Peripheral Venous Cannulae Guidelines

Guidelines for the Insertion, Care and Removal of
Peripheral Venous Cannula (PVC)

CONTROLLED DOCUMENT
CATEGORY: Procedural
CLASSIFICATION: Clinical
PURPOSE To provide clear guidelines to all
clinical staff responsible for the
insertion, care and removal of
peripheral venous cannula.
Controlled Document 225
Number:
Version Number: 5
*amendment May 2016
Controlled Document Executive Medical Director
Sponsor:
Executive Chief Nurse
Controlled Document Intravenous Access Team Lead
Lead:
Approved By: Clinical Guidelines Group
On: 11th January 2016

Review Date: 11th January 2019
Distribution:
 Essential All clinical staff inserting, caring for
Reading for: or removing peripheral venous
cannula
 Information for: All clinical staff
Page 1 of 35
Guidelines for the insertion, care and removal of peripheral venous cannula (PVC) Issued: 05/2016
Controlled Document Number: 225 Version: 5

Contents
Page(s)
1 Introduction 3
2 Scope 3
3 Consent 4
4 Training 4
5 Peripheral Venous Cannula Insertion 6
6 Ongoing Care of the Peripheral Venous Cannula 8
7 Peripheral Venous Cannula Removal 10
8 Documentation 11
9 Monitoring the Effectiveness of these Guidelines 11
10 Supporting Evidence 12
Appendix 1: Procedure for the Insertion of a Peripheral Venous 14-20
Cannula
Appendix 2: Procedure for Accessing Peripheral Venous 21-25
Cannula
Appendix 3: Procedure for the Removal of Peripheral Venous 26-28
Cannula
Appendix 4: Successful Insertion Flowchart 29
Appendix 5: Choice of Cannula Gauge 30
Appendix 6: Causes and Signs of Phlebitis 31
Appendix 7: Examples of Key Parts 32
Appendix 8: Correct application and Removal of a Peripheral IV 33
Dressing
Appendix 9: Saving Lives High Impact Intervention Number 2 34-35
PVC Care Bundle (Elements of the Care Process).
Page 2 of 35

1 Introduction
1.1 These guidelines state the correct technique for the insertion, care and
removal of peripheral venous cannula (PVC; refer to Appendices 1, 2,
3). Although a common procedure, PVC insertion and management
holds a high risk of complications, making adherence to protocols and
guidelines paramount. Associated risks include thrombosis, pain,
structural damage and damage to surrounding structures, local or
systemic infection, extravasation, inoculation injuries and blood borne
virus infection and inappropriate insertion.
1.2 Peripheral venous cannulation is undertaken to provide venous access

for diagnostic, therapeutic or research purposes:
 Where a continual fluid infusion is required, i.e. fluid

maintenance
 For intermittent or continual drug therapy e.g. antibiotics, heparin
 For the infusion of blood and blood products
 In an urgent or emergency situation
 Prior to procedures/surgery
 Replacing a PVC clinically indicated and assessed as unsuitable
for continued use
 Where the administration of drugs by a less invasive route is not
possible or not appropriate
1.3 Peripheral venous cannulation must not be undertaken for blood

collection, except in identified research studies (dependent on research
requirements and associated risk assessment) or in the Emergency
Department (ED) when no other options are available. Blood collection
from a cannula increases the risk of phlebitis, occlusions, infection and
can lead to deranged blood results.
1.4 Peripheral venous cannulae must be inserted and used for short term
vascular access purposes only. Alternative vascular access must be
considered where circulation is poor, administration of a drug is more
suitable via a central venous access device (CVAD) or extended
venous access and management is required.
2 Scope
These guidelines apply to:
 All clinical staff performing peripheral venous cannulation in the Trust

 All clinical staff responsible for the care of indwelling PVC
 All clinical staff responsible for the removal of indwelling PVC
Page 3 of 35

3 Consent
Although formal written consent is not required for minor procedures, verbal
consent to perform the PVC insertion, ongoing care and removal must be
obtained from the patient where possible and this must be documented in the
patient’s records. For further information regarding consent and mental
capacity please refer to the following documents:
 Department of Health Reference Guide to Consent for Examination or

Treatment (2009)
 The Trust’s Policy and procedural document for consent to examination
or treatment (current version)
 Mental Capacity Act (2005)
4 Training
Prior to undertaking any cannulation procedure, all staff must be able to

demonstrate clinical competence and have a clear understanding of the
underlying principles of practice. This will be achieved by:
4.1 Medical Staff:
Foundation Year 1 (FY1) induction will include:
a) Training in cannulation by the Clinical Skills Trainers (unless

documented evidence of competence is provided to Clinical
Skills Manager)
b) Completion of a period of supervised clinical practice by a

member of staff competent in cannulation
c) Training and assessment in Aseptic Non-Touch Technique

(ANTT).
All Medical staff that perform peripheral venous cannulation within the
Trust must be competent in the skill and have read and understood
these guidelines. A staff member who is not competent must undertake
the same training and supervised practice provided to FY1s.
4.2 Nursing and Other Health Care Staff
4.2.1 The registered practitioner must be competent to administer

intravenous medication in accordance with controlled document
number: 232 (Formerly CP 03 / current version): expanded
practice protocol for the administration of intravenous drugs and
infusions by registered practitioners, unless the registered
practitioner is not required to administer intravenous drugs and
infusions as part of their role. In this instance, the additional
Page 4 of 35

competencies for the administration of the sodium chloride 0.9%
(w/v) flush must be completed as per controlled document
number: 229 (Formerly CP 01 / current version): expanded
practice protocol for the performance of peripheral venous
cannulation.
4.2.2 In order for identified non-registered practitioners to expand their

practice to include insertion of PVCs, the need for expansion of
the role of the non-registered practitioner within the clinical area
must be discussed by the relevant clinical manager with the
Divisional Associate Director of Nursing who will then discuss the
case of need at the Chief Nurse Team meeting in order to secure
the agreement of the Executive Chief Nurse.
4.2.3 Identified non-registered practitioners must be competent to

administer the sodium chloride 0.9% (w/v) flush against a written
direction. The education and training will be provided as part of
the cannulation course and their competency will be assessed in
line with the controlled document number: 229 (Formerly CP 01/
current version): expanded practice protocol for the performance
of peripheral venous cannulation.
4.3 All Clinical Staff
4.3.1 All clinical staff new to the Trust who have been performing
peripheral venous cannulation elsewhere, must provide evidence
of previous education and competence, as well as current
competence against Trust standard, and this must be checked
by their line manager. Nursing and other non-medical health care
staff must complete the appropriate Expanded Practice Protocol
competencies and return these to Clinical Skills Centre. Refer
to http://uhbtraining/Downloads/pdf/TdRoutesToEpc.pdf. New
staff are encouraged to attend Clinical Skills Update sessions in
order to familiarise themselves with the cannulation procedures
using ANTT and the equipment used within the Trust.
4.3.2 All clinical staff must also read and understand the Trust
Guidelines for the Insertion, Care and Removal of Peripheral
Venous Cannula.
4.3.3 The Trust has adopted the ANTT as a foundation for good
practice. When inserting, providing ongoing care and removing
PVCs, all staff must adhere to the principles of ANTT:
 Always wash hands effectively

