peripheral intravenous cannula, adults and children (not ... · web viewas soon as possible after...

CHS19/077

Canberra Health ServicesProcedurePeripheral Intravenous Cannula (PIVC), Adults and Children (Not neonates)Contents

Contents....................................................................................................................................1

Purpose.....................................................................................................................................3

Alerts.........................................................................................................................................3

Scope........................................................................................................................................ 4

Section 1 – Site selection and insertion of PIVC........................................................................5

Section 2 – PIVC post insertion care and management............................................................8

Section 3 – PIVC Administration Sets (changing and frequency).............................................10

Section 4 – PIVC removal........................................................................................................12

Implementation...................................................................................................................... 13

Related Policies, Procedures, Guidelines and Legislation.......................................................14

References.............................................................................................................................. 14

Definition of Terms................................................................................................................. 15

Search Terms.......................................................................................................................... 16

Attachments............................................................................................................................17

Attachment 1 - Intravascular Access Device Decision tree......................................................18

Attachment 2 - Adult extravasation chart...............................................................................18

Doc Number Version Issued Review Date Area Responsible PageCHS19/077 1 14/05/2019 01/05/2023 Medical Services 1 of 18

Do not refer to a paper based copy of this policy document. The most current version can be found on the CHS Policy Register

CHS19/077

Purpose

The purpose of this Clinical Procedure is to outline the safe and effective insertion, management, (including line changes) and removal of a Peripheral Intravenous Cannula (PIVC) in people being cared for under the direction of Canberra Health Services (CHS).

Back to Table of Contents

Scope

Alerts

Prior to insertion of a PIVC consideration must be given to the appropriate choice of vascular access device tailored to the patient’s treatment plan including; type of intravenous fluid, intravenous medication, vascular assessment and length of anticipated dwell duration. See Attachment 1: Intravascular Access Device (IVAD) Decision Tree.

PIVC insertion requires the use of Standard Aseptic Technique. This procedure can be performed by staff, who have completed the online aseptic technique training and have been credentialed for PIVC insertion. If staff do not feel confident to complete the procedure without touching key sites and key parts then sterile gloves must be used. Please refer to CHHS Clinical Procedure, Aseptic Technique.

In the event that a PIVC is contaminated at any stage during insertion, it must be discarded and a new PIVC must be used.

Where the PIVC has been inserted in an emergency situation (e.g. Medical Emergency Team (MET) call or by ambulance service) where standard aseptic technique cannot be assured, the cannula must be replaced within 24 hours, in order to prevent infection.

If a patient arrives on the ward/unit from another clinical area or facility without clear documentation or information referring to date plus/minus time of the PIVC insertion, then the undated PIVC must be replaced and then removed. If however, the receiving clinician can clearly determine from the patient or the patient’s documentation when the PIVC was inserted, then a date plus/minus the time should be noted on the PIVC dressing. The PIVC should under no circumstances be left in without a date plus/minus a time recorded on the dressing and in the patient’s notes.

Blood tests should not be drawn from an existing peripheral venous access site as this may give false results and increases the risk of PIVC infection. Haemolysis, contamination and presence of intravenous fluid and medication can all alter the results.

All other PIVC must be replaced WITHIN 72 hours of insertion. This must occur earlier when there are local or systemic signs of inflammation/infection.



CHS19/077

Exceptions: Paediatrics – the line remains in until no longer required, unless there are local or

systemic signs of inflammation/infection. In life threatening situations where a PIVC older than 72 hours has remained insitu

and is functional and alternative appropriate access has not yet been obtained, the reason for retaining this PIVC beyond 72 hours must be clearly documented in the patient’s medical records.

For patients requiring a PIVC for ongoing treatment or management e.g. Intravenous (IV) Antibiotics, fluid resuscitation, DO NOT REMOVE the existing PIVC until a new one is successfully sited.

