peripheral intravenous cannulation best practice … abm...peripheral intravenous cannulation best...

ABMU peripheral cannula best practice guidelines, April 2017 of 20

Peripheral Intravenous Cannulation Best Practice Guidelines

Issue 2.1

April 2017

Document Author: Paul Lee, Medical Device Training Manager Approved by: Cathy Dowling, Interim Deputy Director of Nursing and Patient Experience

Delyth Davies, Head of Nursing: Infection Prevention and Control

Date of Original Version: January 2012

Date of Current Version: April 2017

Review Date: April 2020


Issue status

Issue 1.1 Original version (as PVC care bundle) September 2012 Issue 1.2 • Updated cannula record form (3 x cannulae)

• Added Chloraprep™ cleaning for skin • Updated reference to Epic 3 guidelines • Added ‘no more than 2 failed insertions

attempts ‘ before seeking extra help to cannula bundle forms (see appendix 3)

June 2014

Issue 2 Redrafted as ‘best- practice guidelines’

June 2015

Issue 2.1

• Minor typo. changes, new layout for cannula pack label (includes cannula gauge and ANTT)

• Added 2%CHG + 70% alcohol wipe for hub disinfection

April 2017

CONTENTS Page 1 Introduction

• Definition

3

2 Scope

3

3 Governance

4

4 Roles and Responsibilities 4.1 Practitioner inserting Peripheral Intravenous Cannula

4.2 Staff preparing and second checking the flush solution

4 - 6 4 - 6 6

5 Training and Education Requirements

6

6 Process for Monitoring Compliance and Effectiveness

7

7 ABMU LHB Peripheral Cannula Best Practice Guideline

8,12

8 References, guidelines and initiatives

13

9 Appendices • Appendix 1: Essential elements for insertion of cannula • Appendix 2; Essential elements for monitoring cannula • Appendix 3: Peripheral IV Cannula Care record form • Appendix 4: Removal of peripheral IV cannula check sheet

14 15 -16 17-18 19 - 20


1. INTRODUCTION This guideline relates to the insertion, maintenance and safe removal of peripheral intravenous cannula. It applies to all members of the Health Board multi-professional team and should be followed at all times. Regardless of the type of peripheral intravenous cannula used, the principles of care for the device remain the same; • To minimise infection risk by always using ANTT (Aseptic Non Touch Technique) • To maintain a ‘closed' intravenous system with minimal connections to reduce the

risk of contamination • To prevent damage to the device and associated intravenous equipment • To maintain a patent and correctly positioned device Definition A peripheral vascular access device (VAD) is a device that is inserted into a peripheral vein for therapeutic purposes e.g. administration of medications, fluids and/or blood products. For the purpose of this policy this will be defined as a ‘cannula ‘and the process ‘cannulation’. 1.1 All intravenous peripheral cannulae will be inserted and accessed using

Aseptic Non Touch Technique (ANTT) and Standard Infection Control Precautions adopted at all times (SICP). Staff must also adhere to ABMU Policy in relation to the Control of Substances Hazardous to Health (COSHH) guidelines

1.2 The practitioner carrying out the procedure is fully accountable and

responsible for safe practice in the insertion and removal of peripheral intravenous cannula

1.3 All practitioners have a professional duty to maintain their knowledge and skill.

It is their responsibility to ensure that they undertake this role competently and with the required clinical skills

1.4 All peripheral intravenous cannulation will be carried out upon the request of a

Registered Practitioner. This will be a Medical Practitioner or a Registered Practitioner who is acting upon specific approved protocols and guidelines

1.5 All peripheral intravenous cannulation will be carried out in accordance with

this guideline. This includes elements for both insertion and ongoing maintenance of the vascular access device

2. SCOPE 2.1 This policy applies to all practitioners for whom peripheral intravenous

cannulation has been identified as required within their clinical role. This will include anyone with an employment or honorary contract of employment with ABMU LHB or who work through temporary or locum agencies


3. GOVERNANCE 3.1 All practitioners new to the role of Peripheral Intravenous Cannulation are

required to complete the ABMU LHB approved Peripheral Intravenous Cannulation training package, and deemed competent in using ANTT for the insertion of the Vascular Access Device (VAD)

