Intravenous Cannulation

AMBOSS Clinical Procedures in Emergency Medicine 6th edition

Intravenous 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

Indication

• Blood sampling
• Intravenous fluid administration
• Intravenous medications administration
• Intravenous chemotherapy administration
• Intravenous nutritional support
• Intravenous blood or blood products administration
• Intravenous administration of radiological contrast agents for imaging studies (CT, MRI, …)

Contraindications

• no absolute contraindications exists
• Venous access of location is injured, infected, burned - should be avoided if possible
• Veins of fractured limbs, AAV fistula, side of mastectomy
• irritant solution, which causes blistering, tissue necrosis if they leak into tissue e.g. chemothreapeutic agents. these solutions are more safely infused into central vein

Complications

Pain, failure to access, blood stop flowing, arterial puncture (inadvertent), Thrombophlebitis / Infection, peripheral nerve palsy

• Gauges come in different sizes, higher number = small in size = low flow rate
• Administrate on non-dominant arm

This device is available in various gauges (16-24 G), lengths (25-44 mm), compositions, and designs.

Tips

• Routinely, use the smallest gauge of catheter if possible to prevent damage to the vessel intima.

• In an emergency situation use a large gauge catheter to allow administration of large volumes of fluid.

• The superficial veins of the upper extremities are preferred to those of the lower extremities for peripheral venous access as they interfere less with patient mobility and pose a lower risk for phlebitis.

• It is recommended to choose a straight portion of a vein to minimize the chance of hitting valves.

• Use the patient’s non-dominant arm (if possible)

• For prolonged courses of therapy, it is recommended to start distally and move proximally as distal catheters are replaced.

N.B. Remember best vein 3F&R (Firm,full,foroward &round vein)

Equipment

• Non-sterile gloves
• Tourniquet
• Antiseptic solution
• 5-ml syringe
• Sterile gauze
• Cannula
• Saline
• Plaster

Before the procedure

1. Introduce yourself to the patient. Explain the procedure to the patient and gain informed consent to continue.
2. Make sure there is adequate light and that the room is warm enough to encourage vasodilation.
3. Make sure the patient is in a comfortable position and place a pillow or a rolled towel under the patient’s extended arm.
4. The patient’s skin should be washed with soap and water if visibly dirty.
5. If difficulty is encountered in finding an appropriate vein, one of the following techniques may be used:
   • Inspection of the opposite extremity
   • Opening and closing the fist
   • Using gravity (holding the arm down)
   • Gentle tapping or stroking of the site
   • Applying heat (warm towel/pack)

Technique

1. Apply tourniquet and select the appropriate vein
2. Apply an antiseptic solution with friction for 30-60 seconds, allow to air dry for up. Once cleaned, do not touch or repalpate the skin.
3. Remove the cannula from its packaging and remove the needle cover ensuring not to touch the needle.
4. Stretch the skin distally and tell the patient to expect a sharp scratch.
5. Insert the needle, bevel upwards at about 10 - 30 degrees
6. Advance the needle until a flashback of blood is seen in the hub at the back of the cannula
7. Once this is seen, progress the entire cannula a further 2mm, then fix the needle, advancing the rest of the cannula into the vein.
8. Release the tourniquet, apply pressure to the vein at the tip of the cannula and remove the needle fully.
9. Remove the cap from the needle and put this on the end of the cannula.
10. Carefully dispose of the needle into the sharps box.
11. Check function by flushing with saline. If there is any resistance, if it causes any pain, or you notice any localized tissue swelling; immediately stop flushing, remove the cannula and start again.
12. Apply the plaster to the cannula to fix it in place.
13. Finally, ensure that the patient is comfortable and thank them.

Class procedure steps

1. Introduce yourself, greet patient/name,
2. explain the procedure the whole process
3. take permission
4. expose limb, extend
5. place tourniquet; button up then closure
6. ask patient to close and open their hands to engorge veins
7. Look for straight vein, palpate
8. rubbing alcohol, circular motion - do not re-palpate
9. take i.v. cannula - ensure its closed, open the wings; hold it on both sides
10. ((Strech skin cc) then introduce needle 15-30 degree,
11. till you see blood in flashback channel
12. push it more, then take out the needle
13. use syringe to aspirate/flush to check if it works - check for bulging

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Intravenous fluid

Indications

• Maintain or replace body store .
• Restore acid abase balance
• Restore the volume of blood component
• Administer of medication
• Provide Nutrition/electrolytes correction

Equipment

• Tray
• Kidney dish containing sterile syringes
• Spirit swabs
• Drip stand
• Drip + set

Technique

• Introduce yourself to the patient.
• Check the patient’s mane and the type of fluid to be given
• Explain the procedure to the patient and gain informed consent .
• Prepare your equipment
• Assemble the tubing solution according to the manufacturer’s instruction
• Let out the air from the tubing by letting some of the fluids run down the tubing
• Close the drip set to prevent fluid from following out
• Hang the bag in the drip stand
• Open the cannula and connect it to the drip
• Adjust the drips according to the appropriate dose (drop per minute)
• Check regularly to see that the fluid is dropping at the same rate and that fluid is going in to the vein properly and that the puncture site is not swollen.