Difficulty with PIVC access:Situation where IV access is difficult, taking into account urgency and requirement of access is necessary the following may apply:

Switching to oral therapy. A more experienced clinician attempting further PIVC insertions. The use of ultrasound guided PIVC insertion by a qualified clinician.

If a patient, who has been identified by Intravenous Access Team (IVAT) as a difficult intravenous access patient (DiVA) presents with an IVAT card identifying themselves as DiVA they must be referred to IVAT within working hours. Only highly experienced clinicians, preferably using ultrasound, are to attempt access on an identified DiVA patient when IVAT staff are unavailable. The treating team should give consideration of an alternative IV access using the IVAD Decision Tree (Attachment 1), e.g. peripherally inserted central line, central venous line.


Scope

This clinical procedure applies to the following professionals at CHS who have completed appropriate IV cannulation training and credentialing (this includes attending CHS program and completing all competency requirements or have achieved recognition of prior learning (RPL) equivalence):

Medical officers Registered Nurses/Midwives working within their scope of practice Enrolled Nurses working within their scope of practice who have completed

accredited Intravenous Medication Administration and Monitoring training and Enrolled Nurse Intravenous Medication Administration and Monitoring Competency Package.

Medical Students under direct supervision Radiographers who have completed:

o Administration of Iodinated Contrast Media (eLearning)o Aseptic Technique (eLearning)



https://training.health.act.gov.au/ClientView/Course/319/Details/Aseptic-Technique-el-2016-V4

CHS19/077

o Competency Assessment: Flushing of PIVC’s and administration of contrast media.


Section 1 – Site selection and insertion of PIVC

Equipment Dressing trolley IV starter pack which includes 70% alcohol with 2% chlorhexidine swab stick or basic

dressing pack plus 70% alcohol with 2% chlorhexidine swab stick or equivalent and transparent securement dressing. For patients with a history of chlorhexidine sensitivity/allergy, use:

o 5% alcohol-based povidone-iodine swabo ≥70% alcoholo 10% aqueous povidone-iodine (suitable for patients in whom alcohol is

contraindicated) Peripheral Infusion device (safety cannula preferable) Positive needleless connection valve Extension set with needleless connection valve or safe valve Syringe 5mL to 10mL (children require less volume) Drawing up needle Pre filled Sodium chloride 0.9% (0.9% Sodium Chloride) syringe or Sodium Chloride

0.9% ampoule IV giving set (if required) Infusion pump (if required) Single patient use tourniquet (only if not using IV starter kit or patient is bariatric as

there is a disposable tourniquet in IV starter kit) Tape for securement of extension set (for paediatric patients) Clean non sterile gloves or sterile gloves (decision dependent on skill level) Safety goggles or protective face shield Consider local anaesthetic, if required a medical order is necessary Syringe 2mL with 25g needle if giving local anaesthetic Alcohol based hand rub (ABHR).

Procedure1) Please note: a maximum of two attempts at PIVC insertion is permitted; following

two failed attempts, consult a more experienced clinician. If a more experienced clinician has made two attempts, the clinician is to decide whether they continue attempting to insert the PIVC, or whether an alternate IV access should be considered.

2) Staff must consult the Medical Officer responsible for the patient’s care before insertion to ensure that a PIVC is required, alternatives should be considered and the benefits of PIVC insertion should outweigh the risks (IVAD decision tree Attachment 1).



CHS19/077

3) Check the patient’s history for bleeding disorders, medications (e.g. warfarin, aspirin) and allergies, including whether the patient has allergies to skin antiseptics (e.g. chlorhexidine or iodine) or dressing materials.

4) When repeated or prolonged administration of chemical irritants, such as Potassium Chloride or Vancomycin is required, central venous access should be considered, to avoid peripheral vein damage.

5) Cleaned, ultrasound machine maybe used to assist with identifying peripheral veins that are not visible or palpable.

6) When selecting a PIVC, ensure that it is equipped with safety engineered device with sharps injury protection.

