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PERIPHERAL VENOUS CANNULATION POLICY (ADULTS) Version 1 Name of responsible (ratifying) committee Infection Prevention Management Committee Date ratified December 2014 Document Manager (job title) Consultant in Infection Prevention Date issued 09 December 2014 Review date 08 December 2016 Electronic location Infection Control Policies Related Procedural Documents Hand hygiene, standard precautions, consent Key Words (to aid with searching) Peripheral venous cannulation, Cannulation, Cannulae, Asepsis, AccuVein, IV site, Phlebitis, IV access Version Tracking Version Date Ratified Brief Summary of Changes Author 1 December 2014 Rewrite of Clinical Policy for Peripheral Venous Cannulation Insertion and Management IPCT Peripheral Venous Cannulation (Adults): Issue Number: 1, Issue Date: 09 December 2014 (Review date: 08 December 2016 (unless requirements change)) Page 1 of 17 CONTENTS QUICK REFERENCE GUIDE....................................................................................................... 3 1. INTRODUCTION.......................................................................................................................... 5 2. PURPOSE ................................................................................................................................... 5 3. SCOPE ........................................................................................................................................ 5 4. DEFINITIONS .............................................................................................................................. 5 5. DUTIES AND RESPONSIBILITIES .............................................................................................. 5 6. PROCESS ................................................................................................................................... 6 7. TRAINING REQUIREMENTS .................................................................................................... 14 8. REFERENCES AND ASSOCIATED DOCUMENTATION .......................................................... 14 9. EQUALITY IMPACT STATEMENT ............................................................................................ 16 10. MONITORING COMPLIANCE WITH PROCEDURAL DOCUMENTS ........................................ 17 Peripheral Venous Cannulation (Adults): Issue Number: 1, Issue Date: 09 December 2014 (Review date: 08 December 2016 (unless requirements change)) Page 2 of 17 QUICK REFERENCE GUIDE For quick reference the guide below is a summary of actions required. This does not negate the need practitioners to be aware of and follow the detail of this policy. 1. Peripheral venous cannulation is an aseptic procedure and should only be undertaken when there is a clear and immediate need for intravenous access, or there is significant risk of haemorrhage. Cannulation should not be performed as a routine clinical intervention and should only be carried out by suitably trained practitioners 2. Cannulae should be appropriate for the product to be delivered, the intended speed of delivery, the duration of intended therapy and the condition and size of the vein 24 24 Catheter length (mm) 14 19 22 25 35 28 20 20 18 18 16 14 25 32 32 45 50 50 65 60 105 100 210 345 15 17 9.5 10 5 3 Gauge Flow Rate (ml/min) 26 22 Time to infuse 1L N/S (mins) 38 45 Indication Neonates / Paediatrics Long-term medications / fluid therapy Large fluid volumes/blood or contrast/dyes Whole blood administration Rapid infusion of blood or components 3. An upper extremity site is preferable for cannulation. Areas of flexion e.g. antecubital fossa should be avoided where possible 4. A sterile cannulation pack must be used for all cannulation attempts 5. Skin must be prepared with 2% chlorhexidine gluconate in 70% isopropyl alcohol (2% CHG/70% IPA) (Sanicloth) and allowed to dry between each and every cannulation attempt 6. During cannulation, never re-introduce the needle into the cannula sheath as this may damage the sheath which then has the potential to break and lodge inside the vein 7. Peripheral venous cannulae insertion sites must be visually inspected and palpated for tenderness a minimum of once per shift and a Visual Infusion Phlebitis(VIP) score recorded Peripheral Venous Cannulation (Adults): Issue Number: 1, Issue Date: 09 December 2014 (Review date: 08 December 2016 (unless requirements change)) Page 3 of 17 8. Peripheral venous cannulae should be electively re-sited if a non-aseptic insertion is suspected (e.g. emergency situation), if sited in a lower limb or if the cannula is more than 72 hours old Peripheral Venous Cannulation (Adults): Issue Number: 1, Issue Date: 09 December 2014 (Review date: 08 December 2016 (unless requirements change)) Page 4 of 17 1. INTRODUCTION Peripheral venous cannulation is the process of inserting a small hollow catheter over a needle into a peripheral vein. Peripheral venous cannulation is an invasive intervention that should only be carried out by suitably trained practitioners. 