Care of the cannula

Peripheral cannulas are common invasive devices, used for short-term intravenous fluid management and other therapies. These indwelling medical devices can be seen in many healthcare settings. The importance of cannula care and management must not be underestimated as there is a high risk of infection and other complications that may arise (Gorski et al, 2021; Denton et al, 2016).

There are a variety of intravenous devices which may be encountered, all of which have the potential to cause damage to the vessel wall. Vessel health preservation must be maintained through meticulous assessment and management of the indwelling device (Hallam et al, 2016).

Assessment of the device begins from the point of insertion to removal. Tools are available to assist in the assessment of vessel heath. The Visual Infusion Phlebitis (VIP) scoring system (Jackson, 1998) is accepted as a valid and reliable method of assessment (Gallant and Schultz, 2006). (Table 1).

Prior to assessment of the peripheral cannula utilising an approved VIP scoring system, it is advised that the practitioner considers the equipment required to care for and manage the device without undue disruption. Only practitioners trained and deemed competent in cannula care management should perform this skill and must therefore refer to the relevant guidance (Health and Safety Executive (HSE), 2017). Equipment required for the procedure will include:

• Wipeable tray
• Sharps container
• Sterile 0.9% saline ampule or prefilled syringe device
• Sterile syringe (luer-lock or luer-slip), no smaller than 10ml (Denton et al, 2016; HSE, 2017)
• Decontamination swab 2% chlorhexidine, 70% alcohol (or alternative dependent on allergy status) (Gorksi et al, 2021)
• Latex free non-sterile gloves
• Plastic apron
• Hand sanitisation products
• Sterile, semi-permeable, transparent dressing (optional)

Procedures requiring access to the circulatory system via a vascular access device must be performed under strict ANTT conditions (Loveday 2014; Gorksi et al, 2021) and as such should be prepared in a clean separate area such as a clinic room (HSE, 2017).

1. Cleanse hands by washing with soap and water and pat dry (World Health Organisation (WHO), 2009; Boswell and Longstaff, 2020)
2. Apply plastic apron
3. Clean tray with 70% alcohol, wiping the entire surface and base, according to organisational decontamination of equipment policy.
4. Assemble equipment, ensuring contents are intact and check expiry dates
5. Clean hands using alcohol gel or soap and water
6. Apply non-sterile gloves
7. Prepare flush using sterile normal saline and sterile syringe (alternatively use preprepared flush such as prefilled syringe device)
8. Place equipment in clean tray, ensuring key parts are always protected.
9. Introduce self to patient
10. Explain the procedure to the patient
11. Gain informed consent
12. Identify location

• Vessel wall damage
• Infection
• Dislodgement
• Infiltration
• Phlebitis
• Allergy
• Pain/discomfort

Continue to monitor the indwelling device up until removal is required. Removal of the device should be guided by the VIP tool, the practitioner’s clinical judgement and the patient condition. Furthermore, any device that is no longer required should be removed promptly.

Ongoing training and development for ANTT and care of vascular access devices must be sought in line with organisational policy and professional requirements in line with the practitioner’s code of practice (Denton et al, 2016; Gorksi et al, 2021; Nursing and Midwifery Council, 2018).

References

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 25 November)

Denton A, Bodenham A, Conquest A et al. Standards for infusion therapy. (4th edn). RCN:London; 2016. 

Department of Health. Clean, safe care: Reducing infections and saving lives. 2007. http://data.parliament.uk/DepositedPapers/Files/DEP2008-0037/DEP2008-0037.pdf (accessed 25 November 2022)

Gallant P, Schultz AA. Evaluation of a visual infusion phlebitis scale for determining appropriate discontinuation of peripheral intravenous catheters. J Infus Nurs. 2006; 29(6): 338-345. https://doi.org/10.1097/00129804-200611000-00004

Gorski LA, Hadaway L, Hagle ME et al. Infusion therapy standards of practice. (8th edn). J Infus Nurs. 2021; 44(1S Suppl):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://doi.org/10.1177/1757177415624752

Health and Safety Executive. Guiding Framework for the Education, Training and Competence Validation in Venepuncture and Peripheral Intravenous Cannulation for Nurses and Midwives. 2017.