Peripheral Venous Cannula Insertion and Management (Adults ... · PDF fileHampshire Hospitals NHS Foundation Trust – Peripheral Venous Cannula Insertion and Management (Adults) Policy

Hampshire Hospitals NHS Foundation Trust – Peripheral Venous Cannula Insertion and Management (Adults) Policy – HH(1)/IC/636/13

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Peripheral Venous Cannula Insertion and Management (Adults) Policy - HH(1)/IC/636/13 Previous document(s) being replaced

Location Policy No Policy Name

RHCH CPR012 Policy for the Insertion of Peripheral Intravenous

Cannula

BNHH IC/396/10 Clinical Policy for Peripheral Venous Cannula

Insertion and Management

Document Summary

This policy will provide information about the correct technique for peripherally cannulating a vein aseptically

and the subsequent care of the peripheral venous cannula. By using this policy the user will act to reduce the

risks to patients and staff associated with peripheral venous cannulation. These include thrombosis, pain, local

or systemic infection; occupational sharps injury and inappropriate cannula insertion.

Ownership Author Sandy Kirk

Job Title IV Nurse Specialist

Document Type Level Level 1

Related Documents Document Details Hand Hygiene Policy

Aseptic Technique Policy

Relevant Standards CQC Outcome Outcome 8

NHSLA Standard N/A

Equality Impact

Assessment

Completed by Equality and Diversity Lead

Date Completed 18 March 2013

Final Document Approval Committee Policy Approval Group

Date Approved 18 March 2013

Final Document

Ratification

Committee Executive Committee

Date Ratified 21 March 2013

Authorisation Authoriser Mary Edwards

Job Title Chief Executive Officer

Signature

Date Authorised 25 March 2013

Dissemination Target Audience All Trust Staff

Dissemination and Implementation Plan

Action Owner Due by

Publicise detail of new document via Intranet and

Midweek message

IPCT and Communication Team Within 1 week of

publication

Communication to all Senior Managers to advise

publication of policy

BNHH Healthcare Library On publication

The policy will be available on the intranet and web

site

BNHH Healthcare Library and

Communication Team

Within 1 week of

authorisation

Review Expiry date March 2016

Review date December2015



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Document Control – Document Amendments

Version No. Details Key amendments to note By whom Date

1 Review of BNHFT &

WEHCT policies to

produce harmonised

HHFT policy

Sandy Kirk December

2012



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Contents

1. Introduction ...................................................................................................... 4

2. Purpose ............................................................................................................ 4

3. Scope ................................................................................................................ 4

4. Explanation of Terms ........................................................................................ 5

5. Duties ............................................................................................................... 5

6. Clinical Need and Practice ................................................................................. 6

7. Insertion ........................................................................................................... 8

8. Management .................................................................................................... 9

9. Stakeholders Engaged During Consultation .................................................... 11

10. Dissemination and Implementation ................................................................ 11

11. Training........................................................................................................... 11

12. Monitoring Compliance with the Document ................................................... 12

13. References ...................................................................................................... 12

14. Associated Documentation ............................................................................. 13

15. Contributors ................................................................................................... 13

Appendix A – Equality Impact Assessment ................................................................ 14

Appendix B - Abbreviated guide to Peripheral Venous Cannulation (Adult) .............. 16

Appendix C - Cannula Insertion and Management Form ........................................... 18



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1. Introduction

Aseptic peripheral venous cannulation is undertaken to provide venous access for

either diagnostic or therapeutic purposes:

• Short-term intravenous fluid therapy of usually less than 3-4 days (if

intravenous access is needed for longer periods, other options should be

considered)

• Administration of bolus injections in outpatients or in day case surgery

• Vascular access for fluids or drugs at time of particular procedure e.g.

surgery, endoscopy

It is essential that infection control is seen as an organisational responsibility and

priority, that adequate isolation facilities and resources are provided, and that

appropriate infection control staff and support services are available.

