UNIVERSITY OF MALTA FACULTY OF MEDICINE & SURGERY PHARMACY DEPARTMENT Ref. No. SOP… ·...

UNIVERSITY OF MALTA

FACULTY OF MEDICINE & SURGERY

PHARMACY DEPARTMENT Ref. No. SOP/PD/233_01

STANDARD OPERATING PROCEDURE

GERIATRIC IV TRAINING ARM Valid for:

2 years from

approval

Page 1 of 18

UNIVERSITY OF MALTA





2 years from

approval

Page 2 of 18

1. Scope

This Standard Operating Procedure (SOP) applies to the staff and students using the

Geriatric IV Training Arm in the Pharmacy Practice Resource Unit (PPRU) at the

Pharmacy Department, University of Malta.

2. Objective

To describe the procedure for set-up and use of the Geriatric IV Training Arm.

3. Definitions

3.1. Injections: Sterile solutions, suspensions or emulsions, presented in a suitable

aqueous or non-aqueous vehicle intended for parenteral administration into body

tissues.

3.2. Intravenous Injection: Injection of a substance directly into the vein. The

intravenous route uses a hypodermic injection for the purpose of instilling a

single dose of medication, injecting a contrast medium or beginning an IV

infusion of blood, medication, or a fluid solution, such as saline or dextrose in

water.

4. Responsibility

4.1. The members of the Department of Pharmacy (staff and students) are responsible

for following this SOP.

4.2. The designated Laboratory Officer or Laboratory Assistant is responsible for

ensuring that this SOP is followed.

UNIVERSITY OF MALTA





2 years from

approval

Page 3 of 18

5. Procedure

5.1. Diagram of Geriatric IV Training Arm

a. Arm and hand vein set installed

b. Carry bag

c. Blood powder

d. Reservoir bags with tubing

5.2. Set-up

5.2.1. Put a drop of either dish detergent or surgical lubricant onto the tip of

the connector on each of the reservoir tubes and connect the tubes at

the vein lines that exit at the shoulder area; to avoid leakage, ensure the

tubes are pushed up past the ribbed section of the connectors.

5.2.2. Fill one reservoir bag with simulated blood or coloured water.

5.2.3. Elevate the filled reservoir bag and open the slide clamps of both

reservoirs; gravity will circulate the simulated blood through the

venous network and into the second reservoir bag; the lower bag may

need to be vented to induce flow.

5.2.4. Reverse with the lower bag, now filled with fluid, when the elevated

reservoir is empty.

UNIVERSITY OF MALTA





2 years from

approval

Page 4 of 18

5.2.5. Fill a reservoir with warm tap water and allow it to circulate through

the venous network to wash out the veins from the simulated blood

after each use.

5.3. Injection Preparation

5.3.1. Wash hands thoroughly and wear disposable gloves.

5.3.2. Prepare a sterile syringe and needle using water.

5.4. IV Technique

5.4.1. Apply tourniquet and locate a suitable vein.

5.4.2. Wait for the vein to swell.

5.4.3. Disinfect the skin.

5.4.4. Stabilise the vein by pulling the skin taut in the longitudinal direction

of this vein (SOP/PD/233_01/A1); Do this with the hand you are not

going to use for needle insertion.

5.4.5. Insert the needle at an angle of around 35° (SOP/PD/233_01/A2).

5.4.6. Puncture the skin and move the needle slightly into the vein (3-5mm).

5.4.7. Hold the syringe and needle steady.

5.4.8. Aspirate; if blood appears, hold the syringe steady since you are inside

the vein and if blood does not appear, repeat steps 5.4.5. to 5.4.8.

5.4.9. Loosen tourniquet.

5.4.10. Inject very slowly (SOP/PD/233_01/A3).

5.4.11. Withdraw needle swiftly.

5.4.12. Press sterile cotton wool onto the opening and secure with adhesive

tape.

5.5. Replacing the Skin

5.5.1. Remove the used skin.

5.5.2. Sprinkle talcum powder into the interior of the new skin and upon the

hand and arm body.

