Healthcare and Medicine Reference
In-Depth Information
should be documented, and the cannula either removed or closely
observed (in cases of mild phlebitis). A doctor's opinion should be
sought and antibiotics considered if infection is present.
All cannulae should be removed after 72 hours, regardless
or whether or not they look infected. The risk of infection rises
rapidly with time beyond this. Cannulae no longer in use should
be removed as soon as possible to prevent complications.
Further reading
Centers for Disease Control and Prevention. (2002) Guidelines for the
Prevention
of
Intravascular
Catheter-related
Infections .
MMWR
Recommendations and Reports 51, RR-10, 1-29.
Department of Health. (2007) High Impact Intervention No 2. Peripheral Intravenous
Cannula Care Bundle . www.dh.gov.uk/en/Publichealth/Healthprotection/
Healthcareacquiredinfection/Healthcareacquiredgeneralinformation/
ThedeliveryprogrammetoreducehealthcareassociatedinfectionsHCAI
includingMRSA/index.htm
Department of Health. (2003) Winning ways: Working Together to Reduce
Associated Healthcare Infection in England . www.dh.gov.uk/en/
Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/
Browsable/DH_4095070
Dougherty L, Lister S. (2008) The Royal Marsden NHS Trust Manual of
Clinical Nursing Procedures , 7th edn. Wiley-Blackwell, Oxford.
Nosocomial Infection National Surveillance Service (NINSS). (2002)
Surveillance of Hospital Acquired Bacteraemia in English Hospital 1997-
2002. A National Surveillance and Quality Improvement Program . www.
hpa.org.uk/infections/publications/ninns/hosacq_HAB_2002.pdf
Summary
Intravenous cannulation is a very common, simple procedure
and makes up a large part of the 'bread and butter' work for most
junior doctors. However, it is often a life-saving procedure and can
occasionally be very challenging. Venous cannulation is associated
with a number of complications, resulting in considerable mor-
bidity, prolonged hospitalisation and even death. It is vital that
healthcare practitioners are competent at cannulation, including
cannulation in emergency situations, and that you are aware of the
potential problems and how to manage them.
Handy hints/troubleshooting
Always have a good look at both hands before deciding on the
best vein.
Veins in the antecubital fossa are often easiest (but more
uncomfortable for the patient and the cannula will often kink).
Make sure the area is as well lit as possible, even in the middle of
the night.
Remember, a good vein is one you can feel but not always see!
Ask the patient to hang his or her hand down and to clench and
release the hand.
Tapping the vein gently will vasodilate the vein and make it stand
out.
If you're really struggling, try putting the hands in warm water
or applying a GTN patch - both act as vasodilators, giving you a
bigger target!
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