Iv cannulation 2007

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Iv cannulation 2007

  1. 1. Intravenous Cannulation Training Workbook Name _____________________________ Ward _____________________________ Date: ______________________________
  2. 2. Last Revised: August 2007 Authors: Koli Ali, Clinical Nurse Consultant, Ward 5F Sandra Ridings, Nurse Educator, Centre for Nursing & Midwifery Education and Research 1998 Consultation with: IV Cannulation Working Group Annette Boonen (Chair Person), Nursing Director Surgical & Specialty Services Division Dr Marion Eckert, Director, Nursing and Midwifery Education Jennifer Kempson, Nurse Unit Manager, Medical Imaging Helen Fuss, A/CNC, Ward 5C Kylie Hamblin, A/CNC, Ward 5E Sandra Ridings, Nurse Educator, Centre for Nursing & Midwifery Education and Research Acknowledging: We wish to acknowledge: • the significant contribution of the Infection Control Unit at Flinders Medical Centre in the development of the Guidelines for Prevention of Peripheral Intravascular Device-Related Infections • the skills and clerical support of the Centre for Nursing & Midwifery Education and Research in the design, layout and word processing of this learning package • the clinical areas who contributed expertise and resources adapted for use within this package. Thank You Administrative Assistance: Heather Powell Centre for Nursing & Midwifery Education and Research Disclaimer This program/learning package was produced for the education and use of health care professionals at Flinders Medical Centre/Southern Adelaide Health Service. While every effort has been made to ensure that this learning package information is correct and in accordance with current recommendations in clinical practice at the time of publication, it is not designed to replace independent professional judgement and understanding of the clinical situation. © Flinders Medical Centre 1998 - 2007 For a copy of this booklet please contact Centre for Nursing & Midwifery Education and Research on extension 64227C:Documents and Settingsedt014My DocumentsCannulationOnLineIV Cannulation 2007 V1.2.docVersion 1.2May 2008Next Review Date: 2010
  3. 3. IV Cannulation Training Workbook CONTENTSINTRODUCTION 5PERIPHERAL INTRAVENOUS CANNULATION , PATIENT CONSENT ANDSCOPE OF NURSING MIDWIFERY PRACTICE 7OBJECTIVES 10ANATOMY AND PHYSIOLOGY OF VEINS 11 ACTIVITY 1 12 ACTIVITY 2 13 ACTIVITY 3 15INDICATIONS FOR INTRAVENOUS CANNULATION 17 ACTIVITY 4 19 Guidelines for Prevention of Peripheral Intravascular Device-Related Infections 19CANNULATION 29INTRAVENOUS CANNULATION WORKSHEET 35REFERENCES 39RECOMMENDED RESOURCE 39APPENDIX 1 41 ANSWER: ACTIVITY 1 41 ANSWER: ACTIVITY 2 42 ANSWERS TO WORKSHEET 43APPENDIX 2 47 AUDIT INSERTION OF PERIPHERAL INTRAVENOUS CANNULA 47 AUDIT COMPLETION RECORDED BELOW 50APPENDIX 3 51 PERIPHERAL IV CANNULATION/NURSE PROCEDURE (C3) 53WARD ADDENDUM MATERIAL 61EVALUATION FORM 63C:Documents and Settingsedt014My DocumentsCannulationOnLineIV Cannulation 2007 V1.2.docVersion 1.2May 2008Next Review Date: 2010
  4. 4. IV Cannulation Training WorkbookC:Documents and Settingsedt014My DocumentsCannulationOnLineIV Cannulation 2007 V1.2.docVersion 1.1August 2007Next Review Date: 2010
  5. 5. IV Cannulation Training WorkbookIntroductionPeripheral intravenous cannulation is an invasive medical procedure performed by clinicians thathave received appropriate training in the procedure and have been deemed competent through anaudit process.Increased numbers of nursing staff competent in intravenous cannulation in a clinical unit has beendemonstrated to improve patient outcomes (ie. reduction in delays for peripheral intravenouscannulation by medical staff).THE PURPOSE OF THIS WORKBOOKThe workbook aims to provide a starting point for you to develop and acquire the knowledge andskills necessary to competently insert peripheral intravenous (IV) cannulae. Some clinical specialitiesmay have additional needs, so please talk with your Clinical Nurse/Midwife Consultant (CN/MC)about specific ward needs before commencing the workbook, and ensure you have a copy of yourward-specific addendum.EDUCATIONAL GUIDELINESNurses/ midwives who can evidence the following criteria may insert intravenous cannulae as perprocedure C3 in the Nursing/Midwifery Policies & Procedure Manual. 