 Never contaminate key parts (protect key parts, see
Appendix 7)
 Touch no-key parts with confidence
Page 5 of 35

 Take appropriate infection prevention and control
precautions.
5. PVC Insertion
5.1 Selection of Site
5.1.1 To minimise the risks associated with peripheral venous

cannulation, the following factors must be considered to ensure
optimal placement of the cannula:
 Condition of vein; veins should be easily palpable with

good capillary refill
 Position of valves
 Vein size
 Vein accessibility
 Purpose of the infusion (including rate of flow and solution
to be infused)
 Size of cannula to be inserted
 Duration of therapy
 Site of any previous PVCs; distal veins should be used
first, above previous sites
 Patient preference
 General condition of patient, including skin integrity
5.1.2 The areas listed below give a high risk of complications and
should be avoided unless, following a thorough and clearly
documented risk assessment, there is no other option.
 Sites where there are signs of an infection

 Sites where there are injuries, fractures, burns, paralysis
 Oedematous areas
 Sites over a joint
 Digital veins
 Sites distal to a venepuncture site which has been used
within the previous 24 hours due to the risk of
extravasation
 Legs and feet; due to the increased risk of infection,
particularly in patients who are known to have diabetes or
who have poor circulation to these areas
 Larger veins of vascular patients, as these veins should
be preserved in the event of need during surgery
 The arm on the side where lymph clearance or severance
has taken place (e.g. axillary node clearance) due to risk
of lymphoedema. Lymphoedema may be exacerbated by
cannulation of the affected limb.
Page 6 of 35

5.1.3 In patients with an arteriovenous fistula (AVF), the PVC must not
be inserted into the same arm as the AVF. A forearm that is a
potential site for fistula formation should not be used, except in a
life threatening emergency. In the first instance, the PVC should
be sited in the non-fistula arm on either the dorsum of the hand
or at the antecubital fossa.
5.1.4 Peripheral venous cannulation must be performed with care and

minimal trauma in patients with a known coagulopathy or who
have received thrombolytic therapy.
5.2 PVC Selection
5.2.1 The smallest appropriate PVC must be used in any given

situation; vascular complications increase as the gauge of
the PVC in relation to vessel lumen increases.
5.2.2 There are a number of different PVCs to choose from

depending upon the patient's requirements (Appendix 5).
The patient’s fluid requirements, the drug dilution rate, the
condition of the patient and the accessibility of the patient’s
veins must be taken into consideration.
5.3 Procedure for PVC insertion
The procedure for Peripheral Venous Cannulation is described in

Appendix 1. Aseptic Non Touch Technique (ANTT) must be used.
 If a PVC insertion is not successful after two attempts, then

assistance must be sought from a second practitioner who is
competent in cannulation and this must be documented.
 If the member of staff performing cannulation is not familiar with
the cannula type they must ensure they undergo training in the
equipment prior to inserting the device
 The sodium chloride 0.9% (w/v) flush must be prepared and
checked with a registered practitioner who is competent in the
administration of intravenous drugs and infusions. The flush
must be administered against a written direction, such as a
prescription or Patient Group Direction (PGD).
The process to enable successful cannulation is described in Appendix

4.
Page 7 of 35

6. Ongoing care of the PVC
6.1 Complications
There are recognised complications of peripheral venous cannula,

which include phlebitis, infection, infiltration, extravasation, embolism,
haematoma, thrombosis, transfixation and damage to underlying
structures. Accurate assessment of the site is necessary to minimise
the risk of complications.
6.2 Assessment
It is very important that the PVC site and patient is assessed:
 At least 1 hourly if continuous infusion is in place

 Before, during and after every drug administration
 At least 8 hourly if intermittent IVs are being administered
When inspecting the insertion site it is important to check for signs of

infection and phlebitis. The Causes, Signs of Phlebitis and the Visual
Infusion Phlebitis Score (VIP) required for the assessment and ongoing
care of the PVC insertion site are illustrated in Appendix 6.
The VIP score must be documented at least 8 hourly on the PVC

insertion and ongoing care record.
6.3 Access
6.3.1 ANTT must be used throughout the procedure. The procedure

for accessing a PVC is described in Appendix 2.
6.3.2 Prior to accessing the PVC, the VIP score must be assessed and
appropriate action taken.
6.3.3 When an intravenous drug or infusion is being administered and

following administration, it is important to check the cannula site
for signs of extravasation. Appropriate action must be taken
immediately to prevent further injury; refer to Medusa Injectable
Medicines Guide http://uhbhome/injectable-medicines-guide.htm
and Trust Guidelines for the administration of anti-cancer
treatment.
6.4 Dressings
6.4.1 PVCs must be covered by a sterile, transparent, self-adhesive,

semi-permeable PVC dressings approved by the Trust i.e.
TegadermTM 1633 IV dressing, ensuring that the insertion site
Page 8 of 35

remains visible underneath the clear aspect of the dressing to
allow for continuous inspection of the site.
6.4.2 All dressings must be inspected every shift (minimum 8 hourly).

Wet/soiled or poorly fitting dressings must be changed
immediately using ANTT. The procedure for applying the
TegadermTM 1633 IV dressing is illustrated in Appendix 8.
6.4.3 The tubing of an infusion administration set can put traction on

to the PVC and cause phlebitis and dislodgement (Finlay, 2009).
It is recommended that a small piece of hypoallergenic tape is
placed over the tubing to secure it in place but this must not
restrict the view of the PVC.
6.5 Bandaging
Bandages should not be routinely used to secure PVC sites. It is

acknowledged, however, that in some circumstances it may be
necessary to further secure a cannula with an elasticated tubular
bandage. It is vital that a risk assessment is carried out prior to
application and this is removed completely every time the site is
assessed and drugs are administered to enable VIP scoring and
observation of site.
6.6 Administration Sets
6.6.1 All PVCs must have a needle free connector attached at the
time of insertion, with three recognised exceptions:
 High flow large volume fluid resuscitation

 Total Intra-venous Anaesthesia (TIVA)
 Vaso-active infusions in Critical Care and Theatre
6.6.2 Additionally a needle free connector need not be used when a