2. PURPOSE The purpose of this policy is to inform to all practitioners about the requirements and processes for peripheral venous cannulation and appropriate aftercare and removal. By using this policy, practitioners will act to reduce the risks to patients and staff associated with peripheral venous cannulation. These include thrombosis, pain, local or systemic infection; occupational sharps injury and inappropriate cannula insertion. 3. SCOPE This document sets out the standards to be followed by medical and non-medical members of staff employed by Portsmouth Hospitals NHS Trust whose role involves cannulation or cannula aftercare. For the purpose of this policy a non-medical member of staff is defined as a registered nurse, midwife or support worker. ‘In the event of an infection outbreak, flu pandemic or major incident, the Trust recognises that it may not be possible to adhere to all aspects of this document. In such circumstances, staff should take advice from their manager and all possible action must be taken to maintain ongoing patient and staff safety’ 4. DEFINITIONS Adult: for the purpose of this policy this relates to a person over 16 years of age Asepsis: is recognised as the state of being free from pathogenic microorganisms Aseptic technique: is the means of preventing or minimising the risk of introducing harmful micro-organisms onto key parts or key sites of the body when undertaking clinical procedures Disposable Tourniquet - a disposable single use device that promotes vein distension for insertion of a needle, it should remain taut for a maximum of 60 seconds Extravasation: administration of vesicant solution into the surrounding tissue1 Infiltration: administration of non-vesicant solution into the surrounding tissue1 Phlebitis: inflammation of a vein, more specifically the inner lining (tunica intima). Signs of phlebitis include; localised redness, heat, swelling and pain. Phlebitis may be mechanical (physical trauma to the vein), chemical (irritation caused by strong medicines) or infection (caused by infiltration of micro-organisms) in origin1 Vesicant: an agent or substance that causes blisters, burns and destruction of internal or external tissue1 5. DUTIES AND RESPONSIBILITIES Infection Prevention Team: are responsible for providing cannulation training, reviewing competency and managing the peripheral venous cannulation policy. The Infection Prevention team will also undertake monitoring and clinical audit of insertion and aftercare practice. Ward/Department/Line Managers: need to ensure adequate stock of equipment for peripheral venous cannulation is held and that all staff members who are required to perform cannulation Peripheral Venous Cannulation (Adults): Issue Number: 1, Issue Date: 09 December 2014 (Review date: 08 December 2016 (unless requirements change)) Page 5 of 17 or care for cannulae post insertion are appropriately trained. Managers must report to the Infection Prevention team any incidents of unsuitable or dangerous practice. Medical Consultants: are responsible for ensuring that all peripheral venous cannulation is clinically indicated and carried out in full accordance with this policy. Consultants are also responsible for reviewing the need for existing devices daily and reporting any incidents of unsuitable or dangerous practice. Individuals undertaking peripheral venous cannulation: should ensure they meet the training requirements, are safe and competent to undertake this skill and follow all relevant Trust policies to support safe practice. Staff must be aware of their roles and responsibilities and must identify and communicate any training needs to their Line Manager. Healthcare Workers: are responsible for ensuring safe care, access and removal of peripheral cannulae and reporting overdue or inappropriate devices to the Infection Prevention Team 6. PROCESS 6.1 Peripheral venous cannulation is an aseptic procedure and should