IV Cannulation Good Practice Guidance

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This guidance has been developed in conjunction with the most up to date evidence-base to support safe and effective peripheral IV cannulation (PVC) practise.

It covers the 6 main areas of IV cannulation of Insertion, Skin decontamination, Dressings, Flushing, Personal protective equipment and Sharps Safety.

You will also find the many references to back up this resource at the bottom of this page.

Insertion
Image of a needle Insertion in to vein in hand

When inserting PVC the principles of Aseptic Non-Touch Technique (ANTT) must be adhered to:

  • Standard ANTT must be used for PVC insertion (Rowley and Clare, 2019).
  • Single-patient-use tourniquets must be used (Grohmann et al., 2020; Salgueiro-Oliveira et al., 2019).
  • A new pair of clean disposable, non-sterile gloves must be donned for PVC insertion; the insertion site must not be touched/palpated after skin antisepsis. (Ray-Barruel et al., 2019)
  • Sterile gloves must be worn if re-palpation of the vein is necessary after skin antisepsis. Contamination of non-sterile gloves is well documented. (Ray-Barruel et al., 2019; Loveday et al., 2014)
Skin decontamination

Prior to PVC insertion, the intended site should be decontaminated with the appropriate antimicrobial solution using aseptic technique (Loveday et al., 2014, Nickel et al., 2024).

The skin at the insertion site should be decontaminated with chlorhexidine gluconate in 70% alcohol before inserting a PVC (NICE, 2017).

Dressings
Image of a Dressing on the back of a hand

PVCs should be stabilised in a manner that does not interfere with assessment and monitoring of the access site, that does not impede delivery of the prescribed therapy, and that is acceptable to the patient (Nickel et al., 2024). Device stabilisation should be performed using an aseptic technique (Loveday et al., 2014).

A sterile transparent film dressing must be applied and maintained on PVCs (Loveday et al., 2014).

Transparent film dressings should be used to cover PVC insertion sites where possible (Loveday et al., 2014, NICE, 2017).

In some circumstances a sterile gauze dressing may have to be used; for example, if the patient has profuse perspiration or the insertion site is leaking or bleeding. In these instances the intravascular site should be checked regularly and the gauze dressing replaced as soon as possible with a transparent film dressing (Loveday et al., 2014, NICE, 2017)

Flushing
Image of a syringe upright ready to be inserted
  • Sterile 0.9% sodium chloride should be used to flush and lock PVC lumens that are accessed frequently (Loveday et al., 2014, NICE, 2017).
  • 0.9% saline flushes should be prescribed unless provided in a pre-filled syringe and classed as a medical device (Loveday et al., 2014, NICE, 2017).
  • PVCs must be flushed with preservative-free 0.9% sodium chloride (Goossens, 2015)
  • Never use sterile water for flushing PVCs (Goossens, 2015)
  • Assess PVC function using a 10-mL syringe or a syringe specifically designed to generate lower injection pressure (ie, 10-mL diameter syringe barrel), taking note of any resistance (Keogh et al., 2016; Pittiruti et al., 2016; Pittiruti et al., 2023).
  • Use a gentle pulsatile flushing technique to deliver flush into the PVC (Keogh et al., 2016; Pittiruti et al., 2023).
Sharps Safety
Image of two Sharps Bins

The requirement to use safety devices is set out in the Health and Safety [Sharp Instruments in Healthcare] Regulations 2013 legislation.

The main legislation that govern the use and disposal of medical sharps including PVCs is The Health and Safety (Sharp Instruments in Healthcare) Regulations 2013 (legislation.gov.uk)

Used standard needles

must not be bent or broken before disposal (however, it is acceptable to bend needles when they are part of an approved sharps safety device) must not be recapped.

