Intravenous Insertion and

Ongoing Care Policy

Initiated by:
Approved by:
Issue Date:
Review Date:
Version:
Doc Ref:

Nursing & Midwifery Forum

Nursing & Midwifery Forum
2009
2011
1
IVIOGCv1 .09

Policy Title:

Intravenous Insertion and ongoing care

Executive Summary:

This policy details the requirements of practitioners around IIV

cannula insertion and ongoing care, including the process and
documentation required. The policy also identifies the competency
requirement by the Trust for staff involved in IV cannulation and
ongoing care.
This policy will be updated and amended in line with any Trust or
Department of Health requirements.

Supersedes:

New Policy v1

Description
of N/A
Amendment(s):
This policy will impact on:
All staff who insert peripheral invasive cannulas in clinical practice

Financial Implications:
None

Policy Area:

Trust wide

Version Number:

Issued By:

Director of Nursing and Review Date:

Document
Reference:
Effective Date:

IV insertion/Care
v1 09
2009
2011

Patient Care Standards

Author:

Senior Nurse Infection Impact Assessment 06.09

Date:
Prevention and Control

APPROVAL RECORD
Committees / Group

Date

Consultation:

Nursing Midwifery forum

04.09

Approved by Director:

Director of Nursing and Patient 05.09

Care Standards

Received for information:

IV insertion/Care
March 2009
Review March 2010

East Cheshire NHS Trust

Contents

Page

Introduction

Indications for intravenous cannulation

Hand washing technique

Insertion and Preparation for IV Therapy

Site Selection

Management of IV Catheters

Replacement of IV Catheters

Equipment used in Peripheral IV Therapy

Removal

10 Documentation

11 Audit

12 Training

Appendices
Trust IV Care Plan

10

Supervision of IV Cannulation

12

Staff letter re competencies

13

Legislation, Guidance and References

14

Equality and Impact Assessment Tool

15

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Review March 2010

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1. Introduction
The aim of this policy is to provide a framework and written guidance for the appropriate
selection, assessment of peripheral intravenous cannulation and ongoing care. This is to
ensure the patient is protected against the risk of infection, discomfort, trauma and
complications. By undertaking the appropriate insertion technique and maintaining patency
of the line/site the risk of infection should be minimised.
The purpose of this policy is to ensure that all persons who undertake the insertion of IVs
and ongoing care understand the risks and are competent to do so (Winning Ways 2003).
1.2 Scope of the Policy
This policy relate to all healthcare professionals who undertaken training around insertion of
peripheral invasive cannula and who have undertaken the relevant competency based
assessment in line with their professional accountability.
1.3 Consent
Prior to insertion of the cannula the patients consent must be obtained. Verbal consent is the
usual method based on the information given, however in the case of emergencys clinical
decision must occur.

2. Indications for Intravenous Cannulation

Inappropriate use of cannulation may lead to higher levels of infection and should be avoided
when possible. The need for insertion and ongoing IV therapy should be determined by clinical
assessment. Where possible alternative routes should be considered as first option.

4. Hand washing technique

Thorough hand washing is essential in minimising the risk of infection, therefore it is essential
that the technique below is adhered to when inserting and giving ongoing care to intravenous
devices
Wet hands under running water before applying cleansing agent. Apply liquid soap to palms.
Wash hands thoroughly ensuring that all areas are covered, especially between fingers around
wrists and thumbs, palms and finger tips and under rings. Rinse well under running water and
dry thoroughly on disposable paper towels. The procedure need not take more than 30 second
(follow the procedure in the picture below).
In order to maintain the integrity of the skin apply a moisturiser ideally before starting a break
and at the end of the shift.

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Hand Washing
1

Palm to palm.

Backs of fingers to opposing palms

with fingers interlocked.

Right palm over left dorsum

and left palm over right dorsum.

Palm to palm
fingers interlaced.

Rotational rubbing of right thumb

clasped in left palm and vice versa.

Rotational rubbing, backwards and forwards

with clasped fingers of right hand in left palm
and vice versa.