5.5.3. Shake the excess powder out of the new skin and slide the new skin

over the hand.

5.5.4. Double back the upper portion of the arm skin down over the forearm

area so that there will be room to work around the wrist area; Care

should be taken when sliding the wrist area of the new skin over the

thumb of the hand body to avoid tearing the skin.

5.5.5. Work the skin gently over the thumb area until the skin fits in place on

the hand body; The veins should be placed within the channels and

their position kept in mind as the skin is being installed up the arm

(SOP/PD/233_01/A4 and SOP/PD/233_01/A5).

UNIVERSITY OF MALTA





2 years from

approval

Page 5 of 18

5.5.6. Palpate the veins to ensure they are positioned in the channel on the

arm and hand and adjust them if necessary.

5.6. Replacing IV Veins

5.6.1. Pull the skin down off the arm.

5.6.2. Remove the section of tubing that needs to be replaced by cutting the

tubing on each side of the affected area.

5.6.3. Leave at least 1 inch of veins extending from the moulded arm to

ensure enough material in which to install butt connectors; replace one

section of tubing at a time.

5.6.4. Insert one of the supplied butt connectors into each end of the tubing

that was cut and is protruding from the arm.

5.6.5. Cut a new piece of tubing from the replacement kit and make it the

same length as the piece that was cut out of the vein on the IV unit.

5.6.6. Install the new vein section by lubricating the butt connectors and

sliding the new vein all the way over the connectors; ensure that the

tubing is applied all the way onto the connectors to prevent leakage.

5.6.7. Repeat sections 5.6.2. to 5.6.5. for each area of the veins that needs to

be replaced.

5.6.8. Replace the skin (Section 5.5).

UNIVERSITY OF MALTA





2 years from

approval

Page 6 of 18

5.7. Flow Charts

5.7.1. Set-up

Start

Put a drop of dish detergent/surgical lubricant

onto the tip of the connector on each of the

reservoir tubes and connect the tubes at the

vein lines that exit at the shoulder area; To

avoid leakage ensure the tubes are pushed up

past the ribbed section of the connectors

Fill one reservoir bag with simulated blood/

coloured water

Elevate the filled reservoir bag and open the

slide clamps of both reservoirs; Gravity will

circulate the simulated blood through the

venous network and into the second reservoir

bag; lower bag may need to be vented to

induce flow

Reverse with the lower bag, now filled with

fluid, when the elevated reservoir is empty

Fill a reservoir with warm tap water and allow

it to circulate through the venous network to

wash out veins from the simulated blood after

each use

End

UNIVERSITY OF MALTA





2 years from

approval

Page 7 of 18

5.7.2. Injection Preparation

Start

End

Wash hands thoroughly and

wear disposable gloves

Prepare a sterile syringe and

needle using water

UNIVERSITY OF MALTA





2 years from

approval

Page 8 of 18

5.7.3. IV Technique

Start

Apply tourniquet and locate a suitable vein

Wait for the vein to swell

Disinfect the skin

Stabilise the vein by pulling the skin taut in the

longitudinal direction of this vein

(SOP/PD/233_01/A1); Do this with hand you

are not going to use for needle insertion

Insert needle at an angle of around 35°

(SOP/PD/233_01/A2)

Puncture skin and move needle slightly into

the vein (3-5mm)

Hold syringe and needle steady

Aspirate

Blood

appears

1

No

Yes

UNIVERSITY OF MALTA





2 years from

approval

Page 9 of 18

1

Loosen tourniquet

Inject very slowly (SOP/PD/233_01/A3)