PVC is inserted for a single treatment of chemotherapy, where
the infusion is commenced at the time of cannulation and the
PVC and administration set are removed concurrently and
immediately on completion of treatment.
6.6.3 If it is necessary for compatible drugs/infusions to be

administered at the same time via a single PVC, a microclave
double extension set with back check valves (green ringed)
must be used.
6.6.4 An administration set attached to the needle free connector and

PVC forms a closed system. If the administration set becomes
detached or is disconnected from the needle free connector, the
closed system is broken and the administration set must be
Page 9 of 35

replaced. Infusions must not be ‘capped off’ and kept for future
use. Disconnected administration sets and infusions must be
discarded and must not be left hanging in the clinical area.
6.6.5 Administration sets/lines must be changed every 72 hours for

continuous infusions. When administering blood, the set must
be changed when a transfusion episode is complete or every 12
hours, whichever is sooner (RCN, 2010).
6.7 Line Flags
All administration sets attached to a PVC must be labelled with a line

flag, in accordance with Trust controlled document: 586 Guidance
notes on the use of invasive line flags (current version). The time and
date of connection/administration set change and the initials of the
practitioner connecting/changing the set must be documented on the
line flag.
6.8 Routine PVC replacement (previously 72 hours)
The latest research recommends PVCs should not be re-sited routinely,

such as in previous versions of the guidelines which stated they should
be every 72 hours. A PVC should only be re-sited when clinically
indicated unless device specific recommendations from the
manufacturer indicate otherwise. Clinical indications include removing
the PVC when complications occur or as soon as it is no longer
required.
7. Peripheral Venous Cannula Removal
7.1 PVCs should remain in situ whilst they are required and there are no
signs of complications such as:
 signs of infection
 VIP score
 occlusion
 mal-position of cannula
 other PVC associated complications
7.2 Where PVCs are removed due to complications it is vital that the site is
assessed 8 hourly and this is documented. Where damage or
worsening condition of tissue noted, the patient must be referred as
appropriate for review by teams such as tissue viability or plastics.
Improvements or deterioration and actions planned and treatment given
must be documented.
7.3 A PVC must be taken out when safe to do so and replaced if still
indicated, in the following situations:
Page 10 of 35

 When a patient is transferred into the Trust and there is no
assurance that a PVC has been inserted according to Trust
Standard,
 When a military patient is transferred from an operational area,
 When a PVC is inserted in a high risk situation e.g. trauma alert,
resuscitation.
 When a PVC is identified by a red label, indicating it has been
inserted in a high risk situation by West Midlands Ambulance
Service staff.
7.4 Removal of the peripheral venous cannula must be undertaken using

an ANTT by staff who have had appropriate training. The procedure is
described in Appendix 3.
8. Documentation
Insertion, ongoing care and removal of PVCs must be documented on the

Trust PVC Insertion and Ongoing Care Record. In Critical Care and Theatres
the Trust PVC/invasive device label may be used.
9. Monitoring the Effectiveness of these Guidelines
9.1 The Intravenous (IV) Access Team will lead the audit on the care of
PVCs within the organisation and this will be performed in line with the
guidelines review date and the Trust Saving Lives audit plan. These
audits will include:
 Adherence to guidelines
 Any untoward incidents and complaints, including outcomes of
any Root Cause Analyses.
 Auditing current practice against Saving Lives High Impact
Intervention Peripheral intravenous cannula care bundle
(Appendix 9).
9.2 All expanded practice protocols are audited on review; the Clinical
Skills Trainers and Practice Development Team will lead the audit of
the following expanded practice protocols:
 Controlled Document 229 (Formerly CP 01): Expanded

practice protocol for the performance of peripheral venous
cannulation.
 Controlled document number: 232 (Formerly CP 03): Expanded
practice protocol for the administration of intravenous drugs and
infusions by registered practitioners.
Page 11 of 35

9.3 These audits will include any untoward incidents and complaints,
the number of practitioners trained and the number of
practitioners competent to practise cannulation. All audits must
be logged with the Risk and Compliance Unit.
10. Supporting Evidence
Department of Health (2014) epic 3: National Evidence Based Guidelines for

Preventing Healthcare Associated Infections in NHS Hospitals in England. Journal
of Hospital Infection (supplement): S 1-S 70.
http://www.his.org.uk/files/3113/8693/4808/epic3_National_Evidence-
Based_Guidelines_for_Preventing_HCAI_in_NHSE.pdf
Department of Health (2007) Saving Lives. Department of Health, London.
Department of Health (2006) ‘Winning Ways: Working together to reduce Health

Care Associated Infection in England – intervention 2b.
Department of Health (2009) Reference Guide to Consent for Examination or

Treatment 2nd edn. HMSO London
Dougherty, L. Lister, S (Eds) (2015) The Royal Marsden Hospital Manual of

Clinical Procedures (9th Edition). Blackwell Publishing, Oxford.
Finlay, T (2009) Safe administration and management of peripheral intravenous

therapy, Chapter 6 in Dougherty, L and Lamb, J. (eds) (2009) Safe administration
and administration of peripheral intravenous therapy, 2nd edn, Oxford: Blackwell
Publishing. 143-166.
Hindley, G. (2004) Infection Control in Peripheral Cannula. Nursing Standard. 18,

27: 37-40.
Medusa Injectable Medicines Guide (updated 2011) link available on Trust Intranet
http://uhbhome/injectable-medicines-guide.htm [Accessed 04.12.2015]
Mental Capacity Act 2005,

http://www.legislation.gov.uk/ukpga/2005/9/contents
[Accessed 04.12.2015]
do Rego Furtado, L.C. (2011) Incidence and predisposing factors of phlebitis in

a surgery department. British Journal of Nursing Intravenous Supplement 20(14),
S16-S25.
Rowley, S and Clare, S (2011) ANTT: A standard approach to aseptic technique.

Nursing Times 107(36) 12-14.
Royal College of Nursing (2004) Good practice in infection control – Guidance

for nursing staff. Royal College of Nursing, London.
Page 12 of 35

Royal College of Nursing (2011) Wipe It Out: one chance to get it right. Infection
Prevention and Control Information and Learning Resources for Healthcare
Staff. Royal College of Nursing, London.
http://www.rcn.org.uk/__data/assets/pdf_file/0007/394567/003876.pdf
[Accessed 04.12.2015]
Royal College of Nursing (2011) Sharps Safety. Royal College of Nursing, London.
available from http://www.rcn.org.uk/__data/assets/pdf_file/0008/418490/004135.pdf
[Accessed 04.12.2015]
University Hospitals Birmingham NHS Foundation Trust (current version) Policy for
the management and safeguarding of patients under 18 years of age. University
Hospitals Birmingham NHS Foundation Trust.
http://uhbpolicies/assets/PatientsUnder18Policy.pdf
[Accessed 04.12.2015]
University Hospitals Birmingham NHS Foundation Trust (current version) Procedural

