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IV therapy: the PVC bundle, a bag change and the fluid balance chart

RCSI heading: Peripheral venous catheter and IV therapy. You get 2 minutes with the descriptor outside the door and 10 inside, marked competent or not competent on every line. RCSI publishes no sample for this station; the descriptor below follows the layout of the two samples it does publish. Check rcsi.com before your date.

Rehearse it

Stand up, say it aloud, use whatever is on your desk as the equipment. The debrief is the competency sheet and the assessor’s questions.

Reading time
Outside the door. Two minutes with the descriptor, then in.
2:00
Purpose

To assess care of a peripheral venous catheter with the HSE care bundle and the VIP score, safe priming and changing of an infusion, recognition of phlebitis and infiltration, and an accurate fluid balance chart.

Situation / scenario

Mrs Grace O’Neill, 66, admitted with pneumonia, on IV antibiotics and 1 litre of 0.9% sodium chloride over 8 hours through a cannula in the left forearm inserted three days ago. The current bag is nearly through. She says the cannula site is "a bit sore". Her fluid balance chart for the last 24 hours is on the desk, incomplete.

You are required to assess the cannula and site with the VIP score, decide whether it stays, prime and connect the next bag as prescribed, and complete and interpret the fluid balance chart.

You are required to
  1. Hand hygiene, introduce yourself, identity band against the prescription, allergies, consent
  2. Check the fluid prescription: fluid, volume, rate, additives, prescriber signature, date; calculate the rate in mL/h and drops per minute for the giving set
  3. Inspect the site: dressing intact, dated and clean; pain, redness, swelling, warmth, palpable cord, discharge; compare with the other arm
  4. Score it with the VIP scale and act: 0 observe; 1 observe; 2 early phlebitis, resite; 3 or more, resite, consider treatment, report
  5. Ask whether the cannula is still needed: daily review, IV to oral switch, remove when not in use
  6. State the PVC care bundle: hand hygiene, aseptic non touch technique for every access, scrub the hub, intact transparent dressing, daily site check and documentation, remove when no longer needed
  7. Prime the new bag and line without air, key parts protected, label the line, connect with ANTT, set the rate, check it is running and the site afterwards
  8. Name the complications and what you would see: phlebitis, infiltration, extravasation, occlusion, air embolism, fluid overload, infection and bacteraemia
  9. Complete the fluid balance chart: all intake (oral, IV, antibiotics) and all output (urine, vomit, drains, stool if liquid), running totals, 24-hour balance, insensible loss noted
  10. Interpret it: positive or negative balance, urine output against 0.5 mL/kg/h, what to report and to whom

Throughout: communicate in an accurate, clear and effective manner; demonstrate a level of competence essential for safe practice.

The descriptor, the mistakes and the sources on this page are free to read. The timed run, the competency sheet and the assessor’s questions need the pass. Two stations run free in full: respiratory and observations, INEWS and ISBAR.

The pass: theory and OSCE

Run every station on the clock.

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Competencies assessed

Every RCSI descriptor lists the same five domains from the NMBI standards.

  • Professional values and conduct of the nurse
  • Nursing practice and clinical decision-making
  • Knowledge and cognitive competences
  • Communication and interpersonal competences
  • Management and team competences

Mistakes candidates report

  • Connecting the new bag to a sore cannula and dealing with the site "afterwards".
  • Air left in the line because the chamber was overfilled or the clamp opened fast.
  • Writing "PU" or "good amount" on the chart instead of a number.
  • Adding up the chart and not saying what the balance means or who is told.
  • Touching the spike or the end of the line and carrying on.

Practise the parts

Sources

This descriptor is a practice piece written to the shape of the RCSI samples. It is not an exam task, and the exam may ask anything from the reading list.

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