intravenous peripheral cannulation neonatal clinical

Intravenous Peripheral Cannulation Neonatal Clinical Guideline

V3.0

December 2019

Intravenous Peripheral Cannulation - Neonatal Clinical Guideline V3.0 of 13

Summary

Identify clinical need for intravenous cannula

Unless emergency situation discuss clinical need for cannulation with parents2,3

Identify trained (or under supervision of adequately trained) staff member

Gather listed equipment and prepare trolley surface for sterile procedure

Follow procedure detailed in section 2.2

IF the procedure is unsuccessful after 2 attempts contact a senior/ more experienced practitioner, maximum 4 attempts in total. see section 2.2.21

Ensure baby is left in a comfortable position. Clear sharps and waste as per RCH policy, and wash hands. Document on cannula care plan and ensure

plan in place for monitoring of the cannula site and observations


1. Aim/Purpose of this Guideline

1.1. Neonates commonly require venous access for administration of intravenous (IV) drugs, fluids or blood products. The procedure carries risks of tissue injury, introduction of infection and can be painful for the baby.

1.2. This document details how to perform the procedure and minimise risks. Any staff member performing this procedure needs to have completed the RCHT

Peripheral Intravenous Cannulation training. Implicit consent is considered acceptable for many routine, low-risk procedures performed in neonatology such as cannulation but where possible parents should be informed of the need for the procedure2 (Consent for Common Neonatal Investigations, Interventions and Treatments 2004) 3

1.3. This version supersedes any previous versions of this document.

1.4. Data Protection Act 2018 (General Data Protection Regulation – GDPR)

Legislation

The Trust has a duty under the DPA18 to ensure that there is a valid legal basis to process personal and sensitive data. The legal basis for processing must be identified and documented before the processing begins. In many cases we may need consent; this must be explicit, informed and documented. We can’t rely on Opt out, it must be Opt in.

DPA18 is applicable to all staff; this includes those working as contractors and providers of services.

For more information about your obligations under the DPA18 please see the ‘information use framework policy’, or contact the Information Governance Team [email protected]

2. The Guidance

2.1. EQUIPMENT

Sucrose analgesia

Trolley

Chlorhexidine solution 0.05% (Unisept)

0.9% Saline 5ml ampoule

5ml luer lock syringe

Sterile dressing pack

Sterile gloves

Steristrips

T piece extension set

24g Cannula

Tegaderm

Baby board splint

Tape

mailto:[email protected]


2.2. PROCEDURE

2.2.1. Prepare a trolley surface, clean with 70% alcohol wipe and allow to dry

2.2.2. Gather equipment.

2.2.3. Wash hands

2.2.4. Place equipment listed on sterile surface

2.2.5. Clean hands with alcohol gel

2.2.6. Identify the patient in accordance with RCHT policy

2.2.7. Administer sucrose analgesia/ ensure baby has adequate pain relief and position baby to promote comfort of baby and practitioner for procedure eg. adjust incubator height/ move baby to resuscitaire

2.2.8. In good light/ using vein illumination device, inspect limbs for suitable peripheral cannula sites. Basilic and cephalic veins in the hands and forearms or superficial veins in the feet are preferable. Avoid long saphenous veins or antecubital fossa sites if baby likely to require these sites for central/ longline access

2.2.9. Wash hands again before putting on sterile gloves

2.2.10. Prepare equipment on trolley.

2.2.11. Clean the skin using 0.05% Chlorhexidine soaked gauze and position limb on/through sterile towel and allow skin to dry

2.2.12. Ensure supportive hold of limb at chosen site.

2.2.13. Insert the cannula, bevel uppermost. When a flash of blood is seen in the cannula chamber withdraw the stylet slowly whilst inserting the cannula further into the vein. Remove the needle

2.2.14. Take any blood samples required then attach the primed extension set and flush gently with saline

2.2.15. If resistance or swelling occurs, remove cannula and apply pressure to site to reduce any haematoma formation

2.2.16. If the cannula flushes satisfactorily, apply steristrips to secure the cannula and place the transparent dressing over the site, allowing for ongoing site inspection. Ensure the dressing does not circumference the limb


2.2.17. Support the limb with a splint as necessary, avoid tape directly contacting the baby’s skin

2.2.18. Dispose of waste according to RCH waste and sharps policy and wash hands

2.2.19. Date the dressing/splint and complete and sign a cannula care plan, indicating gauge and lot number of cannula and site of insertion.