7) The size of the PIVC should be determined by the intended use (e.g. blood and blood products, drug therapy, hydration etc.), the condition of the patient’s veins, likely length of time PIVC is expected to remain in situ and the insertion site.

8) The PIVC should be the shortest and smallest gauge that can meet the anticipated clinical need (i.e. operating theatre, trauma, labour) to ensure optimal flow.

9) The staff member must wash their hands or apply ABHR.10) Explain the procedure to the patient and obtain informed verbal consent, if

appropriate, as per Consent and Treatment Policy,11) Conduct Positive Patient Identification (PPID) procedure as per Patient Identification

and Procedure Matching Procedure.12) Check for previous difficulties with cannulation and/or IV therapy.13) Ensure patient privacy is maintained.14) Clean trolley and gather procedure equipment and take to patient bedside

(procedure area)15) Wash hands or apply ABHR.16) Position patient comfortably, supporting proposed area of insertion. Place the

underpad as required.17) Apply tourniquet, select vein then release tourniquet. Once the tourniquet has been

successfully applied, never leave it on for more than one minute at a time. If you're having difficulty finding a vein, remove the tourniquet after one minute and try again on the other arm.

18) Select the most appropriate vein for insertion of the PIVC. Points to consider include: Patient’s activity level Size and condition of patient’s veins Indication for PIVC and expected duration of PIVC Position of patient during any planned procedure(s) Use non-dominant forearm if practical Use basilic or cephalic veins on the posterior (dorsal) forearm if possible The metacarpal veins on the dorsum of the hand are easier to visualise but

are more liable to clot, difficult to stabilise, and prone to vessel damage. Note: These are a preferred site for children.

In patients with chronic renal failure, the use of the anterior (ventral) forearm veins (especially the cephalic vein) should be avoided, as these may be required for fistula formation for dialysis.

Avoid if possible the use of veins in the following sites: Areas of flexion, e.g. antecubital fossa, or bony prominences



CHS19/077

a) Vein easily damagedb) Uncomfortable

Areas below previous cannulation site a) Vein may be damaged

Bruised or phlebitic areas a) Poor venous return b) Pieces of clot can be dislodged into the system

A limb with an arteriovenous fistulae or shunta) May compromise haemodialysis access

An arm on the same side as a previous lymph node dissection, mastectomy or affected by cerebrovascular accident

a) Poor venous and/or lymphatic return An infected limb e.g. with cellulitis A limb with a peripherally inserted central catheter (PICC) or implanted

venous access device (portacath) Lower limbs (with the exception of infants)

a) Risk of deep vein thrombosis b) Limits access, patient comfort and mobility.

19) Wash hands or apply ABHR.20) Open IV starter kit and prepare general aseptic field, ensuring that all key parts are

protected from contamination.21) Don protective eyewear.22) Prepare insertion site as required e.g. remove hair at the insertion site (prior to

antiseptic application) if necessary, using clippers, to improve adherence of the dressing. Clean the skin with neutral soap and water if the insertion site is visibly dirty.

23) Wash hands or apply ABHR.24) Place sterile towel under the selected area.25) Clean insertion site and surrounding area, applying gentle friction in a cross-hatching

motion, for 30 seconds using 70% alcohol with 2% chlorhexidine or other appropriate cleanser if the patient has a chlorhexidine allergy. Apply antiseptic to cover an area of approximately 5 x 5cm, allow the skin to air-dry for at least 30 seconds. Do not wipe, fan or blot dry the area. Do not re-palpate the vein after skin preparation.

26) Reapply tourniquet and reapply ABHR.27) Don gloves, sterile or non-sterile according to skill level.28) If required and has been ordered by a medical officer, inject local anaesthetic

intradermally, beside the elected IV site creating a small bleb on the skin. Do not puncture vein when anaesthetising the skin. Draw back on syringe to identify local anaesthetic placement ensuring you are not giving intravenous lignocaine.

