Feidhmeannacht na Seirbhise Siainte Hea1Ul Service Executive TITLE: Cannula Care Guideline for Nurses and Midwives at Mid-Western Regional Hospital, (MWRH),, Regional Orthopaedic Hospital, Croom and Regional Maternity Hospital, Document NG/PVCI0010 Document Reference Drafted By Number M-fhUb~a.2. ~ Catherine Mur~1 NPDU Revision No 1 Document Number Approved By /' ~ / 1 11.. 1 GeraJdR1e 8naw Director of Nursing and Midwifery Mid-Western Regional Hospitals tjr~ l~,~-<l G"erardine Kennedy~DON} NPDC Approval February 2010 Responsibility Nurse Practice Date For Development Unit, Implementation Registered Nurses and Midwives Revision February 2012 Responsibil ity Gerardine Kennedy ADON} Date For Evaluation NPDC And Audit Catherine Murphy CNM II NPDU L..... Pages 6 Title: Cannula Care Guideline for Nurses and Midwives at Mid-Western Regional Hospital, (MWRH),, Regional Orthopaedic Hospital Croom and Regional Maternity Hospital, Page 1 of6
1 Policy Statement p3 Purpose p3 3.0 Scope p3 4.0 Definitions p3-4 5.0 and responsibilities p4 6.0 p4-5 7.0 Implementation p5 8.0 Audit p5 9.0 Bibliography & References p6 Cannula Care Guideline for Nurses and Midwives at Mid-Western Regional Hospital, (MWRH), Regional Orthopaedic Hospital Croom and Regional Maternity Hospital, 20f6
1.0 Policy statement 1.1 intravenous cannula will functional and uncontaminated while in place. peripheral cannulae (PVCs) must be indicated. Where there is no clinical indication PVC removed. 2.0 Purpose 1 support nursing and midwifery staff in caring for the Peripheral Intravenous Cannula in accordance with practlc:e and National Guidelines. 3.0 Scope 1 This guideline applies to Registered Nurses I Midwives and to Student Nurses/Midwives supervision in the Mid- Western Regional Hospitals 4.0 Definitions 4.1 A temporary device, less than inq,~rte:.rf in the veins the or hand, (although sites can be used) to administer Intravenous fluids and medications (Hindley, 2004). A is a collection of interventions that may be management of a particular condition. care bundle aims tie criteria together into a cohesive unit that must be adhered to for every patient every time. The criteria in a are best practices on evidence and the cannula care bundle includes: PVC stili in.::;nj~.:oi"'i"';:' of inflammation or extravasation, intact, the PVC has inserted for less than hand has been out 1"\01',1'\1'"0 procedures, (HSE/hpsc. 2008/9) 4.3 Inflammation of cannulated vein characterised by erythema, and swelling. "-''''''...'''''''''' be infection or in the venospasm, mechanical irritation of the cannula or mechanical trauma resulting from the cannula rubbing against lumen of the vein (Dougherty 2008). 4.4 Thrombophlebitis: Inflammation of the vein with clot formation. It may arise the cannula is near a bony prominence or in antecubital fossa. Infusate chemicals may also cause or Thrombophlebitis may result if cannuia is not flushed correctly. The vein may corded on palpation. appearance of red running 'tracking' from the vein. :.:...:..:.:.==.:..:.. Leakage of non-vesicant medication/fluid from into the surrounding {Vesicant is a Cannula Care Guideline for Nurses and Midwives at Mid-Western Hospital, (MWRH)., Regional Orthopaedic Hospital Croom and Regional Maternity Hospital, Page 3 of6
substance that is capable of causing injury to the if it escapes from the vein) It occurs when the is dislodged and punctures the wall of the vein. ~~@ @J!Q.!l::leiaK(llge of vesicant medication or fluids into the surrounding (Dougherty 2008). 5.0 Roles and responsibilities 1 Nurses and midwives caring for the patient should explain the procedure to the Patient and discuss. first sign of possible leakage drugs into the tissues is pain and discomfort, so patients must be informed of what symptoms to out for and be to report any change in sensation as soon as they are aware of it. n (L Dougherty 2008 BJN) 5.2 The nurse or midwife is responsible to check the intravenous site in with this guideline every administration of intravenous medicationlfluid, during shift and shift handover. 6.0 Prodedure (in accordance with Cannula Care Bundle) 6.1 Check that the cannula is still in use. If not remove it. 6.2 Ensure that there is a dry adherent transparent dressing in which is not or damp. If necessary remove ret:>la(~ the dressing. 6.3 If there is inflammation, infiltration or extravasation stop the procedure/infusion and remove the cannula. Report extravasation immediately. 