Appendix 5 Record Peripheral IV Cannulation Instruction: Please if performed, cross (X) if not performed, or write N/A if deemed tick (√) not applicable Surname Forename Ward/Dept Assessment Dates Assessor(s) Lab Skills Clean tourniquet Correct Sterile glove equipment Syringe, needle and normal saline collected Cannula pack with appropriate size of cannula Checks packaging and expiry dates Transporting Safely transfers equipment to patient Identifies patient and explains procedure Preparing the Obtains consent from patient patient Encourages questions Establishes comfort and privacy of patient Hand washing Washes hands using the Ayliffe technique Selects appropriate limb Applies tourniquet safely and checks pulse. Supports arm patient’s Selects appropriate vein Loosens tourniquet Cleanses skin aseptically with patient’s chlorhexidine 2% and allows to dry Washes hands/ disinfects hands with alcohol hand gel Performs Opens equipment maintaining sterile field procedure Places blue towel under chosen limb Reapplies tourniquet Disinfects hands with hand gel Applies sterile gloves Introduces needle safely until flashback Removes/loosens tourniquet Introduces of cannula carefully and withdraws introducer at the right time Stabilises cannula Flushes cannula with normal saline Appropriate sterile dressing applied Patient comfort Comfort of patient re-established & safety Explains care of cannula to patient Safety Disposes of sharps appropriately Maintains aseptic technique throughout Hand washing Washes hands Applies by “Review date” sticker Documentation Completes cannula insertion record Completes VIIAD form
Appendix 5 Record Peripheral IV Cannulation Instruction: Please tick (√) if performed, cross (X) if not performed, or write N/A if deemed not applicable Surname Forename Ward/Dept Assessment Dates Assessor(s) Skills Lab Correct equipment collected Clean tourniquet Sterile glove Syringe, needle and normal saline Cannula pack with appropriate size of cannula Checks packaging and expiry dates Transporting Safely transfers equipment to patient Preparing the patient Identifies patient and explains procedure Obtains consent from patient Encourages questions Establishes comfort and privacy of patient Hand washing Washes hands using the Ayliffe technique Performs procedure Selects appropriate limb Applies tourniquet safely and checks pulse. Supports patient’s arm Selects appropriate vein Loosens tourniquet Cleanses patient’s skin aseptically with chlorhexidine 2% and allows to dry Washes hands/ disinfects hands with alcohol hand gel Opens equipment maintaining sterile field Places blue towel under chosen limb Reapplies tourniquet Disinfects hands with hand gel Applies sterile gloves Introduces needle safely until flashback Removes/loosens tourniquet Introduces of cannula carefully and withdraws introducer at the right time Stabilises cannula Flushes cannula with normal saline Appropriate sterile dressing applied Patient comfort & safety Comfort of patient re-established Explains care of cannula to patient Safety Disposes of sharps appropriately Maintains aseptic technique throughout Hand washing Washes hands Documentation Applies “Review by date” sticker Completes cannula insertion record Completes VIIAD form