IV cannulation 2012.ppt for information and procedure on iv

INTRA-VENOUS
CANNULATION
Clinical Skills NRMSM 2013 (N. Sunderlall)

VASCULAR ACCESS
 Access to vascular system
 Arterial access
 Venous access
 Peripheral vein
 Central vein
 Intra-osseous access

INTRA-VENOUS VASCULAR ACCESS
Means to gain direct access to the venous circulation
Cannulation of vein (or bone)
Central or peripheral vein

INTRA-VENOUS ACCESS
WHY?
Administer drugs and fluids/blood and blood
products
Obtain venous blood for diagnostic tests
To insert catheters into central areas/circulations for
physiological monitoring

INTRA-VENOUS ACCESS
WHERE?
Peripheral veins
 Arm vein (e.g. antecubital vein)
 Leg veins (e.g. saphenous vein)
 Neck veins (e.g. external jugular vein)
Central Veins
 Femoral vein
 Internal jugular vein
 Subclavian vein

INTRA-VENOUS ACCESS
WHAT?
A VASCULAR ACCESS DEVICE is a device that is
inserted into a vein or an artery via central or
peripheral vessels for diagnostic (or therapeutic
purposes)
DEVICES
 Hollow needle (e.g. butterfly)
 Indwelling catheters (catheter over needle, e.g. venflon)
 Indwelling catheter (through needle/over guide-wire e.g. CVP)

INTRA-VENOUS ACCESS
HOW?
Establish the need for procedure
Inform patient
Explain procedure
Obtain verbal consent
Prepare for procedure
 Personal protective equipment
 Wash hands and dry
 Select arm and peripheral vein
 Equipment

PERIPHERAL INTRA-VENOUS ACCESS
EQUIPMENT – PERSONAL
Gloves
Eyewear
Apron
Sharps container
WASH AND DRY HANDS
Soap and water vs hibitane solution

SELECT ARM and PERIPHERAL VEIN
Select Arm
 Uninjured
 No infection
 No swelling/oedema
 Veins easily visible/palpable
Check Pulses on the arm

Select peripheral vein
 Select location for siting device
 Consider condition of vein and overlying skin
 Purpose of cannulation – bolus injection vs. infusion
 consider rate of flow you want to achieve for bolus or
infusion (resuscitation/emergency vs “elective”)
 Consider duration of therapy
 Size of vein

Select peripheral vein
 Always select vein before selecting the device: Size of vein
determines the size of the device
 Avoid joints (increased risk of complications; uncomfortable
for patients)
 Veins must
 feel bouncy, refill when depressed
 Be straight,
 Be free of valves

SELECT PERIPHERAL VEIN (ARM)
Dorsal venous arch
Radial vein
Antecubital vein
Cephalic Vein
Basilic vein
start distal and move proximal (unless emergency)

SELECT PERIPHERAL VEIN (ARM)
may need to occlude vein to prevent venous return in
order to make the vein prominent for ease of insertion.
Two methods employed:
BP cuff Method: Apply blood pressure cuff to arm or to area
above the insertion site and inflate bladder to pressure above
diastolic but below systolic
Tourniquet Method: confirm presence of distal pulses and
apply tourniquet proximal to insertion site (release tourniquet if not
ready to cannulate; reapply when ready)

EQUIPMENT
Choose cannula – note the appropriate size of
(standard wire gauge – number of cannulae that can
fit into a tube 25.4mm in diameter; therefore smaller
gauge larger the diameter of the catheter) NB: even
numbers for cannulae gauge vs odd numbers for
needle gauge
Similar considerations as for vein, i.e., purpose, rate
of flow required, duration of therapy

EQUIPMENT
SHARPS CONTAINER
Cleaning fluid/material for skin
Tape to secure catheter (at least 2 pieces)
Gauze swabs
Infusion fluid and giving set
 Select appropriate fluid (crystalloid vs colloid vs blood)
 Check to ensure not expired, no holes, etc.
 Connect giving set to fluid and prime giving set to ensure that there
are no air bubbles

READY TO BEGIN - PROCEDURE
Put on gloves
Clean area over the selected vein and site of insertion
(4-5cm; from central to peripheral) with appropriate
cleaning material
allow to air dry
Do not blow, pat or wipe area
Once cleaned do not touch the area/point of insertion

READY TO BEGIN - PROCEDURE
Reapply torniquet
Remove cannula from package
Wait for vein
Stabilize the vein by
 Using thumb to stretch the skin downwards
 Place hand under the arm and stretch skin with index finger and
thumb – create enough traction and ensure vein does not collapse
 Stretch vein between thumb and forefinger (be careful!!)
DO NOT TOUCH INSERTION SITE – STERILE!!!

BEGIN - PROCEDURE
Ensure needle bevel is facing upwards
Puncture skin and enter vein
 2 methods for entering vein
 Direct method: enter skin directly over vein and immediately
enter vein
 Indirect method: enter skin 0.5-1.0cm distal to vein and then
advance catheter and needle under skin until you enter the
vein; either from side or from above

PROCEDURE
Once you enter the vein you will feel a “POP” or
“giving way” sensation
Confirm entry into the vessel by observing blood
flow into cannula chamber – “flashback”
Once flashback seen withdraw needle while
simultaneously advancing the catheter
Maintain visualization of the insertion site at all times

PROCEDURE
Once the needle has been withdrawn slightly over the
catheter NEVER reinsert the needle!
Maintain pressure over the tip of the cannula (distal
end) to prevent bleeding if the needle is withdrawn
completely.
Keep fingers clear of the needle tip as you are
withdrawing it
Maintain visualization of the insertion site at all times

PROCEDURE
Once needle has been completely withdrawn dispose
entire needle immediately in the sharps container
[NEVER re-sheath needle or stick it into the bed].
Maintain stability of the cannula and connect the
giving set (or syringe with appropriate fluid)
Release pressure on catheter tip
Release tourniquet

PROCEDURE
Maintain stability of the cannula and inject a bolus of
fluid slowly or open giving set and allow fluid to run in
Visualise the insertion site and confirm that there is no
leakage
Visualize the catheter tip site and confirm there is no
swelling – infiltration
Place drip below the level of the patients heart and
confirm backflow of blood (maintain hold on cannula)

PROCEDURE
Once you have confirmed that the cannula is
correctly sited and that the line is patent, you must
secure the cannula and the tubing
Use tape to secure the cannula
do not cover the insertion site with tape
Can use dry gauze and clear adhesive dressing
 OR transparent dressings only

PROCEDURE – END
Ensure that the correct and appropriate flow rate is
commenced
Drip is appropriately labelled
Thank patient
Ensure comfort and reassure that the drip will be
monitored

Clean area and dispose of used equipment
Remove gloves dispose and wash hands before moving on
to next patient

AFTER CARE
Prevent infection
Maintain a “closed” system to reduce contamination
and prevent introduction of air into the system
Maintain a patent device
Prevent damage to the device

COMPLICATIONS
LOCAL
 Haematoma
 Cellulitis
 Thrombosis
 phlebitis
SYSTEMIC
 Sepsis
 Thrombo-embolism
 Air embolism
 Catheter fragment embolism

QUESTIONS

References
 Royal Marsden Hospital – Manual of clinical
Nursing Procedures 5th
edition
 Advanced Cardiac Life Support –Provider Manual
1997-1999
 Peripheral Intravenous Cannulation Skills protocols

IV cannulation 2012.ppt for information and procedure on iv

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