IV CANNULATION COURSE

Prepared by: kaiwan azad

DEFFINITION:
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.

VEIN VS ARTERY:
Arteries:
1. Carry blond from the heart, carry oxygenated blood (except pulmonary artery).
2. Normally bright red in color.
3. Elastic walls that expand with surge of blood.
4. No valves.
5. Can feel a pulse.

Veins:
1. Carry blood to the heart, carry deoxygenated blood (except pulmonary vein).
2. Normally dark red in color.
3. Thin walls/less elastic.
4. Valves.
5. No pulse.

HISTORY:
Problems associated with early IV drug delivery included migration of the steel needle, intra-arterial injection, and
breakage. This could possibly place a limb in jeopardy if not promptly recognized or treated. In order to prevent these
devastating complications, it was important to invent a more reliable indwelling catheter. The plastic cannula was critical
in the development of a safe, indwelling intravenous access. The first report dates back to July 5, 1950, where David
Massa described the technical details of a plastic needle, the beginnings of the IV cannula so commonly used today.

INDICATIONS OF CANNULATION:
 Administration of drugs
 Administration of intravenous fluids
 Administration of blood and blood products
 Administration of intravenous nutritional support
 Administration of chemotherapy drugs
 Repeated blood sampling

Internal
SITES OF INTRAVENOUS CANNULATION:
 Veins of the fore arms:
 Basilic vein
 Cephalic vein
 Median cubital vein
 Veins of the hands:
 Metacarpal veins
 Dorsal venous arch

GENERAL RULES IN SELECTING AN IV SITE:

1. Start in the most distal area before going proximally.
2. Use the upper extremities rather than the lower extremities.
3. Avoid areas of flexion.
4. Use the largest, longest, straightest palpable vein.
5. Non-dominant hand.

VEINS TO AVOID:
 Obvious valves
 Sclerosed veins
 Limbs affected by clinical conditions or surgery E.g. Stroke & Mastectomy side limb
or an arteriovenous fistula
 Avoid ACF & Cephalic vein at wrist in renal patients
 Infected sites or Broken skin, Injured, infected, swelled or burned extremity

HOW DO WE GIVE BLOOD AND ITS COMPONENTS?

 Maximum achievable flow rate is mainly limited by the size of the IV cannula and its length
 Other important factors include pressure of infusion and viscosity of fluid (e.g. saline faster than blood)
 Flow is inversely proportional to the 4th power of the radius [Pouseuille's law] - i.e. small changes in cannula diameter
= large changes in flow
 Fluid resuscitation requires at least 16 G cannula

POTENTIAL COMPLICATIONS:
1. Extravasation: The infiltration of a drug from an I.V. line into surrounding tissue.
Causes:
a. Catheter erodes through the vessel wall at a second point,
b. Increased venous pressure causes leakage around the venepuncture site
c. When a needle pulls out of the vein.
d. Vesicant drugs/solutions may cause severe tissue injury

Internal
Signs & Symptoms:
a. Oedema and changes in the site's appearance
b. Coolness of the skin.
c. Slowing of infusion
d. Pain or a feeling of tightness around the site.
e. Possible consequences include necrotic ulcers, infection, disfigurement, and loss of function.
Intervention:
a. Remove cannula
b. Elevate affected arm

2. Hematoma: Localized collection of extravasated blood, usually clotted, in an organ or tissue.

Cause:

a. Blood leaking out of the vein into the tissue due to puncture or trauma

Signs & Symptoms:

a. Swelling, tenderness and discoloration

Prevention:

a. Proper device insertion

b. Pressure over site on removal of cannula

Intervention:

b. Apply appropriate pressure bandage, monitor the site

3. Phlebitis: Inflammation of the vein

Cause:
a. Poor aseptic technique
b. High osmolarity I.V. infusions or drugs
c. Trauma to the vein during insertion/incorrect cannula gauge
d. Prolonged use of the same site
Signs & Symptoms:
a. Tenderness, redness, heat and oedema
b. Advanced-induration, palpable venous cord
Intervention:
a. Remove cannula
b. Apply warm compress
c. Observe for signs of infection
d. If phlebitis is advanced antibiotics may be required

4. Venous Spasm: Spasm of the vein wall.

Cause:
Internal
 a. Patient anxiety
b. Cold I.V. fluids
c. Drug irritation
d. Trauma to the vein during cannula insertion
Signs & Symptoms:
a. Pain
b. Slowing of the I.V. infusion
c. Blanching at the insertion site
d. Vein difficult to palpate
Intervention:
a. Apply warm compress
b. Slow the infusion rate
c. Reassure the patient