29) Insert cannula ensuring vein is punctured, visualising ‘flashback’ at the hub of the cannula. Advance plastic cannula and withdraw the stylet.

30) If the PIVC fails to enter vein or becomes contaminated do not reinsert or re-use. Do not attempt to reintroduce the stylet into the insitu PIVC. Remove entire device and commence again with a new PIVC and a new IV starter kit if sterility of the kit has been breached.



CHS19/077

31) Release tourniquet, attach extension set with needleless injection cap to the hub of the cannula and flush cannula with 0.9% Sodium Chloride to confirm placement.

32) Secure the IV cannula by dressing the site, covering the hub of the cannula with an occlusive transparent securement device dressing. Insertion site should remain visible at all times.

33) Clearly record the date and time of insertion of the PIVC on the tape or occlusive transparent dressing.

34) As soon as possible after the insertion of the PIVC, document in the patient’s clinical records and nursing care plan, the date, time, site and size of cannula using the sticker supplied in the IV starter kit.

Paediatric specific securement Paediatric patients will require additional securement of the cannula, with tape using

an under / over technique, prior to applying the occlusive dressing. Ensure the extension tubing attached to the cannula is secure to minimise the risk of

the cannula being pulled out. Use an elasticized tape to secure the limb to the appropriately sized and positioned

board ensuring the tape is as far away from the cannula while still being effective and not obstructing flow.

Immobilise the joint with a suitably sized splint if the PIVC is inserted into the antecubital fossa.

Apply protective tubular net dressing over cannula site and tubing ensuring that insertion site is still visible.


Section 2 – PIVC post insertion care and management

Medical staff are to review the requirement for the PIVC at least daily and document in the clinical record the indication for the ongoing use of the PIVC (e.g. continue IV fluids or IV antibiotics) or requirement to have the PIVC removed.

Equipment Sterile basic dressing pack 70% alcohol with 2% chlorhexidine swab stick / applicator Transparent securement dressing Secura swab if required to increase adhesion of dressing Splint or elasticised net, if required (insertion site needs to be visible at all times) Underpad Disposable gloves or Sterile gloves Protective goggles or protective face shield ABHR Injection tray/or kidney dish 1 x 10mL ampoules 0.9% Sodium Chloride for injection and 10mL syringe x 1 and

drawing up needle or pre filled 0.9% Sodium Chloride syringe Alcohol chlorhexidine swabs to scrub the PIVC hub



CHS19/077

Procedure Observation

1) The PIVC insertion site must be observed and documented in the nursing care plan and clinical notes each shift and/or whenever the PIVC is accessed for IV medication. The site should be checked to ensure the PIVC site is phlebitis and infection free, therapy has not infiltrated the tissues, the site is clean, dry and the dressing is intact.

2) Paediatrics and Intensive Care Unit (ICU) patients PIVCs site to be checked hourly and documented.

3) Explain the procedure to the patient and ensure privacy.4) Wash hands or apply ABHR.5) Observe the dressing ensuring that the dressing is dry and intact.6) Palpate the insertion site for tenderness; ask the patient if it is painful.7) Check that the date of insertion of the PIVC is legible on the dressing and when the

PIVC requires changing. 8) Observe for any signs of infiltration, extravasation, inflammation, swelling and

redness before and after access and/or each shift. See IV Extravasation Management Practice Guideline [infants, children and adolescents] Procedure and Immediate Management of an Extravasation Related to Chemotherapy Attachment 2 for more information.

9) If there are any signs of adverse reactions, e.g. phlebitis, infiltration, pain, tenderness, infection, the PIVC needs to be removed and reported to the medical officer. The initiation of the removal of the PIVC is by an enrolled and/or registered nurse, midwife or medical officer.

10) Redress the PIVC site if required. 11) Bandages should not be used in adult patients except when protection of the PIVC

insertion site from interference is required.

