Commencing PN - separate aqueous & fat (lipid) infusions

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 IN-LINE 0.2micron FILTER FOR AQUEOUS BAG
7. GIVING SET FOR FAT BAG/SYRINGE
8. Y-EXTENSION TUBE
9. ALCOHOL 70% & CHLORHEXIDINE 2% WIPES
10. 5mL AMPOULE OF SODIUM CHLORIDE 0.9% FOR INJECTION
11. GREEN NEEDLE (21G)
12. 10mL LUER LOCK SYRINGE
13. SYRINGE CAP
14. SODIUM CHLORIDE 0.9% LABEL
15. ALCOHOL HAND RUB
16. SHARPS BIN

DO NOT TOUCH KEY PARTS – DISCARD IF CONTAMINATED

1. Wash and dry hands
2. Suspend the PN bags 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 sets, extension tube, 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 (with a registered nurse)
13. Draw up the 5mL of sodium chloride 0.9%
14. Remove green needle from the syringe and dispose of in sharps bin and then remove any air present from the syringe, attach syringe cap. Affix sodium chloride 0.9% label to syringe.
15. Connect giving set for fat bag/syringe to a Y type extension set along with a giving set with an in-line filter for the aqueous bag
16. Close all clamps on the giving sets and extension tube
17. Remove the cover(s) from the giving set spike(s), ensuring not to touch the spike(s) at any time and insert the giving set spike(s) into the bag(s)
18. After inserting the giving set inspect the bag(s) for leakage or cracks

IF ANY LEAKAGE OR CRACKS ARE PRESENT,
THE BAG MUST BE DISCARDED & DUTY PHARMACIST CONTACTED

1. Slowly run through the giving set(s), ensuring that no air is present when filled
2. Insert the giving set to the infusion pump
3. Clean the Smartsite® on the intravenous catheter with an alcohol 70% & chlorhexidine 2% wipe and allow to dry for 30 seconds
4. Connect syringe containing the sodium chloride 0.9% to the Smartsite® and turn ¼ of a circle
5. Check the line for flashback of blood
6. Slowly inject the sodium chloride using a pulsing action.
7. Holding the syringe, remove from the Smartsite® and discard directly into sharps binIF RESISTANCE IS PRESENT,
   YOU MUST CONTACT MEDICAL STAFF AND GET FURTHER INSTRUCTIONSDO NOT USE EXCESSIVE FORCE AS THIS MAY DAMAGE THE CATHETER.
   DO NOT USE ANY LESS THAN A 10mL SYRINGE TO CHECK PATENCY OF LINE
8. Connect the giving set to the Smartsite®
9. Ensure the connection is secure and there is no possibility of it becoming disconnected
10. 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
11. Open all clamps & commence the infusion
12. 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 AND APPROPRIATE IV FLUIDS COMMENCED (BEARING IN MIND GLUCOSE CONCENTRATION OF ORIGINAL PN FORMULATION)