Summative

Clinical Preparation, Medication Orders, and Reference Verification

•  Medication Order Validation: Verify prescription completeness, legibility, and legal validity for cefazolin  IV prior to preparation.

•  Australian Medicines Handbook (AMH) Reference:

•  Indication: Treatment of moderate to severe bacterial infections (such as respiratory tract, urinary tract, skin/soft tissue, bone/joint infections, or septicaemia) caused by susceptible organisms, or for surgical prophylaxis.

•  Precautions/Contraindications: Known hypersensitivity to cephalosporins or previous severe/immediate allergy (anaphylaxis) to penicillins; renal impairment (requires dose/interval adjustment due to reduced clearance and seizure risk); history of gastrointestinal disease (risk of pseudomembranous colitis).

•  Adverse Reactions: Hypersensitivity reactions (rash, pruritus, drug fever), gastrointestinal disturbance (diarrhoea, nausea, vomiting, Clostridioides difficile-associated colitis), neurotoxicity (seizures, encephalopathy, myoclonus), and local injection site phlebitis.

•  Usual Adult Dose:  to  IV every  (up to  in severe infections such as endocarditis).

•  Australian Injectable Drugs Handbook (AIDH) Reference:

•  Safety Warnings: Rapid direct injection can cause neurotoxicity, lightheadedness, or localized phlebitis; ensure emergency resuscitation measures are accessible for anaphylaxis.

•  Reconstitution and Diluent Guidelines: Reconstitute the  vial with Water for Injections (WFI) and dilute to a total volume of at least  of WFI.

•  Administration Method: Slow direct IV push over .

•  Fluid/Line Compatibilities: Compatible with  sodium chloride, glucose , glucose , and Hartmann's (Lactated Ringer's) solution.

•  Rate Calculations:

•  Total Volume:

•  Administration Duration:  (target  for patient comfort)

•  Exact Delivery Rate: Administer at  over  (equivalent to  every ; maximum allowable rate is  over ).

Equipment Gathering and Aseptic Workstation Setup

•  Workstation Decontamination: Clean the preparation trolley with a disinfectant surface wipe and allow to air dry completely, or verbalize that cleaning occurred.

•  Equipment Inventory: Gather two kidney dishes, cefazolin sodium  powder vial, diluent ( Sterile Water for Injections ampoule),  Luer-lock syringe, drawing-up needle/blunt filter needle, micropin/reconstitution spike, sterile red combi-stopper,  alcohol swabs, two pairs of clean gloves, two   sodium chloride flushes, medication chart, and PIVC/PIVAS documentation forms.

•  Initial Independent Check: Conduct the initial "six rights" check with the buddy Registered Nurse (RN), inspect packaging integrity and expiry dates on the cefazolin  vial, diluent, and flushes, and check the patient's recorded allergy status.

•  Aseptic Non-Touch Technique (ANTT): Perform hand hygiene, don clean gloves immediately prior to reconstitution, and protect all key parts (syringe tip, needle hub, vial septum, combi-stopper) from touch contamination.

Medication Reconstitution, Preparation, and Independent Checking

•  Diluent Aspiration: Aseptically draw up  of Sterile Water for Injections using the  syringe and needle; show and verify the volume with the buddy RN.

•  Reconstitution: Swab the vial rubber septum with an alcohol swab, allow to air dry, introduce the  diluent via micropin/needle per AIDH guidelines, and agitate/swirl gently until the powder is dissolved into a clear, colourless solution.

•  Dose Withdrawal & De-aeration: Aspirate the prescribed  dose (the full  reconstituted volume), remove the micropin/needle while maintaining syringe luer asepsis, expel all air bubbles, and seal the syringe tip with a sterile red combi-stopper.

•  Labeling & Secondary Independent Check: Doff gloves, perform hand hygiene, complete and affix an additive label (recording patient name, UR/MRN, drug: Cefazolin, dose: , diluent: WFI, total volume: , date, time, and preparer signature; cosigned by buddy RN). Present the prepared syringe and original ampoules/vials to the buddy RN to confirm correct volume, absence of air, and full independent second check verification.

•  Disposal & Clean-Up: Discard sharps immediately into an approved sharps container, dispose of clinical rubbish, and perform hand hygiene on leaving the preparation area.

Patient Engagement, Bedside Verification, and PIVC Assessment

•  Patient Identification & Consent: Perform hand hygiene on entering the room, introduce self, explain the procedure, obtain verbal consent, and complete a 3-point ID check (full name, date of birth, MRN) with the buddy RN against the medication chart and ID band.

•  Bedside Six-Rights Check: Cross-check the six rights with the buddy RN for cefazolin , both sodium chloride flushes, diluent, and expiry dates; verbally re-confirm allergy history with the patient.

•  PIVC Assessment: Inspect dressing integrity; assess the cannula site for erythema, edema, leakage, exudate, warmth, or vessel hardening (PIVAS score); assess for pain/tenderness; instruct the patient to report any discomfort immediately. Perform hand hygiene and don clean gloves before touching the cannula.

Pre-Administration Flushing and Site Patency Evaluation

•  Port Decontamination: Scrub the needle-free access port with an alcohol swab for  and allow to air dry completely for .

•  Syringe Connection: Inspect the first   sodium chloride flush for air bubbles, clear any air, and connect aseptically to the needle-free port.

•  Patency Assessment: Administer the pre-flush using a pulsatile (push-pause) technique, feeling for resistance while monitoring the insertion site for swelling, blanching, or extravasation, and verifying patient comfort.

Intravenous Antibiotic Administration and Bubble Management

•  Pre-Administration Inspection: Re-check the cefazolin  () syringe for clarity and absence of air bubbles, remove the sterile combi-stopper, and connect the syringe aseptically to the needle-free port.

•  Timed Drug Delivery: Administer the cefazolin solution slowly at the calculated rate of  over  (delivering  every , ensuring not to administer faster than over ) while continuously observing the site and monitoring patient tolerance.

•  Air Bubble Remediation: If an air bubble is seen, halt injection immediately, disconnect aseptically, invert and expel air, re-scrub the needle-free port with an alcohol swab for  (allow to air dry for ), reconnect, and resume delivery.

Post-Administration Flushing, Positive Pressure Technique, and Clamping

•  Dead Space Clearance: Connect the second   sodium chloride flush; administer the initial  at the same slow delivery rate as the antibiotic (over ) to prevent rapid bolusing of the drug remaining in the extension set dead space.

•  Turbulent Clearance & Positive Pressure: Administer the remaining  using a pulsatile push-pause technique to generate turbulent clearance. Maintain continuous positive pressure on the plunger while disconnecting, or close the extension line slide clamp before detachment to prevent intraluminal blood reflux.

Patient Safety, Documentation, and Post-Procedure Clean-Up

•  Patient Safety Check: Doff gloves, perform hand hygiene, position the call bell within easy reach, and instruct the patient to alert staff to any delayed symptoms (such as pain, swelling, rash, itching, shortness of breath, or malaise).

•  Documentation: Sign the medication chart immediately following administration with the buddy RN cosignature; record the PIVC/PIVAS score ( for healthy, functioning site) and clinical observations on the approved form.

•  Waste & Environment: Segregate waste into appropriate clinical and sharps streams, clean reusable equipment and surfaces, and perform final hand hygiene.