IV Cannulation

Indications

1. Administration of IV fluids
2. Administration of blood products
3. Administration of IV therapy

Procedure

1. Confirm patient identity
   
2. Communicate with the patient
• Explain the procedure to the patient and get his/her verbal consent
• Try to minimize the patient distress
• Answer any questions the patient has
      
3. Gather the equipment needed
• Non sterile pair of gloves
• Kidney tray
• Tourniquet
• Sterile alcohol swabs
• IV Cannula of appropriate size

o Large bore cannulas are needed for rapid / thick fluid administration. E.g. 16 gauge gray canula

o The commonest used in day to day practice for IV fluid administration and drug administration are gauge 18 and 20

• Drip set and IV fluid bag as necessary
• Blood collecting tubes or bottles if necessary
• 2 rectangular pieces of Plaster / hypoallergenic tape split at the middle of the length
• Ensure there is adequate light    

     4. Select a site for cannulation

• Peripheral superficial veins in the upper limbs are the most commonly used, especially of dorsum of the hand
• Avoid Dominant hand and other sites stated to be avoided in the venepuncture section   

     5. Wash the hands and wear gloves
    

• Apply the tourniquet above the proposed site. It should be tightened just enough for venous flow to be obliterated but not the arterial flow

     6. Make the vein prominent by asking the patient to clench and open a fist

 

TIPS TO MAKE A VEIN PROMINENT

·         Make sure the patient’s arm is below the heart level

·         Gently tap the vein – But this might cause discomfort to the patient

·         Apply the tourniquet for one minute à Remove for 30s à Reapply

7. Clean the puncture site as described under venepuncture
     
8. Anchor the vein as described under venepuncture
       
9. Insert the canula
• Hold the canula as shown in the picture
       
• Puncture the vein as described under venepuncture
• Once inside the vein pull the stylet a little back to avoid double puncture
• Pull the stylet back and advance the canula forward simultaneously
• Insert canula up to the hub, don’t stop halfway
• Release the tourniquet
• To prevent blood leaking

o Apply pressure at the proximal location of the canula

o Elevate the arm above the heart level

• Apply the canula cap    

    10.  Securing the canula

• Apply the 2 plasters embracing the plastic pads at injection hub

    11.  Dispose the waste as described under venepuncture
   

   12.  Documentation

• Document the time of insertion of the canula and any complications experienced during the procedure    

    13.   Features of inadvertent drug administration  into an artery

 Early:

1. Severe pain down the limb soon after drug administration
2. Pallor or cold skin distal to the site of the cannula/puncture
3. Reduced capillary filling in the limb.

Late

1. Cyanosis of the limb
2. Paralysis of fingers or toes
3. Loss of distal pulse

Action to be taken:

•      Stop further administration of drug

•      Leave the canula in-situ. DO NOT REMOVE THE CANULA. Flush with heparinsed saline or normal saline if heparin is not immediately available.

•      Start systemic heparinisation . 5000 IU as a bolus dose and continue 100 IU/hour via another vein.

•      Contact a vascular unit.