Redressing the site1) The PIVC site should be redressed if the dressing becomes soiled, damp or loose.2) If the site needs to be redressed, explain the procedure to the patient, obtain

consent and ensure privacy is maintained.3) Wash hands or apply ABHR. 4) Prepare equipment.5) Position the patient comfortably. Support the proposed site.6) Don gloves and protective eyewear.7) Remove and discard the soiled dressing and then wash hands or apply ABHR.8) Observe the PIVC site for signs of inflammation, infection or infiltration. Remove the

PIVC if these conditions are apparent and report to the medical officer.9) Wash hands or apply ABHR.10) Secure the IV cannula with transparent securement dressing.11) Clearly record the date of insertion of the PIVC on the tape or occlusive transparent

dressing.12) The insertion site should remain visible at all times.



CHS19/077

13) Document the date and time of redressing of cannula in patients’ clinical notes and nursing care plan.

Flushing of a PIVC1) Flushing of PIVC in situ maintains PIVC patency, minimises risk of adverse reactions

and prevents thrombus formation.2) Flushing of a PIVC must be performed for the following:

Pre and post administration of routine intravenous therapy including chemotherapy

Pre and post medication administration Pre and post routine blood administration and/or blood sampling Prescribed order from a medical officer If IV fluids are not running, flush 6th hourly to keep the vein patent.

3) When preparing for flushing of a PIVC, collect equipment and place in clean injection tray or similar item.

4) Explain procedure to patient and obtain consent.5) Don protective eyewear.6) Wash hands or apply ABHR.7) Don gloves8) Check PIVC site for signs of infiltration and /or phlebitis or infection. If signs are

present, arrange for insertion of a new PIVC prior to removal of the old PIVC (refer to section 1).

9) Use pre filled 0.9% Sodium Chloride syringe or draw 0.9% Sodium Chloride solution into 10mL syringe using drawing up needle (label as per National Standard for User-applied Labelling of Injectable Medicines, Fluids and Lines procedure as applicable).

10) Swab needleless injection valves thoroughly for 10 seconds with a 70% alcohol with 2% chlorhexidine swab and allow to dry 30 seconds.

11) Slowly inject the 0.9% Sodium Chloride to flush the PIVC to ensure accurate placement and patency.

12) If the patient experiences pain or tenderness review before considering removing and re-siting PIVC as per Section 1.


Section 3 – PIVC Administration Sets (changing and frequency)

The process and frequency for changing administration sets on PIVC is listed in the table below. IV administration sets include both the IV line and any additional attachments such as 3-way luer locks, Y connections and extension tubing that may be added.

NOTE: Changing of an Intravenous Line is a STANDARD Aseptic Technique procedure. When re-siting a PIVC, the administration set and all additional attachments, fluids

etc. must be changed at the same time. IV tubing sets should not be disconnected for routine care. When unavoidable and

tubing sets have been disconnected, replace the entire IV tubing.Doc Number Version Issued Review Date Area Responsible PageCHS19/077 1 14/05/2019 01/05/2023 Medical Services 9 of 18


CHS19/077

Best practice states that once disconnected, IV tubing should not be reconnected. However a health care professional can risk assess the situation in case of urgent therapy.

Standard fluids are less irritant to veins whilst antibiotic and other chemicals have the ability to cause additional harm.

Line Use Frequency of line changesStandard fluids used continuously and not disconnected

Every 72 hours

Used to infuse blood and blood products When transfusion is complete or after a maximum of 2 units – lines to be left up no longer than 12 hours

Neutropenic patients Every 24 hours Main lines with additives e.g. heparin, insulin

Every 24 hours

Side lines and syringe lines for intermittent medications, e.g. antibiotics

Single use, because sterility is in question

Propofol Every 12 hours Lipid containing substances (including Total Parenteral Nutrition (TPN)) not recommended to be used with PIVC

Every 24 hours Must infuse via a CVC or PICC

Specific cytotoxic / immunotherapeutic agents

Single use Some cytotoxic and immunotherapeutic agents, e.g. Blinatumomab, require extended, continuous line use up to 72 hours. These lines are not to be disconnected / interrupted at any time during the infusion period

