Peripheral Intravenous Cannulation  
                             Best Practice Guidelines 
                                                           
                                                Issue 2.1 
                                                     April 2017 
               
               
               
              Document Author:            Paul Lee, Medical Device Training Manager  
              Approved by:                Cathy Dowling, Interim Deputy Director of Nursing and  
                                                       Patient Experience  
               
                                          Delyth Davies, Head of Nursing:  Infection Prevention and 
                                          Control 
              Date of Original Version: January 2012                   
              Date of Current Version:  April 2017 
              Review Date:                April 2020 
               
               
               
               
               
               
               
               
               
               
               
               
                           ABMU peripheral cannula best practice guidelines, April 2017                                                                     Page 1 of 20 
                 
                Issue status 
                 
                Issue 1.1        Original version (as PVC care bundle)                        September 2012 
                Issue 1.2        •   Updated cannula record form (3 x cannulae)                
                                 •   Added Chloraprep™ cleaning for skin                      June 2014 
                                 •   Updated reference to Epic 3 guidelines 
                                 •   Added  ‘no more than 2 failed insertions 
                                     attempts ‘ before seeking extra help to cannula 
                                     bundle forms (see appendix 3) 
                Issue 2              Redrafted as ‘best- practice guidelines’                 June 2015 
                                  
                Issue 2.1        •   Minor typo. changes, new layout for cannula  April 2017 
                                     pack label (includes cannula gauge and ANTT)   
                                 •   Added 2%CHG + 70% alcohol wipe for hub   
                                     disinfection                                              
                                                                                               
                 
                 
                 
                CONTENTS                                                                                   Page 
                1     Introduction                                                                     3 
                              •   Definition 
                       
                2     Scope                                                                            3 
                       
                3     Governance                                                                       4 
                       
                4     Roles and Responsibilities                                                       4 - 6 
                                                                                                        
                               4.1  Practitioner inserting Peripheral Intravenous Cannula              4 - 6 
                             4.2   Staff preparing and second checking the flush solution              6 
                                                                                                         
                5     Training and Education Requirements                                              6 
                       
                6     Process for Monitoring Compliance and Effectiveness                              7 
                       
                7     ABMU LHB Peripheral Cannula Best Practice Guideline                              8,12 
                       
                8     References, guidelines and initiatives                                           13 
                       
                9     Appendices                                                                        
                          •   Appendix 1: Essential elements for insertion of cannula                  14 
                          •   Appendix 2; Essential elements for monitoring cannula                    15 -16  
                          •   Appendix 3: Peripheral IV Cannula Care record form                       17-18 
                          •   Appendix 4: Removal of peripheral IV cannula check sheet                 19 - 20 
                       
                 
                 
                 
                 
                              ABMU peripheral cannula best practice guidelines, April 2017                                                                     Page 2 of 20 
                1. INTRODUCTION  
                This guideline relates to the insertion, maintenance and safe removal of peripheral 
                intravenous cannula. It applies to all members of the Health Board multi-professional 
                team and should be followed at all times. 
                 
                Regardless of the type of peripheral intravenous cannula used, the principles of care 
                for the device remain the same; 
                •   To minimise infection risk by always using ANTT (Aseptic Non Touch Technique) 
                •   To maintain a ‘closed' intravenous system with minimal connections to reduce the 
                    risk of contamination 
                •   To prevent damage to the device and associated intravenous equipment 
                •   To maintain a patent and correctly positioned device 
                 
                Definition 
                A peripheral vascular access device  (VAD)  is a device that is inserted into a 
                peripheral vein for therapeutic purposes e.g. administration of medications, fluids 
                and/or blood products. For the purpose of this policy this will be defined as a 
                ‘cannula ‘and the process ‘cannulation’. 
                 
