This page contains a Flash digital edition of a book.
CLINICAL: BASIC CARE Sue O’Hanlon


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


D


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.


www.nursinginpractice.com


Nursing in Practice March/April 2012 77


Page 1  |  Page 2  |  Page 3  |  Page 4  |  Page 5  |  Page 6  |  Page 7  |  Page 8  |  Page 9  |  Page 10  |  Page 11  |  Page 12  |  Page 13  |  Page 14  |  Page 15  |  Page 16  |  Page 17  |  Page 18  |  Page 19  |  Page 20  |  Page 21  |  Page 22  |  Page 23  |  Page 24  |  Page 25  |  Page 26  |  Page 27  |  Page 28  |  Page 29  |  Page 30  |  Page 31  |  Page 32  |  Page 33  |  Page 34  |  Page 35  |  Page 36  |  Page 37  |  Page 38  |  Page 39  |  Page 40  |  Page 41  |  Page 42  |  Page 43  |  Page 44  |  Page 45  |  Page 46  |  Page 47  |  Page 48  |  Page 49  |  Page 50  |  Page 51  |  Page 52  |  Page 53  |  Page 54  |  Page 55  |  Page 56  |  Page 57  |  Page 58  |  Page 59  |  Page 60  |  Page 61  |  Page 62  |  Page 63  |  Page 64  |  Page 65  |  Page 66  |  Page 67  |  Page 68  |  Page 69  |  Page 70  |  Page 71  |  Page 72  |  Page 73  |  Page 74  |  Page 75  |  Page 76  |  Page 77  |  Page 78  |  Page 79  |  Page 80  |  Page 81  |  Page 82  |  Page 83  |  Page 84