Equipment IV administration set(s) IV therapy as ordered 70% alcohol with 2% chlorhexidine swab extra gauze as necessary clean gloves

Procedure1) Confirm patient identity, select prescribed therapy and perform second check with

authorised personnel. 2) Explain the procedure to the patient, gaining verbal consent if appropriate and ensure

patient privacy is maintained.3) Wash hands or apply ABHR.4) Using aseptic technique assemble equipment, prime lines including all associated

connections with IV fluids, ensuring no air is present within the administration set and close clamp. Hang newly primed administration set and fluid on an infusion stand.

5) Wash hands or apply ABHR.



CHS19/077

6) Don clean gloves.7) Clean needleless injection cap thoroughly 70% alcohol with 2% chlorhexidine for 10

seconds, allow to dry for 30 seconds.8) Adhering to standard aseptic technique principles, attach IV giving set to needleless

injection cap. 9) Two healthcare workers (nurses, midwives and/or medical officers) accredited in

medication and infusion pumps management, to program the infusion pump using the drug library and confirm the correct drug entry has been selected including the parameter settings as per the Medication Handling Policy.

10) Open the clamp to the patient; ensure flow and set rate of infusion.11) Discard equipment and remove gloves.12) Wash hands or apply ABHR.13) Ensure that all lines are labelled with the date of commencement of infusion and the

type of infusion and document in clinical notes.


Section 4 – PIVC removal

Equipment Gauze swab Transparent occlusive dressing Injection site pressure pad Protective eyewear Gloves Underpad Specimen container, if required for infected PIVC Sterile scissors if required if cutting tip off after removal of the PIVC ABHR

Procedure1) PIVC are to be removed and/or replaced:

a) As soon as they are no longer clinically required ORb) When there are signs of adverse reactions or inflammation/infection/infiltration ORc) Within 24 hours for PIVC inserted in emergency situations or by ambulance

officers/other facilities ORd) Within 72 hours (with the exception of paediatric patients or adults with life

threatening situations where alternate IV access is not available). 2) If ongoing IV access is required, a replacement PIVC should be in situ prior to removal of

the existing PIVC.3) If a patient is admitted with a cannula inserted by paramedics/ambulance officers or

from another institution and it is not labelled, or the date of insertion is not documented, the cannula must either be removed or:a) Dated, if the insertion date is known.b) Have the words ‘ambulance’ or other similar/appropriate identifying information

written on the dressing to clearly identify it including current date and time4) When removing PIVCs, explain the procedure to the patient and ensure privacy.



CHS19/077

5) Wash hands or apply ABHR.6) Don gloves and protective eyewear.7) Prepare equipment.8) Cease the intravenous therapy if in progress.9) Loosen the occlusive dressing and tapes - use skin adhesive removal wipes for fragile skin

or as required.10) Grasp the hub firmly and slowly withdraw the PIVC, check that the PIVC is complete on

removal. Ensure none has been retained within the patient.11) Immediately apply firm pressure to the PIVC site with a gauze swab. 12) Apply pressure to the site until bleeding ceases.13) Inspect the PIVC site for signs of inflammation or infection.14) If PIVC site is suspected of being infected cut the tip of the cannula off with sterile

scissors and send to pathology in a specimen container labelled with the patient’s details. Collect a swab of the insertion site. Complete a pathology request providing relevant clinical details. Complete a Riskman.

15) Observe PIVC site for fluid leak or ooze. 16) If no signs of infection present and bleeding has ceased apply injection site pad.17) If required, cover the site with either gauze and adhesive tape, or injection site pressure

pad.18) If intravenous fluids were in progress up to the time of the PIVC removal, calculate the

volume of fluid and adjust the patient’s intake in the patient’s fluid balance chart.19) Document in the patient’s clinical records and nursing care plan that the PIVC has been

removed.20) Document in the patient’s clinical records if the tip of the PIVC has been sent to

pathology.