document on the management and safeguarding of patients less than 18 years
of age. University Hospitals Birmingham NHS Foundation Trust.
http://uhbpolicies/assets/PatientsUnder18Procedure.pdf
[Accessed 04.12.2015]
the safeguarding of vulnerable adults. University Hospitals Birmingham NHS
Foundation Trust. http://uhbpolicies/assets/SafeguardingAdultsAtRiskPolicy.pdf
[Accessed 04.12.2015]
University Hospitals Birmingham NHS Foundation Trust (current version) Procedure

for the safeguarding of vulnerable adults. University Hospitals Birmingham NHS
Foundation Trust. http://uhbpolicies/assets/SafeguardingAdultsAtRiskProcedure.pdf
[Accessed 04.12.2015]
consent to examination or treatment, University Hospitals Birmingham NHS
Foundation Trust
http://uhbpolicies/Microsites/Policies_Procedures/consent-to-examination-or-
treatment.htm
[Accessed 12.01.2015]
University Hospitals Birmingham NHS Foundation Trust (current version) Procedure

for consent to examination or treatment. University Hospitals Birmingham NHS
Foundation Trust
http://uhbpolicies/Microsites/Policies_Procedures/consent-to-examination-or-
treatment.htm
[Accessed 04.12.2015]
Page 13 of 35

Appendix 1
(Page 1 of 7)
Procedure for the Insertion of Peripheral Venous Cannula using ANTT

Equipment
Clean hard surface blue tray (dressing trolley may be used if extra space is required)
Sani-Cloth 70% isopropyl alcohol wipes
Alcohol hand gel
PVC- appropriate size depending upon intended use x 2 (Choice of PVC gauge is
illustrated in Appendix 5)
2% chlorhexidine in 70% isopropyl alcohol wipes (For patients with a proven allergy
to chlorhexidine seek advice from pharmacy or the Infection Prevention and Control
Team)
X2 clean non-sterile gloves (X1 sterile gloves if re-palpation needed)
Visibly clean or disposable tourniquet
Clean apron
Sharps bin
Sterile, transparent, self-adhesive, semi-permeable PVC dressing approved by the
Trust i.e. TegadermTM 1633 IV Dressing
Prepared 5ml sodium chloride 0.9% (w/v) in a 10ml syringe IV flush (or pre-filled
device if using)
Extension set with a needle free connector (if required, dual lumen extension set with
non-return valve)
Action Rationale
Preparation
1 Identify clinical need for PVC insertion. To prevent inappropriate insertion
and exposure to associated risks.
2 Identify patient by obtaining three pieces To ensure correct identification of
of information from the patient; e.g. the patient and patient safety.
surname, first name, date of birth and
patient ID number.
3 Explain and discuss the procedure with To ensure that the patient
the patient. Obtain informed verbal understands the procedure and
consent for the procedure (wherever gives his/her valid consent.
possible) and establish whether the To ensure the risk of allergic
patient has any known allergies for reaction is minimised.
example to cleaning solution and
dressings.
4 If the patient requires topical local To reduce pain/discomfort on
anaesthetic, then apply it to chosen insertion.
insertion site(s) for 30–60 minutes prior to To give adequate time for local
cannulation. anaesthetic to be effective.
Local anaesthetic should be considered
when PVC of 17G and larger are to be
inserted.
Page 14 of 35

Appendix 1
(Page 2 of 7)
In IV Room
5 Decontaminate hands using liquid soap To minimise the risk of infection.
and water and dry thoroughly. Apply
apron.
6 Clean the blue tray or trolley with soap To minimise the risk of infection.
and water followed by a Sani-Cloth 70%
isopropyl alcohol wipe and allow to air
dry.
7 Collect the required equipment, check To ensure that time is not wasted
packing and expiry dates and place next and that the procedure goes
to the clean blue tray/bottom of the trolley smoothly without unnecessary
in the identified clean preparation area. interruptions.
Position the sharps box to prevent cross To prevent sharps injury.

over of hands when discarding sharps.
Adopt an aseptic non touch technique To maintain asepsis throughout

(Refer to Appendix 1 page 7 of 7and and check that no equipment is
appendix 7) damaged or out of date.
8 Decontaminate hands using alcohol hand To minimise the risk of infection.
gel and rub until dry.
9 Don clean non-sterile gloves. To prevent shedding of the
operator’s skin onto the key parts,
and to protect the operator against
hazardous substances if drawing
up drugs.
10 Draw up sodium chloride 0.9% (w/v) To prepare the flush for the PVC.
using a blue needle in to a 10ml syringe
(checked with second registered
practitioner as per medicines procedural
document: 443) and pre-prime extension
set with needle free connector (e.g.
micro-clave). Ensure the needle free
connector is protected and not
contaminated when in the blue tray.
(if using a pre-filled syringe, prepare as
required)
11 Remove gloves. To allow the practitioner to
decontaminate their hands.
12 Decontaminate hands with alcohol hand To minimise the risk of infection.
Page 15 of 35

Appendix 1
(Page 3 of 7)
In patient area
13 Close curtains or doors as appropriate. To maintain the patient’s privacy
and dignity.
14 Identify the patient and ensure they are To ensure correct identification of
appropriately positioned to aid access to the patient and patient safety and
the PVC and ensure patient and operator prepare the patient for the
comfort. procedure.
15 Apply proximal tourniquet to the chosen To dilate the veins by obstruction
limb without obstructing arterial flow. of the venous return. If necessary
use other methods to encourage
venous access e.g. heat pads.
Optimal time for tourniquet application is
2 minutes.
16 Select potential anatomical site for The PVC site must be appropriate
insertion of PVC dependant on clinical to the clinical need of the patient
indication. and the treatment prescribed.
When potential site is identified, position To allow veins to fill with blood and
patient comfortably with appropriate limb to ensure the patients comfort and
supported and below the level of the ease of access.
heart.
17 Assess and select the appropriate vein. To ensure the patient does not feel
discomfort whilst the equipment
Release the tourniquet. and site are prepared
Remove excess hair by using clippers as Local trauma can be caused by
appropriate (dry shaving must not be dry shaving, increasing risk of
used). infection.
18 Ensure the PVC previously selected is To reduce damage or trauma to

appropriate for the selected vein size. vein and reduce the risk of
phlebitis.
19 Clean insertion site using 2% Remove skin flora.
chlorhexidine in 70% isopropyl alcohol
applying up and down and back and forth To minimise risk of infection.
movements for 30 seconds and allow to To maintain aseptic non touch
air dry for at least 30 seconds. Do not re- technique.
palpate the vein or intended insertion site
skin.
Page 16 of 35

