6.4 Renal CP Administrations of Antibiotic during

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Renal: IV Antibiotic administration during Haemodialysis
HNE Local Health District
Clinical Procedure
Renal: Administration IV Antibiotic during Haemodialysis
Sites where Clinical Procedure applies
Target audience:
Description
All HNE facilities where a patient undergoes haemodialysis
Nephrology clinical staff, which provide care to
haemodialysis patients.
This document comprises part of the clinical information
package for care for haemodialysis patients.
This Clinical Procedure applies to:
1. Adults
Yes
2. Children up to 16 years
No
3. Neonates – less than 29 days
No
Keywords
Renal Haemodialysis
Replaces Existing Procedure
Yes
Registration Number(s) and/or name and
HNELHN Grand 11_13
of Superseded Documents
Related Legislation, Australian Standards, NSW Health Policy Directive, NSQHS Standard/EQuIP
Criterion and/or other, HNE Health Documents, Professional Guidelines, Codes of Practice or Ethics:
 NSW Health Policy Directive 2007_079 Correct patient, Correct procedure, correct site
http://www.health.nsw.gov.au/policies/pd/2007/pdf/PD2007_079.pdf
 NSW Health Policy PD 2005_406 Consent to Medical Treatment
http://www.health.nsw.gov.au/policies/PD/2005/pdf/PD2005_406.pdf
 NSW Health Policy Directive PD 2007_036 Infection Control Policy
http://www.health.nsw.gov.au/policies/pd/2007/pdf/PD2007_036.pdf
 NSW Health Policy Directive 2012-007 User Applied Labelling of Injectable Medicines, Fluids and
Lines.
 NSW Health Policy Directive PD 2007_077 Medication Handling in NSW Public Hospitals
http://www0.health.nsw.gov.au/policies/pd/2007/pdf/PD2007_077.pdf
 NSW Health Policy Directive PD 2012_064 The Administration of Medications by Enrolled Nurses
http://www0.health.nsw.gov.au/policies/pd/2012/pdf/PD2012_064.pdf
 Product Information Leaflet
Prerequisites (if required)
Procedure Note
Position responsible for the
procedure and authorised by
Procedure Contact Person
Contact Details
Date authorised
This Procedure contains
advice on therapeutics
Issue Date
Review due date
TRIM Number
Version 3
Registered or Endorsed Enrolled Nurses who have been deemed
competent in the performance of haemodialysis
This document reflects what is currently regarded as safe and
appropriate practice and requires mandatory compliance. If staff
believes that the procedure/s should not apply in a particular clinical
situation they must seek advice from their unit manager/delegate and
document the variance in the patient’s health record.
If this document needs to be utilised in a Non Nephrology Area please
liaise with the local Renal Service to ensure the appropriateness of the
information contained within the Clinical Procedure.
Renal Stream Leadership Group
Tina Straker & Kelly Adams (Renal Coordinators)
Ph. 67769912 ph49 048800
No .
October 2016
October 2013
Page 1 of 4
Renal: IV Antibiotic administration during Haemodialysis
Consultation has occurred across the HNELHD Renal network utilising a group of identified
haemodialysis specialists as well as broader consultation with the general nephrology workforce,
nephrologists and the HNELHD Renal Leadership Group.
Note: Over time links in this document may cease working. Where this occurs please source the
document in the PPG Directory at: http://ppg.hne.health.nsw.gov.au/
RISK STATEMENT
This clinical procedure has been developed to provide guidance to staff and to ensure that the risks of harm
to patients and staff associated with performing Haemodialysis are identified and managed.
Staff may potentially be exposed to body substance and needle injury when carrying out this procedure.
Therefore strict Infection Control and Occupational Health and Safety rules should be followed when
attending this procedure; including wearing recommended Personal Protective equipment and following the
procedure steps.
Any unplanned event resulting in, or with the potential for, injury, damage or other loss to
patients/HCN/visitors as a result of this procedure must be reported through the Incident Information
Management System and managed in accordance with the Ministry of Health Policy Directive: Incident
Management PD2007_061. This would include unintended injury that results in disability, death or prolonged
hospital stay.
