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or department that they were referred from. This is not usually an acceptable option for patients or their families, judging by the negative comments on our patient survey forms. It was also problematic because ported cannulae were used, which hadn’t been properly flushed and locked under positive pressure, making access to them in the community following insertion difficult. Interestingly, in a recent ‘missed dose’ audit that was undertaken within our service over a three-month period, only nine doses were missed as a result of failed PVC. A total of 911 doses were given in that period. All of the missed doses due to cannula failure were during the weekend, although we did not count the number of PVCs that were being used as opposed to the number of long lines. Some IV services may recruit the help of healthcare profession-

als with the necessary skill to provide a service out-of-hours (OOH). Emergency care practitioners may sometimes be recruited to re-cannulate if the need arises. However the response times may not always be immediate, depending upon their workload, and they are not available in all areas. Some IV therapy services are delivered by rapid response teams, who may be trained in PVC. Peripheral midline catheters are being increasingly used

throughout the field of IV therapy. Some IV services locally will not accept a patient onto the service with PVCs which could limit the number of referrals that can be made and delay some discharges whilst a long line is inserted. We find these lines are particularly useful for patients requiring more than seven days treatment, or if they have poor peripheral access. The three IV nurses are able to place these lines in patients’ homes. Whilst this is a positive development for patients, it further reduces the number of PVCs in the community, and also the availability of patients for community nurses to attempt cannulation. To further compound this issue, a recent Cochrane review

suggests that PVCs should only be replaced when clinically indicated for those patients who receive intravenous therapy in acute and community settings. The evidence recommends discouraging the routine change of catheters every 72-96 hours.8

ISSUES According to Nutbeam and Daniels,9

“The days of ‘see one, do one,

teach one’ are over. Experts estimate that each new practical competency (eg, intravenous cannulation) must be performed a minimum of 30 times to be ‘learned’ as a new psychomotor process; it is more difficult to estimate how frequently the process must be performed to be retained.” In view of this, we need to admit defeat with our community nurses. Due to the lack of patients requiring PVCs we are unable to up-skill our community nurses unless they were competent beforehand, as in the case of the IV trained nurses. Our service is now providing total parenteral nutrition (TPN) for

patients with lifelong requirements. The effects of accepting the TPN patients could have a detrimental effect upon the capacity referrals of patients who require other types of therapy. We have decided to complete a business case to employ more IV/TPN trained nurses with the ability to do PVC in OOH, so that there will always be a nurse who can cannulate available whenever the community nurses need one. Services might also consider an on-call IV service, which may be quite costly.

CONCLUSION The development of IV therapy in the community has meant that nurses working in these roles have had to gain many new compe- tencies in the field of IV therapy. Whilst this presents services with an

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enormous education and training programme, it is extremely beneficial for both the service and the professional development of the nurses themselves. However I believe that skills such as PVC and long-line placement should remain the domain of IV trained nurses, who can support the community nurses with advice, education and up-to-date information to enable them to practice safely and effectively; not to pile on more pressure considering the range of skills that is needed for today’s community nurse.

REFERENCES 1. Kayley J. IV therapy in the community. Nursing Times 2011;07(19/20): 15-18.

2. Nursing and Midwifery Council. The NMC Code of Professional Conduct: Standards for Conduct, Performance and Ethics. London: NMC; 2006.

3. Royal College of Nursing. Standards for Infusion Therapy. Second edition. London: RCN; 2010.

4. Kayley J. IV training is important for community nurses. British Journal of Nursing (Supp.), 2010;19(5).

5. Depledge J, Gracie F. Providing IV therapy education to community nurses. British Journal of Community Nursing 2004;11(10):428-432.

6. Collins M et al. A structured learning programme for venepuncture and cannulation. Nursing Standard 2006; 20(26):34-40.

7. Jackson A, A battle in vein: Infusion phlebitis. Nursing Times 1998;94(4):68-71.

8. Webster J et al clinically indicated replacement versus routine of peripheral venous catheters. Cochrane database of Systematic Reviews Issue 3, Art no: CD00779. DOI: 10.1002/14651858.CD007798.pub2.

9. Nutbeam T Daniels R. ABC of Practical Procedures. London: Blackwell; 2010.

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