1. The effect of different manipulation techniques on the accuracy and reproducibility of small dose volume I.V. measurements Rhian Isaac

5. The effect of different manipulation techniques on the accuracy and reproducibility of small dose volume IV measurements Rhian Isaac Birmingham Children’s Hospital Aston University

6. Why? Unexpected effects/ levels ‘Purple oral syringes’ NPSA alert 20 risk assessment – SOP – Increasing risk score CHIP trial ‘Premmies’

7. Small dose volumes

8. Aims Determine methods used on PICU Repeat in laboratory to determine – Accuarcy – Reproducibility

10. PICU nurses asked – “how would you prepare 2.5units insulin in 50ml” – “how would you prepare 5 units insulin in 50ml” Methods described simulated 10 times each

11. Method A 1.Volume withdrawn using filter needle 2.Excess in syringe expelled 3.Needle changed, 4.Transferred to 50ml syringe made to volume. Method B 1.Volume withdrawn using filter needle 2.Needle changed 3.Excess in syringe expelled 4.Transferred to 50ml syringe made to volume.

13. Method C 1.0.5ml drawn into syringe via filter needle 2.Transferred to 5ml syringe 3.Made up to 5ml 4.Needle changed 5.Dose required transferred to 50ml syringe Method D 1.0.5ml drawn into syringe via filter needle 2.Transferred to 5ml syringe 3.Made up to 5ml 4.Needle changed 5.Needle primed 6.Dose required transferred to 50ml syringe

14. Results for 2.5units Method AMethod BMethod CMethod D Average02.71.82.4 Max03.12.92.7 Min00.20.62.1 Std dev0+/- 0.26+/- 0.74+/- 0.17 C of V09.6340.777.1

15. Results for 5units Method AMethod BMethod CMethod D Average05.233.505.58 Max05.55.46.1 Min05.02.05.2 Std dev0+/- 0.01+/- 0.98+/-0-28 C of V02.6827.75

16. Conclusion Small study Repeat – Larger numbers – Variable personnel – Validated personnel Variable end dosing Protocols need to be detailed What is cut off small dose volume?