Practitioners for whom the skill has been identified as being required in their role and who have previously been assessed as competent in a different Healthcare Organisation and/or educational setting will be assessed for competency by an IV cannulation assessor

3.2 An assessor is identified as a Registered Healthcare Practitioner who has carried out the procedure of peripheral intravenous cannulation for a minimum of 12 months and for whom the procedure is a core element of their practice

3.3 All practitioners undertaking this procedure should wear disposable, protective

gloves and plastic apron (or clean scrub-suit in theatres environment: scrub suits must be changed immediately upon contamination)

3.4 All peripheral intravenous cannula will be inserted using ANTT (Aseptic Non

Touch Technique). 3.5 In order to ensure staff safety, practitioners must not practice the procedure of

intravenous peripheral cannulation on themselves or other colleagues 3.6 The administration of 5ml of 0.9% sodium chloride flush is an integral part of

peripheral IV cannulation and ongoing maintenance and is covered by an organisational patient group directive (PGD) therefore does not require a prescription. However, all IV flushes must be checked, labelled and documented by a second practitioner during their preparation. The tip of the syringe must be protected from contamination and touch by using either a sterile single use caps or returned to its original packaging prior to use

3.7 The removal of an IV cannula should be performed using ANTT. The device

should be removed carefully using a steady movement and pressure applied until haemostasis is achieved. Once inspected, the device should be discarded immediately into a sharps bin (See cannula removal check-sheet: appendix 5)

4. Roles and Responsibilities 4.1 Practitioner inserting Peripheral Intravenous Cannula. 4.1.1 The Practitioner inserting the cannula shall be trained and competent, which

will include the following aspects: • Appropriate assessment and indications/contraindications for

peripheral cannula insertion • Relevant anatomy and physiology


• Patient identification and informed consent (this may include the parent and/or carer)

• Appropriate communication with patient, parent and/or carer • Appropriate site placement • Appropriate visual inspection and palpation techniques • Measures to improve venous access • Manual holding of a paediatric and/or neonate patient (where

appropriate) • Appropriate choice of cannula gauge • Skin preparation • Adherence to using SICP’s • Demonstrate use of ANTT for insertion, ongoing maintenance (and

removal) procedure • Correct procedure when obtaining venous blood samples immediately

following cannula insertion • Use of needle-free connectors • Correct dressing placement (including fixation and date strips) • Recognition of signs and symptoms for extravasation, infiltration and

phlebitis and the relevant action to be taken • Side-effects and potential adverse reactions of all medications and

fluids being administered • Correct sharps handling and waste disposal • Appropriate monitoring of the patient following intravenous peripheral

cannulation • Risk management and patient safety principles • Correct procedure for reporting of incidents

4.1.2 It is the responsibility of the practitioner to accurately prepare the equipment

required. This will include the appropriate second-checking of any flushing solutions

4.1.3 The practitioner must ensure correct patient identity and obtain consent

according to ABMU LHB policy, prior to cannulation and any IV administration 4.1.4 The practitioner must identify any special instructions, investigations and

baseline parameters required, or issues for which advice must be sought, prior to inserting the cannula

4.1.5 The practitioner is required to explain, where appropriate, the procedure and

potential side effects/adverse reactions and their management to the patient and/or carer. For patients in an outpatient setting and/or who will be leaving the organisation immediately following insertion and removal of a peripheral intravenous cannula, written information regarding the side effects/adverse reactions and their action should also be provided

4.1.6 The practitioner must assess the patient’s physical condition, their fitness for

the procedure and the suitability of their venous access prior to inserting the cannula


4.1.7 The practitioner inserting the cannula is responsible for preparing, checking, administering and documenting the flush correctly

4.1.8 The practitioner is responsible and accountable for monitoring and evaluating

the effectiveness of the procedure. This will include observation of the patient and site of insertion, documenting patient response and monitoring for adverse reactions

