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CLINICAL: BASIC CARE


‘Peripheral midline


catheters are being increasingly used


throughout the field of IV therapy’


PERIPHERAL INTRAVENOUS CANNULATION Patients are admitted onto our IV service directly from general practitioners. This usually means that they will receive treatment via PVC. Within the service, patients are referred with a range of vascular access devices.


TYPES OF VASCULAR ACCESS DEVICES USED All the following devices are used within our IV service. Only patients with non-cuffed, non-tunnelled central catheters placed are not accepted. • Peripheral intravenous cannula. • Peripheral midline catheter. • Peripherally inserted central catheter (PICC). • Tunnelled cuffed central catheter. • Totally implanted vascular access device.


The three IV trained nurses within our team are able to


cannulate. We advocate the use of non-ported safety cannulae with an integral extension set and needle-free device, chlorhexidine 2% for skin disinfection, a transparent IV dressing and a full aseptic non-touch technique (ANTT) whenever the cannula is being manipulated. Anecdotally we have found these measures have increased the number of days that our cannulas last. All cannulas are assessed at every manipulation using the Visual Infusion Phlebitis Score7


and documented in the patients’ notes. Newly-qualified nurses, or more recently, trained nurses are


taking roles in the community more than ever before. These nurses have often practiced cannulation in the hospital and many are keen to continue to practice PVC within the community. As long as proof of training and education is available, and competency is assessed by a member of the team, the nurse is able to practice. In my experience some team leaders are reluctant to allow them to


practice this skill for fear of them being asked to see patients outside of their own teams. The nurses themselves do not see this as an essential component of their role, but one which they can use if they choose to. The community nurses have embraced IV therapy and have


developed it into a fascinating field. I find that it isn’t very difficult for them to gain the theoretical component of PVC. A number of companies provide this at a cost, most acute trusts have in-house courses for their staff, and companies supplying cannulas will also provide some training if required. In view of this, it would be fair to say that nursing knowledge in relation to PVC is wide - varied but inconsistent. Within our service, we have offered study sessions to teach the theoretical component of PVC, yet the attainment of practical skills and competency is much more difficult to achieve.


CHALLENGES As already stated, our community nurses were offered a number of study sessions to learn about PVC. Large numbers of community nurses undertook the training. However, due to the small number of cannulas used throughout the service compared to the numbers used in an acute trust, we had to find placements for them in areas that used high volumes of cannulas. This included A&E depart- ments, chemotherapy units and theatres. Using an honorary contract, the nurses were able to carry out PVC only. A member of the IV team would accompany the nurses, however problems arose due to the fact that the acute trusts were not using the same consumables as in the community, which seemed to make everything more difficult. Community nurses can encounter problems outside of the hours


9am to 5pm when the IV nurses are not available, and on bank holidays and weekends. Small numbers of community nurses are proficient in cannulation, but if they are not available, the patient would either have to attend a walk-in centre or go back to the ward


78 Nursing in Practice March/April 2012


www.nursinginpractice.com


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