Appendix 1
(Page 4 of 7)
20 Re-apply proximal tourniquet to the To dilate the veins by obstruction

chosen limb without obstructing arterial of the venous return. If necessary
flow. use other methods to encourage
venous access.
Optimal time for tourniquet application is To avoid tissue damage/bruising.
2 minutes.
21 Encourage patient to exercise limb Muscle pump forces blood into
muscles e.g. ask patient to make a fist veins to distend them further.
and release hand (repeat as required).
22 Decontaminate hands using alcohol hand To reduce the risk of infection and
gel and rub until dry. Don clean non- prevent contamination of operator.
sterile gloves.
Inserting the PVC
(Peripheral Venous Cannulation Procedure is illustrated in Appendix 1 page 7of 7)
23 Take control of PVC ensuring that the key To minimise risk of infection.
parts (Appendix 7) are not contaminated
by operator. Adopt an aseptic non touch
technique (ANTT).
24 Gently pull on skin, distal and lateral to To “fix” the skin and the superficial
insertion site. veins underlying it.
Anchor the tissue; continue to apply To ensure straightening of vein

traction throughout the insertion. and prevention of movement.
Do not touch the key parts of PVC or the To minimise risk of infection.
insertion site.
25 Insert PVC (bevel uppermost) through the To use the sharpened needle to
decontaminated skin area at an angle of introduce the plastic PVC into the
30 degrees. vein.
26 Observe for initial flashback and then To ensure the needle is in the vein
lower angle and advance the PVC a initially and then needle and PVC
further 2-3mm. are in the vein.
27 Retract needle 2-3mm. This ensures that the needle will
not penetrate the vein wall. Never
remove more than this as it
causes buckling of the PVC.
28 Observe for secondary flashback along To ensure the PVC is patent in the
the length of the PVC. vein.
29 Advance PVC into vein by either To introduce the PVC fully into the
a) Pushing the PVC/needle into the vein vein.
up to the hilt
Or
b) Holding the needle still and advancing
the PVC over the needle until the PVC is
inserted up to the hilt.
Page 17 of 35

Appendix 1
(Page 5 of 7)
30 Remove the tourniquet and apply To prevent excessive bleeding

pressure proximal to the insertion site, during needle-removal.
above the tip of the PVC. Close to the tip
of the PVC – a second person may be
required for this.
31 Remove needle and dispose of To reduce risk of needle stick
immediately into sharps container, close injury and prevent blood spillage.
venous circuit with a sterile pre-primed
extension set with integral needle free
connector. A white bung can be used if
preparing for high flow large volume fluid
resuscitation or vasoactive infusion (as in
6.5).
32 Secure PVC with a Trust approved, To minimise the risk of infection
sterile, transparent, self-adhesive, semi- and secure PVC in position.
permeable PVC dressing i.e. TegadermTM
1633 IV Dressing ensuring it is applied
correctly. The procedure is illustrated in
Appendix 8
33 Flush PVC with 5 ml of sodium chloride To ensure PVC patency and to
0.9% (w/v) using a pulsatile flush ending create positive pressure to prevent
with positive pressure. blood re-entering the PVC tip.
34 Dispose of clinical waste as per Trust To minimise the risk of infection.
Infection Prevention and Control Policy
and procedural documents.
35 Remove non-sterile gloves and apron and To minimise the risk of infection.
carefully wash hands using liquid soap
and water and dry thoroughly.
36 Clean the blue tray or trolley with soap To minimise the risk of infection.
and water followed by a Sani-Cloth 70%
isopropyl alcohol wipe and allow to air
dry. (Clean non-sterile gloves and clean
apron must be worn if there is risk of
contamination)
38 Provide patient with information in relation To increase the patient’s
to ongoing care of the PVC and PVC site awareness in relation to the
and check their understanding. purpose and associated risks of an
in-dwelling PVC.
Page 18 of 35

Appendix 1
(Page 6 of 7)
39 The following must be documented: To ensure adequate record

 Reason for PVC insertion. keeping, establish an audit trail
 Unsuccessful attempts, number and enable continued care of
and reason. device and patient.
 The signature, name and
designation of the person inserting
the PVC.
 The time, date and site of
cannulation.
 The PVC gauge.
 The expiry date and lot number of
PVC.
 Next review date.
 Administration of the sodium
chloride 0.9% (w/v) flush.
 Any complications on insertion(s)
e.g. haematoma.
This must be documented on the Trust
PVC Insertion and Ongoing Care
Record/PICS or the Trust PVC label used
(in Theatres and Critical Care).
40 In the event of unsuccessful PVC of the To minimise haematoma formation
vein withdraw the PVC from the puncture and /or excessive bruising.
site and apply pressure to the puncture
site with a sterile gauze swab until the
bleeding has stopped.
41 Prior to subsequent attempts at To ensure cannulation is always
cannulation it is the responsibility of the undertaken by competent
individual practitioner to risk assess the practitioners and minimise risks
difficulty of further attempts against their associated with failed attempts at
own competence and experience. If the gaining venous access.
practitioner anticipates the difficulty level
to be beyond their scope of practice,
then referral to more experienced,
competent practitioners must be made.
If PVC insertion is not successful after
two attempts, then assistance must be
sought from a more experienced
registered practitioner who is also
competent in cannulation.
Page 19 of 35

Procedural Board for Insertion of Non Ported PVC using ANTT Appendix 1 (Page 7 of 7)
1 2 3 4 5 6
Gel Hands Collect equipment Gel hands Clean site with 2% CHG Don clean non sterile Flatten angle
Identify clinical need Don clean non sterile Don clean apron / 70% IPA wipe for 30 gloves Advance cannula 2-
Identify patient gloves and apron Ensure patient comfort secs, air dry 30 secs Prepare cannula of 3mm
Explain procedure Check, draw up and Apply tourniquet Do not repalpate site appropriate size Retract needle 2-3mm
Gain informed consent prime extension set Palpate for appropriate once cleaned Anchor selected vein, Observe for secondary
Check allergies using 10 ml syringe with vein Reapply tourniquet insert cannula at 15-30° flashback
Wash hands 5mls of 0.9% NaCl Release tourniquet Gel hands Observe for primary
Clean trolley or tray as Remove gloves, apron flashback
per guidelines Gel hands
7 8 9 10 11 12
Advance cannula using Release tourniquet Attach primed extension Secure cannula using Remove gloves and Document procedure in
hooded or guide wire Place sterile gauze set Tegaderm™ 1633 IV apron Peripheral Venous
technique under cannula Flush cannula observe dressing Gel hands Cannulation (PVC)
Insert to hub of cannula Hold cannula wing, for extravasation Write date of insertion Dispose and clean insertion and ongoing
occlude vein Finish with positive on dressing strip equipment as policy care record
Remove needle, pressure Clean connector with Wash hands Any unsuccessful
dispose immediately Close clamp 2% CHG / 70% IPA attempts must be
into sharps bin wipe for 30 secs - air recorded
dry 30 secs
Page 20 of 35

