INTRAVENOUS CANNULATION

INTRODUCTION:

Insertion of an intravenous (IV) cannula involves connecting a tube into a patient's vein so that
infusions can be inserted directly into the patient’s bloodstream. Cannulas (also known as
venflons) are available in various colours, each of which corresponds to the size of the tube. The
subsequent venous access can be used for the administration of fluids, medication and nutrition.
In some cases, blood samples can also be obtained from the cannula.

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.

OR

Intravenous cannulation is a process by which a small plastic tube (a cannula) is inserted into a
peripheral vein.

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 minimize 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
CONTRAINDICATIONS :
 Injured, infected, swelled or burned extremity
 Extremity that have an arteriovenous fistula
 The arm on the side of a mastectomy

SITES FOR INSERTION OF PERIPHERAL IV CANNULAE:

I. Veins of the fore arms:
 Basilic vein
 Cephalic vein
 Median cubital vein

II. Veins of the hands:

 Metacarpal veins
 Dorsal venous arch

General rules in selecting an IV site:

 Start in the most distal area before going proximally

 Use the upper extremities rather than the lower extremities
 Avoid areas of flexion
 Use the largest , longest ,straightest palpable 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)
 Tournique
 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: Pediatrics, elderly, chemotherapy patients
24G: Neonates
PROCEDURE:

S.No. Action Rationale

1 Collect all appropriate equipment. To allow full concentration

on patient and procedure.

2 Locate patient and check patient identification. To minimize the risk of error and
ensure the procedure
on correct patient.

3 Ensure the patient is in a comfortable position. To avoid any problems to

the patient.

4 Establish whether patient has allergy to skin To prevent skin irritation.

preparation solution and adhesive material.
5 Wash hands. To prevent cross-infection.

6 Select and assemble appropriate equipment for To prevent undue delays.

procedure.

7 Assess venous access and choose appropriate To optimize the best site for
vein. treatment.

8 Position patient in supine position with arm at To aid insertion of introducer and
45degress,with ability to move arm at 90 degree then advancement of canula.
angle.

9 Put on sterile gloves. To minimize risk of infection.

10 Remove cap from the extension set and attach To prevent spillage and cross
0.9% sodium chloride, gently flush with 2ml and infection.
leave syringe attached.

11 Clean the insertion site with alcohol swipes from This rapidly reduces microbial
insertion site towards outwards. counts on the skin and provides
sterile field .

12 Allow it to air dry 40 seconds. To provide sterile field.

13 Do not re-palpate the site To prevent recontamination

14 Apply tourniquet 7-10cm above site. To encourage venous distension.

15 Use non dominant hand to achieve skin traction, To promote stability of vein to ease
above or below the insertion site. for cannula insertion.
16 Insert the cannula through the skin at an angle of To ensure atraumatic entry and
10-30degress, with the bevel of needle in the reduce pain.
upward position.

17 As the tip of the cannula enters the vein a To indicate the needle has entered
flashback of blood will appear in the chamber of the vein.
the cannula.

18 Decrease the angle between the cannula and the To prevent the puncturing
skin and advance the cannula a further 2mm into the posterior wall of the vein.
the vein.
19 Withdraw the stylet slightly and advance the To prevent the stylet
cannula a fully and gently. from penetrating the vein.

20 Remove tourniquet. To reduce the blood flow.

21 Apply digital pressure over the cannula tip and To prevent the back flow of blood.
remove stylet.

22 Place alcohol swab under the cannula hub. To absorb blood spillage

23 Place stylet in sharp box. To minimize any damage.

24 Flush catheter. To ensure the patency of device.

25 Secure the catheter with adhesive tape. To anchor the catheter securely to
the skin, preventing movement.

26 Dispose of equipment appropriately. To prevent cross infection.

27 Wash hands. To prevent cross infection.

28 Document the procedure. To maintain patient records.

AFTER CARE:

 Document the procedure including:

1. Date and time
2. Site and size of the cannula
3. Any problems encountered
4. Review date (cannula should be in situ no longer than 72 hours)
 Thank the patient for cooperation.
COMPLICATIONS:

1. Infection
2. Cellulites
3. Infiltration
4. Thrombophlebitis
5. Air embolism
BIBLIOGRAPHY:-

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