Implementation

This procedure will be communicated to staff via: An all staff email News item on the Health HUB. At relevant Staff Development courses.

Information on PIVC insertion and management policy to be provided to Quality Officers for display on Quality Boards.


Related Policies, Procedures, Guidelines and Legislation

Policies ACT Government Health Directorate Nursing and Midwifery Continuing Competence

Policy, ACT Government Health Policy, Incident Management, CHHS Clinical Policy, Medication Handling



CHS19/077

CHHS Clinical Policy, Consent and Treatment

Procedures ACT Government Health Directorate Procedure , Patient Identification: Pathology

Specimen Labelling, ACT Health Incident Management Procedure CHHS Clinical Procedure, Healthcare Associated Infections CHHS Clinical Procedure, Aseptic Technique CHHS Clinical Procedure, Clinical Handover CHHS Clinical Procedure, Clinical Records Management Procedure CHHS SOP, Venepuncture Blood Specimen Collection CHHS Clinical Procedure, Pathology Requests and Specimens National Standard for User-applied Labelling of Injectable Medicines, Fluids and

Lines

Guidelines IV Extravasation Management Practice Guideline (infants, children and adolescents)

Legislation Health Records (Privacy and Access) Act 1997 Human Rights Act 2004 Work Health and Safety Act 2011

References

1) Australian Commission on Safety and Quality in Healthcare (ACSQHC) (November 2017). National Safety and Quality Health Services Standards, ACSQHC, Sydney.

2) Australian and New Zealand Guidelines for the Administration of Blood Products 1st edition (2004) 2011

3) Austin Health Clinical Procedure, Insertion, Care and Maintenance of Peripheral Intravenous Cannula Document No: 10987, Version No: 1.4, 2013.

4) BBraun Cannulation Theory 2011.5) BBraun Introcan Cannula 2011.6) Center for Disease Control and Prevention, U.S. Department of Health and Human

Services. 2011 guidelines for the prevention of intravascular catheter-related infections. Available at: http://www.cdc.gov/hicpac/pdf/guidelines/bsi-guidelines-2011.pdf updated February 2017

7) Collignon, PJ, Kimber FJ, Beckingham, WD and Roberts, JL. Prevention of peripheral intravenous catheter-related bloodstream infections: the need for routine replacement. Med J Aust 2013; 199(11):750-751.

8) Collignon, PJ et al. Intravascular catheter bloodstream infections: an effective and sustained hospital-wide prevention program over 8 years. Med J Aust 2007; 187(10):551-554.

9) Hand Hygiene Australia. Accessed at: http://www.hha.org.au/10) Joanna Briggs. (2008). Management of Peripheral Intravascular Devices. Best Practice, 12

(5), Pages 1-6.11) Nursing 2018 the Peer Reviewed Journal of Clinical Excellence. Are you up-to-date with

the infusion nursing standards?Doc Number Version Issued Review Date Area Responsible PageCHS19/077 1 14/05/2019 01/05/2023 Medical Services 13 of 18


http://www.hha.org.au/

http://www.cdc.gov/hicpac/pdf/guidelines/bsi-guidelines-2011.pdf

CHS19/077

12) Rickard, Claire., Marsh Nicole., Webster Joan., Runnegar, Naomi., McGrail Matthew., PhD.. Dressings and securements for the prevention of peripheral intravenous catheter failure in adults (SAVE): a pragmatic, randomised controlled, superiority trial. The Lancet Volume 392, Issue 10145, P 419-430

13) Smith, S.F., Duell, D. J., Martin, B. C., (2004) Clinical Nursing skills-Basic to Advanced, 6th edition, Pearson Education, New Jersey, Chapter 20 Specimen Collection, pages 641-642

14) Stuart, RL et al. Peripheral intravenous catheter-associated Staphylococcus aureus bacteraemia: more than 5 years of prospective data from two tertiary health services. Med J Aust 2013; 198(10): 551-553.