1. completion of this workbook, 2. attendance at an IV cannulation workshop, 3. achievement of at least 3 successful supervised cannulations, (the learner can request more supervision if desired) 4. self declaration of clinical competence (annually)Recognition of prior learning of achievements from an equivalent training program may be grantedby the appropriate clinical manager.The Clinical Nurse/Midwife Consultant/Manager of the Clinical Unit/Service is responsible foridentifying nurses/midwives suitable for entry into the training program.Progress toward achievement of competency is documented on the Audit Tool located in Appendix2.If you would like more information, please contact your CNC or Nurse Educator. Under no circumstances shall Students of Nursing be trained to insert peripheral intravenous cannulae.MAINTAINING IV CANNULATION COMPETENCEFollowing accreditation, it is your professional responsibility to maintain your competence in theprocedure and to request further education and audits if you do not perform the procedure withsufficient regularity to maintain competence. 5 of 64
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  7. 7. IV Cannulation Training WorkbookPeripheral Intravenous Cannulation , Patient Consent And Scope OfNursing Midwifery PracticeThe scope of practice of nurses/midwives to insert peripheral intravenous cannulae (PIVC) atFlinders Medical Centre (FMC) is outlined below using the Scope of Practice Decision Making FlowChart. NBSA 2006.Public Interest & Client CentredA client need for insertion of peripheral intravenous cannulae is evident, with the procedure beingthe second most common invasive procedure for patients in hospital. (Dougherty 1996).Benefits to the client of nurse insertion of PIVC include reduction of waiting time for analgesia inthe Emergency Department and reduction in waiting times, particularly after hours for initiation orrecommencement of intravenous therapy.Historically, peripheral intravenous cannulation has been a clinical skill not associated with thenursing/midwifery profession. However, over the last 30 years the number of nurses/midwivestrained and proficient in the skill has increased. Consultation with the client prior to invasiveprocedures is mandatory under Australian Law. The Australian Nursing & Midwifery Council , Codeof Professional Conduct for Nurses in Australia states a nurse must: 1. Practise in a safe and competent manner 2. Practise in accordance with laws relevant to the nurse’s area of practice.Scholefield et al (1997) in Lavery I (2003) stated that for consent to be legally valid, the patient must: • Have capacity in law • Be properly informed beforehand • Give consent voluntarily. (Verbal consent is satisfactory for PIVC)Nurses/midwives whose scope of practice includes PIVC at FMC must be familiar with theseconcepts as outlined in Procedure/Guideline LM2.6 : Consent to Treatment and Related MedicalProcedures. FMC procedures/guidelines/protocols online 2006.Information to be discussed with the patient must show a balanced view of options and includesufficient information to enable a choice to proceed or refuse the cannulae placement. Lavery, 2003asserts that information given about cannulation should inform and educate, be timely and includedetails of the procedure and post procedure care at a level appropriate for the individual.“Education must include appraising patients of their responsibilities to report pain, swelling,discomfort, redness, leakage or loose dressings, as well as giving advice about not touching thesite/cannula, and care when dressing/undressing. If it is a site of flexion, the patient must be advisedto minimise movement. Many patients think they are being left with a needle in their arm, so eachnurse has a responsibility to ensure educating the patient includes giving information about thecannula.”(Lavery, 2006, p41)Consultation with medical staff prior to placement of PIVC is mandatory where a clear clinicalrationale for cannulation is not evident to the nurse/midwife, concerns are raised by the patientabout the necessity for the procedure or nurse workload is such that patient care could becompromised by performance of the procedure. 7 of 64