2.2.20. If unsuccessful, a new cannula should be used for subsequent attempts. Another suitably trained/ more experienced practitioner should be consulted after 2 unsuccessful attempts.

2.2.21. Non NNU babies should have IM cefotaxime if Cannulation NOT achieved after 4 attempts. NNU babies should be considered for UVC insertion and IV antibiotics via that route. All antibiotics should be administered within 1 hour of decision to treat (if first dose) or within 1 hour of dose being due (if subsequent dose).

2.2.22. The cannula site should be monitored and documented daily on the care plan (Appendix 3) with discussion at 72 hours for renewal as per RCHT cannula care policy

2.2.23. Whilst a cannula is in situ the baby should have a minimum of 4 hourly charted observations

2.3. RESPONSIBILITIES

It is the responsibility of the clinical area nurse ward manager and medical clinical lead to ensure that staff are adequately prepared to carry out this procedure and audit matrices are returned.


3. Monitoring compliance and effectiveness

Element to be monitored

Full adherence to the guideline

Lead Ward manager

Tool Cannulation and documentation audits. Safety briefing audits monitoring.

Frequency At time of review or following incident

Reporting arrangements

Child Health Directorate Audit, Paediatric governance meetings and Neonatal clinical Guidelines Group

Acting on recommendations and Lead(s)

Consultant Paediatrician and Neonatologist. Paediatric Governance lead

Change in practice and lessons to be shared

Required changes to practice will be identified and actioned within three months. A lead member of the team will be identified to take each change forward where appropriate. Lessons will be shared with all the relevant stakeholders

4. Equality and Diversity

4.1. This document complies with the Royal Cornwall Hospitals NHS Trust

service Equality and Diversity statement which can be found in the 'Equality, Inclusion & Human Rights Policy' or the Equality and Diversity website.

4.2. Equality Impact Assessment The Initial Equality Impact Assessment Screening Form is at Appendix 2.

http://www.rcht.nhs.uk/GET/d10268876

http://www.rcht.nhs.uk/GET/d10268876

http://intranet-rcht.cornwall.nhs.uk/shelf/equality-and-diversity/


Appendix 1. Governance Information

Document Title Intravenous Peripheral Cannulation - Neonatal Clinical Guideline V3.0

Date Issued/Approved: 20 November 2019

Date Valid From: December 2019

Date Valid To: December 2022

Directorate / Department responsible (author/owner):

Sarah Tabrett, ANNP

Contact details: 01872 252667

Brief summary of contents

Procedure for peripheral intravenous cannulation, equipment required, technique to be used, documentation and monitoring required

Suggested Keywords: Neonate. Neonatal. Cannula. Cannulation. peripheral

Target Audience RCHT CFT KCCG

Executive Director responsible for Policy:

Medical Director

Date revised: October 2019

This document replaces (exact title of previous version):

Clinical Guideline for Neonatal Intravenous Cannulation V2.2

Approval route (names of committees)/consultation:

Neonatal Guidelines Group

Care Group General Manager confirming approval processes

Debra Shields

Name and Post Title of additional signatories

Not Required

Name and Signature of Care Group/Directorate Governance Lead confirming approval by specialty and care group management meetings

{Original Copy Signed}

Name: Caroline Amukusana

Signature of Executive Director giving approval

{Original Copy Signed}

Publication Location (refer to Policy on Policies – Approvals and Ratification):

Internet & Intranet Intranet Only

Document Library Folder/Sub Folder Child health. Neonatal


Links to key external standards None

Related Documents:

References

1. RCHT documents: Record keeping standards, Patient identification policy, Infection control policy, Intravenous policy, Waste management policy, Medications policy RCH document library 2. Enhancing shared Decision making in Neonatal Care: A Framework for Practice 2019. https://hubble-live-assets.s3.amazonaws.com/bapm/attachment/file/89/BAPM_Shared_Decision_Making_for_consultation.pdf 3. Rennie,J. Roberton Textbook of Neonatology 5th Edition, 2012 Elsevier.