2. Purpose

The aim of this policy is to inform best practice on the aseptic insertion of peripheral

venous cannulation of adults. The implementation of this policy will reduce the risks

associated with this procedure including thrombosis, pain, local or systemic

infection; occupational sharps injury and inappropriate cannula insertion.

3. Scope

This policy extends to cover and will be applied fairly and consistently to all

Hampshire Hospitals NHS Foundation Trust employees regardless of their protected

characteristics as defined by the Equality Act 2010 namely age, disability, gender

reassignment, race, religion or belief, sex, sexual orientation, marriage or civil

partnership, pregnancy and maternity, length of service, whether full or part-time or

employed under a permanent or a fixed-term contract, irrespective of job role or

seniority within the organisation.

Where an employee has difficulty in communicating, whether verbally or in writing,

arrangements will be put in place as necessary to ensure that the processes to be

followed are understood and that the employee is not disadvantaged during the

application of this policy and related procedures.

In line with the Equality Act 2010, the Trust will make reasonable adjustments to the

processes to be followed where not doing so would disadvantage an employee with

a disability during the application of this policy.

This policy complements professional and ethical guidelines and the Nursing and

Midwifery Council (NMC) Code of Professional Conduct (NMC 2008).



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4. Explanation of Terms

Aseptic Technique - clinical practices used to protect the patient from micro-

organisms by preventing contamination of wounds, manipulated devices and other

susceptible sites. Aseptic technique involves the use of appropriate hand hygiene,

use of sterile equipment, no touch technique and robust patient skin/site

disinfection.

Venous Cannulation - procedure for insertion of a hollow fine bore tube into the

venous system.

Healthcare professional - a registered or trained member of staff including but not

exclusively nurses, doctors and operating department practitioners.

Infection - entry of a harmful microbe into the body and its multiplication in the

tissues.

Peripheral cannula - a specifically-designed flexible tube designed for insertion into

a blood vessel, with a proximal connector to allow injection or infusion of liquids.

Sizes range from:

• Yellow 24g

• Blue 22g

• Pink 20g

• Green 18g

• Grey 16g

• Orange 14g

22-20g - optimal for administration of intermittent medications

16-14g - routinely used to administer fluids in acute situations i.e. haemorrhage

Phlebitis - inflammation of a vein

Thrombosis - formation, development or existence of a blood clot within the

vascular system.

5. Duties

Chief Executive Officer (CEO) – The CEO has overall responsibility for the strategic

and operational management of the Trust ensuring there are appropriate strategies

and policies in place to ensure the Trust continues to work to best practice and

complies with all relevant legislation in regard to the insertion and management of

PVCs.

Director of Infection Prevention and Control (DIPC) – The DIPC is the Trust Director

responsible to the board for the delivery of IPC standards.



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Director of Nursing - The Director of Nursing will ensure that the Divisional Directors

take clinical ownership of the policy.

Divisional Operational Directors - The Divisional Operational Directors will ensure

that all health care workers comply with this policy and that all health care workers

attend mandatory infection prevention and control training. They are responsible for

ensuring adequate facilities and resources are available to adhere to this policy.

Clinical Service Managers/Leads - The Clinical Service Managers/Leads will ensure

that the current version of this policy is available in all of their areas. They will

ensure that all health care workers comply with this policy and that all health care

workers attend mandatory infection prevention and control training.

Infection Prevention and Control Team (IPCT) – The IPCT will act as a resource for

information and support. They will provide education in relation to this policy which

includes mandatory training. They will monitor the implementation of this policy via

audit within clinical areas and be responsible for regularly reviewing and updating it.

Health4Work - Health4Work will act as a resource for information, and support and

consult with managers, the Infection Prevention and Control Team and health care

workers regarding the use of personal protective equipment.

Health and Safety - Health and Safety will act as a resource for information, and

support and consult with managers, the Infection Prevention and Control Team and

health care workers regarding the use of personal protective equipment.

