GUIDELINES FOR THE INSERTION, CARE AND REMOVAL OF PERIPHERAL INTRAVENOUS CANNULAE
Patient Care and Professions
27 January 2009
NHS Kirklees Governance Committee
NICE GUIDANCE Once NICE guidance is published, health professionals are expected to take it fully into account when exercising their clinical judgment. However, NICE guidance does not override the individual responsibility of health professionals to make appropriate decisions according to the circumstances of the individual patient in consultation with the patient and/or their guardian or carer.
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Version Control Document Title:
Guidelines for the Insertion, Care and Removal of Peripheral Intravenous Cannula
Document number: Author: Contributors: Version: Date of Production: Review date: Postholder responsible for revision: Primary Circulation List: Web address: Restrictions:
One Joanne Crewe Louise Hodgson 1 June 2007 June 2010 Louise Hodgson
Standard for Better Health Map Domain: Safety, Clinical & Cost Effectiveness, Governance Core Standard Reference: Performance Indicators:
C1,C3, C4, C5, C7, C9, C11, C13 1. All practitioners who administer IV Therapy are appropriately trained 2. All patients who receive IV Therapy are treated in accordance with these guidelines 3. Documentation is complete for each intervention 4. Medicines are safely and securely prescribed, prepared and administered and monitored accurately and in accordance with these guidelines
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Associated policies and procedures
Aims and objectives
Scope of the guidelines
Accountabilities and responsibilities
Choice of vein / site
Choice of cannula
Important practice points
Care of the cannula, cannula site and removal
Equality Impact Assessment
Training needs analysis
Monitoring compliance with these guidelines
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Visual Infusion Phlebitis Score (VIP)
Patient Care Management Plan
Key Stakeholders consulted/involved in the development of the guidelines/procedure
Equality Impact Assessment Tool
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Guidelines Statement NHS Kirklees is committed to implementing National Guidelines and Guidance on the safe and effective insertion, care and removal of intravenous cannula to reduce the transmission of healthcare associated infections.
The NMC Code of Professional Conduct (NMC, 2004) and the development of new roles (DoH, 2000) has empowered nurses, midwives and allied health professionals to develop the skill to facilitate the timely and appropriate use of intravenous access, for the benefit of patients. 2.
Associated policies & procedures
This guideline should be read in accordance with the following Trust policies, procedures and guidance: • • • • • • • • •
Kirklees Primary Care Trust’s Medicines Management Policies Kirklees Primary Care Trust’s Infection Control Policies – De-contamination, disinfectants and antiseptics, Hand Decontamination, Management of clinical sharps injuries and high risk fluids and Waste Management guidelines. RCN Standard for infusion therapy (2005) The Royal Marsden Hospital – Manual of Clinical Procedures (2007) Guidelines for the Administration of Medicines (NMC 2004) Guidelines for Records and Record Keeping (NMC 2004) Code of Professional Conduct (NMC 2004) Incident Reporting Guidelines Medical Devices Guidelines
Aims and objectives
Aim: To provide guidelines for health care practitioner on the insertion, care and removal of peripheral intravenous (IV) cannula.
Objectives: Each practitioner will be able to: • • • • • • •
Ensure that a short peripheral cannula is the appropriate device for the intended need. Decide the size/type of device to be used. Choose an appropriate insertion site. Prepare the appropriate equipment. Complete the procedure safely. Flush the cannula to ensure patency, in readiness for future use. Identify indicators for removal of a cannula
Scope of the guidelines
This guideline must be followed by all NHS Kirklees employees who are trained and competent to care for and remove peripheral IV cannula Page 5 of 20
It must be followed by all staff who work for NHS Kirklees, including those on temporary or honorary contracts, bank staff and students.
Breaches of these guidelines may lead to disciplinary action being taken against the individual. Independent Contractors are responsible for the development and management of their own procedural documents and for ensuring compliance with relevant legislation and best practice guidelines. Independent Contractors are encouraged to seek advice and support as required. 5. 5.1
Accountabilities and Responsibilities It is the responsibility of the each practitioner undertaking cannulation to be satisfied with and demonstrate his/her knowledge and competence.
