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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
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 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
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 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
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 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
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 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
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 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
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 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
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 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
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 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
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 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
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 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
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 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
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 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
SOP/PD/233_01/A5 - Diagram of veins placed within the channels
9. Revision History
Version Number Amendments/ Reasons for change
01 Initial Release
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 14 of 18
SOP/PD/233_01/A1 – Diagram of vein being stabilised by pulling skin taut in the
longitudinal direction
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 15 of 18
SOP/PD/233_01/A2 – Diagram of needle being inserted at an angle of around 35°
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 16 of 18
SOP/PD/233_01/A3 – Diagram of needle being inserted in the vein
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 17 of 18
SOP/PD/233_01/A4 – Diagram of veins placed within the channels
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 18 of 18
SOP/PD/233_01/A5 - Diagram of veins placed within the channels