Student compliance with taught indications for intravenous cannulation during clinical learning

Abstract: One of the guiding principles behind the teaching and performance of a medical intervention is to “firstly do no harm”. Gaining access to a patient’s circulatory system for the purposes of administering fluid and / or medications is commonly achieved through a procedure that involves piercing the skin with a needle and inserting a cannula into a vein. Whilst intravenous (IV) cannulation remains a relatively common procedure, routinely performed by a number of health care professionals, it has the potential to create unintended adverse effects. Subjecting patients to medical procedures in the absence of a clearly established need may be considered an unethical form of “overtreatment”. Conversely, failing to perform an intervention when it is clearly indicated is equally undesirable. For this reason, it is important that medical professionals and educators ensure a real need or indication for IV cannulation exists prior to the performance of the procedure by students. The University of Johannesburg (UJ) is one of four higher education institutions in South Africa that currently offer a four-year professional bachelor degree in emergency medical care. Intravenous cannulation is a clinical procedure that is taught in the second year of study. The didactic approach followed at the UJ is to firstly teach and assess theoretical knowledge and understanding relating to the procedure with regard to the technique, indications, risks and benefits. The procedure is then demonstrated, practiced and assessed in a simulated environment making use of an intravenous trainer (medium fidelity manikin). Thereafter students are required to demonstrate performance of the procedure a set number of times on real patients. Whilst this naturally creates a desire in students to perform IV cannulation when the opportunity presents itself, as mentioned above, seeking clear indications for the performance of the procedure is essential to prevent unnecessary exposure of patients to potential adverse effects. The Department of Emergency Medical Care at the UJ currently teaches four indications for intravenous cannulation in the pre-hospital setting which are well supported by literature. These include: a) the administration of intravenous fluid in an effort to reverse hypovolaemic and associated dehydrated states, b) administration of intravenous medications, c) securing intravenous access in the case of acutely-ill, high-acuity “priority 1” or “code red” patients and d) obtaining blood samples/specimens for further laboratory testing. The authors aimed to assess the extent to which emergency medical care students may have been establishing IV access on patients during the course of their clinical learning without a clear indication