Policy on Peripheral Intravenous Cannulation - Halton and St ...

Peripheral Intravenous Cannulation <strong>Policy</strong> (Version 1.0) Nov 2007
<strong>Policy</strong> on Peripheral Intravenous Cannulation
For use in:
All areas of the Trust
For use by:
Competent Practitioners
Document Owner:
Lead Nurse for Intravenous Therapy
Approval Date:
Pending
Version Number: 1.0
Implementation Lead:
Statutory and Legal Requirements:
Implementation Process
Lead Nurse for Intravenous Therapy
Royal College of Nursing
Nursing and Midwifery Council
Standards for Better Health
Official launch day.
Distribution of the document to District Nursing
Teams within Halton and St Helens Primary Care
Trust (PCT).
Available on Trust Intranet site.
Assessment and monitoring of staff competencies.
The Trust is committed to an environment that promotes equality and embraces
diversity both within our workforce and in service delivery. This document should
be implemented with due regard to this commitment.
This document seeks to uphold the duties and principles contained within the
Mental Capacity Act. All Staff within the PCT should be aware of its implications.
If clinical activity takes place i.e. examination, hand decontamination should take
place before and after the procedure following the PCT Hand Decontamination
<strong>Policy</strong>.
This policy is due for review in February 2010, after this date, policy and process
documents may become invalid. <strong>Policy</strong> users should ensure that they are
consulting the current version of this document.
Issue Date: ??????? Author: Lead Nurse for Intravenous Therapy Page 1 of 9
Review Date: ??????? Lead Director: Director for Workforce & Development

<strong>Policy</strong> Content
1. Introduction
The majority of patients who are accepted by the Home Outpatient Parenteral
Therapy (HOPT) Service will have a suitable access device in situ. However, in
certain circumstances that are listed below, some nurses will need to be able to
perform peripheral intravenous cannulation.
• Patients who are receiving single dose infusions such as iron sucrose,
Herceptin etc.
• Some patients are discharged from hospital and may only require a few
days of intravenous therapy, therefore a peripheral cannula would be most
appropriate device.
• Patients who have been discharged from other acute Trusts may be
discharged with peripheral devices that could be used in the short term
until a more appropriate device can be placed.
2. <strong>Policy</strong> Status
This is a clinical policy document
3. Purpose
This <strong>Policy</strong> is designed to give information about peripheral intravenous
cannulation to any practitioner who has undertaken the appropriate training and
has been assessed as competent by either the HOPT Service or a delegated
assessor. It is to be used in conjunction with Halton & St Helens PCT’s Clinical
Guidance for the Insertion/Removal of Peripheral Intravenous Cannulae.
4. Scope
It applies to all practitioners who have undertaken a recognised training course
which consists of a theoretical and practical component and have been assessed
as competent, by the HOPT Service or a delegated assessor, following five
successful insertions of peripheral intravenous cannulae.
5. General <strong>Policy</strong> Statement
Halton & St Helens PCT will ensure that patients receive a high standard of care
within the community setting whilst receiving therapy via a peripheral cannula.
Clinicians will achieve this by:
• Staff adhering to the policy and guidelines
• Maintaining their own professional development
• Working within the NMC code of conduct
Issue Date: ??????? Author: Lead Nurse for Intravenous Therapy Page 2 of 9
Review Date: ??????? Lead Director: Director for Workforce & Development

6. Definitions
Definitions of terms used in the document:
Peripheral Intravenous - a procedure whereby a device is placed into a
Cannulation
patient’s vein to provide the therapeutic
administration of drugs, fluid and/or blood
products.
Herceptin - medication used to treat patients with breast
cancer.
Iron Sucrose - medication used to treat patients with iron
deficiency anaemia.
7. Duties and Responsibilities
Legal and statutory duties and responsibilities to the following general (Statutory)
duties apply:-
The following guidance was used in the production of this document
• Nursing and Midwifery Council (2004) Code of Professional Conduct
• Royal College of Nursing (2005) Standards for infusion therapy.
The following specific duties and responsibilities within Halton & St Helens PCT
apply:
The HOPT Service
The HOPT Service are responsible for the delivery of training and education
sessions around Peripheral Intravenous Cannulation. They are responsible for
the assessment of practice of Community Nurses who have completed the
theoretical component of the course and for the assessment of any other
nominated assessors.
Chief Executive:
The Chief Executive has overall accountability for the implementation and
adherence to the policy.
Trust Board:
The Trust Board is responsible for signing off the policy and has responsibility of
all clinical care within the PCT.
Director of Service Provision:
Is responsible for ensuring the policy is implemented and adhered to.
Halton & St Helens PCT Staff:
Have the responsibility for co-operating with the development and
implementation of Corporate and Directorate policies and procedures as part of
their normal duties and responsibilities.
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Review Date: ??????? Lead Director: Director for Workforce & Development