only be undertaken when there is a clear and immediate need for intravenous access, or there is significant risk of haemorrhage. Cannulation should not be performed as a routine clinical intervention. Indications for peripheral venous cannulation1: Peripheral venous cannulation is generally indicated for: Short-term administration of intravenous fluid therapy of usually less than 3-4 days Administration of intravenous medication or blood and blood products Administration of dyes and contrast media Vascular access for emergency Peripheral venous cannulation is not indicated at Portsmouth Hospitals NHS Trust for: The administration of Total Parentral Nutrition (TPN) Vesicant and irritant solutions which can cause blistering and tissue necrosis if they leak into the tissue (sclerosing solutions, some chemotherapeutic agents, and vasopressors) Longer term fluid or drug infusions (>3 days) or medications (>5 days) where multiple attempts are required to establish peripheral venous access An appropriate vascular device should be inserted to administer these solutions. Intravenous device decision tree: Peripheral Venous Cannulation (Adults): Issue Number: 1, Issue Date: 09 December 2014 (Review date: 08 December 2016 (unless requirements change)) Page 6 of 17 6.2 Cannula selection: The cannula should be appropriate for: The type of infusion / medication / contrast to be delivered The intended or required speed of delivery The duration of intended therapy The condition and size of the vein Non-ported cannulae may be associated with a reduced risk of infection and should be used for the majority of patients2. Ported cannulae should only be used in main and maternity theatres, where rapid sequence induction may be necessary. Always select the smallest cannula necessary for the task. Gauge 24 24 22 20 20 18 18 16 14 Catheter length (mm) 14 19 25 25 32 32 45 50 50 Flow Rate (ml/min) 26 22 35 65 60 105 100 210 345 Time to infuse 1L N/S (mins) 38 45 28 15 17 9.5 10 5 3 Indication Neonates / Paediatrics Long-term medications / fluid therapy Large fluid volumes/blood or contrast/dyes Whole blood administration Rapid infusion of blood or components 6.3 Prevention and management of incidents and adverse events: Peripheral venous cannulation carries a risk of inoculation injury with contaminated sharps. The following must be adhered to at all times: Used cannulae must be discarded immediately at the point of use by the person generating the waste into a sharps bin that complies to UN 3921 and BS7320 Sharps bins must not be overfilled, and must have the temporary closure mechanism in place when not in use Practitioners should no work alone with confused or disoriented patients who may move unexpectedly, contributing to inoculation injuries 6.4 Consent: Informed consent must be obtained from all patients who have capacity prior to any cannulation attempt3. Consent may be given verbally or non-verbally and may be the act of the patient holding out their arm for the practitioner to carry out a procedure, providing the patient has received appropriate information prior to this3. The key principles of informed consent include: The patients right to consent voluntarily without pressure or coercion The patients right to withdraw consent at any time The provision of sufficient information to allow informed consent. This includes: i. The reason for the procedure ii. What the procedure involves iii. Any significant potential complications 6.5 Complications: Complications of peripheral venous cannulation include: Peripheral Venous Cannulation (Adults): Issue Number: 1, Issue Date: 09 December 2014 (Review date: 08 December 2016 (unless requirements change)) Page 7 of 17 Prolonged bleeding time (caused by medical condition or drug therapy) Haematoma (caused by puncturing the front and/or back wall of the vein or failure to apply correct pressure post failed attempt or removal) Infiltration (see definition) Extravasation (see definition) Phlebitis (see definition) Accidental damage (of adjacent structures including nerves, tendon or artery) Infection 6.6 Hand Hygiene: Hand hygiene with liquid soap and water or alcohol hand-rub must be performed before and after each patient procedure, before putting on gloves and after removing them4,5. The Trust standard 7-stage hygiene technique should be used at all times. 6.7 Personal protective equipment (PPE): When cannulating, practitioners should wear well-fitting sterile gloves. These are single use items and must be disposed of immediately after use4,5. 