PURPOSE Line preparation and administration of Intravenous High Hazards Category Medications. DEFINITIONS Required line set-up and configuration for the safe administration of Hazard Category High Medications by intravenous route in the Neonatal Program. For a complete list of hazardous drugs, see Hazardous Drugs List. Personal protective equipment (PPE): Gloves: 2 pairs of Nitrile gloves with long cuffs that can extend over cuff of gown sleeves. Change both pairs of gloves every 30 minutes or if visibly damaged Gown: Disposable non-permeable gown with solid front and long sleeves with cuffs Eye and face protection: Fluid resistant mask with eye shield or goggles Cytotoxic Waste Container PROCEDURE Procedure Table of Contents: Pg. 1: Line Configuration for Hazard Category - High Medication by Intravenous Administration Pg. 4: Preparation for Hazard Category - High Medication by Intravenous Administration Pg. 5: Administration of Hazard Category - High Medication by Intravenous Administration Pg. 6: Flush of Hazard Category High Medication by Intravenous Administration Line Configuration Initiation or Line Change 1. Gather Supplies Supply List: Cytotoxic Waste Disposal Receptacle For single lumen (UVC/PICC) Y-Site (1) to attach to line configuration below the medication port, closest to the patient. Sterile Gloves Microbore Tubing (1) Large Volume Tubing (1) Y-Site (1) Prescribed Solution for Large Volume Channel (e.g. D10W, D10W with Heparin) ***Check Compatibility*** Prefilled 0.9% Saline Syringe (2) or Compatible Solution Syringes Injection Cap (1) Chlorohexidine/Alcohol swab (2%/70%) (2) Initial Dose Pump Syringe Channel (1) Large Volume Channel (1) Separate IV pole (1) Cytotoxic Sign on IV Pole Page 1 of 7
Line Configuration SINGLE LUMEN (UVC/PICC) a. Prepare and prime lines for administration by aseptic technique. (See photo). *Remember to Add Injection Cap to the pump end (where the medication will be connected) of the line. Full line changes as per procedure: CENTRAL VENOUS CATHETER (CVC), PERIPHERALLY INSERTED CENTRAL CATHETER (PICC): MEDICATION EXTENSION SET CHANGE: PROCEDURE. Page 2 of 7
Line Configuration DOUBLE LUMEN (UVC/PICC) or Dedicated PIV 2b. Prepare and prime lines for administration by aseptic technique as seen in the images. *Remember to Add Injection Cap to the pump end (where the medication will be connected) of the line. Full line changes as per procedure: CENTRAL VENOUS CATHETER (CVC), PERIPHERALLY INSERTED CENTRAL CATHETER (PICC): MEDICATION EXTENSION SET CHANGE: PROCEDURE. 3. Ensure Cytotoxic Line properly labelled. Labels can be obtained from pharmacy. Page 3 of 7
Preparation 1. Cytotoxic Waste Container For the disposal of all supplies, lines, diapers etc. 2. Confirm Medication Administration by the nine rights 3. Two RN procedure; primary care RN and second RN 4. Gather Supplies Supply List: Right: Patient, Drug, Dose, Route, Time and Documentation, Reason, Form and Response Both RNs must have the knowledge, skill and ability to administer Hazard Category High medications; second RN should be a CNL/CN/CRN/Delegate if primary RN novice to procedure PPE Texium Cap (1) Chlorohexidine/Alcohol swab (2%/70%) (2) Hazard Category High Hazard Medication Syringe 5. Place appropriate signage on door and IV pole to communicate to staff cytotoxic medication administration Cytotoxic Precautions Required, form CW087 Page 4 of 7