Please note the same steps must be followed when using Alcohol hand Gel

5. Insertion and Preparation for IV Therapy

Intravenous cannulation is performed on the instructions of medical staff or by a suitably
trained/experienced nurse.
Where difficulty is experienced or anticipated, appropriate assistance should be sought.
5.1. Site Selection
In adults cannulation usually occurs in the upper extremities of the body in superficial veins
located just below the surface of the skin.
When undertaking the patients assessment for cannulation consideration must be given to
the size of cannula required (assessed on clinical need) and the available vein. The vein
should be unused, easily detected, patent and healthy.
General rules
Avoid median cubital veins; this should be reserved for venous blood sampling.
These are at the antecubital fosa in the elbow region.
Distal veins should be used first with subsequent attempts proximal to previous sites
Always allow time for inspection and palpation of the patients forearm and dorsum of
hand to select site.
In difficult cases, ensure maximum venous dilatation before inspection.
If in doubt, consult a more experienced colleague
Use veins on the patients non dominant side if possible.
Use opposite side for cannulation to any surgical procedure
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A good vein is:

Soft
Bouncy
Refills when depressed
Well supported
Visible straight
The following veins should be avoided if at all possible;
Small and visible but impalpable
Irritated from previous use
Tortuous/mobile
Sclerosed /fibrosed/ thrombosed
Inflamed
Painful/sore/bruised
Hard
Thin/fragile
Near bony prominences or areas of joint flexion
Adjacent to infection
In the lower extremities( increased risk of thrombophlebitis and pulmonary emboli)
Close to arteries or deeper lying vessels.
Veins on the same side as a mastectomy/previous breast or axillary surgery
Arteriovenous fistula (AV fistula)

When cannulating a patient, if unsuccessful a new cannula must be used

5.2 The protocol for insertion is as follows:
Collect all required equipment, checking expiry date and integrity of packages
Select the appropriate size catheter pack for the purpose and length of
infusion/therapy
Decontaminate hands
Clean the trolley with detergent and water (or detergent and alcohol wipe) and dry
Set trolley with all equipment, then move to patient bedside
Confirm patient identity and provide explanation
Position the patient and select the site
Decontaminate hands
Put on clean (i.e. non-sterile) gloves
Open sterile catheter pack
Apply a tourniquet
Disinfect the skin for at least 30 seconds with chloraprep
Allow site to air dry and do not touch the insertion site
Remove catheter from packaging
Insert catheter with bevel up at selected angle
Advance cannula into vein once flashback is seen
Release tourniquet
Secure catheter in place with a sterile, transparent, semi permeable, self-adhesive
dressing
Check patency of cannula
Ensure patient is made comfortable
Dispose of waste equipment as appropriate
Clean trolley
Remove gloves
Decontaminate hands
Complete documentation
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6. Management of IV Catheters
Complications such as phlebitis, entry site infection and blood stream infection can occur as
a result of peripheral IV cannulation. It is important to detect at the earliest opportunity to
prevent complications. All insertion sites should therefore be checked at least daily for signs
of infection. These include:

Erythema
Oedema/swelling
Tracking
Heat
Pain/tenderness
Purulent discharge

The VIP scored must be recorded by staff on the relevant documentation twice daily.
If any of the above signs are noted, the IV catheter must be removed.
All lines must be checked for patency before each by flushing with 0.9% sodium chloride.
If an IV line related infection is suspected, the following should be carried out:
A swab for culture and sensitivity should be taken from the site
If there is clear evidence of infection, the tip of the catheter should be sent for culture
and sensitivity.
Blood cultures may be required based on the patients clinical condition
Where the line needs to be accessed intermittently e.g. when IV medication needs to be
given, it is essential that risks of contamination are minimised by undertaking an Aseptic
technique and use needle free devices to reduce strain on the cannula.

Prepare all equipment

Clean the trolley with detergent and water (or detergent and alcohol wipe) and dry.
Prepare patient
Decontaminating the hands
Put on clean (i.e. non-sterile) gloves
Check IV site
Reduce site manipulation to a minimum
Use a non-touch technique
Ensure equipment in contact with cannula and line is sterile
Replace cap, if removed, with sterile one
Flush the circuit through before and after each use
Dispose of waste
Clean trolley
Remove gloves
Decontaminate hands