5. Occlusion: Slowing or cessation of fluid infusion

due to:
a. Fibrin formation in or around the tip of the cannula
b. Mechanical occlusion (kink) of the cannula
Cause:
a. Cannula not flushed
b. Kinking of the cannula
c. Back flow or interrupted flow
Signs & Symptoms:
a. I.V. not running
b. Blood in the line
c. Discomfort
Intervention:
a. Check for kinks in cannula
b. Raise IV higher
c. Remove cannula

6. Thrombophlebitis: Formation of a thrombus and inflammation in the vein, usually occurs after
phlebitis.
Cause:
a. Injury to the vein
b. Infection
c. Chemical irritation
d. Prolonged use of the same vein
Signs & Symptoms:
a. Tenderness/redness
b. Heat/oedema

Internal
 c. Cordlike appearance of the vein
d. Slowing of the IV infusion
Intervention:
a. Remove cannula
b. Observe for signs of infection
c. Change cannula frequently (48-72hrs)

7. Infection: Pathogen in the surrounding tissue of the I.V. site.

Cause:
a. Lack of asepsis
b. Prolonged use of the same site
Signs & Symptoms:
a. Tenderness and swelling
b. Erythema/purulent drainage
Intervention:
a. Remove cannula
b. Antibiotics may be required
c. Documentation

COMMON DIFFICULTIES:
1. Missing a better vein: Always find the BEST vein!
2. Obtain flashback but cannot advance sheath.
 Typically occurs when the bevel is in the vein, but sheath is not in the vein (see pictures below)
 Solution: bring sheath back to hub, advance needle in slightly further, then advance sheath
3. Vein moves, causing you to miss (no flashback).
• Best avoided with good positioning, and tethering the skin prior to insertion
• Remember to penetrate the skin slowly but steadily, with the bevel pointing up (so sharpest point of the
needle touches the vein first)
4. Excessive pain
• If there is no flashback and the patient is in more pain than expected, cease procedure and reassess (or
use a different site).
5. Transection.
• When the needle is inserted too far and goes through the vein (it has transected the vein)
• If the camber is not full, it will stop filling
• Solution: Pull the needle back until you see blood filling the chamber again, then advance sheath
• if there is rapid swelling (bleeding), pull the IVC out and apply pressure.
6. Hit a valve.
 Typically, the sheath will advance in the vein somewhat before resistance is encountered
 Solution: attach the bung to the sheath’s hub, attach saline syringe, advance sheath forward while flushing
saline into the vein (this opens the valve)
o Do not force the sheath in
o Stop if pain is experienced by the patient

Internal
OTHER USES OF IV CANNULAS:

1. Needle thoracocentesis
2. Needle paracentesis
3. Venous cut-down
4. In open heart surgery

EQUIPMENTS:

 Cannula with the correct size

 Dressing/IV trolley with sharps container and waste bag
 Dressing pack
 Gloves (sterile)
 Alcoholic chlorhexidine
 Transparent semi permeable dressing
 Cannula (size depending on need)
 Giving and Extension set (and prescribed IV fluids)
 Water proof protective cover
 Syringe 10ml with 0.9% Normal saline
 Tourniquet

PROCEDURE:
Position the patient in lying or sitting position.
Adequately expose the arm, removing any tight clothing.
Apply a tourniquet 10 cm above the injection site (tourniquet should not be left on for more than 2-3 minutes.
Tapping the vein & asking the patient to pump their fist can make it easier to see & feel veins.
Wear a pair of clean gloves.
Open wings.
Slightly withdraw & replace needle (this will make it glide easier).
Unscrew the cap at the back of the cannula & place it upright in a tray.
Remove the cannula sheath.
Ensure needle’s bevel is pointing upwards.
Secure the vein with your non-dominant hand from below.
Warn the patient of a sharp scratch.
Insert cannula at an angle of 30–45 degrees.
Observe flashback of blood in the flashback chamber.
Reduce the angle and advance the needle a further 1-2mm after flashback to ensure it’s in the vein’s
lumen.
Withdraw the needle slightly so that its sharp point is inside of the plastic tubing.
Advance cannula fully into vein.
Release the tourniquet.
Place some gauze directly underneath the cannula.
Apply pressure over the vein from above directly on the tip of the catheter.
Remove the needle and dispose it into a sharps bin.
Replace cap onto the cannula.

THANK YOU….

Internal