15) Trinh TT et al. Peripheral venous catheter-related Staphylococcus aureus bacteraemia. Infect Control Hosp Epidemiol. 2011 Jul; 32(7); 735

16) Waitt C, et al. Review: Intravenous Therapy. Postgrad Med J 2004; 80:1-6.Webster J, Osborne S, Rickard C, et al. Clinically-indicated replacement versus routine replacement of peripheral venous catheters. Cochrane Database Syst Rev. 2010;(3):CD007798

17) WHO Guidelines on Drawing Blood: Best Practices in Phlebotomy 2010 Geneva: World Health Organization; 2010.https://www.ncbi.nlm.nih.gov/books/NBK138665/

Definition of Terms

Antiseptics Antimicrobial substances that are applied to the skin to reduce the number of micro-organisms. Examples include topical alcohols, chlorhexidine, triclosan and iodine.

Alcohol-based hand rub (ABHR) An alcohol-containing preparation designed for application to the hands in order to reduce the number of viable micro-organisms with maximum efficacy and speed.

Aseptic technique An aseptic technique aims to prevent microorganisms on hands, surfaces and equipment from being introduced to susceptible sites.

Attempt Each effort at placing a PIVC at one site.

Clinician For the purpose of this Guideline a clinician is defined as a medical practitioner registered nurse or midwife, endorsed enrolled nurse, assistant in nursing, qualified paramedic, radiographer, anaesthetic technician, pathology collector or student in any of those fields.

Competent/Trained For the purpose of the guideline, a competent clinician is one who hascompleted a training program in the insertion of PIVCs or who is in, or has completed, a specialist medical training program

Escalation An inexperienced clinician who fails to cannulate a vein after two attempts should escalate the procedure to an experienced clinician.

Experienced clinician A clinician who has completed a training program in the insertion of



CHS19/077

PIVCs or who is in, or has completed, a specialist medical training program and has inserted a considerable number of PIVCs. Experienced clinicians are not necessarily more senior clinicians; they may be colleagues such as a Registered Nurse/Midwife or a Junior Resident Medical Officer.

Inexperienced clinicianA clinician who has completed a training program but is still gaining clinical experience and confidence in the insertion of PIVCs.

Peripheral Intravenous Cannula (PIVC) a device that is designed to be inserted into and remain within a peripheral vein (excludes peripherally inserted central line catheters).

Personal Protective Equipment (PPE)Refers to a variety of protective barriers used alone, or in combination, to protect mucous membranes, skin, and clothing from contact with recognised and unrecognised sources of infectious agents in healthcare settings.

Safety engineered deviceAn invasive device that has been designed with built-in safety features that reduce the risk of injury. Examples include devices such as syringes with guards, sliding sheaths, shielded, blunting or retracting needles, blunt suture needles and surgical blades with protective covers.


Search Terms

PIVC, Cannula, Peripheral Intravenous Cannula, IV cannula, Intravenous Cannula, Intravenous Cannula management, Intravenous Cannula insertion, Intravenous Cannula removal, Decision tree


Attachments

Attachment 1: Intravascular Access Device Decision Tree Attachment 2: Adult Extravasation Chart

Disclaimer: This document has been developed by Canberra Health Services specifically for its own use. Use of this document and any reliance on the information contained therein by any third party is at his or her own risk and Canberra Health Services assumes no responsibility whatsoever.

Date Amended Section Amended Divisional Approval Final Approval



CHS19/077

This document supersedes the following: Document Number Document NameCHHS15/116 Peripheral Intravenous Catheter Adults and Children (not neonates)



CHS19/077

Attachment 1 - Intravascular Access Device Decision tree



CHS19/077

Attachment 2 - Adult extravasation chart



peripheral intravenous cannula, adults and children (not ... · web viewas soon as possible after...

Documents