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This guide provides a step-by-step approach to performing a visual infusion phlebitis (VIP) assessment and administering an intravenous flush in an OSCE setting.
Visual infusion phlebitis (VIP) assessment
To ensure optimal care of a peripheral cannula, it should be inspected at a minimum daily and each time the cannula is to be used.1 This is to ensure signs of infiltration (leakage of non-irritant fluids into the surrounding tissue) and extravasation (leakage of irritant fluids into surrounding tissues associated with significant tissue damage) are recognised.2
Introduction
Wash your hands using alcohol gel. If your hands are visibly soiled, wash them with soap and water.
Don PPE.
Introduce yourself to the patient including your name and role.
Confirm the patient’s name and date of birth.
Briefly explain what the procedure will involve using patient-friendly language: “I am going to inspect your cannula to ensure there are no signs of inflammation or infection.”
Gain consent to proceed with the VIP assessment.
Check if the patient has any allergies (e.g. latex), including an allergy wristband.
Adequately expose the patient’s arm for the procedure.
Position the patient so that they are sitting comfortably.
Ask the patient if they have any pain before continuing with the clinical procedure.
Procedure
1. Wash your hands again
2. Don non-sterile gloves and a disposable apron
3. Inspect and assess the cannula site utilising the VIP scale, noting any signs of:
- Pain (palpate for any tenderness)
- Palpable venous cord (feel for a hardened, cord-like thickening along the vein)
- Pyrexia (feel if the area is warm to touch)
- Erythema (observe for redness)
- Oedema
4. Calculate the VIP score based on the findings
- Action should be based on the score generated from the VIP scale (e.g. a score of 2 requires resiting the cannula). Proceed with flushing only if the score is 0 or 1.
Administering an intravenous (IV) flush
Gather equipment
Collect the equipment required for the procedure and place it within reach on a tray or trolley, ensuring that all the items are clearly visible:
- Clean procedure tray
- Non-sterile gloves
- Disposable apron
- Pre-filled 10 mL 0.9% sodium chloride syringe
- Alcohol swab (2% chlorhexidine in 70% isopropyl alcohol)
- Prescription chart
Check that all equipment is in date, sterile where applicable, and the packaging is dry and undamaged.
Introduction
Wash your hands using alcohol gel. If your hands are visibly soiled, wash them with soap and water.
Don PPE if appropriate.
Introduce yourself to the patient including your name and role.
Confirm the patient’s name and date of birth.
Briefly explain what the procedure will involve using patient-friendly language: “I am going to inject a syringe of salty water into your vein to make sure the cannula is working correctly. It may feel cold, but it shouldn’t be painful. If you experience any discomfort, tell me straight away.”
Gain consent to proceed with administering an IV flush.
Check if the patient has any allergies (e.g. latex), including an allergy wristband.
Final checks
Before proceeding, check and verbalise the seven rights of medication administration.
1. Right person: ask the patient to confirm their details and then compare this to the patient’s wristband (if present) and the prescription. You should use at least two identifiers.
2. Right drug: check the labelled drug against the prescription and ensure the medication hasn’t expired
3. Right dose: check the drug dose against the prescription to ensure it is correct
4. Right time: confirm the appropriate date and time to administer the medication and check when the patient received a previous dose if relevant
5. Right route: check that the planned route is appropriate for the medication you are administering
6. Right to refuse: ensure that valid consent has been gained before medication administration
7. Right documentation of the prescription and allergies: ensure that the prescription is valid and legible, and check the patient isn’t allergic to the medication you will administer
If any of the above information is missing, incorrect, or unclear, it is not a valid prescription. You should not proceed and must escalate the issue to the prescriber immediately.
Procedure
1. Wash your hands again
2. Don non-sterile gloves and a disposable apron
3. Open the cannula port or unlock the clip if an extension set is used
4. Clean the cannula port using an alcohol swab for 30 seconds and allow to dry for 30 seconds
5. Remove any air bubbles from the syringe by pulling back slightly and expelling air
6. Attach the syringe to the cannula using an aseptic non-touch technique (ANTT)
7. Administer the flush using a pulsation (start/stop) action
- Ask the patient if they experience any discomfort while the flush is administered
8. Disconnect the syringe
9. Close the cannula port or lock the clip if an extension set is used
To complete the procedure…
Explain to the patient that the procedure is now complete and that they should seek review if the cannulation site becomes painful or inflamed.
Thank the patient for their time.
Dispose of your PPE and other clinical waste into an appropriate clinical waste bin.
Wash your hands.
Complete the documentation on the medication administration record, including the date, time and your signature.
Editor
Dr Jamie Scriven
References
- The Royal Marsden NHS Trust. Post-procedural considerations. In: The Royal Marsden Manual of Clinical and Cancer Nursing Procedures. 10th ed. Available from: [LINK].
- Tarpey A, Malesker M. What is the optimal approach to infiltration and extravasation of nonchemotherapy medications? Cleveland Clinic Journal of Medicine. 2023. [LINK].
- National Institute for Health and Care Excellence. Discussing and Planning Medicines Support. 2023. Available from: [LINK].
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