Appendix 2
(Page 1 of 5)
Procedure for Accessing Peripheral Venous Cannula using ANTT
Equipment
Clean hard surface blue tray (dressing trolley may be used if extra space is required)
Alcohol hand gel
X2 2% chlorhexidine in 70% isopropyl alcohol wipes
Clean non-sterile gloves x 2
Clean apron
Sterile, transparent, self-adhesive, semi-permeable Trust approved PVC dressing i.e.
TegadermTM 1633 IV dressing (where change of dressing being undertaken)
X 2 prepared 5ml sodium chloride 0.9% (w/v) in a 10ml syringe IV flush
Drug or infusion as required
Extension set with needle free connector as required
Action Rationale
Preparation
1 Identify clinical need for accessing To ensure appropriate access
PVC. and exposure to associated
risks.
2 Identify patient by surname, first To ensure correct identification
name, date of birth and patient ID of the patient and patient
number. safety.
3 Explain and discuss the procedure To ensure that the patient
with the patient. Obtain informed understands the procedure and
verbal consent for the procedure gives his/her valid consent.
(wherever possible) and establish To ensure the risk of allergic
whether the patient has any known reaction is minimised.
allergies for example to cleaning
solution.
4 Visually check the PVC insertion site To ensure PVC is viable prior to
for signs of phlebitis. Where signs of accessing.
phlebitis are present, take appropriate
action following a risk assessment
(See VIP score in Appendix 6.)
5 Decontaminate hands using liquid To minimise the risk of
soap and water and dry thoroughly. infection.
Apply apron.
6 Clean the blue tray or trolley with To minimise the risk of
soap and water followed by a Sani- infection.
Cloth 70% isopropyl alcohol wipe and
allow to air dry.
Page 21 of 35

Appendix 2
(Page 2 of 5)
7 Collect the required equipment, check To ensure that time is not wasted
packing and expiry dates and place next and that the procedure goes
to the clean blue tray/bottom of the trolley smoothly without unnecessary
in the identified clean preparation area. interruptions.
Adopt an aseptic non touch technique To maintain asepsis throughout

(Refer to Appendix 2 page 5 of 5 and and check that no equipment is
appendix 7). damaged or out of date.
9 Don clean non-sterile gloves. To prevent shedding of the
operator’s skin onto the key parts,
and to protect the operator against
hazardous substances if drawing
up drugs.
10 Prepare the equipment, open packaging To minimise the risk of
as required, draw up flush using a 10 ml contamination and ensure all
syringe and a blue needle and drugs equipment is to hand.
prescribed/required as appropriate and
place into the blue tray. (Follow the
procedural document for medicines
controlled document number: 443)
11 Remove non-sterile gloves and To minimise the risk of infection.
decontaminate hands.
*(In circumstances where the equipment

is being prepared next to the patient the
non-sterile gloves do not need to be
changed unless they have been
contaminated).
the PVC and ensure patient and operator prepare the patient for the
comfort. procedure.
Close curtains or doors as appropriate. To maintain the patient’s privacy

and dignity.
gel and rub until dry. (*-see action 11
when exceptions may apply).
14 Don clean non-sterile gloves. (*-see To minimise the risk of
action 11 when exceptions may apply). contamination blood or body fluids
to the operator.
Page 22 of 35

Appendix 2
(Page 3 of 5)
15 Clean the accessing part of the needle To minimise the risk of infection.
free connector thoroughly with 2%
chlorhexidine in 70% isopropyl alcohol by
using a vigorous frictional rub for 30
seconds and allow to air dry for at least To avoid mechanical phlebitis.
30 seconds. Ensure that the needle free
connector is supported to avoid PVC
movement against the cannulated vein
wall.
To avoid contamination
Following decontamination, do not touch
the needle free connector and do not
allow them to touch the skin.
16 When flushing the PVC: To ensure PVC patency.
Flush the PVC with sodium chloride 0.9%
(w/v) using a pulsatile flush ending with
positive pressure.
Attach and administer the intravenous To ensure the patient receives
drug/infusion as required. their medication.
Observe the patient and the PVC site for To identify and manage
complications and take appropriate complications such as
immediate actions. extravasation and anaphylaxis
Flush the PVC with sodium chloride 0.9% To ensure PVC patency.
(w/v) using a pulsatile flush ending with
positive pressure as required.
Maintain pressure on the plunger as the

syringe is disconnected from the needle To maintain positive pressure and
free connector. prevent backflow of blood into the
catheter and possible clot
formation.
Clean the accessing part of the needle
free connector thoroughly with 2% To remove any drug residue and to
chlorhexidine in 70% isopropyl alcohol by minimise risk of infection.
using a vigorous frictional rub for 30
seconds and allow to air dry for at least
30 seconds.
17 Ensure the dressing remains clean, dry, To minimise the risk of infection.
and intact, change dressing if required.
(For dressing application see Appendix
8). To prevent damage to the vein and
Support PVC through-out. displacing the PVC.
Page 23 of 35

Appendix 2
(Page 4 of 5)
18 Dispose of clinical waste, including To minimise the risk of infection

sharps as per Trust Infection and sharps injury.
Prevention and Control Policy and
procedural documents.
19 Remove non-sterile gloves and apron To minimise the risk of
and carefully wash hands using liquid infection.
soap and water and dry thoroughly.
20 Clean the blue tray or trolley with To minimise the risk of
soap and water followed by a Sani- infection.
Cloth 70% isopropyl alcohol wipe and
allow to air dry. (Clean non-sterile
gloves and clean apron must be worn
if there is risk of contamination).
21 Decontaminate hands using liquid To minimise the risk of
soap and water and dry thoroughly. infection.
22 Provide patient with information in To increase the patient’s
relation to ongoing care of the PVC awareness in relation to the
and PVC site and check their purpose and associated risks of
understanding. an in-dwelling PVC.
23 The following must be documented on To ensure adequate record
the Trust PVC Insertion and Ongoing keeping, establish an audit trail
Care Record/PICS: and enable continued care of
device and patient.
Where there are any complications on
accessing the PVC e.g. signs of
phlebitis:
 The name, signature and
designation of the person
accessing the PVC.
 Date and time the PVC was
accessed.
 The VIP score (at least 8
hourly).
 Any actions taken.
When a PVC dressing has been
replaced:
 The name, signature and
designation of the person
replacing the PVC dressing.
 Date and time the dressing
was replaced.
 Any actions taken.
Page 24 of 35

