Commencing PN- 3-in-1 bag (all in one bag)

Paediatric guidelines (in development)
NHS Lothian

Requirements

  1. DRESSING TROLLEY
  2. STERILE DRESSING SHEET
  3. PARENTERAL NUTRITION (should be taken from fridge 1 hour prior to infusing)
  4. APRON
  5. PAIR OF NON STERILE GLOVES
  6. GIVING SET WITH NO INLINE FILTER
  7. ALCOHOL 70% & CHLORHEXIDINE 2% WIPES
  8. 5mL AMPOULE OF SODIUM CHLORIDE 0.9% FOR INJECTION
  9. GREEN NEEDLE 21G
  10. 10mL LUER LOCK SYRINGE
  11. SYRINGE CAP
  12. SODIUM CHLORIDE 0.9% LABEL
  13. ALCOHOL HAND RUB
  14. SHARPS BIN

Procedure

DO NOT TOUCH KEY PARTS – DISCARD IF CONTAMINATED

  1. Wash and dry hands
  2. Suspend the PN bag on the stand
  3. Put on apron
  4. Apply alcohol hand rub and allow to dry
  5. Clean trolley with alcohol 70% & chlorhexidine 2% wipe and allow to dry for 30 seconds
  6. Open sterile dressing sheet
  7. Apply alcohol hand rub and allow to dry for 30 seconds
  8. Unfold dressing sheet and place on top of trolley
  9. Open giving set, 10mL syringe and green needle onto dressing sheet
  10. Apply alcohol hand rub and allow to dry for 30 seconds
  11. Put on non sterile gloves
  12. Check sodium chloride 0.9% with a trained nurse
  13. Using syringe with green needle draw up the 5mL of 0.9% sodium chloride 0.9%.
  14. Remove green needle from the syringe and dispose in sharps bin and then remove any air present from the syringe, attach syringe cap. Affix sodium chloride 0.9% label to syringe
  15. Close all clamps on the giving set (if using IVAC infusion set, close air inlet)
  16. Clean the giving set port on the PN bag with an alcohol 70% & chlorhexidine 2% wipe and allow to dry, break off the bag port protector
  17. Remove the cover from the giving set spike, ensuring not to touch the spike at any time and insert the giving set spike into the bag
  18. After inserting the giving set inspect the bag for leakage or cracksIF ANY LEAKAGE OR CRACKS ARE PRESENT,
    THE BAG MUST BE DISCARDED & DUTY PHARMACIST CONTACTED
  19. Run through the giving set, ensuring that no air is present when filled
  20. Insert the giving set to the infusion pump
  21. Clean the Smartsite® on the intravenous catheter with an alcohol 70% & chlorhexidine 2% wipe and allow to dry
  22. Connect syringe containing the sodium chloride 0.9% to the Smartsite® and turn ¼ of a circle.
  23. Check the line for flashback of blood
  24. Slowly inject the sodium chloride using a pulsing action.
  25. Holding the syringe, remove from the Smartsite® and discard directly into sharps binIF RESISTANCE IS PRESENT YOU MUST CONTACT MEDICAL STAFF AND
    GET FURTHER INSTRUCTIONS    DO NOT USE EXCESSIVE FORCE AS THIS MAY DAMAGE THE CATHETER.
    DO NOT USE ANY LESS THAN A 10mL SYRINGE TO CHECK PATENCY OF LINE
  26. Connect the giving set to the Smartsite®
  27. Ensure the connection is secure and there is no possibility of it becoming disconnected
  28. Prior to commencing infusion the rates and child’s identity should be independently checked by two IV competent registered nurses in line with medicine administration policy
  29. Open all clamps & commence the infusion
  30. The accessing of the intravenous therapy device and the beginning of PN infusion must be documented in the child’s healthcare records. The prescription and rate charts must be signed by both registered nurses. The infusion device numbers must be recorded on the prescription chart.

IF FOLLOWING COMMENCEMENT OF INFUSION PN BECOMES DISCONNECTED FROM THE CVAD IT SHOULD BE DISCARDED AND APPROPRIATE IV FLUIDS COMMENCED
(BEARING IN MIND GLUCOSE CONCENTRATION OF ORIGINAL PN FORMULATION)