4.1.9 The practitioner is responsible for following the correct procedure when

obtaining venous blood samples from the intravenous peripheral cannula, immediately following insertion of the cannula

4.1.10 The practitioner must recognise when they need help and seek advice and

support from an appropriate source when the needs of the individual and the complexity of the procedure are beyond their competence and capability. Should a practitioner not be able to insert the cannula successfully after 2 attempts they should seek assistance form a more experience colleague

4.2 Staff preparing and second checking of the flush solution. 4.2.1 All Intravenous medications and fluids are required to be checked by a

second registered healthcare practitioner within the hospital setting 4.2.2 The practitioner inserting the cannula is responsible for ensuring that the

second checker has been identified as having the relevant approved skills required

4.2.3 The second checker is responsible for checking the medication/fluid to be

administered against the prescription and/or fluid chart during preparation 4.2.4 Preparation of the intravenous flush solution must be witnessed by both the

practitioner who is performing the cannulation procedure, and the second-checker

5. Training and Education Requirements 5.1 All practitioners who insert peripheral intravenous cannula will have

completed an identified training package and have been assessed as competent in the correct procedure

5.2 All practitioners that insert peripheral intravenous cannula must provide

evidence of continuing competency at the required level 5.3 All staff involved in the assessment and checking of IV cannula insertion sites

(e.g. VIP scoring) will be trained to do so


6. Process for Monitoring Compliance and Effectiveness 6.1 Intravenous peripheral cannula audits will be carried out under the guidance

of the ABMU LHB Infection Control Team 6.2 All patient and safety incidents involving peripheral cannula (including VIP

scores of 2 and above) will be reported and reviewed via the ABMU LHB incident reporting system (DATIX) and followed up via risk management procedures

6.3 Training records will be maintained that indicate;

• Practitioners are competent in ANTT and peripheral intravenous cannulation • Identified assessors/facilitators for peripheral intravenous cannulation

6.4 Peripheral intravenous cannula must be removed immediately if complications

occur, or if no longer required for intravenous medications and/or fluids (i.e. not used for over 24 hours). They should be insitu for 72 hours (or manufacturer’s recommendations).

This time may be extended if the cannula remains fit for purpose and; • has a VIP score of less than 2 and • Cannula remains in use for intravenous medications and/or fluids. The reasons for this extended time must be documented in the patient’s nursing and/or medical notes. NB the longer the device remains in situ the greater the risk of phlebitis and infection


ABMU LHB Peripheral Cannula Best Practice Guideline

The practitioner performing the procedure must accurately and safely prepare the environment, the equipment and the patient prior to performing the procedure. This may include appropriate communication with the parent and/or carer and preparation of a child by a play specialist. Asepsis is the aim for all invasive clinical procedures, including the maintenance and use of the device. This is achieved by always using Standard Infection Control Precautions, identification & protection of Key parts and key sites, using a non touch technique and aseptic field management. Standard ANTT (Aseptic Non touch technique) should be adopted for the insertion and maintenance of Peripheral venous cannula. Non touch technique is mandatory to protect the key parts & key sites. Standard ANTT advocates the use of non sterile gloves and a General Aseptic Field. To reduce the transfer of micro-organisms in the healthcare setting, hands must be decontaminated in line with World Health Organsiation’s (WHO) ‘My 5 moments for hand hygiene at the point of care’. The practitioner must wash their hands before preparing the equipment and decontaminate hands at different stages of the procedure. Alcohol hand rub should be available to use at these key stages particularly before touching the patient and applying gloves. Hands should be washed on completion of the procedure. Gloves protect the Healthcare Worker (HCW) from body fluid risks and aprons protect the uniform from contamination. Personal Protective Equipment (PPE) should be worn as single use disposable items and discarded as clinical waste. They should be removed promptly on completion of task and hands washed. A plastic tray with integral sharps bin must be used at the point of care. There should be no visible blood or body fluid present. Detergent/disinfection wipes should be available and the tray must be disinfected before and after every use. This will provide a general aseptic field that promotes asepsis. Prior to undertaking aseptic procedures, it is important to limit environmental risks such as bed making, dusting or patients using commodes within the patient care zone. This will reduce the risks from airborne micro-organisms. Key parts and key sites require protection from direct contact with healthcare worker, the procedure environment and airborne contamination. If contaminated they present a significant infection risk to the patient. Key sites are considered to be open wounds, puncture or insertion sites. Key parts are the critical parts of the procedure equipment and should be protected by sterile caps or covers (Micro Critical Aseptic Fields). All flush solutions must be prepared by the practitioner using the correct equipment and be checked, labelled and administered according to the ABMU LHB Policy for Intravenous Administration of Medications.