6.1 Flushes
In order to prevent vascular thrombosis and to ensure the patency of lines cannula should be
flushed after insertion and prior to use using a sterile 0.9%sodium chloride solution. A needle
free device should be in situ.
This should be no more than 5mls using a 10ml syringe or larger
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7. Replacement of IV Catheters
If a peripheral IV catheter needs to be replaced, the new catheter should be inserted into a
separate site.
If there is evidence of local catheter site or systemic infection, the catheter should be
removed and replaced, if necessary, with a new catheter in a separate site.
The peripheral IV catheter should be changed every 72 hours (even in the absence of signs
of infection) as there is a marked increase in phlebitis and colonisation in peripheral
catheters left in place for longer than 72 hours. If there are difficulties cannulating the patient
then a risk assessment must be undertaken and clearly documented listing why the cannula
needs to stay in place and a clear review process.
8. Equipment used in Peripheral IV Therapy
Administration sets IV tubing should be replaced every 72 hours unless otherwise
clinically indicated. If the set is used for the administration of blood, blood products or
lipid emulsions, they should be replaced following administration.
Stopcocks and caps after each use they must be flushed with normal saline. Caps
must be replaced with a new sterile one after they have been removed from the
circuit. If an octopus device is attached this must be decontaminated prior to use.
IV dressings it is recommended that IV site dressings have several properties.
These include transparency, being self-adhesive, semi-permeable and sterile. While
transparent polyurethane dressings may remain in place for the life of the device, the
dressing should always be changed if it becomes soiled, loosened or damp or if you
are unable to observe the insertion site.
Infusion devices for ambulatory use the manufacturers instructions always be
followed for the device used and training should have been completed by the staff
commencing the infusion.
9. Removal
Prior to removal of a peripheral cannula hands must be decontaminated.
Ensure an aseptic technique and gloves are worn
Remove intravenous device carefully, apply pressure and an appropriate dry
dressing.
Inspect the device on removal for signs of cannula embolism
Document removal in appropriate nursing/medical notes
10. Documentation
In order to minimise and assess the risks of infection caused by peripheral cannulation it is
essential that all documentation is completed appropriately (Saving Lives 2007) this
documentation is contained within the cannulation packs. It is essential for a tracking and
traceability of the cannula and the patients journey.
This documentation includes;
Date and time of procedure
Who the cannula was inserted by
Gauge and lot number
Insertion reason
Insertion site
Aseptic technique undertaken
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Associated pain
Successful flush
VIP score
Removal reason and length of time cannula in place

In addition to this all patients who are admitted as an inpatient with an IV cannula must have
the appropriate Trust care plan in situ(Appendix 1).
11. Audit process
The Health Act (2006) requires NHS organisations to undertake audits of Key polices and
procedures. This will be undertaken in clinical areas monthly using the Saving Lives (2007)
high impact intervention Peripheral intravenous cannula care bundle. The results of these
audits will be fed back to each business unit matron who will discuss the findings with the
appropriate ward / department. In addition to this exception reporting will be through the
Infection Prevention and Control Committee.
12.

TRAINING
Only Medical staff, nurses and midwives who have completed an educational
programme and undertaken the relevant competency assessments on intravenous
cannulation may insert a peripheral vein cannula.
In addition to receiving theoretical study each practitioner must have received a
minimum of five supervised practice sessions (Appendix 2) in intravenous
cannulation and be able to demonstrate competency in this procedure.
Clinical supervision may be undertaken by a first level nurse who has completed an
approved educational programme regarding intravenous cannulation or a member of
the medical team at staff grade level or above. The supervisor must have a minimum
of 12 months experience in inserting cannulas
Responsibility for appointing Clinical Supervisors rests with the ward manager/nurse
in charge.
On completion of training the practitioner must forward a copy of their
Competency/Intention to Practice Form (see appendix 3) to their Ward Manager for
retention in their and the Clinical Skills Facilitator for Education and Training Records.
Responsibility for maintaining skills, as per the Code of Professional Conduct, NMC
2002B, lies with the individual practitioner

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Appendix1

Patients Name:

Hospital Number

DOB
Ward/Dept:

Consultant
Bay/Side room

Aspect of Care

Peripheral
Cannula
Insertion
and
Intravenous Therapy Core Care Plan

Peripheral

AIM/GOAL
To minimise risk of infection or cellulitis associated with intravenous therapy.
To prevent infection by ensuring an Aseptic Technique is used.
To maintain a 'closed' intravenous system with few connections to reduce risk of
contamination.
To maintain a patent device thus ensuring the integrity of lines and venous access.
To ensure accurate documentation of Cannula insertion and care.
NURSING CARE/ACTION
Explain procedure to the patient. Gaining either implied or verbal consent.
Before commencing the procedure and after each patient contact wash hands
and dry thoroughly.
Maintain aseptic technique at all times.
Gather the appropriate cannula pack (colour coded relating to the size of the
cannula).
Ensure a sharps bin and tray are taken to the patients bedside.
Sterile gloves should be worn. (Gloves are single use items and should be
removed and discarded immediately after the care activity).
Gowns, aprons, eye/face protection are indicated if there is a risk of splashing
with blood or body fluids.
Use 2% chlorhexidine gluconate in 70% isopropyl alcohol. Clean an area of 45 cm
in diameter wiping the site from the centre outwards for a minimum of 15 seconds
and allow to dry.
Insert appropriate cannula aseptically.
Use a sterile, semi-permeable, transparent dressing to allow observation of insertion
site.
Record Cannula insertion and pain score on the Cannula Assessment Record (This
is included in the cannulation pack).
Check clinical indication for continued use of intravenous Cannula if no longer
indicated remove device and document removal in patients nursing records.
Decontaminate hands and use aseptic technique when manipulating the Cannula
and or line.
All lines must be checked for patency before each use.
Observation of the cannula must occur twice daily. Observe for signs of infection
before each use erythema, tracking (redness along the line of the vein),
oedema/swelling, heat, pain/tenderness, and purulent drainage.
Record visual infusion phlebitis (VIP) score( The Phlebitis Score is on the reverse of
the Cannula Assessment Record) twice daily on the Cannula Assessment Record.
And more frequently e.g., 2 hourly, if there are indications of phlebitis. Cannula
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should be changed at the first indication of infusion phlebitis (Stage 2 on VIP score
chart).

If any signs of infection are observed the following actions MUST be undertaken
1. Swab from the cannula entry site,
2. Blood cultures obtained through the cannula and via a separate peripheral
vena-puncture before antibiotics are started.
3. The cannula MUST be removed.

Flush the cannula with at least a 5ml flush of 0.9% Sodium Chloride (as prescribed)
before and after the administration of medications, using a 10ml syringe as a smaller
syringe may damage the catheter.
Administration sets should be changed every 72 hours with the exception of infusion
sets used for blood products, blood and lipid emulsion (TPN), which should be
changed every 24 hours. Change giving set immediately upon suspected
contamination or when the integrity of the product or system has been compromised.
Cannula dressings should be assessed twice daily and changed if required. A semi
permeable dressing should be used at all times to secure the cannula.

Print Name:

Signature:

Date Commenced:

Print Name:

Signature:

Date Discontinued:

Date

Variance

Signed

References
Department of Health The Health Act (2006)- Code of practice for the prevention and
control of healthcare Associated Infections.
Department of Health Saving Lives (2007). Reducing Infection, delivering clean and safe
care.
Department of Health Winning Ways (2003). Working together to reduce Healthcare
Associated Infection in England.
Cheshire and Merseyside NHS Northwest (2007) Intravenous Access Care and Maintenance in
hospital and at home. (Developed by the Collaborative Intravenous Nursing Service)

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Appendix 2

Supervision of IV cannula insertion

This is NOT a CERTIFICATE of COMPETENCY. It serves only as a record of supervised

sessions. Your ward manager will appoint a Clinical Supervisor.

Each nurse/ Medical staff must arrange as many supervised sessions as necessary
prior to practice. A minimum of five supervised sessions is recommended.

All sessions must be signed by the Clinical Supervisor

Name of Nurse/ Dr being supervised:

Ward/Department:
Name of Clinical Supervisor:

Supervision of IV Cannulation
Date

Signature

Designation

1
2
3
4
5

If following 5 supervised attempts the nurse had failed to be deemed competent then the
supervisor should seek advice form the ward manager about further training.

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Appendix 3

To: Ward Manager and Clinical Skills Facilitator

I have received theoretical study on Intravenous Cannulation and have undertaken

supervised practice. I have enclosed a copy of my supervised practice form and deem
myself to be competent in IV cannulation.
It is my intention to commence practice from - specify date:

Print Name:
Job Role
Area of practice
Signature:
Date:

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LEGISLATION, GUIDANCE AND REFERENCES

British Medical Association (2006) Healthcare associated infections A guide for healthcare
professionals. London
Melzer M, Bain,L, DrabuY(20008) Preventing Infections from Cannulas reduces
MRSA(Letter) BMJ Volume 336, pge1085-1086
Craven, Harrogate and Rural District NHS Trust (2004) Intravenous Lines Policy
Department of Health (2003) Winning Ways working together to reduce Healthcare
Associated Infection in England
Department of Health (2007) Saving Lives: reducing infection, delivering clean and safe care
high impact intervention No2, Peripheral intravenous cannula care bundle.
Department of Health- The Health and Social Care Act 2008- Code of practice for the NHS
on the prevention and control of healthcare associated infections and related guidance.
Department of Health (2008) Going Further Faster II: Applying the learning to reduce HCAI
and improve cleanliness.
East Cheshire NHS Trust (2007) Good Practices policy Infection Prevention and Control
Manual
East Cheshire NHS Trust (2008) Aseptic Technique Policy
Epic.2(2007) National Evidence-Based Guidelines for Preventing Healthcare-Associated
Infections in NHS Hospitals in England. Thames Valley University. London
ICNA (2001) Guidelines for Preventing Intravascular Catheter-related Infection ICNA/3M
Northern General Hospitals NHS Trust (2000) Guidelines for the insertion and care of
indwelling peripheral venous cannulae
The Royal Marsden Hospital (2005) Manual of Clinical Nursing Procedures 6th Ed. Blackwell.
London