Withdraw needle swiftly

Press sterile cotton wool onto the opening and

secure with adhesive tape

End

Hold syringe steady since you are inside vein

UNIVERSITY OF MALTA





2 years from

approval

Page 10 of 18

5.7.4. Replacing Skin

Start

Remove the used skin

Sprinkle talcum powder into interior of the

new skin and upon the hand and arm body

Shake the excess powder out of the new skin

and slide the new skin over the hand

Palpate the veins to ensure they are positioned

in the channel on the arm and hand and adjust

them if necessary

End

Double back the upper portion of the arm skin

down over the forearm area so that there will

be room to work around the wrist area; Care

should be taken when sliding the wrist area of

the new skin over the thumb of the hand body

to avoid tearing the skin

Work skin gently over thumb area until the

skin fits in place on the hand body; veins

should be placed within the channels and their

position kept in mind as the skin is being

installed up the arm (SOP/PD/233_01/A4 and

SOP/PD/233_01/A5)

UNIVERSITY OF MALTA





2 years from

approval

Page 11 of 18

5.7.5. Replacing IV Veins

Start

Pull the skin down off the arm

Remove section of tubing that needs to be

replaced by cutting the tubing on each side of

affected area; Leave at least 1 inch of veins

extending from the moulded arm to ensure

enough material in which to install butt

connectors; replace one section of tubing at a

time

Insert one of the supplied butt connectors into

each end of the tubing that was cut and is

protruding from the arm

Cut a new piece of tubing from the replacement

kit and make it the same length as the piece that

was cut out of the vein on IV unit

Install the new vein section by lubricating the

butt connectors and sliding the new vein all the

way over the connectors; prevent leakage

End

Replace the skin

UNIVERSITY OF MALTA





2 years from

approval

Page 12 of 18

6. Precautions

6.1. General cleaning should be done with mild soap and water to remove

particulate matter.

6.2. Simulator should not be placed, written on or wrapped in any type of ink

product to avoid staining the skin e.g. newspaper.

6.3. Simulated blood, which accumulates under the skin, in the veins, or in the

reservoirs should be removed by washing with warm tap water after each use.

6.4. Care should be taken when sliding the wrist area of the new skin over the

thumb of the hand body to avoid tearing.

6.5. When removing the section of vein tubing that needs to be replaced, it is

important to replace only one section of tubing at a time.

6.6. When installing the new vein section, ensure that the tubing is applied all the

way onto the connectors to prevent leakage.

7. References

de Vries TPGM, Henning RH, Hogerzeil HV, Fresle DA. Guide to good prescribing:

A practical manual. Checklist 6. Intravenous injection [Online]. World Health

Organization; 1994: 115 pages [cited 2014 Jan 21]. Available from: URL:

http://apps.who.int/medicinedocs/en/d/Jwhozip23e/7.4.7.html

Simulaids. Geriatric IV Training Arm Manual (No. 610) [Online]. Simulaids; New

York; 2005 [cited 2014 Jan 21]. Available from: URL:

www.simulaids.com/PDF/GeriIvArm.pdf

http://apps.who.int/medicinedocs/en/d/Jwhozip23e/7.4.7.html

UNIVERSITY OF MALTA





2 years from

approval

Page 13 of 18

8. Appendices

SOP/PD/233_01/A1 – Diagram of vein being stabilised by pulling skin taut in the

longitudinal direction

SOP/PD/233_01/A2 – Diagram of needle being inserted at an angle of around 35°

SOP/PD/233_01/A3 – Diagram of needle being inserted in the vein

SOP/PD/233_01/A4 - Diagram of veins placed within the channels


9. Revision History

Version Number Amendments/ Reasons for change

01 Initial Release

UNIVERSITY OF MALTA





2 years from

approval

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SOP/PD/233_01/A1 – Diagram of vein being stabilised by pulling skin taut in the

longitudinal direction

UNIVERSITY OF MALTA





2 years from

approval

Page 15 of 18

SOP/PD/233_01/A2 – Diagram of needle being inserted at an angle of around 35°

UNIVERSITY OF MALTA





2 years from

approval

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SOP/PD/233_01/A3 – Diagram of needle being inserted in the vein

UNIVERSITY OF MALTA





2 years from

approval

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SOP/PD/233_01/A4 – Diagram of veins placed within the channels

UNIVERSITY OF MALTA





2 years from

approval

Page 18 of 18


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