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Do you need formal training to manage intravenous infusions?

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16 December, 2013

In latest guidance NICE warned that as many as one in five patients on IV fluids and electrolytes suffer complications or even die due to their inappropriate administration.

It said a lack of formal training was a “major concern” that was putting lives at risk. It is calling on nurses and doctors in England and Wales to become better educated in how to safely care for patients given IV fluid therapy.

NICE has recommended measures to improve education and training, including practical steps to make decision-making clearer, simpler and safer.

The guideline highlights that IV fluid therapy should always be given as part of a protocol and includes a one-page, step-by-step guide on assessing whether patients need a n IV and if they do, what fluids should be given and how long for.


News story: NICE issues IV guidance in bid to improve drip safety


Have you had training to manage IV infusions?

Has your competency been assessed?

Do you think formal training is needed?


Readers' comments (44)

  • What is taught by the universities ,

    Do they concentrate on touchy feely stuff only ?

    Where is the real life knowledge which permits someone to practice safely.

    Why do nurses "qualify" with a massive knowledge deficit that has to be corrected post registration ?

    Perhaps the "EDUCATORS " need to return to school !

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  • reading these columns there now seems to be quite a few basic but essential skills which used to be an integral part of nurse training now lacking in newly qualified nurses due to new material being taught. is the undergrad. basic training course long enough for the current demands of nursing?

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  • Yup, I agree with my colleagues above.

    As a student nurse, I was taught about infusions & safe management of fluids and drugs by this route from the outset. Qualified clinical teachers monitored my knowledge and practice as safe before I was allowed to handle infusions.

    It's so easy to damage people when you have direct access to their bloodstream or CNS. We need every single student to be able to manage IVs & other lines safely.

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  • The problem is not necessarily the universities. In my experience employing trusts insist that newly qualified nurses have to pass the trust's own training programme in drug administration; that they are qualified for at least 6 months or may be longer before they undertake their trust specific i/v training; even if the student passes assessments on these in their final trimester of their course. Trusts insist that you undertake their training in skills such as venepuncture, cannulation etc, when you move between trusts; you can't even transfer Health and Safety training between trusts even though there is a legal requirement for it.

    There needs to be a national level of certification for:
    a) drugs administration
    b) i/v management and administration
    c) venepuncture
    d) cannulation
    e) all H&S related courses

    which would mean that students could obtain a, b & e at university and would be accepted regardless of where they were employed.
    Registered nurses who wished to undertake c & d could do so and know that they could change employers safe in the knowledge that they could continue using those skills.

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  • Anonymous | 17-Dec-2013 11:40 am

    Or just make sure that all of the above are included in the degree course of every single student!

    I see comments here almost daily talking about the need for nurses holding a degree in these days of increasingly complex interventions. I have always been a great supporter of a degree based profession. But we really need to sort out the content to adequately prepare nurses for their job.

    I agree with Jenny Jones. Why are nurses qualifying with such deficits?

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  • anonymous 6.30 pm
    please re-read my post, in my area most of the above ARE included on the course in the final trimester. However, the local employing trusts insist that NQNs have to undertake their own training, the don't accept the uniiversity's training. It is NOT solely an education issue at the Universities but also the employing trusts. 6 months post qualification - drugs administration. 12- 18 months post registration - i/v administration.

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  • Anonymous | 18-Dec-2013 9:34 am

    " my area most of the above ARE included on the course in the final trimester."

    Please re-read my post. Make sure that ALL (i.e. NOT MOST OR SOME) of the above are included in the degree course. The students that I mentor DO NOT cover cannulation or venepuncture during their university course, which is why my trust has to send them on a course and get them certified, post registration. Too much time and much money (which is why it takes a while to get on a course) is being spent bringing newly qualified nurses up to a basic standard. It is solely an education issue. These should now be considered essential/basic skills for every nurse and should be included in their course.

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  • This is odd. There's no legal requirement for local chitties to be issued to certify competence in such technical tasks for medics, so why for nurses? It seems to be a bit of gravy train for educators.

    If newly qualified nurses can't manage such tasks, we need to take this up with universities. It's basic stuff these days.

    So why all the extra costs and hassle for trusts?

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  • Anonymous | 18-Dec-2013 11:34 am


    However, it is typical of Nursing and its approach to education and training. Nursing has become more of a 'task orientated' profession than it ever was and is obsessed with certification. I think that it is a symptom of Nursing's massive inferiority complex. It seeks to constantly justify ability and competence through worthless bits of paper.

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  • I agree with many of the comments. I first trained in cannulation and venepuncture shortly after qualifying nearly 30 years ago. My first staff nurse post was a small, remote community hospital where I had to learn skills which, had I remained in a big teaching hospital, I would not have had the needed to learn for a few years. I wanted to work abroad and knew that these skills would be required. So I have been able to perform venepuncture, cannulate and administer IV drugs for all of my post-reg years. Through changes of job and, within those jobs, constant changes to post-reg education requirements, I have had to 're-certify' and update these skills countless times over the years, yet no one has once assessed me or required me to re-certify with regard to normal administration of medicines, which I do on a daily basis.

