Intravenous cannula placement: getting it right

Abstract

is a common procedure carried out within hospitals, with many patients being admitted requiring intravenous (IV) drug therapy, allowing rapid and accurate administration of medication (Endacott et al, 2009). However, the placement of an intravenous cannula can lead to a number of undesirable effects, with some of the most common being phlebitis and skin inflammation. It is important that any venous cannula is correctly secured to help prevent infection, phlebitis and cannula displacement. All nurses working in areas where IV therapy is administered have a duty to observe and react to evidence of phlebitis and inflammation. Many patients who are admitted into hospital require some form of IV therapy (via PVC), and for many different reasons. These include: intravenous antibiotic administration, intravenous pain relief and/or total parenteral nutrition (TPN). There are a number of intravenous delivery devices that can be used and these include: ■ Peripheral cannula ■ Peripheral midline catheter ■ Peripherally inserted central catheter ■ Skin tunnelled cuffed central catheter (Hickman line). The type of IV delivery device to be used is related to the type of fluid administered and the length of time intravenous therapy will last. Peripheral venous cannulas are indicated for short-term use only (Dougherty and Lister, 2008). If intravenous therapy is indicated for longer periods, then central venous access will be required. Likewise, central access is required if cytotoxic and/or hypertonic solutions are to be intravenously administered (Hankins et al, 2001; Royal College of Nursing (RCN), 2010). It is estimated that in the UK 20-80% of patients with a PVC develop phlebitis (Pandero et al, 2002). This broad range is in keeping with studies from other countries (Uslusoy and Mete, 2008), suggesting poor identification of phlebitis or poor reporting protocols. It is therefore essential for the nurse to be able to identify patients who are at risk of developing phlebitis. Furthermore, early recognition of its development will enable prompt intervention, with the aim of minimising disruption to treatment and optimising patient care. Peripheral catheter-related phlebitis is the inflammation of the tunica intima of a superficial vein that can lead to infection or thrombus formation if left untreated (RCN, 2010). This inflammation is the result of irritation of the tunica intima by the chemical solution infused, bacterial sources and/or mechanical forces. Chemical phlebitis is attributed to the type of drug or fluid being infused through the cannula. Researchers have concluded that factors such as pH and osmolarity of the substances have a significant effect on the incidence of phlebitis (Monreal et al, Intravenous cannula placement: getting it right