How to assess a peripheral intravenous (IV) cannula

Most patients need at least one peripheral intravenous catheter (PIVC) during their hospital stay for IV fluids and medications, blood products or nutrition. PIVC complications are common, but they can be prevented or minimised by routine assessment. This article discusses the key points of PIVC assessment.

Is it needed?

Does the patient need this PIVC? Many PIVCs are left in without orders for IV fluids or medications (Limm et al, 2013; New et al., 2014). Others are never used at all (Limm et al., 2013). Some patients end up with two, three, or even more concurrent PIVCs, despite only needing one in most cases (New et al., 2014). And there are even reports of patients being discharged home with an IV in place because no one noticed it was there! (AllNurses.com, 2014)

PIVCs are often left in 'just in case' the patient might need it. But any IV catheter leads directly to the bloodstream and can be a source of infection (Zingg & Pittet, 2009). Assess the need for the PIVC every shift. If it wasn't used in the past 24 hours, or is not likely to be used in the next 24 hours, it should come out. Exceptions might be upcoming planned procedure, cardiac monitoring, history of seizures, unstable medical condition or recent rapid response call. If you're unsure, check with the treating team.

Is it working?

When a PIVC is inserted, a flashback of blood in the chamber confirms it's in the vein. Afterwards, the catheter location is estimated by the flow of IV fluids (either by infusion pump or gravity) and/or IV flushes (manual injection). Flushing the PIVC with 0.9% saline before and after IV medications reduces admixture of medicines and decreases the risk of blockage (Goossens, 2015).

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