  8. 8. IV Cannulation Training WorkbookRegulation / ProfessionalExplanatory notes extracted from the Australian Nursing & Midwifery Council , Code ofProfessional Conduct for Nurses in Australia clarify the meaning and scope of operation of theprovision:“ 1. A nurse must practise in a safe and competent manner • A nurse is personally accountable for the provision of safe and competent nursing care. Therefore it is the responsibility of each nurse to maintain the competence necessary for current practice. • Maintenance of competence includes participation in ongoing professional education to maintain and upgrade knowledge and skills relevant to practice in a clinical, management, education or research setting. • A nurse must be aware that undertaking activities that are not within their scope of practice may compromise the safety of an individual. The scope of practice is based on each nurse’s education, knowledge, competency, extent of experience and lawful authority.” (p2)Once nurses/midwives at FMC have successfully completed the Intravenous Cannulation TrainingWorkbook & demonstrated competence and knowledge at a practical workshop they maycommence insertion PIVC under supervision of a person delegated by their CN/MC untilcompetence is demonstrated.Following accreditation, it is the nurse’s/midwive’s professional responsibility to maintaincompetence in the procedure and to request further education and audits if they do not perform theprocedure with sufficient regularity to maintain competence.The procedure for insertion of PIVC is explained in Procedure C3: Peripheral IV Cannulation in theFMC procedures/guidelines/protocols.The procedure/guideline: Guidelines for prevention of peripheral intravascular device-relatedinfections (IC 7) advises responsibilities during and after insertion of PIVC and includesDepartment of Health recommendations in care for South Australia.OrganisationalNursing skills/competencies maintenance procedure guideline: No HR2.5 identifies organisationalresponsibilities for skills development, training programs and review processes.Individual responsibilities for clinical practice are described in job and person specifications for eachclassification of nurse/midwife.The need for skills development in nurse insertion of PIVC has been identified following collectionof after hours clinical data that indicated that patients were experiencing potentially avoidable delaysin intravenous therapy, due to workload issues related to limited numbers of medical staff availableto perform cannulation at this time.A working group was established to review clinical and educational processes associated with PIVCand facilitate an evidenced based and educationally sound approach to improving the numbers ofnurses competent in cannulation. 8 of 64
  9. 9. IV Cannulation Training WorkbookOutcomes included a review of scope of practice for nurses and midwives at FMC anddetermination of best practices to achieve an increase in skill levels of nurses & midwives incannulation. Recommendations were forwarded and ratified by the Professional practice Committee2006.IndividualPrior to inclusion of PIVC into their scope of practice, individual nurses & midwives must answeraffirmatively to the following: • Do I have the educational preparation to insert a PIVC? • Do I have the knowledge and skills to insert a PIVC? • Do I have the appropriate experience or do I require supervision? • Am I competent to insert a PIVC in this patient, for this purpose?Note: PIVC inserted for chemotherapy must be performed by nurses specifically trained for thisprocedure.Declaration of self competence requires supporting evidence be available to validate the claim ifrequired. Accurate documentation of patient assessment, education provided and outcome of PIVCinsertion are essential elements of clinical competence. Additionally, nurses/midwives performingadvanced skills are advised to maintain a personal log of continuing education and feedback todemonstrate ongoing clinical competence.Records of nurses & midwives delegated, through successful application and demonstration of skillsand knowledge outlined in this training workbook, to insert PIVC are to be maintained by relevantClinical Nurse / Midwife Consultants.References:ANMC (2005) Code of Professional conduct for Nurses in Australia www.anmc.org.au accessed 18/09/06Lavery, I (2003) Peripheral intravenous cannulation and patient consent, Nursing Standard, March 2006vol17/No 28 pp40-42.NBSA (2006) Scope of Practice Decision Making Flow Chart.Procedure/Guideline LM2.6 : Consent to Treatment and Related Medical Procedures. FMCprocedures/guidelines/protocols online 2006.Procedure/guideline: Guidelines for prevention of peripheral intravascular device-related infections (IC 7) FMCprocedures/guidelines/protocols online 2006.Procedure/Guideline No HR2.5 Nursing skills/competencies maintenance procedure guideline FMCprocedures/guidelines/protocols online 2006. 9 of 64