Patient Preparation: Pre-Procedure Rationale 1 Confirm identity of the patient. Explain and discuss the

procedure with the patient. Ensure that any questions are answered and concerns discussed and obtain informed consent for the procedure.

To ensure that the patient understands the procedure and gives their valid consent

2 If the patient requires topical local anaesthetic, then apply it to chosen venepuncture sites for 30–60 minutes prior to cannulation

In order to give adequate time for local anaesthetic to be effective

3 In both inpatient and outpatient situations, the correct lighting, ventilation, privacy and position of the patient must be ascertained

To ensure that the operator and patient are comfortable and that adequate light is available to illuminate the procedure

4 Ensure the location where insertion will be undertaken patient environment is free from clutter and inappropriate items

To minimise the risk of cross infection

5 Wash your hands with liquid soap & water covering all surfaces for 15-30 seconds. Dry hands with disposable paper towel

To remove transient bacteria & minimize the risk of cross infection

6 Check your hands for any visibly broken skin, and cover with a waterproof dressing

To prevent inoculation exposure occurring

7 Apply a disposable plastic apron To protect uniform from contamination

8 Disinfect the tray which will hold all equipment and allow to dry before assembling items within

To protect equipment from contamination

9 Assemble all the equipment necessary for cannulation Check all packaging before opening (dates and seals), keep equipment within its original packaging

To ensure that time is not wasted and that the procedure goes smoothly without any unnecessary interruptions. To ensure all equipment is in date and not contaminated

10 Clean hands before direct contact with the patient Hands should always be cleaned before touching a patient.

11 Support the chosen limb on a pillow To ensure the patient's comfort, for ease of access

12 Apply the tourniquet to the chosen limb 3-4 fingers (7-8cm) away from proposed insertion site

To dilate the veins by obstructing the venous return. If necessary, use other methods to encourage venous access

13 Assess and select the vein To select appropriate vein

14 Release the tourniquet To ensure that the patient does not feel discomfort while the device is selected and equipment prepared


continued…..

Product selection and preparation Rationale 15 Select the device based on the vein size. (i.e. smallest

size cannula for the required therapy) To reduce damage or trauma to the vein. To reduce the risk of phlebitis

16 Decontaminate hands using alcohol based hand rub To minimize risk of infection 18 If using a cannulation procedure pack, open pack &

then open sterile components onto the surface. Also place a sterile dressing towel under the patient's arm. Key parts must be protected from contamination; being stored on sterile fields or have sterile hubs attached

To prevent contamination. Sterile items can be stored within their own packaging. These can be referred to as “Micro critical aseptic fields” (MCAF’s), which will reduce contamination risk

19 Taking care not to touch key parts of the equipment, prime the extension set with a syringe of 0.9% sodium chloride (unless taking blood samples immediately after cannulation). Place extension set onto the sterile field.

To remove air from the set prior to connection. If taking blood then the sodium chloride will contaminate the sample

20 Reapply the tourniquet To promote venous filling

Procedure: Cannulation Rationale 21 Clean the patient's skin and the selected vein for at

least 30 seconds using 2% chlorhexidine + 70% alcohol (e.g. SEPP Chloraprep) using back and forth strokes with friction and allow to air dry. Do not re-palpate the vein or touch the skin.

To reduce patients skin flora and reduce risk of infection.

22 Disinfect hands using alcohol based hand rub To reducing transient and resident skin flora from surface of practitioners hands

23 Put on clean, non-sterile gloves. Gloved hands should not touch the environment around the patient.

To protect practitioner from body fluid risks. To prevent introducing organisms from the environment.

