Assess intravenous access needs

Quality statement 1

A patient requiring medicines or fluids is assessed to identify the most appropriate route of administration for their clinical needs.

Purpose

To ensure that all alternative routes of administration are considered and excluded before using the intravenous route.

What the quality statement means

For patients

If you need to have medicines or fluids, your clinician will assess what is the best way for you to have them. It might be as a tablet or liquid that you can swallow, or as an injection into your muscle or under your skin.

Sometimes the best way might be directly into your bloodstream. If this is the case, your clinician will talk with you about whether a PIVC is right for you. In some cases, a different way of delivering treatment into your bloodstream might be needed. This may depend on:

  • How long you need to have treatment
  • The condition of your veins and the chances of being able to successfully insert a PIVC
  • The treatment you need to have and whether it could damage your veins, especially if given for a long time
  • Your history of having PIVCs inserted and whether there were any problems, such as finding your veins
  • Where the PIVC should be inserted, taking into account your preferences and whether therapy can be delivered safely
  • Whether you already have a device in place for receiving medicines and fluids intravenously.

For clinicians

If a patient requires medicines or fluids, assess the patient to identify the most appropriate route of administration for their clinical needs before starting therapy. Consider whether another route of administration (for example, the oral, intramuscular, subcutaneous, rectal, intra-osseous or intra-peritoneal route) is appropriate, before using the IV route.

If all other routes of administration have been excluded and IV access is needed, assess whether peripheral or central venous access is appropriate by considering the:

  • Patient’s medical history, age, clinical and vascular condition
  • Expected duration of therapy
  • Likelihood of repeated or prolonged administration of vesicants or irritants such as vancomycin, flucloxacillin, potassium or certain types of chemotherapy
  • Patient’s history of infusion therapy and whether there were complications associated with its use – for example, difficulty locating suitable veins
  • Availability of appropriate insertion sites and the likelihood of first-time insertion success
  • Position of the patient during any planned procedures
  • Patient’s lifestyle, body image, and preferences for therapy and location of the device, and whether therapy can be delivered safely in accordance with their preferences
  • Availability of resources and ability to care for the device.

Insertion of a PIVC pre-emptively may be appropriate for patients at risk of clinical deterioration. Collection of pathology samples is not a valid reason to insert a PIVC; although this often happens in emergency departments, it can lead to unused PIVCs being left in. If frequent sampling is required, exceptions may be considered after individual assessment; examples include, fourth hourly troponin levels, to optimise patient comfort, or if there is difficult venous access. PIVCs should not be used to obtain blood cultures as this leads to an increased risk of contamination to the blood culture and PIVC.

By discussion with the patient, ascertain that they understand the need for IV therapy, especially if multiple device options are available, specific clinical issues about the therapy need to be raised, or the patient has concerns.

For health service organisations

Ensure that organisational policies and processes support the consideration of all routes of administration of medications and fluids before therapy is started, and that the IV route is only used if other routes are not suitable.

For patients

If you need to have medicines or fluids, your clinician will assess what is the best way for you to have them. It might be as a tablet or liquid that you can swallow, or as an injection into your muscle or under your skin.

Sometimes the best way might be directly into your bloodstream. If this is the case, your clinician will talk with you about whether a PIVC is right for you. In some cases, a different way of delivering treatment into your bloodstream might be needed. This may depend on:

  • How long you need to have treatment
  • The condition of your veins and the chances of being able to successfully insert a PIVC
  • The treatment you need to have and whether it could damage your veins, especially if given for a long time
  • Your history of having PIVCs inserted and whether there were any problems, such as finding your veins
  • Where the PIVC should be inserted, taking into account your preferences and whether therapy can be delivered safely
  • Whether you already have a device in place for receiving medicines and fluids intravenously.

For clinicians

If a patient requires medicines or fluids, assess the patient to identify the most appropriate route of administration for their clinical needs before starting therapy. Consider whether another route of administration (for example, the oral, intramuscular, subcutaneous, rectal, intra-osseous or intra-peritoneal route) is appropriate, before using the IV route.

If all other routes of administration have been excluded and IV access is needed, assess whether peripheral or central venous access is appropriate by considering the:

  • Patient’s medical history, age, clinical and vascular condition
  • Expected duration of therapy
  • Likelihood of repeated or prolonged administration of vesicants or irritants such as vancomycin, flucloxacillin, potassium or certain types of chemotherapy
  • Patient’s history of infusion therapy and whether there were complications associated with its use – for example, difficulty locating suitable veins
  • Availability of appropriate insertion sites and the likelihood of first-time insertion success
  • Position of the patient during any planned procedures
  • Patient’s lifestyle, body image, and preferences for therapy and location of the device, and whether therapy can be delivered safely in accordance with their preferences
  • Availability of resources and ability to care for the device.

Insertion of a PIVC pre-emptively may be appropriate for patients at risk of clinical deterioration. Collection of pathology samples is not a valid reason to insert a PIVC; although this often happens in emergency departments, it can lead to unused PIVCs being left in. If frequent sampling is required, exceptions may be considered after individual assessment; examples include, fourth hourly troponin levels, to optimise patient comfort, or if there is difficult venous access. PIVCs should not be used to obtain blood cultures as this leads to an increased risk of contamination to the blood culture and PIVC.

By discussion with the patient, ascertain that they understand the need for IV therapy, especially if multiple device options are available, specific clinical issues about the therapy need to be raised, or the patient has concerns.

For health service organisations

Ensure that organisational policies and processes support the consideration of all routes of administration of medications and fluids before therapy is started, and that the IV route is only used if other routes are not suitable.

Read quality statement 2 - Inform and partner with patients