  10. 10. IV Cannulation Training WorkbookObjectivesOn completion of the package, you will be able to: • outline the anatomy of veins • state indications for intravenous cannulation • discuss infection control issues related to insertion and maintenance of peripheral venous cannula • appreciate the psychological responses of patients to insertion of an intravenous cannula and the physical changes which may ensue • select a vein suitable for cannulation • select an appropriate cannulae for the patient’s needs • demonstrate knowledge of techniques to promote successful intravenous cannula placement • insert a peripheral intravenous cannula 10 of 64
  11. 11. IV Cannulation Training WorkbookAnatomy and Physiology of VeinsVeins have three layers:a) tunica intima (inner layer) An elastic, endothelial lining which also forms the valves. Valves are semilunar folds of endothelium and their function is to keep the blood flowing towards the heart. They occur more frequently at junctions and can be observed as a small bulge in the veins. Valves can interfere with the withdrawal of blood as well as the advancement of a cannula. (Dougherty 1996)b) tunica media (middle layer) Muscular and elastic tissue, as well as nerve fibres. These keep the vessels in a state of tonus and stimulate the vein to contract and relax. Stimulation by a change in temperature or by mechanical or chemical irritation may produce venospasm, which impedes the flow of blood and causes pain. (Dougherty 1996)c) tunica adventita (outer layer). Comprises the epidermis and the areolar connective tissue which surrounds and supports the vessel. 11 of 64
  12. 12. IV Cannulation Training WorkbookActivity 1Consider the effect of the application of warmth over the vein and the converse effect of a rapidinfusion of cool or irritating infusate into the vein. Outline the clinical implications: 12 of 64
  13. 13. IV Cannulation Training WorkbookActivity 2Locate and name the landmarks indicated on the following diagram:Sites of selection for the insertion of intravenous needles for the parenteral administration of fluids,medication or for blood transfusion.Brunner, Suddarth (1988), Textbook of Medical - Surgical Nursing. Chpt. 9, p 127, 6th Ed, JBLippincott Co, Philadelphia. 13 of 64
  14. 14. IV Cannulation Training WorkbookThe superficial veins of the arms should be used for the placement of intravenous cannulae inadults.• easily accessed• allow patients to perform activities of daily living with minimal impairment to function. (Dougherty 1996)1 Digital veins/Metacarpal veins - easily visualised and palpated - leaves proximal sites on the limb for cannulation - use with caution in elderly people and where skin turgor and subcutaneous tissue is diminished2 Cephalic vein - large vein, which is easily stabilised and accessible. Its size and position make it an excellent choice for intravenous therapy - good vein for large bore cannula, and useful for rapid infusions, including blood - more comfortable for patient, as hand is free3 Basilic vein - large easily palpable vein but may be difficult to access and stabilise due to its location.4 Median Cephalic and Basilic veins - usually used for venipuncture. Their size and superficial location make them easy to palpate and visualise and they are well supported by connecting tissue - can be difficult to stabilise (in joint) - risk of dislodgment , infiltration, extravasion and mechanical phlebitis - median cephalic vein crosses in front of the brachial artery and care must be taken to avoid puncturing the artery. (Dougherty 1996) 14 of 64
  15. 15. IV Cannulation Training WorkbookActivity 3 Inspect your own and a colleague’s arms and locate veins indicated on diagram 1. 15 of 64
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  17. 17. IV Cannulation Training WorkbookIndications for Intravenous CannulationIt is important to find out the reason for IV placement before you approach the patient to avoidpotentially unnecessary procedures and because the indication for IV cannulation will affect site andcannula selection.Four broad categories for intravenous cannula placement include:• restoration and maintenance of fluid and electrolyte balance• administration of drug therapy• transfusion of blood products• access in the case of potential complications. (Lawrence: unpublished)Routine replacement of cannulae after 72 hours (per procedure C3) is performed as the result ofresearch evidence. (CDC Guidelines) 17 of 64