In exercising their personal accountability, practitioners must be prepared to acknowledge any limitations and ensure maintenance of competence.
Practitioners are expected to work co-operatively within teams and to respect the skills, expertise and contributions of their colleagues
CHOICE OF VEIN / SITE
The patientâ€™s general condition must be assessed with regard to the reason for cannulation. The patientâ€™s superficial veins of both hands and arms must be assessed visually and by palpation to determine their suitability for cannulation. Application of a tourniquet will promote venous distension (Dougherty & Lamb 1999). The ideal vein to access should be situated on the distal part of the arm, but proximal to any previous attempt (Terry, Baronowski, Lonsway & Hendrick 1995). If for example, the antecubital veins are ruined as a result of failed cannulation attempts this can cause problems in the event of a successful cannulation further down. Any drugs or fluids put through the cannula may extravasate at the failed cannula site. Sites near joints, in close proximity to an infected wound, or veins that are inflamed should be avoided Practitioners must be aware of factors which can influence vein choice (Dougherty & Lamb 1999).
If there appears to be no suitable veins in the arms, seek the assistance of another practitioner who is skilled in intravenous cannulation. Use of veins in the legs are beyond the scope of this guideline and should be avoided due to the increased risk of thrombophlebitis and embolism (Dougherty and Lister, 2004).
CHOICE OF CANNULA
Most cannula used for peripheral intravenous cannulation are winged with a valved port to facilitate the administration of intravenous drug therapy. Additionally, they have a safety device, which minimises the risks to the practitioner of needle-stick injury. N.B. Ported cannula should be avoided in immunosupressed or severely ill patients due to the increased risk of hospital acquired infection and thrombophlebitis (ICNA 2003).
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The size of cannula is measured by the length of the needle (stylet) and the gauge of the lumen, which corresponds to a coloured port cover.
Following assessment of the patient’s veins, the choice of cannula is determined by its intended use, where it is to be sited and the needs of the patient. N.B The smallest gauge that will accommodate the prescribed therapy should be used (Jackson, 1998) to allow flow of blood around the cannula, thus minimising the risks of chemical irritation and phlebitis.
The condition of the patient’s veins and the following table should guide the practitioner. Where there is more than one reason for cannulation, the larger gauge cannula should be selected. N.B. Not all available sizes are identified in the table.
Maximum flow rate
Common Uses Oncology/haematology patients – can be used to give blood without compromise in these patients Longer term medication; oncology patients and adults with smaller veins; Potential treatment. 2 – 3 litres IV per day and/or on long term medications; Potential treatment; Can be used for blood products Cannula size of choice for blood/blood products or large volumes of fluids Rapid transfusion of blood or blood products McClelland 2001, Millam 2000
N.B. If the intended cannulation site is visibly dirty, wash with soap and water before starting the procedure.
ACTION Taking account of the patient’s condition and cannulation history, carefully discuss and explain the procedure to the patient, allowing time to ask questions, ensuring the patient understands.
RATIONALE To obtain informed consent and to prepare the patient psychologically
All stages of the procedure should comply with the principles of minimising infection. For example: • Good hand washing technique, if a sink is not available hands can be decontaminated with an alcohol hand rub, ensuring a good technique is employed. • Careful handling of the equipment to prevent
To minimise the risks of
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infection To reduce the number of micro-organisms harmful to health
contamination and maintain sterility (non-touch technique). To comply with standard precautions so as to minimise risks to the practitioner To prevent or minimise micro abrasions, which can harbour bacteria
Wear a clean plastic single use apron and non-sterile gloves (DOH 2001, ICNA 2003).
If hair removal is necessary, it should be clipped with scissors. (Terry et al, 1995).
Gather and prepare equipment. Check all equipment packaging before opening and preparation for use.
To ensure sterility of the cannula
Place the patientâ€™s arm on a pillow. Apply the tourniquet 6 to 8cm above the insertion site and allow the vein to engorge with blood (Campbell 1995). Assess suitability of chosen vein i.e. palpable, nonpulsatile, straight and healthy. Veins must be palpated to assess suitability (Millam 2000).