6.8 Skin Preparation: Skin must be prepared with 2% chlorhexidine gluconate in 70% isopropyl alcohol (2% CHG/70% IPA) (Sanicloth) 3. Cleaning should cover the whole area, ensuring that the skin area is in contact with the disinfectant for at least 15-30 seconds4,6. The area should then be allowed to dry4. If more than one attempt is made to access the vessel, the site must be re-cleaned with a new wipe between attempts. 6.9 Number of attempts: Only three attempts should be made to cannulate the patient, using new equipment on each occasion. Never re-introduce the needle into the cannula sheath as this may damage the sheath which then has the potential to break and lodge inside the vein If unsuccessful, support should be obtained from another member of staff qualified in peripheral venous cannulation. Failed attempts should be documented in the patient notes. Use of the AccuVein device (available from the Infection Prevention Department) can increase successful cannulation in difficult patients (e.g. IVDU, oncology patients) and show valves and bifurcations in vessels. 6.10 Site selection: To reduce the risk of device related infection and phlebitis, it is preferable to use an upper extremity site for inserting a peripheral venous cannula in adults and to replace a device inserted in a lower extremity to a site in the upper extremity as soon as possible4. Peripheral Venous Cannulation (Adults): Issue Number: 1, Issue Date: 09 December 2014 (Review date: 08 December 2016 (unless requirements change)) Page 8 of 17 Veins should be looked for in the following order: On the back of each hand I. Metacarpal veins Lower arm I. Cephalic or basilic veins Areas of flexion e.g. antecubital fossa should be avoided where possible for patient comfort4,6 Sites close to existing wounds, or limbs affected by lymph node dissection or renal fistula should be avoided7,8 Inspection will reveal clinical conditions that may prevent the arm being used whilst palpation of the veins will reveal the position of the veins, direction in which they run and their size and other physical features. The vein should be straight and feel soft, cylindrical in shape and ‘bouncy’ when lightly pressed. Veins that are tender, sclerosed, thrombosed, fibrosed, hard or bruised from previous use should be avoided. 6.11 Hair removal: Hair removal may be required if excessive hair interferes with cannulation attempts or hinders device fixation and application of an adhesive dressing. Hair removal around the insertion site should be accomplished using scissors or clippers7 Shaving with a razor should not be performed because of the potential for causing microabrasions, which increase the risk of infection8 Depilatories should not be used because of the potential for allergic reaction or irritation8 Electric clippers should have disposable heads for single-patient use8 Peripheral Venous Cannulation (Adults): Issue Number: 1, Issue Date: 09 December 2014 (Review date: 08 December 2016 (unless requirements change)) Page 9 of 17 6. 12 Equipment required for insertion of a peripheral venous cannula: Cannulation pack, containing; Sterile gloves Sterile towels x2 2% chlorhexidine gluconate in 70% isopropyl alcohol wipe (2% CHG/70% IPA) (Sanicloth) 10mL pre-filled Sodium Chloride 0.9% flush Single use disposable tourniquet Transparent sterile occlusive dressing Sterile gauze Clinical waste bag Appropriate sized cannulae x2 Extension set Sharps container Dedicated tray or identified prepared area, cleaned with detergent wipe or soap and warm water 6.13 Process: Approach patient, introduce yourself and check allergies (e.g. chlorhexidine) Give rationale for cannula insertion and ensure patient consents to the procedure Adjust environment to comfortable working height and ensure adequate lightingwherever possible Decontaminate hands following the Trust Hand Hygiene Procedure Clean tray or dedicated surface with detergent wipe or soap and warm water Open the sterile cannulation pack and arrange contents on field by placing hand inside sterile waste bag Open the cannula, extension set and 2% chlorhexidine gluconate in 70% isopropyl alcohol wipe onto the sterile field Open 10mL pre-filled Sodium Chloride 0.9% flush and place to the side of the sterile field Identify/palpate suitable vessel When potential site is identified, position patient comfortably with appropriate limb below the level of the heart Remove excess hair if required Place one sterile towel under the patients hand/arm