INTERN SURVIVAL GUIDE

Intravenous Cannulation

Tutorial Outline

• Equipment Selection

• Equipment & Patient Preparation

• Procedure Steps

• Reminders & FAQs

Equipment

• Phlebotomy tray

• Sharps bucket

• Gloves

• Clean tourniquet

• Alcohol and Chlorhexidine wipes

Equipment cont.

• Selection of cannulae (PIC)– 20G very useful

• Extension tube

• Needleless bung/clave

• Plasters/Cotton wool

Equipment cont.

• 10ml 0.9% saline flush

• 10ml Syringe

• May need a syringe adaptor

• Fixation method– Veniguard/IV 3000

At Bedside: Equipment Preparation

1. Hand hygiene

2. Draw up saline in 10ml syringe and expel bubbles

3. Attach needleless bung to extension

4. Flush extension and CLOSE the clamp

At Bedside: Patient Preparation

1. Get comfortable

2. Find a straight section of vein

3. Apply tourniquet

4. Hand hygiene

Procedure1. Put on gloves

2. Clean with swab and allow 30 secs to dry. Leave swab on patient’s skin near site

3. Do not touch cannulation site again after cleaning

4. Hold cannula at coloured hub

5. Remove plastic cover

6. Ensure metal trochar tip protruding

Procedure1. Use thumb to stretch skin below site

2. Face cannula bevel up

3. Insert just the tip of the trochar through the skin between 10° - 40° angle until you see a “flashback”

4. RELEASE THE TOURNIQUET

5. Advance cannula until hub is flush with skin (very important)

Procedure6. Place swab under hub

7. Occlude vein with your finger and withdraw trochar, dispose immediately in sharps bin

8. Remove sterile cap and screw on extension tube

9. Clean bung & flush with saline; should be low resistance and painless with no swelling. CLOSE clamp

Securing the Cannula

Reminders• PREPARE YOUR EQUIPMENT in advance

of applying the tourniquet (flush extension, open packets etc.)

• Verbally consent patient

• Always dispose of sharps and wastes in appropriate bins

• Always document time of insertion, number of attempts and that aseptic technique that was used

Frequently Asked Questions• What happens if I cannot find a vein in the back of the

hand?– Look for it in the other hand. Look at the back of the

forearm. The antecubital fossa is used for large gauge cannulae for resuscitation purposes. If you cannot cannulate a patient then call for help.

• What size cannula should I use?– This depends on what you want to use the cannula for.

You should use the smallest cannula that you can, to achieve what you need. Thus for infusions of 125 mls/hour and regular IV antibiotics you should use a 20G Cannula. For faster infusions and resuscitation use larger cannulae.

Frequently Asked Questions• Do I need to use local anaesthetic before I insert a cannula?

– No, not usually. Cannulae up to 18 G are not particularly painful to insert. In children you should apply topical anaesthetic for 30 minutes before you insert a cannula e.g. EMLA

• Do I always need to use an extension tube?– Yes. Using an extension (t-port or microclave double extensions) or

a combined cannulation and tubing set (Nexiva system) is hospital policy. It decreases the risk of infection at the cannula site and minimises the risk of dislodging the cannula.

Frequently Asked Questions

• What is tissuing and how do I recognize it?– This implies that the cannula has pierced the back of the

vein or has migrated out of the vein. The infused substance is now leaking into the surrounding tissues. You will feel resistance when you try to flush the cannula. The patient will complain of burning and pain. It is technically called infiltration. You must remove the cannula immediately and apply a warm compress if necessary. A distinction is made between extravasation and infiltration depending on the toxicity of the leaked fluid. A very toxic fluid such as chemotherapeutic drugs can cause severe tissue damage and necrosis and will require senior medical advice regarding treatment.