where patients have received accidental drug boluses with lots of different medications. I am trying to implement a safety initiative to prevent incidents of NS IV bags for flushes being connected to the wrong IV lines e.g. connected to lines with high-alert drugs like noradrenaline. Thanks all.

Hi Esme12, I am a nursing student and thus do not have access to the hospital policies unless I am on placement. I am in Australia and focusing on the ICU setting. I am trying to find literature on this "general rule" that you do not flush a noradrenaline line. I do not feel there is enough safety measures and education about "accidental drug boluses". I have noticed elsewhere in the world, there are "do not bolus" IV line labels. We had an incident of an accidental noradrenaline bolus. I can not find much information about aspirating blood back from the IV line and reasons why we do this. If we are to finish a noradrenaline treatment (no more infusions), as we can't "flush" the line with NS we would aspirate blood back? This would allow us to check for patency and remove any blood clots? I have seen nurses do this as they have said they don't want to push meds through if they do not know what was in that line before. Thanks for your comments thus far.

I am after information on the administration and safety strategies in place for noradrenaline. As far as I am aware, noradrenaline must be administered to a central line (which in my state the giving set is bright orange coloured) with a three-way tap and must not be flushed with NS after use. So how do you check IV line patency if you can not flush the line? I understand the logistics of not flushing a noradrenaline line as doing so can cause a bolus of medication to the patient which can be life-threatening. Is there any literature on the flushing of noradrenaline lines? Or incidences of medication errors involving noradrenaline? At nursing school, we are taught to flush before and after giving an IV medication as a given. However, this is not the case with noradrenaline? Should I also not flush IV lines for other high-risk medications e.g. insulin infusions? Thanks in advance.

A simple question, for example, if my patient has tingling in the ulna nerve pathway and feels numb in the radial pathway, on the documentation chart would I tick both boxes for tingling and numb under sensation? Normally we just tick one box, for example, warm hands, as a patient can't have both warm and cool hands.... Am i allowed to tick more than one option for sensation as there are more than one nerve pathway we are assessing? Thank you :)

@MrsBoots87, thanks for replying with helpful comments :) However, with the oral drug administration we aren't required to wear gloves as we won't be 'touching' the medication-rather transferring it from the medication cap to the medication cup to give the patient. The medication bottle is kept in the patient's drawer for the assessment. The chart is by the bed and we sign off in the room. I understand it might be different than compared with the clinical setting but with this set-up I wash my hands (hand gel) when entering the room and after I exit the room? But I don't need to wash it after I touch the patient's arm band to check it's the right patient or before/after touching medication bottle? With the NVA, all the student's have recorded each P on the observation chart as they go along. I understand in the clinical setting you do your procedure then document everything at the end? For the purposes of my assessment, we are required to ask the patient for consent and then go grab the observation chart and then do the NVA (the chart will be next to us). Student's have been writing down the results one at a time, doing hand hygiene(hand gel) before and after touching patient...Rather, I should ask for consent (patient will be in 'room'), exit room and grab NVA chart, enter room, do hand hygiene, assess patient's hand for NVA, wash hands, document all 5 Ps, then also wash hands on exiting room? (we document in room) Is this more on par now?

I have an upcoming practical exam where I need to administer an oral medication using the 6 rights of medication administration and do a neurovascular assessment using the 5 Ps. I'm aware of the 5 moments of hand hygiene but I'm still unsure when to perform it for these two situations... Drug administration: Before touching patients identification band (to check it's the right patient) After touching patient identification band Before touching medication bottle After touching medication bottle Before documentation After documentation Am i missing more? (What if I touch the medication chart?) Or do you just wash hands before and after giving the drug (I won't be touching the drug, so I won't be using gloves) Neurovascular assessment? Before touching patient's hand After touching patient's hand Should I wash my hands before and after I document each of the 5Ps? I'd really appreciate some feedback. I don't want to fail! Thanks :)