Peripheral cannulation

The purpose of peripheral cannulation is to gain short-term access to the circulation via peripheral veins by insertion of a plastic hollow tube (Gorski et al, 2021). This invasive procedure, although prevalent in nursing, is a practice common among a variety of professions in health care settings and is not without risk (Hallam et al, 2016; Burnett et al, 2018; Gorski et al, 2021).

Indications for use:

• blood transfusion
• blood Products
• intravenous therapy for bolus, continuous infusion, and maintenance fluid management
• administration of medication
• emergency (Jackson et al, 2013; National Institute for Health and Clinical Excellence (NICE), 2013; Royal College of Nursing (RCN), 2016l; Barton et al, 2017)

Peripheral vascular access is recommended for short-term use, usually 3-5 days (RCN, 2016). In the case that longer term IV therapy is required, an assessment for central vascular access must be completed. All intravenous infusions render the vessel vulnerable to damage, therefore,

Patient assessment should begin with patient needs and preferences which includes the identification of medications and/or therapies required. (RCN 2016; Gorski et al, 2021; NICE, 2013).

Vessel health and preservation

Not all vessels will be suitable for peripheral cannulation. It is necessary to establish the duration of treatment, the treatment to be administered, vascular condition, age and infusion history of the individual, taking into consideration the skills, competence and availability of practitioner prior to deciding on a vascular access device (Gorski et al, 2021, 2021).

It is recommended that the quality the vessel is assessed using a peripheral vein assessment tool (Hallam et al, 2016).

Suitable veins for peripheral cannulation will be found in the forearm or hand (RCN, 2016). It is important to note that dark skin, tattoos and obesity are factors that may affect ease of vessel identification and in some cases, visualisation technology may be required, which

Prior to the insertion the peripheral cannula device, it is essential that the practitioner considers all the equipment required to carry out the procedure to ensure minimal disruption during placement. It is important to note that only practitioners trained and deemed competent in this procedure perform this skill and so must refer to relevant Organisational policies and guidance (Health and Safety Executive (HSE), 2017). Equipment required for the procedure will include:

• Peripheral cannula (Preferably closed system) noting size, gauge, length and CE Marking (Barton et al, 2017)
• Wipeable tray
• Sterile gauze (optional)
• Sharps container
• Sterile 0.9% saline ampule or prefilled syringe device
• Sterile syringe, no smaller than 10ml (RCN, 2016; HSE, 2017).
• Friction Skin preparation swab 2% chlorhexidine 70% alcohol (or alternative due to allergy) (INS, 2021)
• Latex free non-sterile gloves
• Plastic apron
• Latex free, cleanable, single use tourniquet
• Sterile transparent film dressing
• Extension set, preferably a closed Luer-Lok™ design

Preparation of the equipment should ideally take place in a clean separate area such as a clinic room (HSE, 2017). Any procedure relating to infusion is invasive and as such must be performed using aseptic non-touch technique where there is a focus on the protection of key parts throughout the procedure (Loveday 2014; Gorski et al, 2021).

1. Cleanse hands by washing with soap and water and pat dry (World Health Organisation (WHO), 2009; Boswell and Longstaff, 2020)
2. Clean tray with 70% alcohol, wiping the entire surface and base, according to organisational decontamination of equipment policy
3. Assemble equipment, ensuring contents are intact and check expiry dates
4. Clean hands using alcohol gel or soap and water
5. Apply non-sterile gloves and plastic apron
6. Prepare flush using sterile normal saline and sterile syringe (alternatively use preprepared flush such as pre-filled syringe device)
7. Prime add on device with needle-free connector using sterile 0.9% saline
8. Place

Potential complications include:

• Infection
• Haematoma
• Phlebitis (chemical, bacterial, mechanical)
• Transfixation
• Dislodgement
• Pain/discomfort
• Inadvertent arterial or nerve puncture

A Visual Infusion Phlebitis (VIP) tool must be used for ongoing monitoring of the device (Jackson, 1998).

References

Barton A, Ventura R, Vavrik B. Peripheral intravenous cannulation: protecting patients and nurses. Br J of Nurs. 2017; 27(8) 28-33.

Boswell C, Longstaff J. Standard Infection Control Precautions (SICPs) Literature Review: Hand Hygiene: Hand washing, hand rubbing and indications for hand hygiene. 2020. https://www.nipcm.hps.scot.nhs.uk/media/1686/2020-07-13-sicp-lr-hand-washing-hand-rubbing-and-indications-v1.pdf (accessed 3 January 2023)

Bouaziz H, Zetlaoui PJ, Pierre S, Desruennes E et al. Guidelines on the use of ultrasound guidance for vascular access. Anaesth Crit Care Pain Med. 2015; 34(1): 65-69. https://doi.org/10.1016/j.accpm.2015.01.004

Burnett E, Hallam C, Curran ET et al. Vessel Health and Preservation Framework: Use of the outcome logic model for evaluation. J Infect Prev. 2018; 19(5): 228-234. https://doi.org/10.1177/1757177417741971

Gorski LA, Hadaway L, Hagle ME et al. Infusion Therapy Standards of Practice (8th edn). J Infus Nurs. 2021;44(1S Suppl 1):S1-S224. https://doi.org/10.1097/NAN.0000000000000396

Hallam C, Weston V, Denton A, et al. Development of the UK Vessel Health and Preservation (VHP) framework: a multi-organisational collaborative. J Infect Prev. 2016; 17(2): 65–72. https://