24 Remove cannula needle guard and inspect the device for any faults

To detect faulty equipment, for example bent or barbed needles. If these are present, do not use and report to company as faulty equipment

25 Anchor the vein with the non-dominant hand by applying manual traction on the skin a few centimeters below the proposed site of insertion throughout the procedure

To immobilize the vein. To provide counter tension, which will facilitate a smooth needle entry

26 Holding the cannula in the dominant hand, ensure that it is in the bevel-up position and place the device directly over the vein; insert the cannula with conviction through the skin at the selected angle according to the depth of the vein

To ensure a successful, pain-free cannulation


27 Wait for the first flashback of blood in the flashback chamber of the stylet

To indicate that the needle has entered the vein

28 Lower the angle of the cannula by decreasing the angle between the cannula and the skin. Advance the cannula a few millimetres to ensure entry into the lumen of the vein

To avoid advancing too far and causing damage to the vein wall. To stabilize the device

29 Withdraw the stylet slightly with the dominant hand and a second flashback of blood will be seen along the shaft of the cannula confirming the cannula is in the vein

To ensure that the cannula is still in a patent vein. This is called the hooded technique

30 Maintaining skin traction with the non-dominant hand and using the dominant hand, slowly advance the cannula off the stylet and into the vein

To ensure the vein remains immobilized, thus reducing the risk of a ‘through puncture' (transfixation)

31 Release the tourniquet To decrease the pressure within the vein.

32 Apply digital pressure to the vein above the cannula tip and remove the stylet

To prevent blood spillage

33 Immediately dispose of the stylet into an appropriate sharps container

To reduce the risk of accidental needle stick injury

Patency and Flushing Rationale 34 Attach a primed extension set, needleless injection

port or administration set To enable flushing of cannula

35 Secure the cannula in place with securing strips vertically. DO NOT ‘cross’ the securing strips in an attempt to fix the cannula in place. DO NOT use any other tape (e.g. Micropore™) to secure the dressing or cannula in place

To ensure the device will remain stable and secure and also to allow visual inspection of the insertion site

36 Aspirate to check for blood flashback then flush the cannula with 0.9% sodium chloride using a pulsatile flush, ending with positive pressure

To ascertain and maintain patency

Dressing and Disposal Rationale 37 Observe the site for signs of swelling or leakage and

ask the patient if any discomfort or pain To check that the device is positioned correctly and is stable and secure

38 Cover with appropriate IV cannula dressing. In some cases a bandage may be used (e.g. confused patients). However this bandage should be removed during any IV infusion and prior to administering bolus medication

To ensure patient comfort and security of device

39 Discard waste, making sure it is placed in appropriate containers

To ensure safe disposal in the correct containers and avoid laceration or injury of other staff. To prevent reuse of equipment


40 Disinfect the surface of the equipment/sharps tray using a detergent/disinfectant wipe, remove PPE and wash hands.

Documentation and aftercare Rationale 41

Information regarding indications and all insertion details must be documented by the practitioner who has inserted the cannula, immediately following the insertion. Please see; Appendix 1: Insertion elements Appendix 2: Maintenance elements Appendix 3: Cannula record form Document ; • Date and time of insertion • Lot number of cannula • Gauge/size of cannula • Number of attempts to insert • Reason for insertion/reason for re-site • Signature of inserter, including date and designation

To ensure adequate records and to enable continued care of device and patient

42 Once initiated, this documentation must remain with the patient, and stored in the patient’s medical notes following discharge


43 Information regarding ongoing management and cannula access site observations (VIP score) will also be documented. (See p 1: peripheral cannula record)


7. Removal of Cannula 7.1 When removing a peripheral intravenous cannula, the practitioner must wash

their hands and wear gloves and plastic apron. It is the responsibility of the practitioner to ensure that the insertion site is clean and dry and that any bleeding and/or leakage has ceased. All insertion sites must be covered immediately following removal with a sterile dressing. (see Appendix 4: Safe Removal of Peripheral IV cannula check sheet)


7.2 Information regarding removal details must be documented (see Appendix 3:

ABMU LHB peripheral cannula record) by the practitioner who has removed the cannula immediately following the removal.

