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Intravenous Cannulation (IVC) in the Western Health Emergency Departments

This document is a summarised version of OP-GC3 Peripheral Intravenous Cannulation. The summary has been created to be Emergency Department specific, and has been endorsed by the ED Leadership Team. Staff should review OP-GC3 Peripheral Intravenous Cannulation if they require further information.

Overview

This QRG provides staff with an overview on the indications for inserting an IVC.

 

Applicability

This QRG applies to all patients who present to the Emergency Department.

 

Responsibility

It is the responsibility of the Nurse Unit Managers and Directors of the Emergency Departments of each site to ensure the relevant staff are familiar with this QRG, that it is implemented according to the guidelines as outlined within and that it is adhered to by all staff members.

 

Guideline Details

What does this look like in practice?

  • Assessing the need/indication for an IVC i.e., a device for:
    • the administration of medication, fluids and blood products, as per OP-GC3
  • Selecting the right insertion site and appropriately sized IVC.
  • Inserting the device using aseptic technique and ensuring it is secured with a sterile semi-permeable dressing, such as the IV Frame Dressing.
  • Documenting the insertion, maintenance and removal of an IVC on both the nursing chart using the sticker found the IVC packs and also documenting on EMR
  • Routinely inspecting the IVC insertion site once a shift when accessing the device and if the patient raises concerns.
  • Assessing IVC Patency by flushing the device at least once a shift.
  • Reviewing the ongoing need for an IVC.
  • Removing all IVCs inserted under emergency within 24 hrs.
  • Removing all IVCs that were not inserted under emergency within 72 hrs.

All patients who present to the Emergency Department and have an IVC inserted must have this accurately recorded on EMR.

 

Figure 1: Documenting Insertion of an IVC

Figure 2: Documenting IVC Activity on EMR

Important to Know

  • Blood collection alone is not an indication for IVC insertion.
  • Aseptic technique is crucial when inserting an IVC in order to prevent adverse complications, such as Staphylococcus Aureus Bacteraemia (SAB).
  • An important step in the process to reduce the chance of infection is the cleansing of the hub with an alcohol wipe prior to accessing an IVC.

 

Best Practice includes

  • Performing hand hygiene using alcohol hand rub or chlorhexidine 2% or 4% hand wash solution.
  • Inspecting IVCs every shift.
  • Removing an IVC if it is not required.

 

Maintenance & Care

  • All capped IVCs must be flushed with 5mls Normal Saline after each drug injection, or if the medications are not being administered at a minimum of every 8 hours.
  • Ongoing observations pertaining to the IVC site must be recorded on the Peripheral Intravenous Cannula Record (including phlebitis score), along with details of patency maintenance every shift.
  • If still needed, all non-phlebitic cannulas must be resited every 72 hours if not inserted under an emergency.

 

Signs That Indicate Adverse Complications

  • Signs of phlebitis include:
  • Pain or redness near IVC
  • Swelling
  • Erythema
  • Fever

In all cases of infection, elevate the limb with a sling from an IV Stand, or on two pillows.

If the patient with phlebitis is febrile or has 2 or more of any of the following (see below), that are unexplained by other causes, these findings must be reported to a Medical Officer. In addition, 2 sets of Blood Cultures from different sites must be collected. Activation of the Sepsis Pathway should also be discussed with the treating Medical Officer in order to implement the appropriate treatment promptly.

  • Heart Rate >90
  • RR > 20
  • Temperature 38.5′ < or <35.0′
  • WBC 12 < or < 4

After removing the IVC using aseptic technique, cut off the catheter tip with sterile scissors and place in a sterile container for bacterial culture.

Complete a Riskman pertaining to all IVC related complications.

 

Supporting Documents

OP-GC3 Peripheral Intravenous Cannulation

Infection risks associated with peripheral vascular catheters; Journal of Infection Prevention

 

Document Governance

Title: Intravenous Cannulation (IVC) in the Western Health Emergency Departments
Version: 1.0
Date Published: August, 2021
Date of scheduled review: February, 2022
Author:  Approver: 
Alexis Tajkman ED Leadership Team

 

 

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