Apply tournique Repeat hand decontamination with alcohol-based hand rub Apply sterile gloves Clean the site thoroughly with the 2% chlorhexidine gluconate in 70% isopropyl alcohol wipe for at least 15 seconds and allow to air dry Place second sterile towel over the appropriate limb below the site of intended cannulation Gently pull on skin, distal and lateral to insertion site. Do not touch the cannula or the insertion site (at this point local anaesthetic may be administered if prescribed and appropriate) Insert cannula (bevel uppermost) through the cleaned skin area at an angle of 20-30 degrees Advance until just in the vein and then lower the cannula until it is parallel with the skin (a flashback of blood is usually but not always seen at this point) Hold the needle still and advance the cannula over the needle until the cannula is inserted up to the hilt (In the event of unsuccessful cannulation of the vein withdraw the cannula from the puncture site and apply pressure with sterile gauze swab) Release the tournique using a piece of sterile gauze to protect the integrity of the sterile gloves Peripheral Venous Cannulation (Adults): Issue Number: 1, Issue Date: 09 December 2014 (Review date: 08 December 2016 (unless requirements change)) Page 10 of 17 Remove the needle (ensuring the sharps safe mechanism has activated) and dispose of immediately into a sharps container, using the sterile cap to occlude the cannula Secure the device with steri-strips and the transparent occlusive dressing Using the pre-filled saline syringe, flush through the extension set and attach to the cannula. Flush to the cannula with 5-10mLs of saline to check position Complete the time and date sticker from the occlusive dressing and apply near cannula site (ensuring that the entry pint is not obscured) Dispose of gloves, aprons and used equipment into the clinical waste stream Decontaminate hands Complete insertion documentation on VitalPAC or cannula insertion care bundle 6.14 Cannula care (see appendix): Peripheral venous cannulae insertion sites must be visually inspected and palpated for tenderness a minimum of once per shift and a Visual Infusion Phlebitis (VIP) score recorded either on VitalPAC or a paper cannula care bundle4,6 Practitioners must act immediately if the VIP score is >=1 Insertion sites and cannula components should be checked prior to the administration of any intravenous medications or fluids with recording of these observations as best practice All peripheral venous cannulae, prior to use, must have: No evidence of phlebitis, infiltration, extravasation No reported pain at the site An intact transparent dressing which completely covers the entry site and secures the device Needle free extension set in situ A valid date and time on the dressing Cannula dressings should cover the entry site and device up to the notch Peripheral Venous Cannulation (Adults): Issue Number: 1, Issue Date: 09 December 2014 (Review date: 08 December 2016 (unless requirements change)) Page 11 of 17 Leave the transparent semipermeable membrane dressing applied to the peripheral cannula insertion site in situ for the life of the cannula, provided that the integrity of the dressing is retained.5 6.15 Changing a peripheral cannula dressing: Cannula dressings should be changed if they become soiled or their integrity is compromised4,6,8 If the peripheral cannula is older than 48 hours, consideration should be given to removal and re-cannulation, rather than dressing change Dressing changes may be done by a lone practitioner if the patient understands the procedure and is able to co-operate. Two practitioners should change dressings for patients who are confused or disoriented and who may move unexpectedly 6.16 Equipment required for a peripheral cannula dressing change: Non-sterile gloves and apron Replacement transparent cannula dressing 2% chlorhexidine gluconate in 70% isopropyl alcohol wipe (Sanicloth) Cleaned plastic tray Clinical waste bag or bin 6.17 Process: Approach patient, introduce yourself and check allergies (e.g. chlorhexidine) Give rationale for changing the cannula dressing and ensure patient consents to the procedure Adjust environment to comfortable working height and ensure adequate lightingwherever possible Decontaminate hands following the Trust Hand Hygiene Procedure Clean tray with detergent wipe or soap and warm water Open the 2% chlorhexidine gluconate in 70% isopropyl alcohol wipe and transparent dressing into the clean tray Repeat hand decontamination