To improve chances of successful cannulation
Thoroughly disinfect the skin area to be cannulated with the 2% chlorhexidine gluconate in 70% isopropyl alcohol and allow to dry (DH 2007), starting at the intended puncture site and moving outwards in a circular motion, and leave to dry for up to one minute. (Dougherty & Lister 2004). Do not re-palpate the vein.
To remove harmful micro-organisms and prepare the site to be punctured.
Apply traction around the skin of the chosen vein
Insert the cannula, bevel side up, into the patientâ€™s vein at an angle of approximately 15-25Â° to the skin (note: fragile veins usually require a lower angle of insertion), depending on the depth of the vein and the amount of sub-cutaneous tissue.
Stop when blood is seen in the flashback chamber (NB flashback will be slower to appear with smaller cannula and in hypertensive patients. Lower the angle of insertion to correspond to vein depth and direction and carefully advance the cannula and stylet up to 5 millimetres into the lumen of the vein.
Withdraw the stylet up to 5 millimetres to see a second flashback in the length of the cannula. NB Never reinsert the stylet.
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To prevent stinging as the needle pierces the skin To stabilise and anchor the vein. To improve chances of successful cannulation
To establish stylet entry into the vein To establish cannula entry into the vein
Slowly advance the cannula into the vein in short stages, after each stage gradually withdraw a section of the needle – never fully remove the needle from the patient until the cannula is fully inserted.
Once the cannula is fully inserted, release the tourniquet and apply digital pressure to the vein above the cannula tip before completely removing the stylet, disposing of it immediately into the sharps container.
Attach the luer lock cannula cap to the hub of the cannula. Release digital pressure from the vein.
Apply the IV moisture responsive transparent dressing as per manufacturer’s instructions, ensuring the puncture site is covered completely.
To enable visualisation of the puncture site and protect it from microorganisms
Flush the cannula with sodium chloride 0.9% injection, observing for signs of swelling or leakage, asking the patient, where possible, if any pain or discomfort is felt. If so, remove the cannula.
To ensure correct sitting and patency
Dispose of used materials safely in the appropriate waste bag.
To ensure safe disposal
Document in the patient’s records: Date and time annulated Cannula size and site and manufacturer Cannula batch number Flush used Latest re-cannulation date (not more than 3 days from date of insertion) Document any problems or difficulties encountered when undertaking cannulation, e.g. failed attempts (see section 8.4)
To comply with good record keeping standards
To normalise venous pressure in the vein. To prevent bleeding when removing the stylet. To minimise the risks of needle stick injury To seal and protect the cannula form microorganisms
IMPORTANT PRACTICE POINTS
ASEPSIS: The principles of asepsis, including hand washing, a no touch technique and the cleansing of access points prior to use are essential in the care of the patient with a cannula in place see appendix.
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INTRAVENOUS DRESSINGS: These dressings are used because they possess the following qualities: • • • • •
Waterproof Impervious to bacteria Prevent moisture retention Easy inspection of the insertion site Easy to apply/remove and enable minimal dressing change.
LOCAL ANAESTHETIC: Cannulation may be painful. The pain is not always dependent upon cannula size. Each patient should be assessed for his or her need for topical anaesthetic. A topical anaesthetic may be applied. Unless a Patient Group Direction exists to enable its use this must be prescribed.
MULTIPLE ATTEMPTS at cannulation must be avoided. If the practitioner is unable to cannulate the patient using two reasonable attempts, another practitioner with more experience should evaluate the patient’s venous access.
HAEMATOMA PREVENTION: As a result of repeated venepuncture, haematomas often contribute to the reduced choice of suitable veins to access. Upon removal of a cannula, haematoma prevention is encouraged by the application of digital pressure to the puncture site for at least three minutes. An additional measure that may be taken, excluding cardiac patients, is arm elevation. Application of dressings does not replace digital pressure.
VEIN ROLL: Superficial veins may roll (Millam 2000) therefore it is important to maintain skin tension throughout the insertion procedure.
UNSUCCESSFUL cannulation – remove cannula. Do not reinsert the stylet into the cannula as it may shear off the cannula and lead to cannula embolism. Use a new cannula for a repeat attempt. BRUISING – remove tourniquet immediately and then the cannula, applying digital pressure to the puncture site.