6.4 Check how long the has been in Re-site every 48 to 72 hours where in use (Infection Control Manual, Section 2, MWRH, 2007, Dougherty and 2007, p864; O'Grady al Scales 2008, 2008/09) (unless indicated). Perform hand hygiene before and all PVC procedures, (HSE 2009). Use an antiseptic hand wash solution. An alcohol hand rub product may on visibly hands (e.g., Sterilium Gel). 6.6 Adhere to Infection Control Policy before after the (Infection Control Manual! MWRH! 2007) 6.7 In acc:ordan<~e with the direction of the MWRH Consultant Microbiologist, any that are replaced. 6.8 "Drug irritation is the most significant predictor of phlebitis and infiltration (Dougherty and Lister 2007, p864)" and should be considered when the Peripheral Intravenous Cannula over 6.9 When administering medications a clean of non sterile gloves should be worn for all aspects of IV therapy, including preparation, administration and site care, (Hindley Title: Cannula Care Guideline for Nurses and Midwives at Mid-Western Regional Hospital, (MWRH)., Regional Orthopaedic Hospital Croom and Regional Maternity Hospital, 40f6
including preparation, administration and site (Hindley 2004, O'Grady 2002; Scales, Flush cannula in accordance with current Guideline for Intravenous Medication Administration, (MWRH, 2009). 10 Disinfect skin with 70% isopropyl alcohol swab and allow the skin dry removing O'Grady al 2002). should an aseptic procedure a slow steady movement and firm pressure applied is achieved. the site with a sterile dressing. (Dougherty and Lister 2007 P.864, Dougherty 2008) 6.11 Access points to cannula should be kept a minimum. 12 Complications of Infiltration and Extravasation are coolness or blanching cannula swelling, tenderness/discomfort, skin stretched, at site, maollrly to obtain return, in quality and flow of infusion/injection. Where extravasation occurs patient may complain of burning stinging pain and followed by blistering necrosis and (Doughertyy 2008). This is a very serious condition, the infusion remove cannula. Report the medical immediately and document 14Document care management in the NursinglMidwifery of care/notes. 7.0 Implementation plan 1 This is a revised The main is to "Care Bundles" which been rolled out at education sessions and are covered in training including Venepuncture and Cannulation Training, Administration of Intravenous Medication training roll out as required. Further tr!:lllnll'~if'l sessior,s will be by NPDU and InfE~ctlcm Control Department. 8.0 Audit 8.1 This guideline will be in accordance with National Directives through ControL In absence of a National Directive, the lead auditor will otherwise be a Clinical Nurse 2 from Practice Development Unit, MWRH and will supported by staff from Infection Control Department, wards and departments. Audit will commence in three months then 6-12 months tha:'i"~!:.ir'rt~>.r Cannula Care Guideline for Nurses and Midwives at Mid-Western Regional Hospital, (MWRH), limerick, Regional Orthopaedic Hospital Croom and Regional Maternity Hospital, Page 5 of6
9.0 BIBLIOGRAPHY I REFERENCES Creamer et at (2002) A survey of peripheral intravenous catheters ~.o. '1.Jf~:...=...:::=.:...:..:..=.!-.::::;.:. Hindley G., (2004) H~I-'lnn<i::r (2008/9) Mid-Western Regional Hospital (2007) Infection control in peripheral cannula "-'=:...::::..:..:.:..::>-:=;.;..::::.;::::..:..=- 18, no. Peripheral vascular Cannula Bundle, adapted from Health protection Scotland. Infection Control Manual Mid-Western Regional Hospital (2009) Guideline for Intravenous Medication Administration by Nurses and Midwives Dougherty L. (2008) IV therapy: recognising the differences OetweEm infiltration and extravasation. British Joumal of Nursing 17(14),p.896-901. Dougherty &Lister, (eds.) (2008) f!q~f.w]~, 7th Edition OGrady N. ai (2002) Guidelines the Prevention intravascular Catheter-Related Infections, 476-489 Scales, K (2008) Intravenous therapy: a guide to good practice, in British Joumal of Nursing, Vol 1 No 19, IV Therapy Supplement, pp S1 S1 Title: Cannula Care Guideline for Nurses and Midwives at Mid-Western Regional Hospital, (MWRH), limerick, Regional Orthopaedic Hospital Croom and Regional Maternity Hospital, limerick 6 6
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!'ddhmeotlnwiijll Sorbhise ~n'" llcollh ~,:.,.j<:<: I'lo:a,"", TITLE: Cannula Care Guideline for Mid-Western Regional Hospital,, Regional Maternity Hospital and Regional Orthopaedic Hospital, Croom I have read and understand this Guideline Name Area Date