Medical Staff - Medical Staff who handle and care for PVCs should be competent to

do so. This should be assessed by their Educational Supervisor. Additional training

can be offered by the IV Nurse Specialist.

All Trust employees - All Trust employees will comply with this policy and inform the

Infection Prevention and Control Team about any issues or concerns relating to the

policy. All staff will attend mandatory Infection Prevention and Control training

annually. Infection control is the responsibility of ALL staff associated with patient

care. A high standard of infection control is required on ALL wards and units,

although the level of risk may vary. It is an important part of total patient care.

6. Clinical Need and Practice

The table below describes the appropriate procedure prior to the insertion of a

Peripheral Venous Cannula:

CLINICAL PRACTICE

Action Rationale

Identify clinical need for cannula

insertion

To prevent inappropriate insertion and

exposure to associated risks.

Collect equipment needed including:

� Cannula

� Dressing trolley (Cleaned)

To ensure procedure is performed without

disruption



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� White tray (cleaned)

� Sterile gauze

� Single use tourniquet

� Clean gloves

� Sharps box

� 2% Chlorhexidine and 70%

alcohol (Sanicloth CHG 2% or

Clinell skin wipe)

� Local anaesthetic (1% Lidocaine)

orange needle and 2ml syringe

� Cannula - IV dressing

� Saline flush

Choice of cannula must be based on

clinical need but the smallest cannula

should be chosen to reduce risk of

complications associated with larger

bores.

Identify patient by surname, first name

and date of birth

To ensure correct identification of the

patient

Wash hands with soap and water as per

the Trust Hand Hygiene Policy

To reduce the risk of infection

Place White tray onto clean dressing

trolley. Open equipment into the clean

tray.

To ensure patient is informed of

procedure and the risk of allergic reaction

is minimised

Explain to the patient the importance

of keeping the site clean and dry and

advise of risks of infection

To ensure patient compliance and reduce

risk of infection

Decontaminate hands with alcohol gel

or wash with soap and water


Palpate potential sites these include:

� The hand - a lower risk of

phlebitis

� The wrist or upper arm –

increasing risk

The lower limb has a higher risk than

the upper limb

To reduce risk of arterial rather than

venous cannulation and reduce risk of

infection.

When potential site is identified

position patient comfortably with

appropriate limb below the level of the

heart. Removing excess hair (shaving is

not recommended – clippers are

better)

To allow dependent veins to fill with blood

Local trauma can be caused by shaving,

increasing risk of infection

Apply proximal a single use tourniquet,

without obstructing arterial flow.

Optimal time for application is 3 to 5

minutes – if additional time is needed

release tourniquet as vein will tend to

“disappear”.

To distend veins

Encourage patient to exercise limb

muscles (e.g. repeatedly making a fist

and opening hand)

Muscle pump forces blood into veins to

distend them further

Decontaminate hands with alcohol gel To reduce the risk of infection



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7. Insertion

The table below describes the appropriate procedure for the insertion of a

Peripheral Venous Cannula:

or wash with soap and water and don

clean gloves

Clean insertion site using a spiral

motion from the proposed puncture

site outwards with 2% chlorhexidine in

70% alcohol (from pre-soaked wipe

Sani cloth CHG 2%/ Clinell skin wipe)

for 30 seconds and then allow to dry

To reduce risk of infection

Administer local anaesthetic (1%

Lidocaine) which should be encouraged

in all but the most urgent of cases.

Alternatively apply prescribed topical

local anaesthetic cream 45 mins prior

to procedure

To ensure patient comfort

Inserting the cannula

• Gently pull on skin, distal and

lateral to insertion site. Do not

touch the cannula or the insertion

site.

• Insert cannula (bevel uppermost)

through the cleaned skin area at

an angle of 20 degrees.

