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.