Procedural Board for Accessing a Non Ported PVC using ANTT Appendix 2 (Page 5 of 5)
1 2 3 4 5 6
Check prescription Wash hands Collect equipment Check medication Prepare drugs and Remove gloves and
Gel hands Clean equipment tray Ensure packaging intact Confirm dose, amount, flushes using blue (23g) apron
Identify patient as per guidelines and within expiry date and expiry date. needle and ANTT before proceeding to
Gain informed consent Don apron Gel hands Dispose of sharps patient bedside
Check allergies Don clean non sterile immediately into sharps
Perform VIP gloves bin, Label as per NPSA
assessment guidelines
7 8 9 10 11 12
Gel hands Clean needle free Remove flush syringe Clean needle free Dispose and clean Document procedure in
Identify patient and connector with 2% CHG Administer drug(s) connector with 2% CHG equipment as policy PVC ongoing care
check against / 70% IPA wipe for 30 using ANTT, observe / 70% IPA wipe for 30 Wash hands record
prescription details secs, air dry for 30 secs for adverse reaction secs, air dry for 30 secs Document drug
Gel hands Attach 5mls 0.9%Nacl Flush cannula before / Remove gloves and administration on
Don clean non-sterile flush, Release clamp after each drug apron prescription
gloves and apron Flush using agitational Administer final 5mls Gel hands Check patient
(stop start) action 0.9% NaCl flush
Apply clamp prior to Apply positive pressure
each disconnection to syringe
Close Clamp
Page 25 of 35

Appendix 3
(Page 1 of 3)
Procedure for the Removal of Peripheral Venous Cannula using ANTT
Equipment
Clean hard surface blue tray
Alcohol hand gel
Clean non-sterile gloves
Clean apron
Sterile gauze
Small sterile dry dressing
Sharps bin
Tape
ACTION RATIONALE
1 Explain the procedure to the patient and To ensure that the patient
obtain verbal consent for the procedure. understands the procedure and
gives his/her valid consent.
3 Clean the blue tray with soap and water To minimise the risk of infection.
followed by a Sani-Cloth 70% isopropyl
alcohol wipe and allow to air dry.
Prepare the required equipment. To ensure that time is not wasted

and that the procedure goes
smoothly without unnecessary
interruptions.
4 Decontaminate hands using alcohol To minimise the risk of infection.
hand gel and rub until dry.
the PVC and ensure patient and prepare the patient for the
operator comfort. procedure.
Close curtains or doors as appropriate. To maintain the patient’s privacy

and dignity.
6 Decontaminate hands using alcohol To minimise the risk of infection.
hand gel and rub until dry.
7 Don clean non-sterile gloves and apron. To minimise the risk of infection
8 Carefully remove PVC dressing.
Appendix 8
Page 26 of 35

Appendix 3
(Page 2 of 3)
9 Remove the device carefully using a To ensure that haemostasis of the

slow steady movement and use sterile site is achieved following removal
gauze to apply pressure to the insertion and minimise risk of infection.
site until bleeding stops. The pressure
should be firm and not involve any
rubbing movement.
10 Check the PVC to ensure the complete
device has been removed and dispose
of into sharps bin.
11 Apply sterile dry dressing. To minimise the risk of infection.
12 Dispose of clinical waste and sharps as To minimise the risk of infection
per Trust Infection Control Policy and and sharps injury.
procedural document.
13 Remove non-sterile gloves and apron To minimise the risk of infection.
and carefully wash hands using liquid
soap and water and dry thoroughly.
14 Clean the blue tray with soap and water To minimise the risk of infection.
followed by a Sani-Cloth 70% isopropyl
alcohol wipe and allow to air dry. (Clean
non-sterile gloves and clean apron must
be worn if there is risk of contamination)
15 Carefully wash hands using liquid soap To minimise the risk of infection.
16 Provide patient with information in To increase the patient’s
relation to the ongoing care of the PVC awareness in relation to risks
site. associated with the PVC removal.
17 Document the removal of the PVC and To ensure adequate record
any signs of infection on the Trust keeping, complete the audit trail
Insertion and Ongoing Care Record. and enable continued care of the
patient.
18 When a PVC has been removed due to To ensure all complications are
a complication ensure an action plan is monitored and appropriately
initiated and the site is monitored and managed and enable continued
this is documented care
Page 27 of 35

Procedural Board for Removal of Non Ported PVC using ANTT Appendix 3 (Page 3 of 3)
1 2 3 4 5 6
Ensure cannula is no Confirm patients identity Wash hands Prepare tray, wash with Gather sterile gauze, Open gauze packaging
longer required Explain procedure soap/water, clean with tape and sharps box Remove cannula
Hand hygiene at point Gain consent Sanicloth© Hand hygiene at point dressing
of care Check allergies Allow to air dry of care Clean site if indicated
Don clean non sterile with Sanicloth©
gloves and apron
7 8 9 10 11 12
Loosely apply sterile Check cannula is intact Apply adhesive tape to Educate on care of the Dispose of equipment Document removal in
gauze over insertion Dispose of cannula and secure gauze / apply insertion site appropriately Peripheral Venous
site microclave© into sharps spot plaster If bleeding continues Remove gloves and Cannulation (PVC)
insertion and ongoing care
Remove cannula then box elevate arm and apron
record
immediately apply continue to apply Hand hygiene
pressure over gauze on pressure Clean tray
site for at least 2mins Wash hands
Page 28 of 35

Appendix 4
Successful Insertion of PVC
Page 29 of 35

Appendix 5
Choice of Peripheral Venous Cannula Gauge
The smallest appropriate PVC should be used in any given situation; vascular
complications increase as the gauge of the PVC in relation to vessel lumen
increases.
There are a number of different PVCs to choose from depending upon the patient's
requirements. The patient’s fluid requirements, the drug dilution rate, the condition of
the patient and the accessibility of the patient’s veins must be taken into
consideration. A winged non-ported cannula with microclave attached reduces the
risk of infection. It may be appropriate to consider a longer-term central venous
access device if the patient has poor access or requires extended venous access
and management for example Peripherally Inserted Central Catheter.
Size
Colour Common Applications
Gauge
Used in theatres or emergency for
Brown rapid transfusion of blood or 14G
viscous fluids
Used in theatres or emergency for
Grey rapid transfusion of blood or 16G
viscous fluids
Blood transfusions, rapid infusion of
White 17G
large volumes of viscous liquids
Blood transfusions and large
Green 18G
volumes of fluids
Blood transfusions, medications
Pink 20G
and fluids
Blood transfusions, medications
Blue 22G
and fluids
Medications, short-term infusions,
Yellow 24G
fragile veins, children
Yellow
Neonatal 24G
(N)
Page 30 of 35

Appendix 6
Visual Infusion Phlebitis Scores and the causes and signs of phlebitis
The above VIP score is based on the 3 M Company (2008) Visual Infusion Phlebitis
Score originally developed by Andrew Jackson, Nurse Consultant Intravenous
Therapy and Care, Rotherham General Hospitals, NHS Trust.
Page 31 of 35