• Advance until just in the vein and

then lower the cannula until it is

parallel with the skin (a flashback

of blood is usually but not always

seen at this point)

To “fix” the skin and the superficial veins

underlying it.

To use the sharpened needle to introduce

the plastic cannula into the vein.

Then, either;

a) Pull the needle back 1cm and push

the cannula/needle into the vein up to

the hilt

Or;

b) Hold the needle still and advance

the cannula over the needle until the

cannula is inserted up to the hilt

To introduce the cannula fully into the

vein

In the event of unsuccessful

cannulation of the vein withdraw the

cannula from the puncture site and

apply pressure with non woven swab.

Discard cannula into sharps container.

To minimise haematoma formation and

/or excessive bruising



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Prior to subsequent attempts at

cannulation it is the responsibility of the

individual practitioner to risk assess the

difficulty of further attempts against

their own registered competence and

experience. If the practitioner

anticipates the difficulty level to be

beyond their scope of practice, then

referral to more experienced,

competent practitioners should be

made

To ensure cannulation is always

undertaken by competent practioners

and minimise risks associated with failed

attempts at gaining venous access

Remove the tourniquet and apply

pressure on the proximal vein, close to

the tip of the cannula – a second person

may be required for this

To prevent excessive bleeding during

needle-removal.

Remove needle and dispose of

immediately into a sharps container,

cap off cannula with a needle free

extension or attach intravenous fluids

as appropriate

To reduce risk of needle stick injury and

prevent blood spillage

Secure cannula with an approved sterile

cannula dressing, ensuring it is applied

correctly (non-sterile, sticky-tape

fixation or bandage is NOT acceptable).

To reduce risk of infection and secure

cannula in position

Place date and time sticker to outside of

dressing

To ensure timely removal

Flush cannula with 5-10 mls saline using

a 10ml syringe if not being attached to

infusion.

To ensure cannula patency

Document cannula insertion by

completing a Cannula insertion and

management form for each separate

cannula inserted (See Appendix C).

Once cannula has been removed this

document is filed in the patient’s

medical notes.

To establish an audit trail and monitor

management of cannula

8. Management

The table below describes the appropriate procedure for the on-going management

of a Peripheral Venous Cannula:

Ongoing cannula management

Decontaminate hands before and after

each patient contact. Use correct hand

hygiene procedure as per trust policy.




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Always access cannula by cleaning with

2% chlorhexidine and 70% isopropyl

alcohol (Sani- cloth CHG 2%/ Clinell

wipe), and allow to dry before

administering fluid or injections.


Needle free bungs should NOT be

applied directly onto ported cannulas;

single or double lumen extensions

should be applied. Nexiva cannulas have

a pre-attached extension in situ.

To prevent unwanted movement of

cannula in the vein thus causing phlebitis.

Cannula site should be inspected three

times a day (8 hourly) and documented

on the form.

Observe for signs of infection or phlebitis.

Cannula dressing should be, intact, dry

and adherent. The date and time of

insertion must be applied to the

dressing.

To ensure that the cannula is replaced or

removed on time, thus reducing the risk

of infection.

Remove cannula if there is no

continuing clinical indication and

document date and time of removal on

cannula management form.


Replace cannula in a new site after 72

hours (3 days), earlier if clinically

indicated.


Administration sets should be replaced:

• immediately after blood and

blood product administration

• intermittent IV antibiotics and

medicines

• heparin infusion lines should be

replaced every 24 hours

• all other fluid sets should be

replaced after 72 hours

ALL giving sets should be labelled with

date and time on commencement of

use. All disconnected giving sets should

be disposed of and cannot be

reattached.


An abbreviated guide to Peripheral Venous Cannulation is attached at appendix B.



