Description
This label text reads:
RBWH- Peripheral Intravenous Cannulation (Please tick appropriate boxes)
Checks:
Clinical need for cannula (state reason below)
No known allergy to dressings/ skin antiseptic
Known allergy (state below)
Correct patient/ verbal consent
Patient Education given (care of cannula)
Assessment:
Good access
Fair access
Difficult / poor access
Alternate access recommended
e.g. PICC (referred to treating team)
Bundle Insertion:
Hand Hygiene performed (as per 5 moments)
Aseptic Non-Touch Technique insertion
Non Aseptic Insertion e.g. emergent
Chlorhexidine 2% w Alcohol 70%
Alcoholic Povidone Iodine (allergy to CHG)
Alcohol 70% (< 24 hr dwell)
IV dressing applied (as per policy)
Insertion Site:
NO restrictions
Limb:__________________ Left / Right
Vein:________________(e.g.: upper / lower cephalic)
Ante Cubital Fossa (ACF) (state reason below)
Cannula must not be used for blood sampling
Print Name:
Signature:
PRC 114
Cannula Gauge:.
Date:
Time: __:__hrs