The following information must be recorded: • Date of removal • Reason for removal • Signature of remover, including date and designation

8. References, guidelines and initiatives used to develop this guideline. The ABMU LHB peripheral cannula care best practice guidelines align with the following national standards. • Saving Lives: Department of Health (2011) Reducing infection, delivering clean and safe

care. High Impact Intervention Peripheral intravenous cannula care bundle • 1000 Lives plus campaign NHS Wales (2011). Reducing healthcare associated

infections: appropriate and timely use of invasive devices. • Code of practice for the NHS on the prevention and control of healthcare associated

infections 2008, • Department of Health, Evidence Based Practice in Infection Control (EPIC3) National

Evidence Based Guidelines for Preventing Healthcare Associated Infections in NHS Hospitals, 2014.

• Royal Marsden Hospital: Manual of Clinical Nursing Procedures. • Royal College of Nursing Standards for Intravenous Therapy, 4th Edition, 2016 • Association of Anaesthetists of Great Britain and Ireland: Safe vascular access, 2016 • UK Vessel health and preservation framework, 2016


Appendix 1: Essential Elements for Insertion

1. Hand Hygiene DO NOT TOUCH the vascular access device or associated equipment unless you have cleaned your hands – ensure you are compliant with hand hygiene precautions in line with World Health Organisation (WHO) ‘My 5 moments’. 2. Personal Protection Gloves and aprons are required when completing any interaction that requires touching or manipulation of the vascular access device or associated equipment. After cannulation ENSURE gloves are removed and hand hygiene performed. 3. ANTT (Aseptic Non-Touch Technique) Asepsis is the aim of all during insertion or any subsequent interaction, ensure key sites and key parts do not become contaminated. Procedure Tray Disinfect the procedure tray correctly before and after use. Aseptic preparation of a procedure tray MUST be completed and key parts protected by sterile caps, sterile fields or original packaging. 4. Skin Preparation Disinfect the skin thoroughly with single use application of 2% Chlorhexidine Gluconate in 70% isopropyl alcohol e.g. Chlora-prep™ for 30 seconds and allow to air dry. DO NOT re-palpate the cleansed area.

Sharps MUST NOT be used to administer medication via a needle-free device. 6. Dressing Intact Ensure that a sterile, purpose designed IV dressing is applied. Include strips to assist with the stabilisation of the cannula wings. Apply a date strip to the dressing to indicate the date of cannula insertion.

Flush the cannula with sodium chloride 0.9% for intravenous use. Use a short extension and needle-free device to assist with prevention of premature cannula failure and accidental dislodgement. 8. Documentation and Care Planning. Documentation and care planning is an essential element to prevent premature cannula failure. The cannula care document will help plan the care for each patient.

Cannula Insertion : Ensure these essential elements are completed during insertion Seek further help from a more experience cannulation practitioner

if you are unable to cannulate after 2 attempts

5. Sharps Safety Sharps container must be available at the point of care intervention to allow for immediate disposal of sharps.

7. Flushing (5ml 0.9% Sodium Chloride) Always scrub the tip of the hub with a disinfectant wipe (15 seconds for the surface plus 15 seconds for the rest of the port) and allow to air dry.


Appendix 2: Essential Elements for Maintenance

Cannula Care (maintenance): Ensure these essential elements are completed during maintenance