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  19. 19. IV Cannulation Training WorkbookActivity 4GUIDELINES FOR PREVENTION OF PERIPHERAL INTRAVASCULAR DEVICE-RELATED INFECTIONS 19 of 64
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  29. 29. IV Cannulation Training WorkbookCannulationRefer also: Procedure 4.10 Manual of Nursing Policies and Procedures1 Gather equipment Chlorhexidine in alcohol solution/Persist Plus gauze swabs tourniquet non sterile gloves IV cannula of appropriate size primed IV line interlink bung transparent film absorbent sheet to protect linen +/- local anaesthetic2 Approach to the patientFear or anxiety related to IV cannulation may trigger a response by the autonomic nervous system.This may manifest as syncope and/or peripheral vasoconstriction, making venous access moredifficult. You should therefore; • ask the patient about previous experiences with IV cannulation • explain the procedure prior to commencement • encourage the patient to participate in the decision making process of site selection.Whilst you are learning, you should not attempt cannulation on patients: • with blood clotting disorders • on anticoagulant therapy • who have extreme needle phobia • with fragile veins • who have a history of prolonged/multiple IV accesses.The patient should be afforded privacy and be made as comfortable as possible prior tocommencement. Adequate lighting and ambient warmth is necessary to facilitate a successfulcannulation.If the patient has extremely hairy arms, clip the hair to remove, do NOT shave the site as shavingcan increase the risk of infection. 29 of 64
  30. 30. IV Cannulation Training Workbook3 Select a veinApply tourniquet: tight enough to occlude veins check pulse present BP cuff 60 mmHgPerform a visual inspection of both upper limbs, followed by palpation of the veins likely to beused.Palpation is performed using the flat pads of two fingers. The same two fingers should be used consistently to increasesensitivity and accurate assessment skills.Visualisation of the vein as a tube resembling a noodle lying under the skin may assist in assessment.A suitable vein should feel round, firm, elastic and engorged. It should also be visible, straight andwell supported. Hardened, knotty torturous veins are often sclerosed and not suitable forcannulation as they are fragile and lead to premature extravasion.The size of the vein should be suitable for the volume of solution to be infused.Select the most distal site initially so subsequent cannulae can be moved progressively upward.It is recommended to use the non dominant hand/arm.Vesicant medications may cause necrosis and should only be infused through large, stable veins.Generally, the central venous route is preferred, however some chemotherapy may be administeredperipherally. Only RNs who have rotated through the Haematology/Oncology Day Unit and havebeen specifically accredited, may insert an IV cannula for chemotherapy. Areas such as the wrist andthe dorsal aspect of the hand should be avoided. These areas have delicate structures with littleprotection provided by body tissue and fat. Infiltration may cause extensive damage and functionalloss. 30 of 64
  31. 31. IV Cannulation Training WorkbookAVOID• areas of flexion because of risks as outlined above, and bruising/difficulty with stabilisation• areas over arteries. In the cubital fossa, veins and arteries lie close together. Palpate for arterial pulsation before venipuncture.• arms with existing arterial line• arm that has had brachial angiogram performed less than three days before• arms with veins that have been surgically compromised, eg; mastectomy or axillary/arm surgery. Peripheral return may be severely reduced.• limb with Arterio Venous fistula. By using this limb you may compromise the AV fistula• cannulation below a previous infiltration or phlebitis• cubital fossa (where possible)• lower extremities in adults, because of the increased risk of thrombophlebitis and pulmonary embolism• veins near bony prominences. (Evans, 1998)4 Select a CannulaAssess the condition of a patient’s veins and consider the prescribed therapy. Select the smallestcannula that will accommodate the prescribed therapy. “A large cannula will occlude the flow of blood,leading to chemical phlebitis from irritating solution, or mechanical phlebitis from friction exerted by the device on theintima of the vein.”(Dougherty 1996) 24 g paediatrics, cytotoxic therapy 22 g paediatrics, cytotoxic therapy, blood products 20 g maintenance fluids, minor day surgery, infusion of medications (most commonly used gauge), blood products 18 g antibiotics, blood and blood products, multiple line access, large volume fluid, trauma, major surgery. 16 g high volume fluids, major surgery, multiple blood transfusions >200 ml/hr 14 g fast high volume fluid replacement, haemorrhage. (Evans, 1998) 31 of 64
