IV CANNULATION

Dr. Carla O. Pandrya, SpAn

FK UPH
Background
• IV cannulation: is a technique in which a cannula is
placed inside a vein to provide venous access
• This topic describes placement of an over-the-needle IV
catheter, in which the catheter is mounted on the needle
• it is advisable to select the smallest gauge of catheter that
can still be effectively used to deliver the prescribed
therapy; this will minimize the risk of damage to the vessel
intima and ensure adequate blood flow around the
catheter, which reduces the risk of phlebitis
• However, if the situation is an emergency situation or if
the patient is expected to require large volumes infused
over a short period of time, the largest-gauge and shortest
catheter that is likely to fit the chosen vein should be used
• The superficial veins of the upper extremities are
preferred to those of the lower extremities for peripheral
venous access because cannulation of upper-extremity
veins interferes less with patient mobility and poses a
lower risk for phlebitis
• It is recommended to choose a straight portion of a vein to
minimize the chance of hitting valves
Indication
• Repeated blood sampling
• IV fluid administration
• IV medications administration
• IV chemotherapy administration
• IV nutritional support
• IV blood or blood products administration
• IV administration of radiologic contrast agents for
computed tomography (CT), magnetic resonance imaging
(MRI), or nuclear imaging
Contraindication
• No absolute contraindications to IV cannulation exist
• Peripheral venous access in an injured, infected, or
burned extremity should be avoided if possible
• Some vesicant and irritant solutions (pH < 5, pH >9, or
osmolarity >600 mOsm/L) can cause blistering and tissue
necrosis if they leak into the tissue, including sclerosing
solutions, some chemotherapeutic agents, and
vasopressors
Equipment
• Nonsterile gloves
• Tourniquet
• Antiseptic solution (2% chlorhexidine in 70% isopropyl
alcohol)
• Local anesthetic solution
• 1-mL syringe with a 30-gauge needle
• 2 × 2 gauze
• Venous access device
cont’
• Vacuum collection tubes and adaptor
• Transparent dressing
• Paper tape
Patient Preparation
• Anesthesia: Both intradermal injection of a local
anesthetic agent just prior to IV insertion and topical
application of a local anesthetic cream
• Positioning: patient is in a comfortable position, and place
a pillow or a rolled towel under the patient’s extended arm
IV Cannulation Technique
• Introduction
• Wash hands
• Introduce yourself
• Confirm patient details – name / DOB
• Explain procedure:
• “I need to insert a small plastic tube into your vein using a needle“
• “This will allow us to give you fluids and medications
intravenously“
• “It will be a little uncomfortable, but it hopefully won’t be painful“
• Check understanding & gain consent – “Does that all make
sense?” “Are you ok for me to go ahead?“
• Gather Equipment
• Non sterile gloves
• Apron
• Cannula – the standard size is 20g (pink)
• Cannula dressing
• Tourniquet
• Gauze
• Saline – 10ml
• Syringe – 10ml
• Alcohol swab
• Apply a tourniquet – avoid nipping the patients skin
• Palpate a vein:
• Go for a vein you can feel – it’s best if they feel “springy”
• It should ideally be straight
• Tapping the vein & asking the patient to pump their fist can make it
easier to see & feel veins
• Avoid areas where two veins are joining (valves present)
1. put on gloves
2. Clean the area with an alcohol swab for 30 seconds –
outward circular motion
3. Check with the patient that they’re happy to proceed
4. Prepare cannula:
Open wings
Check top cap is working
Slightly withdraw & replace needle – this will make it glide easier
Unscrew the cap at the back of the cannula & place upright in tray
5. Remove the cannula sheath
6. Secure the vein with your non-dominant hand from below
7. Warn the patient of a sharp scratch
8. Insert cannula at 20-40º – ensuring the bevel is facing upwards
9. Observe flashback
10. Advance the needle a further 1-2mm after flashback
to ensure it’s in the veins lumen
11. Withdraw the needle slightly so that it’s sharp point
is inside of the plastic tubing
12. Advance cannula fully into vein – the needle inside
the tubing will prevent kinking
13. Release the tourniquet – reduces bleeding
14. Place some gauze directly underneath the cannula
15. Apply pressure over the vein from above – reduces
bleeding
16. Remove the needle
17. Dispose of the needle into a sharps bin
18. Replace the cannula cap
• Securing the cannula
• Put some tape onto the cannula wings to secure it before flushing
Flushing the cannula
1. Set up flush:
• Open 5-10ml syringe
• Get 10ml bottle of saline 0.9%
• Confirm type of fluid & date of expiry
• Withdraw fluid from saline bottle into syringe
• Remove any air bubbles within syringe
Some hospitals may have ready filled saline syringes.
2. Remove the top cap from the cannula port & insert syringe
3. Inject the saline into the cannula:
• It should go in smoothly with little resistance
• Watch for signs of swelling around the site – stop immediately if you
see this!
• If the patient complains of pain you should also stop immediately!
4. Close the cannula port
5. Apply dressing to the cannula site
• Wash hands
• Thank patient
• Document the following:
• Patient details (name / DOB / hospital number)
• Date & time of cannulation
• Reason for cannulation
• Type of cannula used – (e.g. 20 gauge)
• Date the cannula should be removed/replaced
Complications
• Periprocedural and postprocedural complications may include
the following:
• Pain
• Failure to access the vein
• Blood stops flowing into the flashback chamber
• Difficulty advancing the catheter over the needle and into the
vein
• Difficulty flushing after the catheter was placed in a vein
• Arterial puncture
• Thrombophlebitis
• Peripheral nerve palsy
• Compartment syndrome
• Skin and soft tissue necrosis