1. Hand Hygiene DO NOT TOUCH the vascular access device or associated equipment unless you have cleaned your hands – ensure you are compliant with hand hygiene precautions in line with WHO ‘My 5 moments’. 2. Personal Protection Gloves and aprons are required when completing any interaction that requires touching or manipulation of the vascular access device or associated equipment. 3. Sharps Safety ‘Safer sharps’ and ‘needle-free’ products are available. Ensure you know how to use them and always dispose of them immediately at the point of care. Sharps MUST NOT be used to administer medication via needle-free ports or access devices. 4. ANTT (Aseptic Non-Touch Technique) During any interaction, ensure key parts and key sites are protected from inadvertent touch contamination. 5. Procedure Tray Disinfect the procedure tray before and after use. Aseptic preparation of a procedure tray MUST be completed and key parts protected from touch contamination. 6. VIP Score (Visual Infusion Phlebitis) Visually check the condition of the cannula and the insertion site with the VIP score and document the results EVERY SHIFT. Review ongoing need and replace the cannula if it reaches a score of 2 on the VIP score. Report all VIP scores of 2 and above as a clinical incident. 7. Cannula Check (still required?) Remove the cannula if not used for more than 24hrs. Consider replacing the cannula every 72 hours. (Document the reason/s if it is used beyond this time). As soon as the cannula is no longer in clinical use it MUST be removed. 8. Dressing Check (Clean and Intact) Ensure that the dressing is clean and intact. If loose or contaminated then replace using an Aseptic Non-Touch Technique (ANTT). DO NOT cross the securing strips to hold the cannula in place (use the wings of the cannula) and DO NOT secure with additional tape. 9. Cannula Access (Hub) Visually check the condition of the cannula and ensure key parts are protected on the procedure tray. Scrub the tip of the Hub with ‘2% Chlorhexidine Gluconate (CHG) + 70% alcohol’ disinfectant wipe for 30 seconds then allow to dry before accessing. Disinfect the hub surface for at least 15 seconds.


10. Giving sets (administration set) Label administration sets with the date they are due to be changed, and replace;

• after 72 hrs for continuous IV fluids (pre-made) • after 24 hours for made-up antibiotics or where drug mixing/manipulation has

occurred • after 24 hrs for TPN • After EACH Unit of blood, or 12 hrs for a continuous blood transfusion.

11. Occlusion prevention DO NOT disconnect administration sets unless they are being removed. DO NOT allow empty IV bags to remain in situ as backflow may block the IV cannula. DO flush the cannula immediately after completion of the infusion. 12. Dislodgment prevention Ensure fixation strips (supplied with each dressing) are used to hold the wings of the cannula in place. DO NOT cross the strips to hold the cannula as this also blocks the insertion site. The use of short extension with closed ‘needle-free’ devices will prevent the cannula from becoming loose and dislodging.


Peripheral IV cannula care: record form Seek further help from a more experience cannulation practitioner if you are unable to cannulate after 2 attempts!

• The IV access site must be checked EVERY SHIFT when in use for signs of infusion phlebitis, infiltration and/or extravasation

• Replace and re-site the cannula if it reaches a score of 2 on the V.I.P. score (Record as a clinical incident if it reaches this condition)

• The V.I.P. score MUST be documented and any actions taken recorded in the patient’s documentation

• REMOVE the cannula if it is NOT USED for 24 hours, or after 72 hours use (document the reason if this 72hrs limit is exceeded)

Cannula 1 Date

Time am pm night am pm night am pm night am pm night am pm night

Dressing Checked (√ or R =replaced)

Cannula still req’d

Hub disinfected (2% CHG+70% alco wipe)

Giving set checked (√ or R =replaced)

VIP Score (2 = clinical

incident)

Checked by (PRINT)

------- Addressograph Label ------------- Patient’s Name: …………………...................…… Address:………………………………………….………....

..………………………………………….……..………………

.......................................................................

Hospital No. ………………………….…………...........

DO NOT DESTROY: Please file in patient’s medical records following discharge.

Appendix 3

Peripheral IV cannula care: record form Comments:

Seek further help from a more experience cannulation practitioner if you are unable to cannulate after 2 attempts!

DO NOT DESTROY: Please file in patient’s medical records following discharge.

For long-term IV infusions made up in-house, consider the use of; 1. Particulate filters 2. Air eliminating filters 3. Endotoxin filters (See also pharmacy guidelines) Page 1 of 2 P.T.O. Designed by PT Lee, with help from Andrew Jackson, Consultant Nurse IV Therapy; Rotherham NHS Foundation Trust


Seek further help from a more experience cannulation practitioner if you are unable to cannulate after 2 attempts!

