Peripheral Intravenous Cannula – Reducing the risks

In this article, Cliodhna Grady, Clinical Risk Advisor, describes the complications associated with peripheral intravenous cannula (PIVC) management and how health and social care professionals can avoid them.*

The complications associated with PIVC management can have a significant effect on service users’ health and quality of life, and increase the cost of healthcare through the need for prolonged hospital stays and treatment. For example, mismanagement of PIVCs can result in blood stream infections, which may require prolonged courses of intravenous antibiotics. This in turn can drive anti-microbial resistance.

PIVC-related adverse incidents recorded on NIMS, the National Incident Management System, include infiltration, extravasation, phlebitis, haematoma formation, and failure to remove a cannula prior to discharge.

To reduce the risk of adverse effects to service users, health and social care professionals need appropriate education and training in PIVC management to ensure they undertake this role competently.

Risks associated with PIVC

Possible complications of PIVC management are:

Infection - Bacteria may enter through the insertion site, resulting in local infection or blood stream infection
Extravasation (infiltration of the injected fluid into the surrounding tissue) - particularly during administration of contrast media and iron infusions, which can cause significant skin staining
Phlebitis (vein irritation, more common in older service users) - due to the presence of the catheter, irritation from fluids injected or infection
Haemorrhage/haematoma formation at puncture site - increased risk in service users on anticoagulant medication

What can you do to minimise the risk?
Implement infection prevention and control (IPC) best practices for the care and management of PIVCs, if not already in place Consistently apply aseptic technique for all aspects of PIVC care to minimise PIVC-related infections Assess once every shift to see if the PIVC is still required; it should generally be removed if it has not been used in the previous 24 hours Assess the IV site using a visual phlebitis score to assess for signs of tenderness, swelling, inflammation or thrombosis on every shift Clean and flush the cannula at every access; if pressure is felt during flushing, force should not be applied; PIVC should be removed and only re-sited if still required Remove PIVC if any signs of tenderness, inflammation or phlebitis and only re-site if still required Implement and document care bundles, which minimise PIVC-related incidents: Complete insertion care bundle, including insertion date and time, site and size of cannula, number of attempts Review PIVC maintenance bundle once every shift Document date, time and reason for IV cannula removal; once removed check cannula integrity to ensure the device is complete Include the presence of PIVC / IV lines into the shift handover process Incorporate the PIVC care record into the discharge process / checklist to ensure all IV lines / cannulae have been removed prior to discharge and documented in the patient healthcare record Establish an ongoing system of audit to ensure compliance with best practice in relation to PIVC management

What can you do to minimise the risk?

Implement infection prevention and control (IPC) best practices for the care and management of PIVCs, if not already in place
Consistently apply aseptic technique for all aspects of PIVC care to minimise PIVC-related infections
Assess once every shift to see if the PIVC is still required; it should generally be removed if it has not been used in the previous 24 hours
Assess the IV site using a visual phlebitis score to assess for signs of tenderness, swelling, inflammation or thrombosis on every shift
Clean and flush the cannula at every access; if pressure is felt during flushing, force should not be applied; PIVC should be removed and only re-sited if still required
Remove PIVC if any signs of tenderness, inflammation or phlebitis and only re-site if still required
Implement and document care bundles, which minimise PIVC-related incidents:
- Complete insertion care bundle, including insertion date and time, site and size of cannula, number of attempts
- Review PIVC maintenance bundle once every shift
- Document date, time and reason for IV cannula removal; once removed check cannula integrity to ensure the device is complete
Include the presence of PIVC / IV lines into the shift handover process
Incorporate the PIVC care record into the discharge process / checklist to ensure all IV lines / cannulae have been removed prior to discharge and documented in the patient healthcare record
Establish an ongoing system of audit to ensure compliance with best practice in relation to PIVC management

This advice presented in this article was developed in consultation with the HSE’s Antimicrobial Resistance and Infection Control team. References available on request.

Peripheral Intravenous Cannula – Reducing the risks

Risks associated with PIVC

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