Temporary and Agency Staff, Contractors and Subcontractors:
All temporary and Agency staff, Contractors and Subcontractors will be expected
to comply with the requirements of Trust policies and procedures applicable to
their area of operations.
8. Process
Please refer to Halton and St Helens PCT’s Clinical Guidance for the
Insertion/Removal of Peripheral Intravenous Cannulae.
9. Training Requirements
Only nurses who have:
• Undertaken a recognised training course, which consists of a theoretical
and practical component
• Been assessed as competent by the HOPT Service or a delegated
assessor and completed the necessary number of successful insertions
of peripheral intravenous cannulae
are deemed as suitable to undertake this procedure within the PCT.
Nurses who have come from other Trusts and can prove that they have
completed similar training will need to be assessed at least once by a member of
the HOPT Service or a delegated assessor to ensure that they comply with PCT
guidelines.
10.Implementation Monitoring and Review
The Lead Nurse for IV Therapy is responsible for implementing this <strong>Policy</strong>
The Lead Nurse for IV Therapy is responsible for ensuring that this document is
reviewed and, if necessary, revised in the light of legislative, guidance or
organizational change.
Review shall be at intervals of no greater than 24 months.
Any revisions to this document shall be agreed through the approval process
indicated on the title page.
11. Documentation
This document should be read in conjunction with:
• RCN Standards for Infusion Therapy (Nov. 2005)
• Halton & St Helens PCT Clinical Guidelines for the Insertion/Removal of
Peripheral Intravenous Cannulae.
12.AUDIT
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Review Date: ??????? Lead Director: Director for Workforce & Development

This policy will be audited in line with the document Clinical Guidance for the
Insertion/Removal of Peripheral Intravenous Cannulation.
References
Nursing and Midwifery Council (2004) Code of Professional Conduct
Royal College of Nursing (2005) Standards for Infusion therapy
13. List of Appendices:
Appendix 1 - Visual Infusion Phlebitis Scale (Jackson,1998).
Appendix 2 - Infiltration Scale (Intravenous Nursing Society, 2000).
Appendix 3 - Size and Manufacturers’ Recommended Use of Peripheral
Intravenous Cannula
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Review Date: ??????? Lead Director: Director for Workforce & Development

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Review Date: ??????? Lead Director: Director for Workforce & Development

APPENDIX 1: PHLEBITIS SCALE (Jackson, 1998)
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.
The cannula site must also be observed:
• When bolus injections are administered.
• IV flow rates are checked or altered.
• 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 proven intravenous dressing.
• Replace loose, contaminated dressings.
• Cannula must be inserted away from joints whenever possible.
• Aseptic technique must be followed.
• Consider re-siting the cannula every 48-72 hours.
• Plan and document continuing care.
• Use smallest possible gauge cannula most suitable for the patients need.
• Replace the cannula at first indication of infusion phlebitis (stage 2 on the scale
below).
Stage
IV site appears healthy.
0
No signs of phlebitis.
ONE of the following is evident:
• Slight pain near IV site.
• Slight redness near IV site.
TWO of the following are evident.
• Pain at IV site.
• Erythema.
• Swelling.
ALL the following signs are evident.
• Pain along path of cannula.
• Erythema.
• Induration.
ALL of the following signs are evident and extensive.
• Pain along path of cannula.
• Erythema.
• Induration.
• Palpable venous cord.
ALL of the following signs are evident and extensive.
• Pain along path of cannula.
• Erythema.
• Induration.
• Palpable venous cord.
1
2
3
4
OBSERVE CANNULA.
Possibly first signs of
phlebitis.
OBSERVE CANNULA.
Early stages of phlebitis.
RESITE CANNULA.
Medium stage of phlebitis.
RESITE CANNULA
CONSIDER TREATMENT.
Advanced stages of phlebitis
or the start of
thrombophlebitis.
RESITE CANNULA.
CONSIDER TREATMENT.
5 Advanced stage of
thrombophlebitis.
INITIATE TREATMENT.
RESITE CANNULA
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Review Date: ??????? Lead Director: Director for Workforce & Development

• Pyrexia.
APPENDIX 2: INFILTRATION SCALE (Intravenous Nursing Society, 2000)
GRADE CLINICAL CRITERIA
0 • No Clinical Symptoms.
1 • Skin blanched.
• Oedema. < 1 inch (2.5cm) in any direction.
• Cool to touch.
• With or without pain.
2 • Skin blanched.
• Oedema. 1-6 inches. (2.5cm-15cm) in any direction.
• Cool to touch.
• With or without pain.
3 • Skin blanched, translucent.
• Gross oedema > 6 inches (15cm) in any direction.
• Cool to touch.
• Mild to moderate pain.
• Possible numbness.
4 • Skin blanched, translucent.
• Skin tight, leaking.
• Skin discoloured, bruised, swollen.
• Gross oedema> 6inches (15cm) in any direction.
• Deep pitting tissue oedema.
• Circulatory impairment.
• Moderate to severe pain.
• Infiltration of any amount of blood product, irritant, or
vesicant.
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Review Date: ??????? Lead Director: Director for Workforce & Development

APPENDIX 3: SIZE AND MANUFACTURERS’ RECOMMENDED USE OF
PERIPHERAL INTRAVENOUS CANNULA
COLOUR SIZE USES
Brown 14G Rapid transfusions of whole blood,
resuscitation settings
Grey 16G Rapid transfusion of whole blood
or blood products
White 17G Used for infusion of large volumes
of fluid or viscous fluid
Green 18G Blood transfusions or large
volumes of fluid
Pink 20G Patients receiving up to 20 or 3
litres of fluid a day, patients on
longer term medication
Blue 22G Paediatric and oncology patients
Yellow 24G Paediatric and one-off infusions
Issue Date: ??????? Author: Lead Nurse for Intravenous Therapy Page 9 of 9
Review Date: ??????? Lead Director: Director for Workforce & Development