Biovalve Safe - Vygon (UK)

CANNULATIONAseptic TechniqueCannulationSTEP NINESTEP ELEVENThe intended cannulation siteshould be prepared usingan antiseptic solution (2%chlorhexidine in 70%isopropyl alcohol) or swab.Cleansing should start at theintended cannula insertionpoint and wiping shouldbe performed in a circularmotion, radiating outwards(follow manufacturer’s skincleansing guidelines).The skin must be allowed todry before proceeding.STEP TWELVEInsert the needle cannulaassembly through the skin atan angle of 25-35°.STEP TENStabilisation of the veinis the key to successfulcannulation. If necessaryplace thumb approx 2-5centimetres beneath theinsertion site to anchorthe vein. This red uces therisk of vein movement onneedle insertion.10Vygon (UK) Ltd | A Guide to Peripheral IV CannulationPenetrate the skin and advancethe needle cannula assemblyinto the vein. Successful entryinto the vein is confirmed byfree flow of blood into theflashback chamber.Slightly lower the needleuntil it is almost flushwith the skin. This anglereduces the risk of passingthe needle through thevein (transfixion). Advancethe entire needle and cannulaassembly a further half centimetreinto the vein.Vygon (UK) Ltd | A Guide to Peripheral IV Cannulation11

CANNULATIONCannulationSTEP THIRTEENThe introducer needle is nowwithdrawn a short distanceand blood should be seento enter the cannula. Thisconfirms the position in thevein. The needle must notbe reinserted as this candamage the cannula.STEP FIFTEENApply a pre-primed cannulaextension and attach a 10mlsyringe containing normalsaline. Draw blood back intothe syringe to confirm thecannula’s location in thevein. Flush from the cannulato remove any blood.STEP FOURTEENSTEP SIXTEENWhilst stabilising the needle,The cannula should be secured with aadvance the cannula into thetransparent, semi-permeable membranevein. Release the tourniquetdressing in accordance with hospitaland place a finger over thepolicy. This will reducevein, distal to the cannulathe risk of infection,tip. Remove the introducercannula movement andneedle and safely disposeaccidental cannulain an appropriate sharpsdisplacement, and willcontainer.allow clear observationof the entry site. Recordthe cannula procedurein the patient’s notes.12 Vygon (UK) Ltd | A Guide to Peripheral IV CannulationVygon (UK) Ltd | A Guide to Peripheral IV Cannulation13

CANNULATIONCannula CareCANNULATIONCannula RemovalIn order to prevent infection the following should be included inthe management of all IV cannulae.l Follow aseptic technique when handling the cannula andother equipment.l The cannula should always be secured using a transparentsemi-permeable dressing to prevent movement.l To minimise cannula movement always use a cannulaextension to administer prescribed medication.l All connections should be checked for tightness.l Inspect the insertion site daily for signs of infection, i.e.inflammation, redness, tenderness. Consider the use ofVisual Infusion Phlebitis (VIP) scoring.l Wash your hands.l Apply a pair of gloves.l Remove all IV dressings and tape. Do not use scissors.l Hold a small sterile dressing over the site and slowly removethe cannula.l Immediately apply firm pressure for 2-3 minutes to ensurethere is no subcutaneous leakage of blood. Elevate the armif bleeding persists.l If necessary apply a new sterile dressing to site.l In order to maintain patency, regularly flush the cannulausing a cannula extension.l If any signs of inflammation or infection are found thecannula should be removed and a new one inserted at analternative site.l The cannula should be removed after 72-96 hours unlessclinically indicated otherwise.14Vygon (UK) Ltd | A Guide to Peripheral IV CannulationVygon (UK) Ltd | A Guide to Peripheral IV Cannulation15