RISK CATEGORY: Clinical Care & Patient Safety
OUTCOMES
1
Reduce the risk of incorrect antibiotic dose and administration and drug reactions
2
Maintenance of infection control policies, and safe disposal of contaminated waste
3
Risk of blood exposure or needle stick injury significantly reduced
4
Safe and effective administration of Antibiotics during Haemodialysis by ensuring correct
dosage and correct equipment is utilised e.g. dialyzer selection when administering antibiotics
ABBREVIATIONS and GLOSSARY
Abbreviation/Word
Definition
IV
Intravenous
MO
Medical Officer
ID
Identification
ML
millilitres
PREAMBLE
Prior to IV antibiotic administration during Haemodialysis refer to “Dialysis of Drugs” (see
reference) to check that the antibiotic is not removed during the dialysis procedure. Refer to the
renal team/nephrologist for management plan if medication is likely to be removed during dialysis
e.g. to be given at completion of treatment, change dialyser from high to low flux or swap treatment
from Haemodiafiltration to standard haemodialysis
Caution should be used when administering an antibiotic in the community standalone units if the
patient has not had the drug in the past due to risk of allergic reactions. Ideally first ever dose of a
particular antibiotic should occur in a dialysis unit co-located on a hospital campus.
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October 2013
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Renal: IV Antibiotic administration during Haemodialysis
PROCEDURE
This procedure requires mandatory compliance.
Patient Preparation
It is mandatory to ensure that the patient has received appropriate information to provide informed
consent and, that patient identification, correct procedure and correct site process is completed
prior to any procedure.
Patient advised to inform staff if they notice any unusual symptoms during the administration of the
antibiotics.
Check if the patient has had the drug before and if they have any allergies to medications,
specifically antibiotics.
Staff Preparation
It is mandatory for staff to follow relevant: “Six moments of hand hygiene”, infection control, moving
safely/safe manual handling, and documentation practices.
Ensure potential administration side effects are explained to the patient prior installation.
Staff may need to consider the patient to be dialysed at a hospital unit if patient has had known or
is vulnerable to side effects of the antibiotic being administered.
Equipment Requirements











Alcohol based hand rub
Personal Protective Equipment
Prescribed Antibiotic
1x23g needle
100ml bag Normal Saline (if required)
1x20ml syringe
3 x Alcohol wipes
Infusion pump (if required)
IV giving set (if required)
Drug Additive Label
IV Injectable Drug Handbook
Procedure Steps
1. Check IV antibiotic against prescription, check expiry date, patient ID and patient allergies
with appropriate second person as per NSW Health Policy Directive PD 2007_077
Medication Handling in NSW Public Hospitals
2. Explain procedure to patient
3. Wash Hands
4. Don personal protective equipment (Eyewear, goggles, plastic apron)
5. Reconstitute antibiotic according to IV antibiotic handbook i.e. Dilution/rate
6. Give antibiotic as ordered by MO.
7. If to be given via bolus,
a) ensure short line on venous bubble chamber is clamped before removing cap.
b) Attach luer lock syringe to short line on venous bubble chamber to administer
medication
Version 3
October 2013
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Renal: IV Antibiotic administration during Haemodialysis
Or
8. If antibiotic is to be infused
a) Label the Normal saline bag with the drug additive label of the drug that you have
added to the saline bag.
b) Connect the giving set to normal Saline bag and prime giving set.
c) Clamp short line and attach needleless injection port to the venous bubble
chamber.
d) Connect IV giving set line to the needleless injection port on the short line on the
venous bubble chamber, unclamp the short line and open the roller clamp of
saline line.
e) Infusion rate of the antibiotic should be calculated according to the drug
handbook
f) Infusion rate should be monitored via an electric IV pump
g) When infusion is complete, clamp the bubble trap line and the giving set line and
disconnect the IVI line.
9. Discard needles into the sharps bin and document procedure in patient record
10. Sign medication chart.
11. If the antibiotic is made prior to use and not used immediately either with the syringe or
infusion that both should be labelled correctly as per the Policy Directory 2012_007 Userapplied Labelling of Injectable Medicines, Fluids and Lines.
REFERENCES
Mathew J Cervelli (edited by), February 2007, The Renal Drug Reference Guide, Australia, Kidney
Health Australia
Renal Pharmacy Consultants (2012), Dialysis of Drugs, Amgen: North Ryde, Australia.
FEEDBACK
Any feedback on this document should be sent to the Contact Officer listed on the front page.
Version 3
October 2013
Page 4 of 4
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