Appendix 7
Diagram showing Examples of Key Parts
Key parts are defined as those parts or sites that if contaminated with micro-organisms
increase the risk of infection. Key parts are indicated on the red field.
Page 32 of 35

Appendix 8
Correct application and Removal of a peripheral IV Dressing Tegaderm™ (1633)
Page 33 of 35

Appendix 9
(Page 1 of 2)
Standards for Peripheral Venous Cannula Insertion:

Saving Lives High Impact Intervention (HII) 2 with UHB Guidance
Insertion actions
Hand hygiene
 Decontaminate hands before and after each patient contact and before
applying gloves
 Use correct hand hygiene procedure
Personal protective equipment
 Wear examination gloves if at risk of exposure to body fluids
 Gloves are single use items and must be removed & discarded
immediately after the care activity
 Gowns, aprons, eye/face protection are indicated if there is a risk of
splashing with blood or body fluids
Skin preparation
 Use 2% chlorhexadine gluconate in 70% isopropyl alcohol and allow to
air dry
 If patient has a sensitivity use a single patient use povidone-iodine
application
 Clean the skin for 30 seconds using up, down, back and forth
movements
 Allow to air dry – do not re-palpate insertion site
Dressing
 Use a sterile, semi-permeable transparent dressing to allow observation
of insertion site
 Apply Tegaderm 1633 dressing. Ensure dressing adequately secures the
PVC & leaves the insertion site visible
 Complete time and date label
Documentation
 Date of insertion must be recorded in notes
 Document insertion on PVC insertion record/PICS (sticker in Critical
Care/Theatres)
 Ensure all boxes are completed; include date / time of insertion, gauge,
lot number, review date, reason for access, skin prep used, site of
insertion, signature, name and designation of inserter
Key:
 Saving Lives Standard
 UHB Trust Guideline Standard
Note: Both Standards must be applied at all times
Page 34 of 35

Appendix 9
(Page 2 of 2)
Standards for Peripheral Venous Cannula Ongoing Care:

Saving Lives High Impact Intervention (HII) 2 with UHB Guidance
Ongoing care actions
Hand hygiene
 Decontaminate hands before and after each patient contact
 Use correct hand hygiene procedure
Continuing clinical indication
 All intravenous cannula and associated devices are still indicated
 If there is no indication then the intravenous cannula should be removed
Site Inspection
 Regular observation for signs of infection, at least daily
 Ensure insertion site visible
 Observe and record V.I.P score at least 8 hourly
 V.I.P score must be less than 2. Follow and record actions from V.I.P Score
chart
Dressing
 An intact, dry adherent transparent dressing must be present
 Applied correctly with a time and date label
Cannula access
 Use 2% chlorhexadine gluconate in 70% isopropyl alcohol, and allow to dry
prior to accessing the cannula for administering fluid or injections
 Ensure microCLAVE extension set is attached to cannula
 Decontaminate needle free device for 30 seconds and allow to air dry pre and
post access
 Use ANTT- protect key parts when accessing
Administration set replacement
 Immediately after administration of blood, blood products
 All other fluid sets after 72hours
 Ensure a line flag is in place with the date, time and initials of the person who
initiated the administration set
Routine cannula replacement
 Do not routinely replace a peripheral venous cannula unless complications
occur
Documentation
 Ensure documentation of all ongoing care actions
 Ensure date, time, signature, name and designation to Trust standard
Key Note: Both Standards must be applied at all times
 Saving Lives Standard  UHB Trust Guideline Standard
Page 35 of 35

Peripheral Venous Cannulae Guidelines

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Peripheral Venous Cannulae Guidelines

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Guidelines for the Insertion, Care and Removal of

Peripheral Venous Cannula (PVC)

On: 11th January 2016

 Information for: All clinical staff

Controlled Document Number: 225 Version: 5

Controlled Document Number: 225 Version: 5

1.2 Peripheral venous cannulation is undertaken to provide venous access

 Where a continual fluid infusion is required, i.e. fluid

1.3 Peripheral venous cannulation must not be undertaken for blood

These guidelines apply to:

 All clinical staff performing peripheral venous cannulation in the Trust

Controlled Document Number: 225 Version: 5

 Department of Health Reference Guide to Consent for Examination or

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

4.1 Medical Staff:

Foundation Year 1 (FY1) induction will include:

a) Training in cannulation by the Clinical Skills Trainers (unless

b) Completion of a period of supervised clinical practice by a

c) Training and assessment in Aseptic Non-Touch Technique

4.2 Nursing and Other Health Care Staff

4.2.1 The registered practitioner must be competent to administer

Controlled Document Number: 225 Version: 5

4.2.2 In order for identified non-registered practitioners to expand their

4.2.3 Identified non-registered practitioners must be competent to

4.3 All Clinical Staff

 Always wash hands effectively

Controlled Document Number: 225 Version: 5

5.1 Selection of Site

5.1.1 To minimise the risks associated with peripheral venous

 Condition of vein; veins should be easily palpable with

 Sites where there are signs of an infection

Controlled Document Number: 225 Version: 5

5.1.4 Peripheral venous cannulation must be performed with care and

5.2 PVC Selection

5.2.1 The smallest appropriate PVC must be used in any given

5.2.2 There are a number of different PVCs to choose from

5.3 Procedure for PVC insertion

The procedure for Peripheral Venous Cannulation is described in

 If a PVC insertion is not successful after two attempts, then

The process to enable successful cannulation is described in Appendix

Controlled Document Number: 225 Version: 5

There are recognised complications of peripheral venous cannula,

It is very important that the PVC site and patient is assessed:

 At least 1 hourly if continuous infusion is in place

When inspecting the insertion site it is important to check for signs of

The VIP score must be documented at least 8 hourly on the PVC

6.3.1 ANTT must be used throughout the procedure. The procedure

6.3.3 When an intravenous drug or infusion is being administered and

6.4.1 PVCs must be covered by a sterile, transparent, self-adhesive,

Controlled Document Number: 225 Version: 5

6.4.2 All dressings must be inspected every shift (minimum 8 hourly).

6.4.3 The tubing of an infusion administration set can put traction on

Bandages should not be routinely used to secure PVC sites. It is

6.6 Administration Sets

 High flow large volume fluid resuscitation

6.6.2 Additionally a needle free connector need not be used when a

6.6.3 If it is necessary for compatible drugs/infusions to be

6.6.4 An administration set attached to the needle free connector and

Controlled Document Number: 225 Version: 5

6.6.5 Administration sets/lines must be changed every 72 hours for

6.7 Line Flags

All administration sets attached to a PVC must be labelled with a line

6.8 Routine PVC replacement (previously 72 hours)

The latest research recommends PVCs should not be re-sited routinely,