PHLEBITIS - Two of the most common causes of infusion phlebitis are chemical and mechanical irritation - therefore the correct choice of a suitable access device for a particular patient is vital (Freytes 2000).
INFILTRATION – the inadvertent administration of a non-vesicant solution or drug into the tissues (Weinstein 2000). Venous access devices must be secured in away that does not impede fluid/blood flow and allows the insertion site to be monitored.
EXTRAVASATION – the inadvertent administration of a vesicant solution or drug into the tissues (Weinstein 2000). Tissue necrosis may follow, therefore it is vital that cannula are assessed as patent prior to use and monitored closely.
OCCLUSION – Cannula may become occluded when infusion containers ‘run dry’ or flush solutions are not administered appropriately (Dougherty and Lamb 1999). Cannula must never be forcibly flushed. Page 10 of 20
INADVERTENT ARTERIAL CANNULATION, which is unrecognised, with subsequent administration of specific drugs/solutions may impede and/or stop the circulation to the cannulated limb. Accurate vessel assessment prior to cannulation is vital. This involves palpation - the vessel should be soft, ‘bouncy’ and without a pulse. During assessment removal of the tourniquet would allow the vein to return to its pre-tourniquet state – arteries or thrombosed veins would remain firm. Only soft palpable veins must be cannulated.
CARE OF THE CANNULA, CANNULA SITE AND REMOVAL
A cannula, which is not routinely in use for intermittent or continuous intravenous therapy, should be flushed 12 hourly with 5 to 10mls. Sodium chloride 0.9% injection (Fuller and Winn 1998).
Effective flushing is achieved with a ’push-pause’ technique, i.e. 1ml. at a time (Dougherty & Lamb, 1999).
Sodium chloride 0.9% injection is a prescription only medicine and should be prescribed for cannulated patients according to the use of the cannula.
The cannula site should be checked for signs of infusion phlebitis (redness, inflammation and discomfort) at every intervention or at least every 24 hours (Jackson, 1998). In practice this should be every time it is accessed or flushed. This check should be recorded in the nursing record / care plan (Appendix 2) using the Visual Infusion Phlebitis (VIP) Score (see Appendix 1).
Replace transparent dressing if loose or contaminated.
The cannula should be re-sited at the first signs of inflammation or discomfort (Jackson, 1998), or at least every 72 hours to reduce the risk of phlebitis developing or worsening (Jackson 1998). If it is considered appropriate to leave a cannula in situ for longer than 72 hours (e.g. where venous access is difficult), and where the VIP score is less than 2, the decision and rationale should be documented in the patient’s record/care plan. Additionally, the VIP score should be assessed and documented more frequently to identify problems should they arise. Any cannula not used for treatment within 24 hours should be evaluated as to the appropriateness of remaining in situ.
The following should be documented in the patient’s nursing record/care plan:
Routine observations of the cannula site using the VIP score Problems with the cannula or cannula site Removal of a cannula
All patients are cannulated appropriately, taking into consideration the patient’s need for a cannula, choice of vein, site and type of cannula.
Cannulation is performed by practitioners who have received training and are competent in the procedure.
A patient with a cannula is cared for in accordance with these guidelines. Page 11 of 20
Documentation in the patient’s nursing record is complete for each intervention relating to the patient’s cannula.
Equality Impact Assessment
All public bodies have a statutory duty under the Race Relation (Amendment) Act 2000 to “set out arrangements to assess and consult on how their policies and functions impact on race equality.” This obligation has been increased to include equality and human rights with regard to disability age and gender. The Trust aims to design and implement services, policies and measures that meet the diverse needs of our service, population and workforce, ensuring that none are placed at a disadvantage over others. In order to meet these requirements, a single equality impact assessment is used to assess all its policies/guidelines and practices. This guidance was found to be compliant with this philosophy (see appendix C). 14.
