ntravenous � (IV)� therapyisthemost� commonlycarriedoutprocedurewithin� secondarycare. � Thisindispensablepart� ofmodernmedicineisalsorecognised� asanunpleasantandinvasiveprocedure. � Thereisincreasedawarenessofthe� potentialcomplicationsthatareassociated� withintravenoustherapies; � thereforethe� administrationrouterequirescarefulpatient� assessmentandconsiderationofitspurpose� (Dougherty, �2002;�Scales,�2005).� Evidence-basedguidelinesandpolicies� havebeenproducedinordertopromote� consistencyintheassessmentofpatientsand� toensurethatthemostappropriatevenous� accessdeviceisused � (Sub-groupofthe� ScottishCancerCarePharmacyGroup, �2005;� NHSEducationforScotland� (NES),� 2007;� RoyalCollegeofNursing �(RCN),�2010). Theselectionofanappropriateroute� forvenousaccessinvolvesamulti-factorial� patientassessmentthatincludesage,�condition,� lifestyle, � complianceandpreference. � Further� assessmentofdiagnosis, � treatmentplan, � type� oftherapyindicated,� durationoftherapy� andmaintenancecarerequiredwhilethe� deviceisinplaceshouldthenbecarriedout� (Hamilton,�2000;�RCN,�2010).� ■ Changingglovesbetweenpatientsandhand� washingbetweeneachglovechange � ■ Usinganappropriatecleaningagenton� theskinbeforeinsertionofthecannula:� chlorhexidine �2%�hasbeenshowntoreduce� therateofinfection � ■ Usingatransparent, �semi-permeabledressing� tosecurethecannulaandallowthesitetobe� viewedeasily � ■ Checkingthepatencyoftheveinusing� 0.9%� sodiumchlorideor � 5%� dextroseas� appropriate � ■ Flushingthecannulausing � 0.9%� sodium� chlorideor �5%�dextroseasappropriatebetween� drugsandoncompletingadministration. Ifthecannulaisrequiredforfurther� administrationthegivingsetisdisconnected� asepticallyandthecannulaleftinplaceforup� to �72�hours. � TheindicationsforadministeringIVtherapy� viathecentralrouteincludeprolonged� IVantibiotictherapy, � drugtherapysuchas� chemotherapyandtotalparenteralnutrition� (TPN).�Thecentralrouteisalsomostsuited� whenperipheralaccessispoorandmultipleIV� accessisrequiredforpatientswhoareanxious� orneedlephobic. � Aperipheralinsertedcentralcatheter� (PICC)� isplacedviatheantecubitalveinsin� thearmandisadvancedintothecentralveins, � withthetiplocatedinthelowerthirdofthe� superiorvenacava. � Thechoiceofveinsfor� non-tunnelledcannulationshouldbalancethe� riskofinfectionagainsttheriskofmechanical� complications.�Thecephalic, �basilicormedian� cubitalveinsinanadultpatient'sarmcanbe� usedtoinsertthePICCline�(Scales,� 2005;� Wiseetal, � 2001).� Ideallyitshouldbeplaced� intheupperarmabovetheantecubitalfossa� withtheuseofultrasoundasthisensures� thepatient'scomfortwhenflexingtheirarm� whilealsominimisingtheriskofthecatheter� twistingorkinking.�ThePICClinecanalso� beplacedjustaboveorbelowthefoldin� theantecubitalareawhenultrasoundisnot� available�(Gabriel,�2005).� APICClineofferstheadvantageof� minimisinginsertionandcatheter-related� complicationssuchasthrombophlebitis, � infectionandthrombosis. � However, � safe� maintenanceofthePICClineandrelevant� careoftheinsertionsiteareessentialinorder� topreventpossiblecomplications� (Gabriel,� 2005;� Griffiths, � 2007;� RCN,� 2010).� Other� measuresinclude: � ■ Handwashingwithanalcohol-basedhand� rubandusinganon-touchtechniqueto� preventinfectionwhenaccessingthelineor� changingthedressing � ■ Maintainingaclosedsysteminorderto� preventbloodlossorriskofairembolism � ■ Maintainingcatheterpatencytoprevent� occlusioninaccordancewithlocalguidelines �