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IV Cannulation Aim & Objectives Aim: ¾ The student will be competent and confident in the assessment and performance of peripheral intravenous cannulation. Objectives: TSSBAT ¾ Identify the principals of IV line insertion using aseptic technique. ¾ Identify indications, contraindications and complications of IV cannulation. ¾ Demonstrate the correct technique of IV line insertion. INTRODUCTION Venepuncture is the most commonly performed invasive procedure in hospitals. IV cannulation is the second most invasive procedure for patients in hospital. Today -85% - 95% of all hospitalised patients receive IV’s in one form or another Indications ¾ Administration of fluids. ¾ Administration of medications. ¾ Administration of blood or blood products. ¾ Radiological imaging using IV contrast CONTRAINDICATIONS Sites close to infection Veins of fractured limbs Where there is an AV fistula present Oedema Affected side of CVA Side of Mastectomy Extra care to be taken on patients with bleeding, clotting disorders & on warfarin. POTENTIAL COMPLICATIONS Haematoma Haemorrhage Infection Phlebitis Thrombophlebitis (Dehn and Asprey,2007) Puncturing an artery Puncturing a nerve Infiltration Extravasation VEINS vs. ARTERIES Bluish & superficial Not seen No pulsation Pulsation Thin muscular wall Thick muscular wall Valves No valves VEIN SELECTION Where: - Back of hand - Forearm - Antecubital fossa What: - Patent - Palpable - Distal - Straight - Avoid bifurcations Areas to Avoid ¾ Areas of joint flexion ¾ Hardened/sclerosed veins ¾ Veins near arteries ¾ Veins in lower extremities ¾ Areas of surgery ¾ Small veins ¾ Previously cannulated veins (Dehn & Asprey, 2007) LOCATION OF VEINS IN ARM & FOREARM Veins of the Hand 1. Digital Dorsal veins 2. Dorsal Metacarpal veins 3. Dorsal venous network 4. Cephalic vein 5. Basilic vein Veins of the Forearm 1. Cephalic vein 2. Basilic vein 3. Median Cubital 4. Medial Cutaneous nerve 5. Lateral Cutaneous nerve HAND Advantages Easy to access More prominent in obese patients. Note Site most frequently chosen for IV cannulation. Use non-dominant hand if possible. Disadvantages Small veins - small volumes. Difficult to secure Increased risk of thrombo-phlebitis. Limits wrist mobility Insertion painful – large number of nerve endings. FOREARM Advantages Disadvantages can be freely used If cannula is placed near the wrist, can restrict wrist movement Larger and straighter veins - more rapid infusion Hand Easier to secure ANTECUBITAL FOSSA Advantages Easy to access The median cubital is preferred as it most stable, close to surface and overlying skin less sensitive Disadvantages Site most frequently chosen to carry out venepuncture Flexion Movement Limited Brachial artery Often not visible COMMON ISSUES Anxiety Needle phobia History of fainting Obesity Allergies Aggressive & confused Learning Points Hypovolaemia -use larger veins as small veins collapse. In difficult cases - ensure maximum venous dilation before inspection. Large vein - high infusion rate. Use veins of non-dominant side- consult with patient. If in doubt – consult. Terminate after two attempts and seek assistance. References ¾ Dehn, R.W. and Asprey, D.P. (2007) Essential Clinical Procedures. 2nd ed. Saunders Elsevier, Philadelphia. ¾ Doughter, L. and Lister, S. (2008)The Royal Marsden Hospital Manual of Clinical Nursing Procedures. Wiley-Blackwell. UK Recommended Reading ¾ Weinstein, S. (1997) Plummers Principles and Practices of Intravenous Therapy. Lippincott/ Raven. New York. ¾ Cox, N. & Roper, T.A. (2005) Clinical Skills. Oxford university Press; New York.