Training Needs Analysis
To establish uniform practice, to a standard acceptable to the Trust, appropriate competences have been identified. The knowledgeable practitioner must be able to demonstrate that she or he:
abides by these and other associated guidelines for practice has an understanding of the reasons for peripheral venous cannulation knows the situations where it is inappropriate to insert a peripheral venous cannula and the alternative action to take can outline the risks and complications associated with peripheral venous cannulation, their prevention and treatment can describe the procedures for reporting errors and adverse incidents is able to consider factors affecting the choice of vein/site used for peripheral IV cannulation is aware of the factors affecting the choice of cannula and gives rationale for choice uses appropriate methods to prepare suitable sites for peripheral venous cannulation understands the correct procedures for minimising infection including hand washing, use of gloves, non-touch technique and aseptic technique can successfully undertake the procedure for the insertion of a cannula uses an appropriate technique and dressing to secure the cannula understands the ongoing care required when a peripheral venous cannula is in place recognises when cannulation has failed and takes appropriate action is able to assess the need for removing or re-sitting a peripheral venous cannula and the rationale for this records information relating to the peripheral venous cannulation in a manner that is clear, concise, timely and accurate
In order to achieve competence, theoretical and practical education and training will be needed. The practitioner, undertaking such education and training, must be directly supervised in all aspects of peripheral intravenous cannulation until such time as they are able to demonstrate their knowledge and competence. Final assessment of competence will be undertaken by a competent practitioner who holds the ENB 997/998 certificate, or equivalent knowledge. Page 12 of 20
It is recommended that practitioners review their practice annually, to ensure competence. This could consist of a review of these Guidelines, and at least one observed cannulation, by a colleague experienced in cannulation and assessing clinical practice 15.
Monitoring Compliance with these guidelines
The success of the implementation of these guidelines will be measured by clinical audit approximately six months after their introduction and thereafter at 2 yearly intervals to inform the regular review process. Sample size, audit tool and location and how the audit is conducted will be determined at the time of audit.
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16. References CAMPBELL J. (1995) Making sense of the technique of venepuncture. Nursing Times. 91(31), p.29-31. DEPARTMENT OF HEALTH (2001) ‘Guidelines for preventing infections associated with insertion and maintenance of central venous catheters’. In Journal of hospital infection, 47 (supplement), S47– S67. DEPARTMENT OF HEALTH (2000) The NHS plan: A Plan for Investment, A Plan for Reform, The Stationary Office, London DEPARTMENT OF HEALTH (2001) Reference Guide to Consent for Examination or Treatment. The Stationary Office, London DEPARTMENT OF HEALTH (2007) Saving Lives: reducing infection, delivering clean and safe care. High Impact Intervention no2, Peripheral intravenous cannula care bundle. The Stationary Office, London DOUGHERTY L. AND LAMB J. (1999) Intravenous Therapy in Nursing Practice (1st Edit). Churchill Livingstone. Edinburgh. FREYTES C.O. (2000) Indications and complications of intravenous devices for chemotherapy. Supportive Care in Oncology. 34, p-2-6. FULLER A, WINN C. The management of peripheral IV lines. Professional Nurse, 1998 13; 10: 675 – 678 ICNA (2003) Reducing sharps injury – prevention and risk management, Infection Control Nurses Association, February. JACKSON A. A battle in vein: infusion phlebitis. Nursing Times, 1998 94; 4: 68 – 71 McCLELLAND D (2001) Handbook of transfusion medicine 3rd ed. London. The Stationary Office. MILLAM D.A (2000) On the road to successful IV starts Nursing 2000 30 (4), p34-48. NURSING AND MIDWIFERY COUNCIL (2004) Code of Professional Conduct: Standards for conduct, performance and ethics. London. NMC NURSING AND MIDWIFERY COUNCIL (2005) Guidelines for records and record keeping (2005) London. NMC PERUCCA, R, (2001) ‘Obtaining vascular access’. In Infusion therapy in clinical practice. (2nd ed.). Pennsylvania: WB Saunders, Chapter 20, 338–397. (III) SMITH J (1998) The practice of venepuncture in Lymphoedema. European Journal of Cancer Care 7 p97 – 98. TERRY J., BARONOWSKI L., LONSWAY R. A. & HENDRICK C (1995) Intravenous therapy – Clinical principles and practice W.B. Saunders Co., Philadelphia. WEINTEIN S.M (2000) Plumber’s principles & practice of intravenous therapy (6th edit) J.B. Lippincott Company, Philadelphia. Page 14 of 20
