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Extravasation Audit IV Monitoring

Please enter all available details

 

Your Email Address
Your Name
Hospital Centre

 

Time Cannulated
Size of Cannula
Make of Cannula
Person Cannulating
Ease of Cannulation (on a scale of 1 to 10, where 1 is Very Easy and 10 is Extremely Difficult)
State of the Veins (on a scale of 1 to 10, where 1 is Very Healthy and 10 is Collapsed)
No of Attempts at Cannulation
Cannula finally placed in
Reason for Cannula Failure
Patient's Age

Site of Cannula (Please enter coordinates)

 

Observation

[Grade each criterion against the standard scales shown in the table below]

Colour Feel Flow Sensation
0 hrs
+4 hrs
+8 hrs
+12 hrs
+16 hrs
+20 hrs
+24 hrs
+28 hrs
+32 hrs
+36 hrs
+40 hrs
+44 hrs
+48 hrs
+52 hrs
+56 hrs
+60 hrs
+64 hrs
+68 hrs
+72 hrs

 

Grade Colour Feel Flow Sensation
1 No discolouration of vein or surrounding area Fat 'juicy' veins, no pain Normal No adverse sensation
2 Vein looks slightly red Firm and fixed, no pain Slower than when started, but not interrupted Can feel flow through cannula but no discomfort
3 Vein and surrounding tissue look red +/- inflamed Tender and irritable. Especially painful on palpation Partial Flow Discomfort, but not really painful
4 Frank phlebitic discolouration of vein and tissues Sclerotic and fibrous, very painful No Flow Painful