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How to prepare an intravenous insulin infusion

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A concise ‘how-to’ video to show best practice of preparation of IV insulin infusions. 

This is a video demonstration of how to prepare an intravenous insulin infusion these steps should be used for preparing both fixed and variable rates insulin infusions for diabetic patient before you begin there are a number of checks you should carry out the first of these is to ensure you have both the patient specimens chart and their insulin charms the

Insulin infusion itself should always be prescribed on one of the designated sections of the insulin chart but all patients will also need iv fluids to be administered alongside the insulin and they should be prescribed on the medicines chart in the iv section of the back next you need to go to the patient and once you have confirmed their identity you should

Check that they are available and happy for the infusion to go ahead making sure they understand what is involved at this point you should check the patient have a working cannula in place and check the vip school delivery of the fluid solution and the insulin must be via a single cannula so check you have an octopus in place unless your patient has a central

Line in which case you need to use two lumens you also need to make sure they’ve had a recent blood glucose recorded for administration you’ll need to use both the syringe driver and an infusion pump so check you have these and set them up at the patient’s bedside lastly you need to ensure you have an appropriate second checker available and it’s a good idea to

Let them know you’ll be needing them shortly once you’re satisfied with all of these checks enter the area you will be preparing the infusion in and wash your hands thoroughly with soap and water select a visually clean tray and clean all sides with white containing a detergent and a disinfectant and whilst the trays drying use the same type of wipes to clean

Your trolley you are now ready to begin gathering your equipment and don’t forget to check expiry dates items as you do here is an overview of what you will need a bottle or bag of iv sodium chloride not 0.9% a vial of act rocket insulin this will be stored in the fridge a clearly extendable administration line for your insulin infusion the bag of iv fluids

That’s being prescribed on the medicines chart an iv administration set for the fluids at least five disinfectant wipes to drawing up needles a 50 ml syringe to deliver the insulin infusion an insulin syringe to measure the insulin units in 10 mils of sodium chloride not point nine percent for a flush and a 10 mil iv syringe also for the flush a drug infusion

Label and you’ll also need a small sharp spin once you have everything you need you should wash or decontaminate your hands again and put on an apron and gloves you can now begin to set up your anc tea preparation area in your clean tray open your insulin vial and decontaminate with disinfectant wipes before placing it in the tray taking care to clean and protect

Between parts as you do repeat this process with the sodium chloride bottle an ampule remove each of the syringes from the outer packaging and place in the tray attaching the needles to both of the iv syringes before you do so don’t forget to also place your extendable lime in the tray just opening the end slightly of the packaging to allow attachment to the

Syringe try to always keep your preparation area clear from rubbish and discard this as you proceed you will now need your second checker to be present before you prepare any of your products check the details of the prescription with your checker then begin to withdraw 49.5 mils of sodium chloride note point nine percent into your 50 ml syringe next select your

Insulin vial checking name and expiry dates with your checker visually inspect the vials and gently roll it before withdrawing 50 units using your insulin syringe remove the needle from your 50 ml syringe and add the 15 units of act rapid into the sodium chloride invert the syringe several times to ensure the insulin is disbursed now connect your 50 ml syringe

To the curly extendible administration line and return it to the tray prepare a sodium chloride flush at this point just in case are any problems with the patient’s line at the administration stage complete the details on the drug infusion label including both signatures and attach it to the 50 ml syringe take care not to obscure the gradient marking so you can

Check the syringes infusing correctly at regular intervals you are now ready to return to the patient don’t forget to take with you both the insulin and the medicines chart the tray containing the insulin infusion the ivs fluids a spare pair of gloves some disinfectant wipes and you will also need your second checker to be present to check your patient identity

And your administration rates at the patient’s bedside you should both confirm the patient’s identity and they are happy to proceed attach your 50 ml insulin infusion into the syringe driver and once in place purge the line whilst keeping the other end in your clean tray set the rate as prescribed on the insulin chart and ensure your second check had concerns

This now check the fluids that have been prescribed on the medicines chart patch the iv administration set and keeping the end in your clean tray set this to run through your infusion pump you should now decontaminate your hands and put on clean gloves before you touch the patient use your disinfectant wipes to clean each port separately and let them dry before

Connecting one to the insulin infusion line and the others to the iv fluids you may now safely begin the infusions but finally you should check the patient isn’t in any pain as the infusions begin and dispose of any rubbish into clinical waste then remove your gloves and wash your hands with soap and water before you both sign the prescription and insulin charts

And make sure you record the asset numbers of both infusion devices you are using clean your tray and finally make sure you are familiar with what monitoring the patient requires that’s the end of this video guide we hope you found it useful in summary here are the key points make sure you maintain a ntp throughout always use a specific insulin syringe for

Measuring insulin ensure appropriate fluids run concurrently with the insulin infusion where possible work in an area where disturbances are minimized the accuracy of all products used including dose volumes rate and pump settings must be second checked and monitor the patient in line with the appropriate pathway remembering to use the opposite hand for blood

Glucose monitoring thank you for watching you

Transcribed from video
How to prepare an intravenous insulin infusion By East Cheshire NHS Trust