In dentistry, if recapping or disassembly is unavoidable, a risk assessment must be undertaken and appropriate safety devices should be used (see the Health and Safety [Sharp Instruments in Healthcare] Regulations 2013)

The Health and Safety (Sharp Instruments in Healthcare) Regulations 2013 legislation

Use and disposal of medical sharps

"5.—(1) An employer must ensure that—

  • (a) the use of medical sharps at work is avoided so far as is reasonably practicable;
  • (b) when medical sharps are used at work, safer sharps are used so far as is reasonably practicable;”
References
  • Goossens, G.A., 2015. Flushing and locking of venous catheters: available evidence and evidence deficit. Nursing research and practice2015(1), pp. 985686. https://doi.org/10.1155/2015/985686
  • Grohmann, M., Schomakers, L., Wolschendorf, F., Grosch, J., Lindner, S. and Witte, A.K., 2020. Reduced bacterial contamination rates detected on silicone tourniquets compared to conventional tourniquets in clinical routine. BMC Infectious Diseases, 20, pp.1-6. https://doi.org/10.1186/s12879-020-04975-y
  • Keogh, S., Flynn, J., Marsh, N., Mihala, G., Davies, K. and Rickard, C., 2016. Varied flushing frequency and volume to prevent peripheral intravenous catheter failure: a pilot, factorial randomised controlled trial in adult medical-surgical hospital patients. Trials17, pp.1-10.https://doi.org/10.1186/s13063-016-1470-6
  • Loveday, H.P., Wilson, J.A., Pratt, R.J., Golsorkhi, M., Tingle, A., Bak, A., Browne, J., Prieto, J. and Wilcox, M., 2014. epic3: national evidence-based guidelines for preventing healthcare-associated infections in NHS hospitals in England. Journal of Hospital Infection86, pp. S1-S70. https://doi.org/10.1016/S0195-6701(13)60012-2
  • National Institute for Health and Care Excellence (NICE)., 2017. Healthcare-associated infections: prevention and control in primary and community care. Available at: https://www.nice.org.uk/Guidance/CG139#:~:text=This%20guideline%20covers%20preventing%20and (Accessed: 22 October 2024).
  • Nickel, B., Gorski, L., Kleidon, T., Kyes, A., DeVries, M., Keogh, S., Meyer, B., Sarver, M.J., Crickman, R., Ong, J. and Clare, S., 2024. Infusion therapy standards of practice. Journal of Infusion Nursing47(1S), pp. S1-S285. https://doi.org/10.1097/NAN.0000000000000532
  • Pittiruti, M., Van Boxtel, T., Scoppettuolo, G., Carr, P., Konstantinou, E., Ortiz Miluy, G., Lamperti, M., Goossens, G.A., Simcock, L., Dupont, C. and Inwood, S., 2023. European recommendations on the proper indication and use of peripheral venous access devices (the ERPIUP consensus): a WoCoVA project. The journal of vascular access24(1), pp.165-182. https://doi.org/10.1177/11297298211023274
  • Pittiruti, M., Bertoglio, S., Scoppettuolo, G., Biffi, R., Lamperti, M., Dal Molin, A., Panocchia, N., Petrosillo, N., Venditti, M., Rigo, C. and DeLutio, E., 2016. Evidence-based criteria for the choice and the clinical use of the most appropriate lock solutions for central venous catheters (excluding dialysis catheters): a GAVeCeLT consensus. The journal of vascular access17(6), pp.453-464. https://doi.org/10.5301/jva.5000576
  • Ray-Barruel, G., Xu, H., Marsh, N., Cooke, M. and Rickard, C.M., 2019. Effectiveness of insertion and maintenance bundles in preventing peripheral intravenous catheter-related complications and bloodstream infection in hospital patients: a systematic review. Infection, disease & health24(3), pp.152-168. https://doi.org/10.1016/j.idh.2019.03.001
  • Rowley, S. and Clare, S., 2019. Standardizing the critical clinical competency of aseptic, sterile, and clean techniques with a single international standard: aseptic non touch technique (ANTT®). Journal of the Association for Vascular Access, 24(4), pp.12-17. https://doi.org/10.2309/j.java.2019.004.003
  • Salgueiro-Oliveira, A.D.S., Costa, P.J.D.S., Braga, L.M., Graveto, J.M.G.N., Oliveira, V.S. and Parreira, P.M.S.D., 2019. Health professionals’ practices related with tourniquet use during peripheral venipuncture: A scoping review. Revista latino-americana de enfermagem27, pp. e3125. https://doi.org/10.1590/1518-8345.2743-3125.