NURSING PROCEDURE:INTRAVENOUS CANNULATION
Definition:
Intravenous (IV) cannulation is a technique in which a cannula is
placed inside a vein to provide venous access. Venous access allows sampling of
blood, as well as administration of fluids, medications, parenteral nutrition,
chemotherapy, and blood products.
Principles :
To monitor and assess the IV cannula site and surrounding area atleast
hourly or more frequently as required and document the same.
To apply measures to minimise and/or prevent IV related complications.
To implement aseptic technique prior to manipulation of IV device and IV
system to reduce the risk of infection.
Indications:
Fluid and electrolyte replacement
Administration of medicines
Administration of blood/blood products
Administration of total parenteral nutrition
Hemodynamic monitoring
Blood sampling
Sites for Insertion of Peripheral IV Cannulae:
Metacarpal veins
Dorsal Venous network,including the cephalic and basilic veins.
Antecubital Fossa containing the : Median Basilic,Cubital,Cephalic and
Antebrachial veins.
Axillary Basilic vein
Long and Short saphenous vein.
Assessing and Preparing the patient:
Check patient for baseline vital signs, diagnosis and allergies to
medication.
Provide a clear explanation of the procedure including the complications.
A relaxed patient is generally easier to cannulate.
Assess the dominant/non-dominant side and check the veins for
suitability.
Check for any contra-indications ex:infection,damaged tissue,AV fistula
etc.
Positioning the Patient:
If possible use the non dominant arm.
Raise bed prior to procedure.
Place the arm in a supported comfortable position.
Use a tourniquet to find vein but release it while you are getting
equipment ready.
Give patient a comfortable position.
Equipment Required:
Dressing tray*2
Sterile Gloves
Cleaning wipes
Gauze swab
IV cannula(size depending on need)
Tourniquet
Tegaderm
Syringe 10ml with 0.9% Normal saline
Sterile dressing pack-to provide a sterile field
Sharps container
Cannulae:
14G:Large volume replacement
16G:Rapid transfusion of whole blood or components
18G:IV maintenance,NBM patients
20G:IV analgesia
22G:Paediatrics,elderly,chemotherapt patients
24G: Neonates
Procedure:
Action Rationale
Collect all appropriate To allow full concerntration on
equipment. patient and procedure.
Locate patient and check patient To minimize the risk of error and
identification. ensure the procedure on correct
patient.
Ensure the patient is in a To avoid any problems to the
comfortable position. patient.
Establish whether patient has To prevent skin irritation.
allergy to skin preparation
solution and adhesive material.
Wash hands. To prevent cross-infection.
Select and assemble appropriate To prevent undue delays.
equipment for procedure.
Assess venous access and choose To optimize the best site for
appropriate vein. treatment.
Position patient in ssupine To aid insertion of introducer
position with arm at 45 and then advancement of canula.
degress,with ability to move arm
at 90 degree angle.
To minimize risk of infection.
Put on sterile gloves.
To prevent spillage and cross
Remove cap from the extension
infection.
set and attach 0.9% sodium
chloride,gently flush with 2ml
and leave syringe attached.
Clean the insertion site with
This rapidly reduces microbial
alcohol swipes from insertion
counts on the skin and provides
site towards outwards.
sterile field .
Allow it to air dry 40 seconds.
To provide sterile field.
Do not repalapte the site.
To prevent recontamination.
Apply tourniquet 7-10cm above
To encourage venous distension.
site.
To promote stability of vein to
Use non dominant hand to
ease for cannula insertion.
achieve skin traction,above or
below the insertion site.
To ensure atraumatic entry and
reduce pain.
Insert the cannula through the
skin at an angle of 10-30
degress,with the bevel of needle
in the upward position.
To indicate the needle has
As the tip of the cannula enters
entered the vein.
the vein a flashback of blood will
appear in the chamber of the
cannula.
To prevent the puncturing the
Decrease the angle between the
posterior wall of the vein.
cannula and the skin and advance
the cannula a further 2mm into To prevent the stylet from
the vein. penetrating the vein.
Withdraw the stylet slightly and
advance the cannula a fully and
gently. To reduce the blood flow.
Remove tourniquet. To prevent the back flow of
blood.
Apply digital pressure over the
cannula tip and remove stylet. To absorb blood spillage.
Place alcohol swab under the
cannula hub. To minimize any damage.
Place stylet in sharp box . To ensure the patency of device.
Flush catheter. To anchor the catheter securely
to the skin,preventing
Secure the catheter with adhesive movement.
tape.
To prevent cross infection.
Dispose of equipment
appropriately. To prevent cross infection.
Wash hands. To maintain patient records.
Document the procedure.
Complications that might occur:
IV infection.
Cellulites
Infiltration
Thrombophlebitis
Air embolism
After care:
Document the procedure including:
Date and time
Site and size of the canula
Any problems encountered
Review date (cannula should be in situ no longer than 72 hours)
Thank the patient for cooperation.