BIBLIOGRAPHY CAMPBELL, J. (1997) Intravenous cannulation: Potential Complications. Professional Nurse vol. 12 No 8, (supplement S10 – S13) DAVIES S. The role of nurses in intravenous cannulation. Nursing Standard, 1998 12; 17: 43 - 46 DENNIS G, MAKI M, RINGER M. Risk factors for infusion-related phlebitis with small peripheral venous catheters. Annals of internal medicine, 1991 May 114; 10: 845 – 854 DOUGHERTY L AND LISTER S (2004) The Royal Marsden Hospital – Manual of Clinical Procedures 6th Edition Blackwell Publishing, Oxford GRAY S. Expanding practice to include IV cannulation. Intravenous Therapy. Professional Nurse, 1997 December 13; 6: 181 - 182 HOSPITAL INFECTION CONTROL PRACTICES ADVISORY COMMITTEE PART II. Recommendations for the prevention of nosocomial intravascular device-related infections. American Journal of Infection Control, 1996; 24: 262 - 293. LUNDGREN A, CHRISTINA A, WAHREN L. Handling & control of peripheral intravenous lines. Journal of Advanced Nursing, 1998; 27: 897 - 904 LUNDGREN A, WAHREN L, CHRISTINA A. Peripheral intravenous lines: Line in situ related to complications. Journal of Intravenous Nursing, 1996; 19:5: 229 – 238 RCN (2005) Royal College of Nursing: Standards for Infusion Therapy. London: Royal College of Nursing WORKMAN B. Peripheral Intravenous Therapy Management. Nursing Standard, 1999. 14; 4: 53 – 60
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Visual Infusion Phlebitis Score
All patients with an intravenous access device in place must have the IV site checked at least daily for signs of infusion phlebitis. The subsequent score and action(s) taken (if any) must be documented in the patient’s record. The cannula site must also be observed when bolus injections are administered, when IV flow rates are checked or altered and when solution containers are changed. The incidence of infusion phlebitis varies, the following Good Practice Points may assist in reducing the incidence of infusion phlebitis: • •
Observe cannula site at least daily Secure cannula with a proven intravenous dressing
Replace loose, contaminated dressings
Cannula must be inserted away from joints whenever possible Consider re-sitting the cannula every 48 - 72 hours
Aseptic technique must be followed
Plan and document continuing care
Use the smallest gauge cannula most suitable for the patients need
Replace the cannula at the first indication of infusion phlebitis (stage 2 on the VIP Score)
TANDARDS FOR INFUSION THERAPY IV site appears healthy ONE of the following is evident: • Slight pain near IV site OR • Slight redness near IV site
No sign of phlebitis OBSERVE CANNULA
Possibly first signs of phlebitis OBSERVE CANNULA
TWO of the following are evident: • • •
Pain at IV site Erythema Swelling
Early stages of phlebitis
ALL of the following are evident: • • •
Pain along path of cannula Erythema Induration
Medium stages of phlebitis
ALL of the following signs are evident and extensive: • • • •
Pain along path of cannula Erythema Induration Palpable venous cord
Advanced stage of phlebitis or the start of thrombophlebitis
Pain along path of cannula Erythema Induration Palpable venous cord Pyrexia
RESITE CANNULA CONSIDER TREATMENT
ALL of the following signs are evident and extensive: • • • • •
RESITE CANNULA CONSIDER TREATMENT
Advanced stage thrombophlebitis
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INITIATE TREATMENT RESITE CANNULA
Jackson 1998 APPENDIX B
PATIENT CARE MANAGEMENT PLAN
NHS No: __________________
The patient has a peripheral intravenous cannula insitu
To prevent infection/phlebitis
NURSING ACTION: ♦ ♦ ♦ ♦ ♦ ♦ ♦ ♦ ♦ ♦ ♦ ♦ ♦ ♦ ♦ ♦ ♦ ♦
