Intravenous Cannulation (IVC)

Question 1

Equipment

Answer 1

• Alcohol gel
• Clean receptacle
• Gloves
• Apron
• Tourniquet
• Wipe (get a couple in case of blood spilling)
• Sterile intravenous cannula
• Sterile bung
• Sharps bin
• Transparent sterile dressing (so can monitor site)
• Pen (to label dressing)
• Syringe
• 0.9% sodium chloride for injection (saline) bottle (for flush)

Question 2

Complications

Answer 2

• Pain
• Swelling
• Inflammation
• Infection (phlebitis)
• Going through vein (would see bubble of blood under skin)

Question 3

Performance of task

Answer 3

• Clean hands using alcohol gel
• Collect equipment
• Clean hands using alcohol gel
• Don gloves and apron
• Prepare flush: (away from bedside)
• Check name and expiry date of saline ampoule
• Break cap off of ampoule
• Insert syringe straight into ampoule
• Press down firmly to maintain tight seal
• Draw saline into 5ml syringe by moving plunger backwards
• Open bung packaging and insert the flush syringe into the bung (purple end not cap) and flush the bung slightly until a few drops seep out of gaps between white and purple sections
• Put flushed bung back in its packaging (make sure it is accessible as needs to be applied quickly!)
• Store flush syringe back in its own packaging for transport
• Go to patient (EXAMINER)
• Position arm OF EXAMINER + pillow if available - ask them about arterio-venous fistula, breast surgery, axillary lymph node removal or radiotherapy on that side
• Identify suitable vein (palpate) (state that would avoid antecubital fossa/wrist/ broken skin/ local infection/ hard or cord-like veins) - choose vein as distally as possible
• Apply tourniquet
• Re check by palpation
  Move to MANIKIN
• Clean site thoroughly! (circles or crosshatch) allow to dry for 30 secs (maintain asepsis after this)
• Remove remaining packaging from equipment (aseptically) (get new cannula if touch any part of needle or plastic over it)
• Warn patient of sharp scratch
• Un-fold wings of cannula and remove sheath
• Stretch skin below site with non-dominant hand
• Hold cannula: index and 3rd finger cling to front of wings, thumb rests behind cannula
• Insert needle, bevel up, in line with vein, at angle of 15-25 degrees
• Advance needle until see primary flashback in hub (square, clear bit at back, near thumb)
• Lower angle
• Place non dominant hand onto needle section (clear bit at back of cannula) to secure it
• Place dominant hand on wings and advance this part only 1mm into vein (the actual cannula)
• Should see secondary flashback in body of cannula
• Then continue to fully insert cannula into vein (can push whole thing now as needle now not sticking out)
• Release tourniquet
• Apply pressure proximal to tip of cannula (prevents blood flowing back out of cannula)
• Maintain this pressure and anchor the winged section with a finger while removing the needle
• Discard needle immediately into bin
• Maintain pressure and attach bung to end (have to remove bung cap first) - do this quickly but calmly (blood flows out end of cannula)
• Wipe any blood with wipe (or gauze)
• Secure cannula with transparent dressing

Question 4

Once cannula inserted, how do you ensure patency?

Answer 4

After applying dressing to secure cannula…

• Attach syringe to cannula and flush the cannula with the saline.
• Ask patient to tell you about any pain during the flush
• Check for leakage/swelling around site
• Write date and time of cannulation on label (comes on dressing) and attach to dressing clearly

Question 5

Aftercare

Answer 5

• Ask patient to inform staff of any pain, discomfort or swelling around site
• Thank patient
• Remove gloves/ apron
• Wash hands
• Document procedure in notes
• Start a peripheral intravenous cannulation chart

Question 6

What is the pattern of sizes for cannulas?

Answer 6

The smaller the number, the larger the needle

22G -> 20G -> 18G -> 16G -> 14G
blue pink green grey orange

Orange = used for fast flow e.g. sepsis or trauma surgery etc

Question 7

What does the G in 22G needle stand for?

Answer 7

Gauge

Question 8

What would you say to inform the patient about the procedure?

Answer 8

‘I’ve been asked to put a cannula in your hand today.
That will involve putting one small needle to the back of your hand, this will then allow us to put a small plastic tube into your hand so we can give you the drugs and fluids we need to.
It will be a sharp scratch when we put the needle in but besides that no pain’. Warn the patient about potential complications.