CANNULATIONComplications & Recom mendationsPhlebitisVisual Infusion Phlebitis (VIP) ScoreIV site appears healthyOne of the following is evident:l Slight pain near I.V. site l Slight redness near I.V. siteTwo of the following are evident:l Pain at I.V. site l Swelling l ErythemaAll of the following are evidentl Pain along the path of the cannula l Erythemal SwellingAll of the following are evident & extensivel Pain along the path of the cannula l Erythemal Swelling l Palpable venous cordAll of the following are evident & extensivel Pain along the path of the cannula l Erythemal Swelling l Palpable venous cord l Pyrexia012345No signs of phlebitisl Observe cannulaPossible first signs of phlebitisl Observe cannulaEarly stage of phlebitisl Resite cannulaMedium stage of phlebitisl Resite cannula l Consider treatmentAdvanced stage of phlebitis(or start of thrombophlebitis)l Resite cannula l Consider treatmentAdvanced stage of Thrombophlebitisl Resite cannula l Initiate treatmentOxford Radcliffe Trust Infection Control Services. Updated from A Jackson. 1997 OM141067ComplicationsPhlebitis can be defined as the acute inflammation of the intima of thevein. It is characterised by pain and tenderness along the course of the vein.There are three main types of phlebitis: mechanical, chemical and infective.Mechanical Phlebitis occurs where the cannula itself irritates or injures the vein wall.Chemical Phlebitis occurs where the infusate (or particles in the infusate) damagesthe vein wall.Infective Phlebitis occurs where bacteria causes irritation to the vein wall.18Vygon (UK) Ltd | A Guide to Peripheral IV CannulationRecommendationsTo prevent phlebitis - use aseptic insertion techniques, choose the smallest gaugecannula possible for the prescribed treatment, secure the cannula properly toprevent movement. It is important to do regular checks for the signs of phlebitis.Use the smallest gauge cannula neccessary for prescribed therapy in order tominimise catheter and vein wall contact. Stabilise the cannula with a transparent,semi-permeable dressing and assess the cannula site regularly.This can be avoided by ensuring the infusate is filtered, does not exceed a finalosmolarity of 500mmol/l, pH between 5 and 9, dextrose concentrations of >10%.Selecting the smallest gauge cannula and the largest vein possible will allow agreater volume of blood to flow around the cannula tip, thus diluting the infusate.The principles of asepsis, including handwashing, minimal touch technique and thecleansing of access points prior to use are essential. This must also include the useof a sterile dressing to cover the cannula insertion site. Cannula changes of at least72-96 hours are recommended.Vygon (UK) Ltd | A Guide to Peripheral IV Cannulation19

CANNULATIONe-Learning CannulationTraining PackageVygon’s e-Learning Cannulation TrainingPackage is available to existing Biovalvecustomers either as a stand-aloneCD-ROM or available to use on the Intranetof an NHS Trust or workplace.Each of the eight sections contains abuilt-in assessment at the end to test thestudent’s knowledge.The package will upload and track alluser progress for organisations thathave SCORM compliant e-LearningManagement systems.TOPICS COVERED IN THEPACKAGE3 Legal3 Anatomy & Physiology3 Site Selection3 Equipment Choice3 Principles & Practice ofCannulation3 Complications3 Post Insertion Care3 Infection Control“Good teaching is good teaching, nomatter how it’s done.” The old adage stillrings true, and e-Learning brings with itnew dimensions in education and training.20Vygon (UK) Ltd | A Guide to Peripheral IV CannulationAdvantages of e-Learning overconventional trainingIt’s interactive and funTraining material that is designed to get the student to explore ideas then make choicesand decisions based on what they have been taught, will most certainly be effective. Beingfree to make mistakes and repeat the process until you get it right is an excellent way ofembedding information in our brains.It’s self-pacede-Learning programmes can generally be taken when needed. Most e-Learning materialcomes in a module-based design, allowing the learner to go through smaller chunks oftraining that can be used and absorbed for a while before moving on.Students can choose where and when they do theirtraininge-Learners can go through training sessions from anywhere, usually at any time. This benefitcan make learning possible for people who find it hard to work training into their busyschedules.It can lead to increased retention and a strongergrasp of the subjectThis is because of the many elements that are combined in e-Learning to reinforce themessage, such as video, audio, quizzes, interaction, etc. There is also the option to revisit orreplay sections of the training that might not have been clear the first time around.It builds confidenceStudents do not need to worry that they are holding the class up by asking questions. Theycan take their time to learn and understand before moving on to the next topic.It provides a consistent messagee-Learning eliminates the problems associated with different instructors teaching slightlydifferent material on the same subject. For ward-based training, this is often critical.It can be easily managed for large groups of staffe-Learning allows managers and others to keep track of the course offerings, scheduleor assign training for staff and track their progress and results. Managers can review astudent’s scores and identify any areas that need additional training.Vygon (UK) Ltd | A Guide to Peripheral IV Cannulation21

CBP00012061709124800Vygon (UK) LtdThe Pierre Simonet BuildingV ParkGateway NorthLatham RoadSwindonWiltshireSN25 4DLTel: 01793 748800Fax: 01793 748899Web: www.vygon.co.ukEmail: vygon@vygon.co.ukTwitter: @vygonuk0043.IV/CANN Content correct as of 08/2012