Training Need Identified? No

Version Control Table

Date Version

No Summary of Changes

Changes Made by (Name and Job Title)

10 Jun 2005

V1.0

Initial Issue

J. Lane staff nurse NNU(retired)

1 Feb 10

V2.0

Revised procedure

Judith Clegg ANNP, NNU

24 Jun 2013

V2.1 Rewritten in new format. Revised guidance for RCH infection control and audit policy


29 July 2016

V2.2

Flow chart added Amended as guideline not procedure for document library


18 August 2016

V2.2

Reviewed and approved at Neonatal Guidelines Meeting.

No Changes required

04 November

2019

V3.0 Full review: Rewritten and flow chart amended.

Sarah Tabrett ANNP

All or part of this document can be released under the Freedom of Information

Act 2000

This document is to be retained for 10 years from the date of expiry. This document is only valid on the day of printing

https://hubble-live-assets.s3.amazonaws.com/bapm/attachment/file/89/BAPM_Shared_Decision_Making_for_consultation.pdf





Controlled Document This document has been created following the Royal Cornwall Hospitals NHS Trust Policy for the Development and Management of Knowledge, Procedural and Web

Documents (The Policy on Policies). It should not be altered in any way without the express permission of the author or their Line Manager.


Appendix 2. Initial Equality Impact Assessment Form

Are there concerns that the policy could have differential impact on: Equality Strands: Yes No Unsure Rationale for Assessment / Existing Evidence

Name of the strategy / policy /proposal / service function to be assessed

Intravenous Peripheral Cannulation - Neonatal Clinical Guideline V3.0

Directorate and service area: Child Health. Neonatal

New or existing document: Existing

Name of individual completing assessment: Neonatal guidelines group

Telephone: 01872 252667

1. Policy Aim* Who is the strategy / policy / proposal / service function aimed at?

Procedure for inserting a cannula in neonatal patients within neonatal unit. Guideline to assist nursing and medical staff

2. Policy Objectives*

Clearly written instructions Non touch technique used Equipment list needed

3. Policy – intended Outcomes*

Standard procedure for peripheral intravenous cannulation Good infection control technique Standardised practice

4. *How will you measure the outcome?

Audit Quality nursing matrices

5. Who is intended to benefit from the policy?

Practitioners and patients

6a Who did you consult with b). Please identify the groups who have been consulted about this procedure.

Workforce Patients Local groups

External organisations

Other

x

Please record specific names of groups Consultant led, Neonatal guideline group

What was the outcome of the consultation?

Approved

7. The Impact Please complete the following table. If you are unsure/don’t know if there is a negative impact you need to repeat the consultation step.


Age X

Sex (male,

female, trans-gender / gender reassignment)

X

Race / Ethnic communities /groups

X

Any information provided should be in an accessible format for the parent/carer’s needs – i.e. available in different languages if required/access to an interpreter if required

Disability - Learning disability, physical impairment, sensory impairment, mental health conditions and some long term health conditions.

X

Those parent/carers with any identified additional needs will be referred for additional support as appropriate - i.e to the Liaison team or for specialised equipment. Written information will be provided in a format to meet the family’s needs e.g. easy read, audio etc

Religion / other beliefs

X All staff should be aware of any beliefs that may impact on treatment decisions

Marriage and Civil partnership

X

Pregnancy and maternity

X

Sexual Orientation, Bisexual, Gay, heterosexual, Lesbian

X

You will need to continue to a full Equality Impact Assessment if the following have been highlighted:

You have ticked “Yes” in any column above and

No consultation or evidence of there being consultation- this excludes any policies which have been identified as not requiring consultation. or

Major this relates to service redesign or development

8. Please indicate if a full equality analysis is recommended. Yes No x

9. If you are not recommending a Full Impact assessment please explain why.

Not indicated

Date of completion and submission

20 November 2019 Members approving screening assessment

Policy Review Group (PRG) APPROVED

This EIA will not be uploaded to the Trust website without the approval of the Policy Review Group. A summary of the results will be published on the Trust’s web site.


APPENDIX 3 Cannula care plan