with alcohol-based hand rub Apply apron and non-sterile gloves Holding the cannula securely, gently remove soiled/non-intact dressing Once the dressing is removed (and ensuring not to touch any part of the cannula that will be underneath the dressing), clean the site thoroughly with the 2% chlorhexidine gluconate in 70% isopropyl alcohol wipe and allow to air dry Ensuring that the cannula has not moved and is stable, release the cannula and apply the dressing, ensure that the cannula hub is covered Peripheral Venous Cannulation (Adults): Issue Number: 1, Issue Date: 09 December 2014 (Review date: 08 December 2016 (unless requirements change)) Page 12 of 17 Date and time the new dressing with the date and time of the original cannula insertion Dispose of gloves, aprons and used dressing into the clinical waste stream Decontaminate hands 6.18 Cannula access: Access of peripheral cannulae should be performed using a aseptic non-touch technique Hands must be decontaminated with an alcohol-based hand rub or by washing with liquid soap and water before and after any contact with the peripheral cannula or insertion site Gloves must be worn for all procedures All hubs or ports must be cleaned using a single-use application of 2% chlorhexidine gluconate in 70% isopropyl alcohol prior to access. The hub should be cleaned for a minimum of 15 seconds and allowed to dry Primary and secondary solution administration sets used for a continuous infusion must be changed every 72 hours and immediately upon suspected contamination or when the integrity of the product or system has been compromised4,5 Administration sets for blood and blood components should be changed every 12 hours, or according to the manufacturer's recommendations 4,5 Administration sets used for TPN should be changed every 24 hours or immediately upon suspected contamination or when the integrity of the product or system has been compromised 4,5 6.19 Cannula re-siting or removal: Peripheral venous cannulae should be electively re-sited: If a non-aseptic insertion is suspected (e.g. emergency situation) If sited in a lower limb (EPIC) If the cannula is more than 72 hours old The catheter should be removed when complications occur (or VIP >=1) or as soon as it is no longer required4 6.20 Equipment required for removal of a peripheral cannula: Non-sterile gloves and apron Sterile gauze 2% chlorhexidine gluconate in 70% isopropyl alcohol wipe (Sanicloth) clean plastic tray small adhesive plaster 6.21 Process: Approach patient, introduce yourself and check allergies (e.g. chlorhexidine) Give rationale for removing the cannula and ensure patient consents to the procedure Adjust environment to comfortable working height and ensure adequate lightingwherever possible Decontaminate hands following the Trust Hand Hygiene Procedure Clean tray with detergent wipe or soap and warm water Open the 2% chlorhexidine gluconate in 70% isopropyl alcohol wipe and sterile gauze into the clean tray Repeat hand decontamination with alcohol-based hand rub Apply apron and non-sterile gloves Holding the cannula securely, gently remove soiled/non-intact dressing Once the dressing is removed, slide the cannula out and apply pressing using sterile gauze to the puncture site. Do not press firmly on the puncture site until after the plastic sheath has been removed to prevent shearing Peripheral Venous Cannulation (Adults): Issue Number: 1, Issue Date: 09 December 2014 (Review date: 08 December 2016 (unless requirements change)) Page 13 of 17 Apply gentle pressure until bleeding has stopped and raise limb if required Apply small adhesive plaster to site (do not tape gauze over the site as this is not secure) Dispose of gloves, aprons and gauze into the clinical waste stream Contaminated peripheral cannulae should be placed into sharps bins Decontaminate hands 7. TRAINING REQUIREMENTS Prior to undertaking any cannulation procedure, all staff must be able to demonstrate clinical competence and a clear understanding of the underlying principles of practice. This will be achieved by: Nursing and other health care staff; a) b) c) Completion of the Trust venous cannulation competency pack Attendance at the trust cannulation study day Completion of a period of supervised clinical practice (Staff who have been trained and practised in a previous post may be allowed to demonstrate an equivalent level of competence through a period of supervised practice only). Medical staff; Post registration house officer (PRHO) induction will include training by Trust trainers on local policies and principles of practice. Senior House Officer’s and Registrars will be assumed competent unless identified otherwise by their supervisor. If problems are identified, the staff member will be required to: a) b) c) Completion of the Trust venous cannulation competency pack Attendance at the trust cannulation study day Completion of a period of supervised clinical practice Cannula care training for clinical staff is available from the Infection Prevention Team. 8. REFERENCES AND ASSOCIATED DOCUMENTATION 1. McCallum L, Higgins D. (2012). Care of peripheral venous cannula sites. Nursing Times; 108: 34/35, 12-15. 