  32. 32. IV Cannulation Training Workbook5 Consider use of local anaesthetic - Pain Reduction Good technique, skill and vein selection will reduce the amount of pain experienced by patients. Some patients, however, may request a local anaesthetic. The usefulness of lignocaine is debatable, although it can reduce the pain of the insertion, especially when large gauges are used. However, it stings (unless buffered), can obscure the vein, and should not be used if vesicants are to be administered immediately following insertion as it could mask signs of extravasion. Topical anaesthetic creams such as Emla have been found to be useful, but may cause vasoconstriction.’ (Dougherty 1996) If indicated, use a small needle and inject approximately 0.1 mL of Lignocaine 1% or Procaine Hydrochloride 1% intradermally or subcutaneously. A small weal is created. Prior to injecting, withdraw the plunger to ensure needle is not in vein.6 Prepare the site • clean area with chlorhexidine in alcohol solution or Persist Plus7 Obtain assistant (if not done previously)8 Wash hands and don gloves9 Emulate pictorial demonstration of technique of appropriate cannula. 32 of 64
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  35. 35. IV Cannulation Training WorkbookIntravenous Cannulation Worksheet(Additional reading may be required - see references)1 List four factors to consider when assessing the patient for intravenous cannulation.2 List two groups of patients who should be approached cautiously with regards to intravenous cannulation.3 List contraindications for arm choice for IV cannula placement.4 Briefly state the physiological response which may hinder venous cannulation, if the patient does not receive an adequate explanation of the procedure. 35 of 64
  36. 36. IV Cannulation Training Workbook5 State the implication of long term intravenous therapy on vein choice for cannula placement.6 List three veins found in cubital fossa.7 How far above the intended puncture site should the tourniquet be placed?8 Is it necessary to check for a radial pulse when the tourniquet has been applied?9 List actions to help raise a vein not dilated after tourniquet application.10 What should the cannula be inspected for, prior to insertion? 36 of 64
  37. 37. IV Cannulation Training Workbook11 What is the purpose of stretching the skin taut below the puncture site?12 Describe the technique used to advance a cannula if resistance from a valve is encountered.13 If the patient is elderly or has sensitive skin, what nursing action can be taken when applying the tourniquet?14 What is the nursing responsibility when the procedure is complete?15 State two reasons for avoiding the cubital fossa when inserting an intravenous cannula. 37 of 64
  38. 38. IV Cannulation Training Workbook16 What puts a patient at risk of developing a peripheral line infection?17 Name two potential further complications of a peripheral line infection. 38 of 64
  39. 39. IV Cannulation Training WorkbookReferencesBest Practice, Management of Peripheral Intravenous Devices. Vol. 2, Issue 1, 1998.Dougherty, L., 1996, Intravenous Cannulation, Nursing Standard, Vol 11, No 2, pp 47 – 54.Evans, P et al, 1998, Emergency Department-Intravenous Cannulation For Registered NursesFlinders Medical Centre, Clinical Nursing Policies and Procedures ManualInwood Sheila, 1996, Designing a Nurse Training Program for Venepuncture. Nursing Standard, Feb 14, Vol 10, No. 21.Lawrence, B., Peripheral Intravenous Cannulation Learning Package (unpublished)Millam, D A., 1992, Starting IVs Nursing 92, September, pp 33 – 46Redden, M., Bates, W., Intravenous Cannulation Learning Package, Haematology/Oncology Day Unit Orientation Package.Recommended ResourceDougherty, Lisa., Lamb, Julie., (1999) Intravenous therapy in nursing practice, Churchill Livingston, Edinburgh. 39 of 64