Collect all the equipment required. Select the correct cannula size for the purpose and length of the infusion. Explain the procedure to the patient and determine any previous difficulties, gain patients consent. Ensure hands are decontaminated with soap and water or alcohol hand gel. Wear protective clothing i.e. clean gloves and apron. Position the patient and select the most appropriate site. Disinfect the skin prior to insertion with an alcohol-impregnated swab for a minimum of 30 seconds. Allow to air dry. Do not re-palpate the skin and/or vein prior to insertion. Ensure insertion is achieved using an aseptic technique. Secure the cannula with a sterile transparent semi permeable dressing. Do not routinely change dressing only if soiled, wet or insecure Record the date and time of cannula insertion on the dressing and complete insertion record. Check the cannula for patency before each use. Check the cannula site prior to flushing/introducing bolus drugs or 12 hourly for the signs of infection: redness, heat, pain, inflammation, swelling, tracking and purulent drainage. Record the Visual Infusion Phlebitis (VIP) score in the patient’s Cannulation record. If VIP score is 2 or more, re-site cannula. Remove cannula within 72 hours of insertion. If it is considered necessary to leave the cannula in longer, document reasons why in the patient’s record. If any signs of infection are evident remove the cannula immediately regardless of the length of time the cannula has been in place Clean Injection ports with an alcohol impregnated swab before accessing the system/device. Flush the cannula with prescribed normal saline, or compatible flushing solution, after each use or 12 hourly if cannula not in use. When caps are removed from the circuit, ensure they are replaced with a sterile luer-lock cap following each use. Do not routinely attach accessories i.e. stopcocks, (3 way taps).
Cannula Insertion Record Date and Time Inserted Size of Cannula Manufacturer of Cannula Position of Cannula Location of patient when inserted Inserted by: Date and Time of Removal Removed By
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Nursing Team to Complete Nursing Care: 9 = Achieved (no further comments needed)
X = Not achieved, action needed
Record any problems in communication section. If VIP score is 2 or more, re-site cannula Date: Time: I.V. access site observed for signs of infection/phlebitis (record VIP score) Occlusive dressing dry and intact Cannula flushed with normal saline 12 hourly (or compatible flush) REVIEW CARE AND SIGN OPPOSITE Date: Time: I.V. access site observed for signs of infection/phlebitis (record VIP score) Occlusive dressing dry and intact Cannula flushed with normal saline 12 hourly (or compatible flush) REVIEW CARE AND SIGN OPPOSITE Date: Time: I.V. access site observed for signs of infection/phlebitis (record VIP score) Occlusive dressing dry and intact Cannula flushed with normal saline 12 hourly (or compatible flush) REVIEW CARE AND SIGN OPPOSITE References: Guidelines for Preventing Intravascular Catheter Related Infections. Infection Control Nurse Association. 2001 Page 18 of 20
C. Key stakeholders consulted/involved in the development of the guidelines/procedure
Stakeholders name and designation Louise Hodgson P. Horner, Service Manager Intermediate Care Intermediate Care Teams Lucianne Ricketts, Medicine Management Neill McDonald, Medicine Management Catherine Smyth, Professional Development Policy Development Group PEC
Key Participant Yes/No Yes
Feedback requested Yes/No Yes
Feedback accepted Yes/No Yes
No Yes Yes Yes Yes Yes
Yes Yes Yes Yes Yes Yes
Yes Yes Yes Yes Yes Yes
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D. Equality Impact Assessment Tool To be completed and attached to any procedural document when submitted to the appropriate committee for consideration and approval. Insert Name of Guidelines / Procedure Yes/No 1.
Does the guidelines/guidance affect one group less or more favourably than another on the basis of: Race
Ethnic origins (including gypsies and travellers)
Religion or belief Sexual orientation including lesbian, gay and bisexual people Age
Disability - learning disabilities, physical disability, sensory impairment and mental health problems Is there any evidence that some groups are affected differently?
If you have identified potential discrimination, are any exceptions valid, legal and/or justifiable?
Is the impact of the guidelines likely to be negative?
If so can the impact be avoided?
What alternatives are there to achieving the guidelines without the impact?
Can we reduce the impact by taking different action?
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Published on Mar 6, 2010