2. Easterlow et al (2010). Implementing and standardising the use of peripheral vascular access devices. Journal of Clinical Nursing. Vol 19; 5-6: pg 721–727 3. Department of Health (2010). Reference guide to consent for examination or treatment. London: HMSO 4. Loveday et al (2014). epic3: National Evidence-Based Guidelines for Preventing HealthcareAssociated Infections in NHS Hospitals in England. Journal of Hospital Infection 86S1 (2014) S1–S70 5. NICE (2012). Prevention and control of healthcare –associated infections in primary and community care. Clinical guideline 139. National Institute for Health and Clinical Excellence 6.RCN (2010). Standards for infusion therapy. Third edition. Royal College of Nursing IV Therapy Forum. Peripheral Venous Cannulation (Adults): Issue Number: 1, Issue Date: 09 December 2014 (Review date: 08 December 2016 (unless requirements change)) Page 14 of 17 7. Dougherty L and Watson J (2008). ‘Vascular access devices’, in Dougherty L and Lister S (editors) The Royal Marsden Hospital Manual of clinical nursing procedures (7th edition), Oxford: Blackwell Publishing, Chapter 44. (III) 8. Infusion Nurses Society (2006). Infusion nursing standards of practice, Cambridge, MA: INS and Becton Dickinson. Peripheral Venous Cannulation (Adults): Issue Number: 1, Issue Date: 09 December 2014 (Review date: 08 December 2016 (unless requirements change)) Page 15 of 17 9. EQUALITY IMPACT STATEMENT Portsmouth Hospitals NHS Trust is committed to ensuring that, as far as is reasonably practicable, the way we provide services to the public and the way we treat our staff reflects their individual needs and does not discriminate against individuals or groups on any grounds. This policy has been assessed accordingly. All policies must include this standard equality impact statement. However, when sending for ratification and publication, this must be accompanied by the full equality screening assessment tool. The assessment tool can be found on the Trust Intranet -> Policies -> Policy Documentation Our values are the core of what Portsmouth Hospitals NHS Trust is and what we cherish. They are beliefs that manifest in the behaviours our employees display in the workplace. Our Values were developed after listening to our staff. They bring the Trust closer to its vision to be the best hospital, providing the best care by the best people and ensure that our patients are at the centre of all we do. We are committed to promoting a culture founded on these values which form the ‘heart’ of our Trust: Respect and dignity Quality of care Working together No waste This policy should be read and implemented with the Trust Values in mind at all times. Peripheral Venous Cannulation (Adults): Issue Number: 1, Issue Date: 09 December 2014 (Review date: 08 December 2016 (unless requirements change)) Page 16 of 17 10. MONITORING COMPLIANCE WITH PROCEDURAL DOCUMENTS Minimum requirement to be monitored Cannulation Training Cannula care and removal Cannula observations Lead Tool Frequency of Report of Compliance Learning & Development (supported by Infection Prevention) Study day register and competency framework Yearly Infection Prevention & Control TEAL audits of peripheral venous cannula care, use and removal Monthly Infection Prevention Management Committee VitalPAC reporting Daily Reporting arrangements Policy audit report to: Caroline Mitchell Infection Prevention Management Committee Policy audit report to: Infection Prevention Management Learning & Development Infection Prevention Management Committee Policy audit report to: Lead(s) for acting on Recommendations Committee Heads of Nursing Nursing Midwifery Committee Peripheral Venous Cannulation (Adults): Issue Number: 1, Issue Date: 09 December 2014 (Review date: 08 December 2016 (unless requirements change)) Page 17 of 17 Caroline Mitchell