Picture credit: Barney Newman

Do I need to master IV skills to qualify as a nurse?

According to the Nursing and Midwifery Council (NMC) Standards of Proficiency for Registered Nurses, at the point of registration, nurses should be able to safely demonstrate they can undertake venepuncture and cannulation. Additionally, they should be able to ‘recognise the various procedural routes under which medicines can be prescribed, supplied, dispensed and administered,’ alongside ‘administering medications using a range of routes’ and ‘recognising and responding to adverse or abnormal reactions to medications’.

Is IV infusion an aspect of clinical practice that students often find daunting?

Yes, says Mr Parry. ‘Students can be very fearful of IV therapy. It’s always top of the league of what they’re most scared about,’ he says. ‘But that’s OK and it can be a useful safety net if it makes you cautious. It’s good to understand the gravity of what you’re dealing with.’

What are students permitted to do when it comes to IV therapy?

It is variable, says Mr Parry, and depends on where you are studying. ‘In England, it seems to vary from trust to trust,’ he says.

At the outset, seek advice from your practice assessor and practice supervisor, he says. ‘There will also be guidance issued by your university, who will have reached an agreement on what students are able to do and what they should avoid. The two golden rules are to check first what you can and can’t do, and then make sure you are working within your own scope of practice.’

How can I learn how to administer IV infusions?

At Cardiff University, nursing students go through three learning stages, some of which involve simulation sessions, where they can practise cannulation skills, for example.

‘Students find these sessions very useful because the pressure of clinical practice isn’t there and they can stay focused on learning the procedure,’ says Mr Parry.

In their first year of study, students can only observe. ‘This includes watching the prescribing of IVs, the reconstitution, the running through, the checking and the administration,’ says Mr Parry.

‘It’s important for them to do this. Once you’ve seen it a couple of times, the process begins to stick in your mind. You’ll also pick up some nuggets of clinical practice about what can happen at various points of administering an IV.’

Once second-year nursing students have successfully completed an assessment and a simulated session, they can undertake the reconstitution of IV medication. ‘They must have constant and direct supervision while they’re doing it,’ says Mr Parry. They can also participate in various checks carried out by registered nurses, including the drug, the dose, how it is to be administered, the infusion, the rate and duration.

Providing assessments have been successfully completed, third-year students can reconstitute and administer IV therapy, including flushing the cannula and monitoring the patient while they are undergoing the procedure, alongside checking the site where it is being administered. ‘Once again, they must be under constant and direct supervision throughout,’ adds Mr Parry.

What are the key risks with IV therapy?

Introducing infection at the site is among the most likely, says Mr Parry. ‘You need to be extremely disciplined in cleaning the access points into the IV cannula,’ he says. ‘You need to make sure you’re not contaminating the equipment.’

Being aware of any potential allergic reactions is also important. ‘Even if a patient doesn’t have allergies, this may be a medication they’ve never had before and they experience a reaction,’ he says.

‘You need that constant element of caution. It’s about understanding the medication you’re giving, how it works, how it might affect your patient and any side effects. It’s important to take the time to read about it first.’

Monitoring your patient before the IV therapy, during the procedure and afterwards is vital to reducing risk, says Mr Parry. ‘Don’t be complacent. Just because it’s never happened, doesn’t mean it won’t.’

What drugs can be administered via an intravenous infusion?

As well as fluids, such as normal saline, a wide range of medications can be given intravenously, including:

• » Non-steroidal anti-inflammatory drugs (NSAIDs) – for example, ibuprofen

• » Analgesia – including morphine and tramadol

• » Antibiotics – including amoxicillin, flucloxacillin and erythromycin

• » Steroids – such as methylprednisolone

• » Antiemetics – including metoclopramide and cyclizine

Picture credit: John Houlihan

You can find more information about all these drugs in the British National Formulary at bnf.nice.org.uk

Where can I find out more about IV infusions?

The British National Formulary (BNF) and National Institute for Health and Care Excellence (NICE) have produced guidance on intravenous infusions. NICE also has guidance on intravenous fluid therapy in adults in hospital, which covers general principles and protocols.

Mr Parry recommends Rang and Dale’s Pharmacology, now in its 10th edition, which provides accessible, up-to-date information on drugs and their mechanism of action. Many trusts also have their own guidance on IV therapy, including the Royal Marden’s video guides on topics such as how to flush and remove a port needle, and how to flush and dress a peripherally inserted central catheter.

Further information

British National Formulary and National Institute for Health and Care Excellence: Guidance on Intravenous Infusions. bnf.nice.org.uk/medicines-guidance/guidance-on-intravenous-infusions

Gloucestershire Hospitals NHS Foundation Trust (2021) IV Drug Administration: Resource Booklet tinyurl.com/IV-admin-booklet