    I would not have believed then that 30 years later, these skills would not be taught as part of the Nursing curriculum.

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  • This is still a Trust problem, irrespective of which university NQN's come from and which skills they may or may not have acquired at university the Trust where I was first employed in 2006 insisted that:

    a) NQN's could not administer medication until they had completed the trust's education programme.

    b) i/vs could not be administered/managed until NQN's had attended the trust's i/v course, at least six-months post registration.

    c) venepuncture likewise, but at least 12 months post registration.

    d) cannulation as venepuncture

    I wasn't taught venepuncture or cannulation on my course either as they are still considered extended skills for nursing staff (both RNs and HCAs), and therefore are not taught at university. Medical students attend the same courses for these skills as registered/unregistered nursing staff.

    I cannot move trusts without undergoing the new trust's venepuncture/cannulation course, irrespective of how long or how frequently the skill has been practised.

    I am not saying it is right but that is the situation in my experience. However, I think that responsibility has to be shared between the universities and the trusts, after all the latter are responsible for 50% of the education of nursing students.

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  • of course you do. you need in-depth scientific knowledge and well developed technical skills otherwise patents are being put at grave risk.

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  • Anonymous | 19-Dec-2013 12:13 pm

    I'm not sure what it is you don't understand. When it is part of the standard curriculum at all universities for all nursing students, then there will be no excuse/need for trusts to send NQNs on 'a course'. However, as you have admitted, you qualified without the abilities to perform venepuncture or cannulation. Someone has to teach you and assess your competence! If the university have not prepared you, then your employer is landed with the responsibility. Don't get me wrong, I am no fan of the way trusts are run, but if there are obvious inconsistencies in the abilities of NQNs. I don't see that the trusts have much choice at the moment. They would dearly love to save the money.
    It is a basic education issue. Teach it in the Universities and the trusts won't have to run courses! Simple.

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  • Anonymous | 19-Dec-2013 1:15 pm
    Agree. Teach it at uni, gain practical experience in placement and qualify competent in venepuncture, cannulation, IV drug admin as well as everything else students are supposed to be learning over the 3-4 years of their course. Trusts facilitate the practical learning experiences of students. They are not responsible for their education. That is the job of the learning institution to which the student applied and was accepted.

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  • for crying out loud!!! how much money is being wasted sending NQNs off to learn something which they should already know?!! i think the delays in sending NQNs on these courses are obviously to do with the money involved and the amount of NQNs having to be spared from their duties to attend them. you can't all go on the course at the same time. when you qualify, you are now an employee and you are supposed to be at work, not buzzing off on endless courses because your education wasn't up to scratch. get it sorted. teach it as part of the course. it is disgraceful that employers are having to fund this.

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  • oh and if it was taught at uni, there would be no need for any stupid national certificates and all the unnecessary expense and carry-on that these would entail.

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  • I am finding some of these comments very frustrating as people don't seem to grasp what I am saying from personal experience, albeit as a Dippy rather than degree student:
    At the local university student nurses in their final semester now have to undertake a drugs management assessment. Therefore they should be able to administer medication.
    However, the employing trust does NOT accept this and INSIST that the NQN's STILL have to complete the Trust's OWN training, even though the university based training was undertaken on the same trust's own wards.
    This same trust INSISTS that the same NQN's HAVE to follow their training programme for i/vs, 6 months post-registration.

    It is the TRUST who is wasting time and money by their intransigence.
    The same is true of male catheterisation, on my community placement I catheterised, when I started my job on a ward I was not allowed to until I had been on a course run by the trust.

    Cannulation and venepuncture are NOT basic nursing skills required to register, which is what the university courses aim to do, they are extended practice, and it is up to the employing trust to provide training to those nurses who need it. The trust is of the opinion that this shouldn't be undertaken until 12 months post-registration.

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  • The reason I suggested a national scheme was to enable experienced RNs changing trusts would be able to continue using their acquired skills without the time and expense associated with attending courses run by their new employer.

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  • Anonymous | 19-Dec-2013 2:49 pm

    Yes this really is getting frustrating.

    Do trusts request that you carry out a post-reg course and gain a certificate in essential nursing care??? No!!! Why not ?? Because it is part of your fundamental pre-reg course. You have been assessed as competent and able to carry this out when you qualify. There is no need for you to go on a course to gain a certificate. Venepuncture and cannulation are apparently not required to register. Why not? THAT'S the problem. That's what the comments here are trying to convey. In this day of more complex nursing interventions and skill requirements, these should be taught as fundamental skills pre-reg. Stop blaming the trusts who are faced with having to train thousands of NQNs who lack this now basic and necessary skill.

    Your problem with your own trust's insistence on completing their drug admin assessment probably has its roots in litigation (where there has been an incident or incidents) and they got burned for it/them. It has nothing to do with the article subject.

    Anonymous | 19-Dec-2013 2:51 pm

    We wouldn't need a national certificate if it were part of pre-reg training, would we?

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  • Anonymous | 19-Dec-2013 6:08 pm

    Valiant try. But I think the fact that you need to spell it out points to a much greater problem......

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