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  41. 41. IV Cannulation Training Workbook Appendix 1Answer: Activity 1Application of warmth will cause venous dilatation and promote engorgement of the vein.The vein should be more easily palpable and cannulated.To improve the chances of successful cannulation in patients with veins that are difficult tolocate/palpate, apply a warm pack over the chosen site.Conversely, rapid infusions of cool fluids cause vasoconstriction and vasospasm. This will make thevein more difficult to cannulate and increase the pain of the procedure.If the patient is in a cold environment, vasoconstriction may occur as the body attempts to preventheat loss. It is therefore important that this procedure be performed in a warm environment. 41 of 64
  42. 42. IV Cannulation Training WorkbookAnswer: Activity 2Sites of selection for the insertion of intravenous needles for the parenteral adminstration of fluids,medication or for blood transfusion.Brunner, Suddarth (1988), Textbook of Medical-Surgical Nursing. Chapter 9, p127, 6th edition, J..B. LippincottCo., Philadelphia.The veins are numbered according to the preferred choice of cannulation. 1 being the mostpreferred. 42 of 64
  43. 43. IV Cannulation Training WorkbookAnswers to WorksheetQuestion 1(include 4) • patient’s medical history • size, age and general condition • condition of veins • previous experience of patient with IV cannulation • type of fluid/medication to be administered • expected duration of therapyQuestion 2(include 2) Patients with: • blood clotting disorders • on anticoagulant therapy • extreme needle phobia • fragile veins • a history of prolonged/multiple IV accessQuestion 3 Avoid: • arms with existing arterial line • arm that has had a brachial angiogram performed less than three days before • arms with veins that have been surgically compromised; eg mastectomy or axillary/arm surgery • limb with Arterio Venous fistula • arms with burns/sclerosis • if possible, avoid the dominant armQuestion 4 Patient anxiety increases. Increased adrenaline. Peripheral vasoconstriction.Question 5 Select most distal site possible, so you can move up the limb if necessary. 43 of 64
  44. 44. IV Cannulation Training WorkbookQuestion 6 Median cubital vein Basilic vein Cephalic veinQuestion 7 10 - 20 cmQuestion 8 YesQuestion 9 • Tap finger gently over vein • position arm below heart level to encourage capillary filling • apply a warm pack/cloth over vein • release and reapply tourniquet. Veins may refill better on the reboundQuestion 10 Burrs/damage. Discard imperfect cannulae.Question 11 Assists in stabilisation of the veinQuestion 12 Retract stylet. Attach 2ml syringe of N/Saline to catheter. Advance catheter whilst injecting N/Saline, ie. float the catheter past the valve.Question 13 Apply tourniquet on top of the patient’s gown 44 of 64
  45. 45. IV Cannulation Training WorkbookQuestion 14 • Patient comfort • Safe disposal of sharps • Documentation of date, site, operator - use green sticker in medical record.Question 15 • Avoids nerve damage • Save for emergency access • Avoids premature dislodgment. • Reduces risk of infection.Question 16 • Inadequately prepared site • Poor technique • Use of alcohol alone • Leaving the line insitu > 48-72 hrsQuestion 17(include 2) • Bacteraemia • Endocarditis • Valve replacement surgery 45 of 64
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  47. 47. IV Cannulation Training Workbook Appendix 2Audit Insertion of Peripheral Intravenous Cannula IV Cannulation Accreditation and Audit Recording The staff member can be accredited in peripheral IV cannulation insertion when the following have been achieved. • workbook complete • all activities undertaken • worksheet satisfactorily completed • at least three audits performed by a person designated by your CNC - (there is no limit to the number of audits and supervised insertions. You may request as many as you feel you need). AUDIT Insertion of Peripheral Intravenous Cannula Name: Date: Staff Member Instructions: The assessor observes the staff member’s IV cannulation technique and places a YES/NO in the appropriate column to indicate achievement of performance criteria. All aspects must be achieved for satisfactory completion. Criteria achieved YES/NO 1 2 3 Optional Optional 1 Checks • correct patient • cannulation clinically indicated • MO authorisation for cannulation (if required). 2 Obtains informed consent from patient and checks for allergies. 3 Performs hand wash prior to preparation. 47 of 64