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9. Stakeholders Engaged During Consultation

10. Dissemination and Implementation

The Policy will be disseminated in the following ways:

Action(s) Owner

Publicise detail of new document via Intranet and

Midweek message

IPCT and Communication Team

Communication to all Senior Managers to advise

publication of policy

BNHH Healthcare Library

The policy will be available on the intranet and

web site

BNHH Healthcare Library and

Communication Team

11. Training

Individuals in the Trust should receive annual infection prevention and control

training to ensure they are aware of their responsibilities. Education and Training

will be provided in accordance with the Trust Training Needs Analysis (Learning and

Development Policy).

Prior to undertaking any cannulation procedure, all staff must be able to

demonstrate clinical competence and a clear understanding of the underlying

principles of practice. This will be achieved by:

Nursing and other health care staff

• complete the Trust venous cannulation competency pack

• attend a cannulation study day

• complete a period of supervised clinical practice

Stakeholder Date of Consultation

Infection Prevention and Control (Lead Infection Prevention

& Control Nurse)

15 February 2013

Health and Safety (Health and Safety Advisor) 15 February 2013

Safeguarding (Trust Safeguarding Lead) 15 February 2013

Information Governance (Information Governance

Manager)

15 February 2013

Assistant Risk and Compliance Manager (Risk and

Compliance)

15 February 2013

Divisional Directors and Divisional Directors (Operational) 15 February 2013

Equality and Diversity Lead (Equality & Diversity) 15 February 2013

Infection Prevention and Control Committee 15 February 2013

Consultant Microbiologists 15 February 2013

Clinical Service Managers/Leads 15 February 2013

Operational Service Managers 15 February 2013



Page 12 of 19

(Staff who have been trained and practised in a previous post may be allowed to

demonstrate an equivalent level of competence through a period of supervised

practice only).

Medical staff

Post registration house officer (PRHO) induction will include training by Trust trainers

on local Policies and principles of practice.

Senior House Officer’s and Registrars will be assumed competent unless identified

otherwise by their supervisor. If problems are identified, the staff member will be

required to:

• complete the Trust venous cannulation competency pack

• attend a cannulation study day

• complete a period of supervised clinical practice

12. Monitoring Compliance with the Document

Compliance with the Policy will be monitored as described below:

Minimum

requirements Requirement

Reviewed by Method of Monitoring Frequency

of Review Monitoring

Committee

A.

Effectiveness

of policy

Infection

Prevention

and Control

Team

Quality control audits

to ensure continued

standards and

adherence of Policy

during care and

management of

Peripheral Venous

Cannula

Monthly Infection Prevention

and Control

Committee/Divisional

Governance Boards

B. Clinical

Supervision

Supervisors Clinical practice Ongoing N/A

13. References

References

Department of Health (2001) The epic Project: Developing National Evidence – based

Policies for Preventing healthcare associated Infections Journal of Hospital Infection (2001)

47 (supplement)

Donaldson I. (1999) Intravenous therapy in critically ill adults: developing a clinically and

cost- effective approach Intensive and Critical Care Nursing No 15, 338-345

Dougherty L, Mallett J (2001) The Royal Marsden Hospital Manual of Clinical Nursing

Procedures Fifth edition. Blackwell Science

Fletcher SJ; Bodenham A (1999) Catheter related sepsis: an overview – Part 1 British Journal

of Intensive Care. March/April



Page 13 of 19

Infection Control Nurses Association (2001) Policies for preventing intravascular catheter

related infection NICE (2003) (No. 4) Care of patients with central venous catheters Clinical

policy 2 – Infection control, June 2003

Polderman KH; Girbes AR (2002) Central venous catheter use. Part 2: infectious

complications Intensive Care medicine 2002, Jan; 28(1): 18-28

RCN (March 2004) Good practice in infection control – Guidance for nursing staff

RCN (Jan 2010) Standards for infusion therapy

Legislation

DoH (July 2006) Winning ways high impact working together to reduce healthcare

associated infection in England-intervention 2 Department of Health. The Health

and Social Care Act 2008: Code of Practice on the prevention and control of

infections and related guidance. Department of Health, London, 14 Dec 2010.