Cannula 2 Date

Time am pm night am pm night am pm night am pm night am pm night



Hub disinfected (2% CHG+70% alco. wipe)



incident)

Checked by (PRINT)

Cannula 3 Date

Time am pm might am pm night am pm night am pm night am pm night



Hub disinfected (2% CHG+70% alco. wipe)



incident)

Checked by (PRINT)


Appendix 4: Safe Removal of Peripheral IV Cannula

(Page 1 of 2)

Standard. The removal of any vascular access device must only be undertaken by an appropriately trained practitioner. This instruction relates to the removal of IV peripheral cannula only. General Guidance. Peripheral cannulae should be removed after 72 hours but devices may stay in longer with no significant complications, provided that non-irritants are being delivered and regular observations are being made and documented. The cannula may be removed by a suitably trained member of staff in accordance with these instructions provided that they have the appropriate experience, knowledge and skills. Evidence of training and competence in this procedure is required by all healthcare professionals undertaking this task in ABMU Health Board. Removal of a cannula should be an aseptic procedure. The cannula should be removed carefully using a slow, steady movement and pressure should be applied until haemostasis is achieved. This pressure should be firm, and not involve any rubbing movement. A haematoma will occur if the cannula is carelessly removed, causing discomfort and a focus for infection. The site should be inspected to ensure bleeding has stopped and the site should be covered with a sterile dressing. When the cannula is removed the tip should be checked to ensure it is intact and if the tip is not complete it should be reported and the appropriate patient observation and actions taken. It should also be documented in the patient’s medical and nursing notes. The date, time and reason for removal must then be documented in the patient’s notes If removal is due to cannula-related infection the cannula tip should be sent to the microbiology laboratory for culture and antimicrobial sensitivity. It should be placed in a sterile universal container for transportation to Laboratory. This action should also be documented in the patient’s care plan. Any device defect should be reported to the risk management department, the supplies department, the manufacturer, and the MHRA and NPSA as appropriate. The following documents were used for reference. Royal Marsden Clinical Nursing Procedures. 9th Edition Standards for Infusion Therapy: RCN (2016)

(Page 2 of 2)


Equipment Non-sterile gloves Disposable apron Sharps bin Sterile gauze and tape (or other sterile dressing) Clinical waste bag Procedure

Assessor’s Name: (PLEASE PRINT)……………………………………………………....

Candidate’s Name:(PLEASE PRINT..)……………………………………………………..

Staff No………………………………………………………..............................................

Job Title: ……………………………………………………………………………………….

Hospital: ……………………………………….……………………….................................

Ward: ……………………………………….… Ext. No ……………………………………..

The person named above has demonstrated the knowledge and ability to successfully remove IV cannulae in accordance with the instructions given. Assessor Signature ………………………………. Date ………………………….. I agree and support the above statement and feel confident and competent in this process. Candidate Signature: ……………………………… Date …………………………….

Criteria Assessed 1. Wash hands with a liquid soap & water. Dry hands thoroughly using disposable paper towels.

2. Apply alcohol gel to hands and allow to dry 3. Put on well-fitting non-sterile gloves and a disposable apron 4. Prepare a sterile dressing to apply to site, keep within its own packaging. 5. Remove the cannula dressing: DO NOT USE SCISSORS 6. Gently withdraw cannula keeping the hub parallel with the skin 7. When the cannula has been withdrawn, apply firm pressure on the insertion site for 2 to 3 minutes with sterile gauze.

8. If the cannula has been inserted into the antecubital fossa ‘ DO NOT’ advise the patient to bend their arm

9. When the bleeding has stopped, apply a sterile gauze dressing 10. Ensure cannula integrity, if there is any doubt if the device is intact;

• Retain the device for further investigation • Report immediately to ward manager • Seek medical advice

11. Dispose of device into sharps bin. Discard dressing into clinical waste 12. Wash hands on removal of gloves and apron

13. Document that the device has been removed, with the reason for removal in the patent’s notes/care plan.

peripheral intravenous cannulation best practice … abm...peripheral intravenous cannulation best...

Documents