Wilson J. (2000) Clinical Microbiology: An introduction for Healthcare Professionals. Balliere

Tindall. Lon

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Equality and Human Rights Policy Screening Tool

Policy Title: Intravenous Insertion & Ongoing Care Policy

Directorate: Nursing & Patient

Care Standards

Name of person/s auditing / authoring policy:

Senior Nurse Infection Prevention & Control & Infection Prevention & Control Committee
Policy Content:

For each of the following check whether the policy under consideration is sensitive to people of a different age,
ethnicity, gender, disability, religion or belief, and sexual orientation?

The checklist below will help you to identify any strengths and weaknesses of the policy and to check whether it is
compliant with equality legislation.

1. Check for DIRECT discrimination against any minority group of PATIENTS:

Question: Does the policy contain any statements which
may disadvantage people from the following groups?
1.0

Age?

1.1

Gender (Male, Female and Transsexual)?

1.2

Learning Difficulties / Disability or Cognitive Impairment?

1.3

Mental Health Need?

1.4

Sensory Impairment?

1.5

Physical Disability?

1.6

Race or Ethnicity?

1.7

Religious Belief?

1.8

Sexual Orientation?

Response
Yes

No

Action
required
Yes

No

Resource
implication
Yes

No

2. Check for DIRECT discrimination against any minority group relating to EMPLOYEES:
Question: Does the policy contain any statements which
may disadvantage employees or potential employees from
any of the following groups?
2.0

Age?

2.1

Gender (Male, Female and Transsexual)?

2.2

Learning Difficulties / Disability or Cognitive Impairment?

2.3

Mental Health Need?

2.4

Sensory Impairment?

2.5

Physical Disability?

2.6

Race or Ethnicity?

2.7

Religious Belief?

2.8

Sexual Orientation?

Response
Yes

No

Action
required
Yes

No

TOTAL NUMBER OF ITEMS ANSWERED YES INDICATING DIRECT DISCRIMINATION = 0

3. Check for INDIRECT discrimination against any minority group of PATIENTS:

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Resource
implication
Yes

No

Question: Does the policy contain any conditions or

requirements which are applied equally to everyone, but
disadvantage particular people because they cannot comply
due to:
3.0

Age?

3.1

Gender (Male, Female and Transsexual)?

3.2

Learning Difficulties / Disability or Cognitive Impairment?

3.3

Mental Health Need?

3.4

Sensory Impairment?

3.5

Physical Disability?

3.6

Race or Ethnicity?

3.7

Religious, Spiritual belief (including other belief)?

3.8

Sexual Orientation?

Action
required

Response
Yes

No

Yes

No

Resource
implication
Yes

No

4. Check for INDIRECT discrimination against any minority group relating to EMPLOYEES:
Question: Does the policy contain any statements which
may disadvantage employees or potential employees from
any of the following groups?
4.0

Age?

4.1

Gender (Male, Female and Transsexual)?

4.2

Learning Difficulties / Disability or Cognitive Impairment?

4.3

Mental Health Need?

4.4

Sensory Impairment?

4.5

Physical Disability?

4.6

Race or Ethnicity?

4.7

Religious, Spiritual belief (including other belief)?

4.8

Sexual Orientation?

Action
required

Response
Yes

No

Yes

No

Resource
implication
Yes

TOTAL NUMBER OF ITEMS ANSWERED YES INDICATING INDIRECT DISCRIMINATION = 0

Signatures of authors/auditors:
Anita Swaine Senior Nurse Infection Prevention & Control
Dr Alan Wills DIPC, on behalf of the IPCC

Date: 06.2009

Equality and Human Rights Compliance / Percentage Calculation

Number of Yes answers for DIRECT discrimination.

Number of Yes for INDIRECT discrimination.

Total answers for POLICY CONTENTS discrimination.

Percentage content non compliant

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No