                1.1      All intravenous peripheral cannulae  will be inserted and accessed using    
                        Aseptic Non Touch  Technique (ANTT)  and Standard Infection Control   
                        Precautions adopted at all times (SICP). Staff must also adhere to ABMU 
                        Policy in relation to the Control of Substances Hazardous to Health (COSHH) 
                        guidelines 
                 
                1.2     The practitioner carrying out the procedure is fully accountable and 
                        responsible for safe practice in the insertion and removal of peripheral 
                        intravenous cannula 
                 
                1.3     All practitioners have a professional duty to maintain their knowledge and skill. 
                        It is their responsibility to ensure that they undertake this role competently and 
                        with the required clinical skills  
                 
                1.4     All peripheral intravenous cannulation will be carried out upon the request of a 
                        Registered Practitioner. This will be a Medical Practitioner or a Registered 
                        Practitioner who is acting upon specific approved protocols and guidelines 
                 
                1.5     All peripheral intravenous cannulation will be carried out in accordance with 
                        this  guideline. This includes elements for both insertion and ongoing 
                        maintenance of the vascular access device 
                 
                2. SCOPE  
                 
                2.1     This policy applies to all practitioners for whom peripheral intravenous 
                        cannulation has been identified as required within their clinical role. This will 
                        include anyone with an employment or honorary contract of employment with 
                        ABMU LHB or who work through temporary or locum agencies 
                 
                 
                             ABMU peripheral cannula best practice guidelines, April 2017                                                                     Page 3 of 20 
               3. GOVERNANCE 
                
               3.1    All practitioners new to the role of Peripheral Intravenous Cannulation are 
                      required to complete the  ABMU  LHB approved Peripheral Intravenous 
                      Cannulation training package, and deemed competent in using ANTT for the 
                      insertion of the Vascular Access Device (VAD) 
                
                      Practitioners for whom the skill has been identified as being required in their 
                      role and who have previously been assessed as competent in a different 
                      Healthcare Organisation and/or educational setting will be assessed for 
                      competency by an IV cannulation assessor 
                       
               3.2    An assessor is identified as a Registered Healthcare Practitioner who has 
                      carried out the procedure of peripheral intravenous cannulation for a minimum 
                      of 12 months and for whom the procedure is a core element of their practice 
                
               3.3    All practitioners undertaking this procedure should wear disposable, protective 
                      gloves and plastic apron (or clean scrub-suit in theatres environment: scrub 
                      suits must be changed immediately upon contamination) 
                
               3.4    All peripheral intravenous cannula will be inserted using ANTT (Aseptic Non 
                      Touch Technique). 
                
               3.5    In order to ensure staff safety, practitioners must not practice the procedure of 
                      intravenous peripheral cannulation on themselves or other colleagues 
                
               3.6    The administration of  5ml of 0.9% sodium chloride flush is an integral part of 
                      peripheral IV cannulation and ongoing maintenance and is covered by an 
                      organisational patient group directive (PGD) therefore  does not require a 
                      prescription. However, all IV flushes must be checked, labelled and 
                      documented by a second practitioner during their preparation. The tip of the 
                      syringe must be protected from contamination and touch by using either a 
                      sterile single use caps or returned to its original packaging prior to use 
                
               3.7    The removal of an IV cannula should be performed using ANTT. The device 
                      should be removed carefully using a steady movement and pressure applied 
                      until haemostasis is achieved. Once inspected, the device should be 
                      discarded immediately into a sharps bin (See cannula removal check-sheet: 
                      appendix 5)    
                
                
               4.     Roles and Responsibilities 
                
               4.1    Practitioner inserting Peripheral Intravenous Cannula. 
                
               4.1.1   The Practitioner inserting the cannula shall be trained and competent, which 
                      will include the following aspects:  
                      •       Appropriate assessment and indications/contraindications for 
                              peripheral cannula insertion  
                      •       Relevant anatomy and physiology  
                            ABMU peripheral cannula best practice guidelines, April 2017                                                                     Page 4 of 20