Administration 1. Perform Hand Hygiene and Don PPE As per policy, see PTN.02.021 2. Aseptically connect Texium Cap to Medication Syringe ***DO NOT PRIME*** Maintain aseptic technique for infection prevention 3. Ensure medication line clamped ***DO NOT PRIME*** 4. Swab Flush Syringe at Injection Cap Infection prevention and best practice (30/60) 5. If repeated dose, disconnect previous Flush Syringe ONLY Dispose of in appropriate receptacle 6. Swab Injection Cap Infection prevention and best practice (30/60) 7. Connect Medication with Texium Cap to Medication Line 8. Load Syringe Channel 9. Program Pump with use of the appropriate Guardrails DO NOT USE PRIME feature on PUMP 10. Single Lumen and PIVs ONLY: Ensure Primary Infusion on standby and clamped 11. Unclamp Medication Line and Start Infusion Remember for Single Lumen and PIVs to prime the line with a compatible solution prior to medication administration 12. Doff PPE and Perform Hand Hygiene As per policy, see PTN.02.021 Page 5 of 7
Flush 1. Perform Hand Hygiene and Don PPE if not already done 2. Upon Infusion Complete, clamp microbore line as close to syringe as possible As per policy, see PTN.02.021 3. Swab Texium and Injection Cap connection Infection prevention and best practice (30/60) 4. Disconnect Injection Cap and remove Texium Cap and Medication Syringe Dispose of in appropriate receptacle 5. Swab Injection Cap Infection prevention and best practice (30/60) 6. Connect Flush Syringe and flush as per medication flush procedure at the medication administration rate 7. Post Flush: Clamp Line and leave Flush Syringe in channel for next dose DO NOT CHANGE INFUSION RATE. Remember the first portion of the flush will still infuse the medication; therefore we do not to change the rate. Refer to INTRAVASCULAR (IV) FLUSH: INCOMPATIBLE INTERMITTENT INFUSIONS. 8. Resume Primary Infusion(s) 9. Doff PPE and Perform Hand Hygiene As per policy, see PTN.02.021 DOCUMENTATION Handling Record Hazardous Drugs (Employee Record) Medication Administration Record CROSS REFERENCES BC Children s Hospital Intravenous Chemotherapy/Biotherapy Direct IV (Bolus) Administration. Child & Youth Health Policy and Procedure Manual. CM.05.06. BC Children s Hospital Medication Administration: Cytotoxic Chemotherapy and Biotherapy. Child & Youth Health Policy and Procedure Manual. CM.05.05. BC Women s Hospital + Health Centre. Central Venous Catheter (CVC), Peripherally Inserted Central Catheter (PICC): Medication Constitution and Administration. Neonatal Program Policy & Procedure Manual. NN.11.14 Page 6 of 7
BC Women s Hospital + Health Centre. Central Venous Catheter (CVC), Peripherally Inserted Central Catheter (PICC): Medication Extension Set Change. Neonatal Program Policy & Procedure Manual. NN.11.23 BC Women s Hospital + Health Centre. Hazardous Drugs: Handling Precautions. Medication Policy and Procedure Manual. Policy # PTN.02.021 BC Women s Hospital + Health Centre. Hazardous Drugs: Requiring Safe Handling Precautions by Hazard Category* BC Women s Hospital + Health Centre. Handling Record Hazardous Drugs. Medication Policy and Procedure Manual. Policy # PTN.02.021-3 BC Women s Hospital + Health Centre. Intravascular (IV) Flush: Incompatible Intermittent Infusions. Neonatal Program Policy & Procedure Manual. NN.10.12 Version History DATE DOCUMENT NUMBER and TITLE ACTION TAKEN 02-Oct-2018 Intravenous Administration Of High Hazard Approved at: Neonatal Leadership Category Medications Committee DISCLAIMER This document is intended for use within BC Children s and BC Women s Hospitals only. Any other use or reliance is at your sole risk. The content does not constitute and is not in substitution of professional medical advice. Provincial Health Services Authority (PHSA) assumes no liability arising from use or reliance on this document. This document is protected by copyright and may only be reprinted in whole or in part with the prior written approval of PHSA. Page 7 of 7