Paediatric Peripheral Intravenous Cannulation Package to Improve Practice

Dr Michelle Dodds, ED Staff Specialist at Redcliffe Hospital, shared why needle procedures, such as inserting intravenous (IV) cannulas, can be delicate for children under 16 years of age. She also observed that the approach to paediatric cannulation by both medical and nursing staff varied greatly and there was apprehension around the needle procedure and a need for education and standardisation, particularly among new nursing staff. 

Through an EMF Emerge grant, Dr Dodds, together with Nurse Educator Natasha Edwards, Senior Staff Specialist Dr Jason Chan and the late Emergency Physician Dr Kong Liew came up with a solution. They developed a physical bedside resource with equipment needed for the procedure and decision-making guide with pictures to support staff with inserting and securing IV cannulas in children, including resources around pain relief and distraction techniques. 

The results indicate that implementing a readily available, standardised resource guide led to an improved patient and family experience. This was due to increased clinician confidence in preparing for and inserting a cannula and a broader knowledge around pain relief, comfort in positioning and distraction techniques. There were also decreased clinician cognitive load and improved workflow and efficiency due to a structured and standardised approach for paediatric cannulation and consistent PIVC resources shared between nursing and medical streams.

“We’re now more familiar with different ways to have children cuddle with their parents or have babies be breastfed while we put the cannula in, which we didn’t always reach for or weren’t aware were available,” Dr Dodds said. “It just gives us more tools in our toolkit to approach the cannulation procedure and make sure it’s as good as it can be for children and their families.”

In addition to the ED where the cannulation package has been embedded in the nursing orientation, the resources have been translated for use throughout Redcliffe Hospital’s paediatric ward, operating theatres, intensive care unit and post-anaesthetic care unit.

“We’ve also integrated them into the Skills Development Centre, so when anybody does any training across the hospital, they use those resources in their simulations and scenarios as well,” Ms Edwards said.

Looking to the future, the team is investigating ways to expand the scope of their resources, including upskilling nurses in cannulating paediatric patients and applying the relevant skills to other procedures for both children and adults.

“All of those skills regarding preparation and distraction are also translatable to non-cannulation tasks, like when a child might need a few sutures or if we are doing anything painful or invasive,” said Ms Edwards.

“It is translatable to our adult population as well,” Dr Dodds said. “With adults who have lots of apprehension or anxiety around any sort of procedure I find myself using the skills we have refined with this study, to make all our patients feel as comfortable as they can in the emergency department.”