Available at

http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyA

ndGuidance/DH_122604

14. Associated Documentation

Hand Hygiene Policy

Aseptic Technique Policy

15. Contributors

Contributor Job Title Contributor Name

IV Nurse Specialist Sandy Kirk



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Appendix A – Equality Impact Assessment

PART 1

To be completed by the document owner

Document Title: Policy for Peripheral Venous Cannula Insertion and Management (Adults)

Yes/No Comments

1. Could the application of this document have a

detrimental equality impact on individuals with any of

the following protected characteristics? (See Note 1)

Age No

Disability No

Gender reassignment No

Race No

Religion or belief No

Sex No

Sexual orientation No

Marriage & civil partnership No

Pregnancy and maternity No

2. If you have identified any potential detrimental impact,

do you consider this to be valid, justifiable and lawful? If

so, please explain your reasoning.

N/A

3. If you have answered ‘no’ to question 2, has the policy

been amended to remove or reduce any potential

detriment?

• If you answer ‘yes’, please summarise the changes

made

• If you answer ‘no’. please explain why not

N/A

4. Based on the answers to questions 1 – 3 do you consider

that a detailed equality analysis is needed?

No

NAME: Sandy Kirk

JOB TITLE: IV Nurse Specialist

DATE: 14 February 2013



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PART 2

To be completed by the Trust’s Equality and Diversity Lead

Brief Summary of potential impact of this document and whether sufficient consideration

has been given to the Equality Duty

The application of this policy for peripheral venous cannula insertion and management

(adults) is completely clinically based and ensuring appropriate approach would be the

priority, however the Trust would endeavour to continue to meet patients and employees

individual needs as far as it is practicable.

Yes/No Comments

1. Is this document recommended for publication without

amendment?

Yes

2. Is this document recommended for publication but with

recommended amendments? Please specify.

Na

3. Is this document not recommended for publication

without amendments being made? Please specify?

Na

4. Is it recommended that this document requires a more

detailed equality analysis to be undertaken prior to

publication?

No

5. Specify with which, if any, individuals and groups you

have consulted in reaching your decision.

None

NAME: Nicky Smith

JOB TITLE: Equality & Diversity Lead

DATE: 18 March 2013

Note 1

Under the terms of the Equality Act 2010’s public sector Equality Duty, the Trust has a legal responsibility to

think about the following three aims of the Equality Duty as part of our decision making and policy

development.

• Eliminate unlawful discrimination, harassment and victimisation;

• Advance equality of opportunity between people who share a protected characteristic and people

who do not share it; and

• Foster good relations between people who share a protected characteristic and people who do not

share it.



Abbreviated guide to Peripheral Venous Cannulation (Adult) – V.1 Page 16 of 19

Authorised by: Policy Approval Group Date: 18/03/13

Appendix B - Abbreviated guide to Peripheral Venous Cannulation (Adult)

Clinical Practice Policy (abbreviated)

Action

Identify clinical need for cannula insertion

Collect equipment needed including:

� Cannula

� Dressing trolley (Cleaned)

� White Tray (cleaned)

� Sterile gauze

� Single use tourniquet

� Clean gloves

� Sharps box

� 2% Chlorhexidine and 70% alcohol skin preparation (Sanicloth CHG 2%/Clinell Skin

Wipe)

� Local anaesthetic (1% Lidocaine) orange needle and 2ml syringe

� Cannula - IV dressing

� Saline flush

Identify patient by surname, first name and date of birth

Wash hands with soap and water as per the Trust Hand Hygiene Policy

Place White tray onto clean dressing trolley. Open equipment into the clean tray.

