NEONATAL CARE:
ADMINISTRATION OF FLUIDS AND MEDICATION
Administration
of oral medication
Adherence
to the following principles in your professional and legal responsibility and
will assist in safe practice (Griffith et al, 2003)
The Five
Cs/Rs:
·
Correct/
Right Patient/ Child
·
Correct/
Right Medicine
·
Correct/
Right Dose
·
Correct/
Right Time
·
Correct/
Right Route
Double
Checking
If
double checking is required, all aspects of preparation, administration and
documentation must be carried out from start to finish by both practitioners
Basic
principles when administering oral medication
Child development
considerations are important in the administration of medicines. Some basic
principles include (Rationale 17).
·
Be confident
·
Approach the child/family with a
positive attitude
·
Be honest and understanding
·
Allow the child to have control where
appropriate.
·
Use appropriate language that the child
understands.
·
Discuss with the child what they might
taste/ smell/see/hear/feel.
·
Listen to all involved.
·
Explain the benefits of compliance with
the medicine taking.
Age –appropriate
considerations should always be taken into account during drug administration.
Drug
Calculations
Paediatric dose
calculation is usually based on either body surface area (mg/m2) or
body weight (mg/ kg) of the child. Body weight is used more frequently for the
case of calculation.
The calculation of body
surface area (BSA) used to require body weight and height.
To calculate drug
doses, use the following formula:
Dose required/ Present
Standard Quantity of Drug X Present Quantity of Liquid in which Standard
Quantity of Drug is Dissolved
In other words:
What you want/ What you
have X What it is in (dilation)
For example: A child is
prescribed 90mg of Paracetamol and the medication supplied is 120mg of
Paracetamol in 5mls:
90 / 120 X 5 = 3.75mls
CONTRAINDICATIONS
o
Unconscious child
o
Absent gag reflex
o
Inability to swallow
o
Vomiting
CAUTIONS
R Digestive
tract trauma/ illness
R Post
gastro-intestinal surgery
R Nil-by-mouth
R Nausea
R Diarrhoea
IV
CANNULAE INSERTION
Before cannula
insertion, use aseptic techniques by doing the following:
Wash
hands aseptically Wear
sterile gloves Disinfect
the skin Use
no-touch technique
IV
THERAPY
Each NICU should
designate persons to be trained in the preparation of IV fluids, peripheral
additional fluids. They should establish a dedicated area for preparation of
medications and IV fluids. This area should not be used to store/ place any biologic
material (eg. tubes of blood, formula and others). Preparation of IV fluids,
preparation of IV medications or drugs and administration of medications or
drugs are important activities that have to be performed safely to prevent
infections inside NICUs. Therefore, task analysis was performed where all steps
required are described in details to avoid any contamination. Three main
critical activities will be described:
A.
Preparation of IV fluids
B.
Preparation of IV medications or drugs
C.
Administration of IV medications or
drugs
A.
Critical
Steps in Preparation of IV fluids
1.
Perform routine/ hygienic hand wash.
2.
Prepare and clean working area with a
disinfection
3.
Gather necessary materials (IV fluids,
drugs, syringes, needles, disinfecting materials, etc) and place them in the
clean area of possible on a clean cloth/ towel.
4.
Inspect IV fluid containers for expiry
date, cracks, leaks, cloudy/turbid etc.
5.
Wash hands with an antiseptic for 2-3
minutes. Dry hands with paper towel or fresh cloth towel or perform alcohol hand
rub.
6.
Disinfect the port of IV bottles/bags
with appropriate disinfectant (70% alcohol) immediately before removing/adding
fluids.
7.
Wear sterile gloves.
8.
Use a sterile base needle/syringe for
each IV fluids (the container that has the largest volume of the mixture wanted
i.e. adding the smaller amount of fluids to the larger amount which will be the
base)
B.
Critical
Steps in Preparation of IV medications or drugs
1.
Use single-dose ampoules rather than
multi-dose vials. If multi-dose vials must be used, always pierce the septum
with a sterile needle. Never enter multi-dose vials with a needle or syringe
that has been used on a patient. Use a new needle every time you stick into the
multi-dose vial.
2.
If a multi-dose vial needs to be
resolved, the used needle/syringe must be disposed. For each draw from the vial
a new sterile needle and syringe must be used.
3.
Before filling a syringe from an ampoule
or multi-dose vial, inspect for any contamination, turbidity, cracks, leaks and
expiry date.
4.
Between each draw the top of the vial
should be wiped once with alcohol and a cotton pad.
5.
Use for each vial/ampoule a new sterile
needle and syringe.
6.
Any medication left in the vital should
be kept in a fridge for no more than 24 hours or less if the manufacturing
instruction doesn’t allow 24 hours storage.
7.
Aseptic hand washing or alcohol rub
should be performed before each use of a multi-dose vial/ampoule.
C.
Critical
Steps in Administration of IV medications or drugs
A.
Every step must follow strict aseptic
techniques.
B.
Maintain a closed system at all times.
C.
Do not mix medications together.
D.
If medications are not compatible with
IV fluids, the IV line needs to be stopped and flushed before administration as
follows:
a. Stop
the IV fluid first.
b. Flush
the cannula with saline solution.
c. Infuse
the medication.
d. Flush
again.
e. If
needed infuse the second medication and flush again.
f. Restart
the routine IV fluid.
BIBILIOGRAPHY
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Armitage G, Knapman H (2003). Adverse
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2.
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3.
BMJ Group (2009) BNF for Children. London, RPS Publishing.
4.
Cope J (2006) Administration of medicines Operational Policy. London, Great
Ormond Street Hospital
5.
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Galbraith, A. Bullock, Sand Manias, E
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9.
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