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BA(Hons) DPSN RGN Lead Nurse for IV Therapy Bridgewater Community

Healthcare NHS Trust Halton & St Helens Division

IV cannulation for

community nurses Although community nurses are perfectly placed to carry out peripheral intravenous cannulation, it is vital that they gain the practical skills required


ue to the rise in intravenous therapy (IV) administered in the home, nurses working in the community are increasingly expected to practice a number of skills that were traditionally only carried out in secondary care settings. In some services, the need to perform peripheral intravenous cannulation

(PVC) has become integral.

SHOULD COMMUNITY NURSES CARRY OUT PVC? This is a question that I have attempted to answer repeatedly over the past six years. Whilst community nurses are ideally placed to deliver IV therapy to a large number of patients in the community, teaching and learning the necessary practical skills can very difficult in a community setting for a number of reasons. Nobody could dispute that there has been an enormous shift in

the delivery of IV therapy over the years, from secondary to primary care. Kayley1

alludes to a number of factors such as improvements

in technology, drugs that allow daily dosing, patient choice, government policies and pressure on acute beds to name but a few. This means that there also needs to be, as Kayley puts it, an “expansion in the range of skills among community nurses.” Whether or not PVC and other IV skills, such as long line place- ment, should be included in that remains controversial. In the past, community nurses have dipped in and out of this

speciality. They have undertaken care and maintenance of long lines and disconnection of infusional cytotoxic chemotherapy, and as a result have been forced to look to secondary care for teaching and education in a very ad hoc manner.

BACKGROUND NHS Halton and St Helens developed a community IV therapy service in 2005. The broad aims of the service are to provide complete admission avoidance and early discharge of patients who were medically stable and could easily complete their

treatment within a community setting, whether that is in their own home, nursing or residential care. There are three IV nurses, one IV support worker and the community/district nurse workforce.

TRAINING AND EDUCATION Both the Nursing and Midwifery Council2 Nursing3

and the Royal College of are absolutely clear about the need for nurses to perform

the skills related to their jobs, and that they require adequate training, education, knowledge and competence. Much has been written about the need to provide suitable

training and education to equip community nurses with the necessary skills and knowledge to be able to practice safely and effectively. Kayley4

points out that “the delivery of any IV therapy

requires suitably trained health care professionals to be involved” and goes on to state that “community nurses are ideally placed to do this as well as support patients and carers. However in order to do this safely and effectively, the nurses must have community based theoretical and skills based training.” Few could disagree with this, and with that in mind we devised an IV therapy introduction day for all community nurses to undertake prior to administering therapy. We also provide an update day that nurses are required to

attend at least once a year, including infusion pump training, PVC theory and venepuncture training for all healthcare professionals. It is worth noting that in some areas providers have worked closely with universities in an effort to provide IV education to their staff. Sadly this partnership was only established in response to a serious untoward incident.5 A group in the South developed a structured learning programme

for venepuncture and cannulation, but this was focussed in secondary care. Out of 250 staff who undertook this programme, only 75 (30%) achieved competency in cannulation, which despite being an improvement on numbers prior to the study, remains quite small.6

Even when nurses have undertaken the training and have

easy access to a large cohort of patients to gain competency, there is no guarantee that competency will be achieved.

Nursing in Practice March/April 2012 77

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