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Clinical governance

Competencies

Nurses are now being named in malpractice allegations, and infiltration and extravasation injuries are an area for concern (Dougherty [76], Masoorli [187], Roth [307], Weinstein and Hagle [363]). Therefore, it is vital that nurses have the necessary level of knowledge and skills in order to:
  • correctly choose the device and location
  • understand the medication and whether it is a vesicant
  • use the most appropriate vasodilation techniques
  • recognize infiltration and extravasation early, and take prompt action (Dougherty [78], Goolsby and Lombardo [107], Sauerland et al. [322], Schrijvers [325]).
Successful cannulation at the first attempt is ideal, as vesicants have been known to seep into tissues at a vein entry site of a previous cannulation (Gault and Challands [104]). This also includes accessing a port as it is vital that the correct needle is selected and that the device is secured adequately (Camp‐Sorrell and Cope [37]).

Consent

Patients should be informed of the potential problems when administering vesicants and the possible consequences of extravasation (Polovich et al. [287], Sauerland et al. [322], Stanley [340], Weinstein and Hagle [363]). Giving adequate information to patients will help to ensure early recognition and co‐operation as patients are the first to notice pain. Patients should be urged to report any change in sensation, such as burning or stinging, immediately (Goolsby and Lombardo [107]).
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