Hi! In this video we are talking again about the HDC but we're gonna focus on
priming, flushing, and infusing fluids, right after this.
Welcome back my name is
Tammy and this is Nurseminder and on this channel we do everything nursing, so
if you're new here consider subscribing below so that you get the next video
when it's released. So here I have an HDC that's already been removed from its
packaging just so I can show you what it looks like. On the end here, this is where
the needle is, but this is what stays inside your patient - it is a plastic
flexible Cathalon, and after we've pulled the needle out what we're left
with is a rubber stopper here, and we often will take this off to put on a
neutral connector - but if you don't have these I'm going to show you both ways
today. So as a quick review we're going to insert an HDC. There is another video
on this, you can watch that as it pops up. This is just to use the injector pad and
oversight so I've got my HDC, my alcohol swab to clean, my Tegaderm and my neutral
connector, and a pen to label. I've already opened my packages. First thing
we're gonna do is swab. Remember that 30 second clean. Now because this is an
injector pad, it doesn't dry nicely like skin does so I'm just gonna flip it over
and we're gonna use this side. Insert, and this is the part I wanted you to see,
You see that there comes with the rubber stopper. I'm going to go ahead and date
this. So with the magic of TV I've just put in my already labeled HDC here. You can
see it's got its tegaderm around. The cathalon is underneath the skin. My
label is dated for today and it says ondansetron two milligrams per ml. That
means this HDC is specific only for that medication. I need to clamp off my line
and I still have my rubber stopper on. I'm gonna show you how to work with this
first in case where you work you do not have the neutral connectors, so what I
need next is my medication and I've tinted this blue so you can see it in
action. I have a 3 ml syringe, I have my
blunt fill needle and my plastic cannula, as well as my two cleaning swabs.
So I've attached my blunt fill needle onto my 3 ml syringe and I've cleaned
my multi-dose vial. I've checked to make sure I have ondansetron 2 milligrams
per ml, 20 mil multi-dose vial, it expires in 2020.
Now I know once I puncture this, it's only good for 28 days per the parenteral
monogram, so I would need to put an "opened on date" so that we know when not
to use it anymore. Let's look at our order for ondansetron 4 milligrams
sub-q every six hours. It comes in a multi dose vial at a concentration of
two milligrams per ml. I need to find out how many mls I'm drawing up. I know
in 1 ml there is 2 mg, that's my available dose, and my ordered
doses 4 milligrams. Using dimensional analysis you just cross off the
milligrams, I have mls isolated and now I can solve
the equation. I know I need to draw up 2 mls of medication. Now because this
is a first insertion and a first medication administering
I can see it up the HDC without the y adapter
requires 0.25 mls, and that is the style I'm using today. So I need to
draw up an additional 0.25 ml for priming. Going back to my original math
problem, I now know that I have two mls that makes four milligrams of medication
plus my prime means I will be drawing up 2.25 mls of medication. Now it is always
best to get at eye level to do your medication draw. So I've gone ahead and I
already inserted my air I'm now going to just pull back, it doesn't matter if you
go past what you need, I'm gonna make sure the air goes back in and I get to
2.25. Okay so between two and 2.5, I've got my prime and my dose so now we're
gonna go back to the HDC. So I have my medication here my ondansetron, I
have two 2.25 mls drawn up; but in order to access this rubber one I can't use my
blunt and needle I actually need to put on the blunt plastic cannula so we're
going to open that next.
What we're gonna do is just swap out the needle for the cannula. Make sure we
clean, don't forget your 30 second clean. and I'm gonna fast forward for this
video, and once the alcohol is dry we can go ahead and prepare to insert the blunt
end cannula into the rubber end. Once this is seated in, we're going to open up
our line and infuse our medication. We see the medication is going in,
and dispose of this. What I want you to notice is that you see how this is now
blue. That 0.25 ml is sitting inside this line and the only medication
my patient got was actual the two mls or the four milligrams inside the
patient. So now because this is a medication only - it's a specific to ondansetron,
the next time I go to give my medication all I need to draw up
is the actual required dose. So in this case four milligrams, two mls, because I
already have the line primed I no longer need to calculate that additional
medication. When I hook this in using my blunt end cannula that will push in this
medication that's already sitting in the line and it will leave about 0.25 mls
from this dose. Now it is preferred to switch out to a neutral connector if
possible, that means we're going to take this end off and replace it with this. So
let's see what that looks like next. So now we're just going to remove the
rubber cap, keeping the end of our neutral connector sterile, switch this on, and
that's it. Next we will look at sites that are used for multiple medications
or multiple concentrations. What's important to remember here is that all
the medications that are used in the 1 HDC must be compatible. If you're going
to give a medication through a site that's existing that is not dedicated, so
it's either going to be unlabeled or it may be labeled multiple medications,
depending on your agency's policy. You do not need to flush previous but you do
need to flush post. So I've gone ahead and drawn out in four milligrams my two
mls and I simply will infuse that - and I have a flush and my alcohol swab.
Complete a 30-second scrub and let air dry. Keeping this in sterile, we're going
to disconnect now and simply attach to our Neutral connector, and infuse the
medication.
Disconnecting. Now you can see there is medication still in this line and I need
to flush that. I know from my policy there's 0.25 of the ml in here, so I've
grabbed a 3 cc syringe and I'm just going to infuse half of a ml, so again I
need to clean it to access it - 30 seconds. I'm going to get rid of the air and
attach,
Looking at my plunger, I just need a small amount of saline. Line is clean,
lock it and release. When using an HDC for fluid replacement, the average rate
is usually 20 to 80 mls per hour; although it can go faster but you'll
want to check your agency's policy. If you are preparing to use your HDC for
fluid administration, you simply need to prime your bag, and I have a video link
popping up for that, and then you attach it once it's primed and you start your
infusion. You do not need to flush this prior to infusion as it is only 0.25 ml
of air that would be going into the patient's body. Well that's our lesson so
now you've had the theory on how to insert an HDC and the sights to select
an assessment of an HDC, combined with infusion and flushing, you're ready to
rock. Until next time make it a great day