Chapter 17: Vascular access devices: insertion and management
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Clinical governance
Consent
Implied (presumed) consent is felt adequate for a procedure such as placement of a peripheral venous cannula; therefore, patients usually give verbal consent for cannulation (Frank [157], Hyde [222]). Consent can also sometimes be assumed if the patient extends their arm for the procedure to be performed (Frank [157]).
Competencies
Nurses and other healthcare professionals who practise intravenous cannulation must ensure that they are operating within their scope of practice (HCPC [204], NMC [356]). Pre‐registration nurse education does not normally cover cannulation, necessitating post‐registration training (Phillips et al. [372]). Post‐registration nurses must follow professional guidelines and local policy prior to taking up these skills as they are classified as expanded practice. Nurses must be taught both theory and practical skills in cannulation (RCN [381]). Competencies include:
- knowledge and skills in anatomy and physiology of the veins
- selection of the vein and equipment
- ability to improve venous access
- prevention and management of complications.
One way of gaining these skills is to use a structured learning programme (Collins et al. [82]) that provides supervised self‐assessment using objective structured clinical examinations (Phillips et al. [372]). Additionally, less skilled practitioners can refer patients to more skilled practitioners who undertake cannulation on a regular basis, for example those in intravenous therapy teams; this can reduce pain and discomfort for patients and reduce local complications such as phlebitis (Dougherty [122], McGowan [306]).
