Administering Intravenous (IV) Medication – OSCE Guide

Preparing the IV medication

Wash your hands using alcohol gel. If your hands are visibly soiled, wash them with soap and water.

Double-check the prescription and drug calculation with another registered health professional (e.g. nurse, doctor, pharmacist). 

Clean the tops of the ampoules/vials with an alcohol wipe for approximately 15 seconds and set aside.

Prepare a flush

If not using a pre-filled flush (e.g. PosiFlush^™), prepare a flush:

1. Use an aseptic non-touch technique to assemble a 10ml syringe and a drawing up needle, then draw up 10mls of 0.9% saline

2. Remove any air bubbles by gently flicking the syringe, then pulling back slightly and pushing air out of the syringe

3. Dispose of the drawing up needle in the sharps bin and put the syringe back in the original packet to preserve the sterility of the tip of the syringe

Liquid preparations (ampoule)

Intravenous medications in liquid form can be drawn up from their ampoule. 

1. Gently tap the neck of the ampoule to ensure all the liquid is in the main body of the ampoule

2. Using a swab, snap open the glass ampoule

• The aim is to snap open the neck of the ampoule away from you, try to avoid crushing the top of the ampoule
• There is a risk of being cut by broken glass, a specialised ampoule breaker can be used if required
• Do not use the medication if it has been contaminated with glass while opening the ampoule

3. Assemble a syringe and a drawing up needle

4. Draw up the required volume of medication from the ampoule; you may need to tilt the ampoule when drawing up the liquid

5. Remove any air bubbles by pulling back slightly and expelling air from the syringe

6. Dispose of the drawing up needle in the sharps bin and put the syringe back in the original packet to preserve the sterility of the tip of the syringe

7. Label the medication syringe to correctly identify the medication if drawing up several medications or if a drawn-up flush is being used

Powder preparations (vial)

If a medication is a powder, it must be reconstituted (which involves adding a liquid) before use. Some medications may have specific instructions for reconstitution. More information regarding medicine reconstitution can be found in local hospital guidelines or online databases (e.g. Medusa).

1. Draw up the correct volume for dilution using an aseptic non-touch technique with a syringe and drawing up needle

2. Remove the plastic cap from the vial

3. Puncture the rubber seal of the vial and gradually fill the vial with diluent

• As you inject diluent into the vial, you need to allow an equal volume of air to be released into the syringe to relieve the pressure building up inside the vial

4. Mix the medication by holding the vial and syringe in place with one hand, taking care not to shake too vigorously; some medications require swirling action to dissolve fully

• Ensure the medication is fully dissolved and no powder is left in the vial

5. Draw up the required volume of the reconstituted medication with the same syringe and drawing up needle by turning the vial upside down and pushing the existing air into the syringe according to the volume of medication required

• For example, if 3mls of medication is required, pushing ‘3mls’ of air into the vial will displace 3mls of medication in the vial and allow it to enter the syringe; make sure the needle tip is submerged in the medication to allow this to happen

6. Remove any air bubbles by pulling back slightly and expelling air from the syringe

7. Dispose of the drawing up needle in the sharps bin and put the syringe back in the original packet to preserve the sterility of the tip of the syringe

8. Label the medication syringe to identify the medication if drawing up several medications correctly or if a drawn-up flush is being used

Additional steps for infusion medication

Medications to be administered via infusion must be added to an intravenous fluid bag. Prepare a flush and reconstitute or draw up medicine as above.

1. Open the required intravenous fluid bag packet and use an alcohol wipe for 15-30 seconds to decontaminate the ports

2. Attach a hypodermic needle (23G to 25G) to the medication syringe

3. Inject the medication into the infusion port on the fluid bag, then dispose of the needle in the sharps bin

4. Gently invert the bag a few times to ensure the medication is evenly distributed in the fluid

5. Make sure this bag is labelled with the medication details appropriately

6. Attach a giving set and prime the line; keep the packet to place the giving set inside once the line is primed to reduce the risk of contamination before going to the patient

7. Attach the prepared fluid bag to an infusion device and set the program for the rate and volume to be infused

Final checks

Before proceeding, check the seven rights of medication administration.

1. Right person: ask the patient to confirm their details and then compare this to the patient’s wristband (if present) and the prescription. You should use at least two identifiers.

2. Right drug: check the labelled drug against the prescription and ensure the medication hasn’t expired

3. Right dose: check the drug dose against the prescription to ensure it is correct

4. Right time: confirm the appropriate time to administer the medication and check when the patient received a previous dose if relevant

5. Right route: check that the planned route is appropriate for the medication you are administering

6. Right to refuse: ensure that valid consent has been gained before medication administration

7. Right documentation of the prescription and allergies: ensure that the prescription is valid and check the patient isn’t allergic to the medication you will administer

Introduction

Wash your hands using alcohol gel. If your hands are visibly soiled, wash them with soap and water.

Don PPE if appropriate.

Introduce yourself to the patient including your name and role.

Confirm the patient’s name and date of birth.

Briefly explain what the procedure will involve using patient-friendly language: “Today I need to administer some medication through your cannula – the small plastic tube in your arm. This will involve flushing the medication through a small port in the cannula using a syringe. This should not be painful but you may experience a strange sensation as the medication starts flowing into your vein.”

Check the patient’s understanding of the medication being administered and explain the indication for the treatment.

Gain consent to proceed.

Check if the patient has any allergies.

Check and flush the IV cannula

1. Inspect the cannula site for any evidence of leakage, phlebitis or inflammation

2. Clean the ports on the cannula using an alcohol wipe

3. Connect the flush to the port, and flush the cannula with 5ml of fluid (keep the remainder 5mls to flush after the medication has been administered)

• The flush should be easy to administer with minimal resistance
• Observe for signs of swelling around the site or pain during administration and stop if this occurs

Administer the medication

Bolus administration

1. Attach the medication syringe to the cannula

2. Administer the medication by pressing down on the syringe

• Check the rate of administration, as this varies for different medications

3. Flush the cannula (as some medicine may be left in the barrel)

4. Clamp the cannula line or close the cannula port after flushing

Infusion medication

1. Hang the primed bag on a drip stand and connect the giving set to the cleaned and flushed cannula port

2. Set the drip rate or set up and use an infusion pump if required

• Specific training is required to setup and operate infusion pumps, always follow your local guidelines

3. When the bag is finished, disconnect the giving set, flush, and clamp the cannula

To complete the procedure…

Explain to the patient that the procedure is now complete.

Thank the patient for their time.

Dispose of PPE appropriately and wash your hands.

Document the details of the procedure and the medication administered.

Reviewers

Dr Matthew Size

Consultant Anaesthetist

Stephen Cross

Operating Department Practitioner

References

1. Gloucester Hospitals NHS Foundation Trust. IV Drug Administration Resource Booklet. Published in 2021. Available from: [LINK]
2. NHS Greater Glasgow and Clyde. NHSGGC – Introduction to Intravenous Medicine Administration. Published in 2020. Available from: [LINK]
3. National Institute for Health and Care Excellence (NICE). Guidance on intravenous infusions. Published in 2023. Available from: [LINK]