  48. 48. IV Cannulation Training Workbook Criteria achieved YES/NO 1 2 3 Optional Optional4 Prepares equipment prior to commencement of procedure. • Appropriate size safety cannula (smallest gauge possible) • Does not rotate cannula prior to insertion • Chlorhexidine (1%) Ethanol (75%) (Persist Plus) • Tourniquet • Non-sterile gloves • Interlink cannula and bung • Tape (if required to secure IV tubing) • Transparent film dressing • Syringe and ampoule 0.9% saline for flushing • Sharps disposal container5 Ensures second assistant is present • To support patient and assist in insertion as required.6 Prepares patient for procedure • Positions patient comfortably and ergonomically (for operator) • Explains procedure to patient • Assesses and selects appropriate vein • Clips hair from site if necessary • Ensures equipment prepared • Performs surgical handwash • Dons gloves • Applies tourniquet 20cm above insertion site • Re-assesses selected vein (palpate and visually inspect) • Cleanses skin 5cm in circular motion around selected site with chlorhexidine and allows to dry7 Performs cannulation procedure if indicated: • Infiltrates around site with local anaesthetic (must be ordered MO) • Draws skin taut below site • Inserts cannula stylet with bevel uppermost (angle 30°) • Ensures ‘flashback’ of blood into chamber • Releases tourniquet • Lowers cannula stylet by 5°-10° towards skin • Advances whole assembly approx. 5mm • Holds stylet and completes insertion of cannula until HUB is flush with skin • Places finger over vein distal to catheter tip • Removes stylet and disposes it into sharps container • Attaches IV line to cannula and ensures patency on commencement of infusion OR • Ensures patency with IV flush and attaches bung to cannula • Seals IV site with transparent dressing (dated) • Secures IV tubing with tape in J loop 48 of 64
  49. 49. IV Cannulation Training Workbook Criteria achieved YES/NO 1 2 3 Optional Optional8. Ensures patient comfort and safety.9. Disposes of used equipment maintaining standard and additional precautions.10. Performs handwash.11. Documents in progress notes appropriately.12. Codes Procedure in Excelcare 49 of 64
  50. 50. IV Cannulation Training WorkbookAudit completion recorded below1 All criteria met as above. Comments: Signature: Date: Assessor2 All criteria met as above. Comments: Signature: Date: Assessor3 All criteria met as above. Comments: Signature: Date: Assessor4 (Optional) All criteria met as above. Comments: Signature: Date: Assessor5 (Optional) All criteria met as above. Comments: Signature: Date: Assessor 50 of 64
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  53. 53. IV Cannulation Training WorkbookPeripheral IV Cannulation/Nurse Procedure (C3) 53 of 64
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  61. 61. IV Cannulation Training WorkbookWard Addendum Material Ensure you have a copy of your ward-specific IV cannulation addendum; available from your CNC. 61 of 64
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  63. 63. IV Cannulation Training WorkbookEvaluation Form IV Cannulation Training Workbook/Training ProcessYour comments and opinions on the content of the IV cannulation workbook & training processare very important to facilitate review and development for the future.All information will remain anonymous.Please circle your response and comment specifically1. The workbook achieved its overall aim to provide me with sufficient information on IV cannulation to commence the clinical procedural training. YES NO UNSUREComments2. The clinical procedural training was (circle appropriate response): a. Delivered in my clinical unit(if not, please comment) Yes No b. Relevant to my learning needs Yes No c. Enabled sufficient development of skills to progress confidently to supervised clinical practice Yes NoComments3. The supervised clinical practise enabled me to be confident in my ability to proceed to independent clinical practice within the scope of my professional designation/role. YES NO UNSURE Comments PTO 63 of 64
  64. 64. IV Cannulation Training Workbook4. I understand my role in peripheral IV cannulation procedure. YES NO UNSUREComments5. I am aware of my professional responsibility to maintain clinical competence through regular practice and to request additional training if required.-+CommentsProvide any suggestions to assist with future planning below.CommentsThank you for your valued comments. Please return, either personally or via internal mail system toAdministration Staff at Centre for Nursing & Midwifery Education and Research (CNMER) Level 7. 64 of 64

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