Peripheral intravenous cannulation: reducing pain and local complications
Caring for patients with peripheral intravenous cannulas/catheters (PIVCs) is an important part of the nurse's role and insertion of PIVCs has traditionally been a post-registration nursing skill. With the introduction of the Nursing and Midwifery Council Standards of Proficiency for Registered Nurses in 2018, insertion of PIVCs is to be incorporated in pre-registration nursing programmes for all four fields of nursing practice. Although IV cannulation is a commonly performed clinical procedure, it is associated with significant risks and complications, which can cause pain for patients. This article outlines the factors that can cause pain for adult patients requiring a PIVC and recommends that the use of local anaesthetics be more widely considered when inserting a cannula. The identification, prevention and clinical management of commonly occurring painful local complications that can arise post-PIVC insertion are also discussed.
Peripheral intravenous cannula/catheter (PIVC) insertion is the most common invasive procedure performed across a range of healthcare settings (Jackson et al, 2013), with up to 70% of inpatients requiring a PIVC during hospitalisation (Ray-Barruel et al, 2018). PIVCs are essential for a plethora of clinical reasons, including the administration of fluids, medications such as antibiotics, chemotherapy and blood products (McGowan, 2014), or contrast agents, which are required for imaging (Piredda et al, 2017). Despite multiple international and national guidelines—and such widespread use—PIVC-associated complication rates persist at an unacceptably high rate. Reasons for PIVC failure include accidental removal or dislodgement, pain, phlebitis, occlusion, infiltration and infection (Ray-Barruel et al, 2018), which can result in future vascular compromise, treatment delays, extended hospital stay, and local and systemic infections (Johann et al, 2016).
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