Explain the procedure to the patient, discuss the need for a cannula, obtaining verbal consent

for procedure establishing whether patient has any known allergies

Explain to the patient the importance of keeping the site clean and dry and advise of risks of

infection

Decontaminate hands with alcohol gel or wash with soap and water

Palpate potential sites these include:

� The hand - a lower risk of phlebitis

� The wrist or upper arm – increasing risk

� The lower limb has a higher risk than the upper limb

When potential site is identified position patient comfortably with appropriate limb below

the level of the heart. Removing excess hair (shaving is not recommended – clippers are

better)

Apply proximal single use tourniquet, without obstructing arterial flow. Optimal time for

application is 3 to 5 minutes – if additional time is needed release tourniquet as vein will tend

to “disappear”.

Encourage patient to exercise limb muscles (e.g. repeatedly making a fist and opening hand)

Decontaminate hands with alcohol gel or wash with soap and water and don sterile gloves

Clean insertion site using a spiral motion from the proposed puncture site outwards with 2%

chlorhexidine in 70% alcohol (from a pre-soaked wipe Sani cloth CHG 2%/Clinell Skin Wipe)

for 30 seconds and then allow to dry

Administer local anaesthetic (1% Lidocaine) which should be encouraged in all but the most

urgent of cases.

Alternatively apply prescribed topical local anaesthetic cream 45mins prior to procedure




Abbreviated guide to Peripheral Venous Cannulation (Adult) – V.1 Page 17 of 19


• Gently pull on skin, distal and lateral to insertion site. Do not touch the cannula or the

insertion site.

• Insert cannula (bevel uppermost) through the cleaned skin area at an angle of 20

degrees.

• Advance until just in the vein and then lower the cannula until it is parallel with the skin

(a flashback of blood is usual but not always seen at this point)

Then, either;

a) Pull the needle back 1cm and push the cannula/needle into the vein up to the hilt, or;

b) Hold the needle still and advance the cannula over the needle until the cannula is inserted

up to the hilt

In the event of unsuccessful cannulation of the vein withdraw the cannula from the puncture

site and apply pressure with non woven swab. Discard the cannula into a sharps container

Prior to subsequent attempts at cannulation it is the responsibility of the individual

practitioner to risk assess the difficulty of further attempts against their own registered

competence and experience. If the practitioner anticipates the difficulty level to be beyond

their scope of practice, then referral to more experienced, competent practitioners should be

made

Remove the tourniquet and apply pressure on the proximal vein, close to the tip of the

cannula – a second person may be required for this

Remove needle and dispose of immediately into sharps container, cap off cannula with a

needle free extension or attach intravenous fluids as appropriate

Secure cannula with an approved sterile cannula dressing, ensuring it is applied correctly

(non-sterile, sticky-tape fixation or bandage is NOT acceptable)

Place ‘date for cannula review’ sticker to outside of dressing

Flush cannula with 5-10 mls saline in a 10ml syringe if not being attached to infusion.

Document cannula insertion by completing a Cannula insertion and management form for

each separate cannula inserted. Once cannula has been removed this document is filed in the

patients medical notes


Decontaminate hands before and after each patient contact. Use correct hand hygiene

procedure as per trust policy

Always access cannula by cleaning with 2% chlorhexidine and 70% isopropyl alcohol wipe,

and allow to dry before administering fluid or injections

Needle free bungs should NOT be applied directly; single or double lumen extensions should

be applied

Cannula site should be inspected at least three times a day (8 hourly) and documented

Cannula dressing should be, intact, dry and adherent. The date and time of insertion must be

applied to the dressing

Remove cannula if there is no continuing clinical indication

Replace cannula in a new site after 72 hours, earlier if clinically indicated

Administration sets should be replaced:

• immediately after blood and blood product administration

• intermittent IV antibiotics and medicines

• heparin infusion lines should be replaced every 24 hours

• All other fluid sets should be replaced after 72 hours

ALL giving sets should be labelled with date and time on commencement of use.



Cannula insertion and management form – V.1 Page 18 of 19


Appendix C - Cannula Insertion and Management Form



Cannula insertion and management form – V.1 Page 19 of 19
