Intravenous

Cannulation
By: Kalthum Mohammed Gharib
MSc. Adult Nursing
[email protected]
College of Nursing
1
At the end of this class, you should able to
recollect.

Locate and assemble required equipment for IV

cannulation

Perform a successful IV cannulation

Be aware of documentation requirements

complications of IV cannulation

2
 Anatomy and physiology
• Approximately 2/3 of total blood volume is in the veins which transport deoxygenated
blood to the heart from the tissues

• Veins are thin-walled, fibrous, have a large diameter and low pressure

• Veins contract to propel the blood through the vein towards the heart

• Some veins contain valves to regulate the one way flow to the heart (usually lower
limbs)

• The skeletal muscle pump influences venous return

Anatomy and
physiology cont
Major veins of the arm

• Dorsal
• Cephalic
• Basilic
• Cubital Fossa
 Purposes of Intravenous (IV)
Therapy
• To supply fluid when clients are unable to take in an adequate volume of fluids by
mouth

• To provide salts and other electrolytes needed to maintain electrolyte imbalance

• To provide glucose (dextrose), the main fuel for metabolism

• To provide water-soluble vitamins and medications

• To establish a lifeline for rapidly needed medications.

Colour Gauge Flow Rate Infusion
mls/min

Orange 14 343 Rapid blood transfusion

Emergencies
Grey 16 196 Rapid blood transfusion.
Emergencies

Green 28 90 Blood products, medicines,

fluids
Pink 20 61 General crystalloid use,

Blue 22 36 Paediatrics, oncology.

Yellow 24 22 Paediatrics, oncology.

Neonates, elderly
 Visual inspection – veins should be visible

• Sites to avoid • Limb where IV infusion is running

• on or near site of infection • Near phlebitis
• Small superficial veins • Oedematous areas
• Bruised areas • Previous Venepuncture sites
• Areas of scarring • Limb affected by injury/disease

14
 Tourniquet
• Know how to use it before
approaching patient!

• 10cm above site (3 finger breadths)

• 2 fingered gap

• Apply tourniquet to the upper arm

ensuring it does not obstruct arterial
flow

• Check patient is comfortable

• A latex glove must never be used 15

 Palpation – veins should be bouncy
• Sites/veins to avoid
[contraindications]

• Thrombosed hard veins • Inflamed veins

• Fibrosed veins • AV fistula
• Sclerosed veins • Axillary Clearance/Mastectomy

16
 Venepuncture

20.08.09 17
 Material and Equipment
• 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
• Fluid balance sheet
Material and Equipment
 Steps of the procedure

1- Assessing & preparing the patient

After introduce your self and explain the procedure for

patient start with comfortable position for the patient and
procedure and chose the appropriate size of the cannula.
 Steps of the procedure

2- Select the most suitable site for cannulation

 Steps of the procedure

3- Apply clean tourniquet 10 to 15 cm above the vein.

 Steps of the procedure

4- Clean the skin adequately with antiseptic solution such as

2% Chlorhexidine solution or 70% alcohol and let it to dry.
 Steps of the procedure

5- Remove the cannula from its protective covering

and inspect the device for any faults.
 Steps of the procedure

6- Visualize the chosen vein once more but Do Not re-palpates the
site. If re-palpation is necessary, re-cleanse site with alcohol
wipe and let dry.

7- Immobilize the vein, stretch and stabilize vein and soft tissue by
thumb and tip of fingers about 5cm below intended site of entry
 Steps of the procedure

8- Warn patient before inserting the needle. Ask her/him to take a deep
breath to prevent movement of patient.

9- Inter the cannula from the skin with the cannula at 30 – 40º angles.
 Steps of the procedure

10- As the tip of the cannula enters the vein a flash-back of

blood will appear in the chamber advance the cannula and
stylet another 2mm into the vein
 Steps of the procedure

11- Decrease the angle between the cannula and the skin and hold
the stylet stationary and advance the cannula fully into the vein.
 Steps of the procedure

12- Release tourniquet

 Steps of the procedure

13- Apply gentle but firm pressure over internal tip of

catheter, withdraw introducer and place it into sharps
container. Place alcohol swab under cannula hub
 Steps of the procedure

14- Attach the white stopper or prepared infusion set to

the cannula.
 Steps of the procedure

15- Gently flushing the cannula with 5- 01ml of Normal

Saline. Ensuring all remnants of blood is removed from
pt.’s skin and within the cannula device. Write date,
time and name of the nurse on outer piece of the tape.
 Important note
A peripherally inserted catheter is usually replaced every 72
to 96 hours to prevent infection and phlebitis in adults
 Steps of the procedure

16- finally collect the equipments and for your safety:

Do not recap the needle.

Dispose needle and syringe in a sharps container,

document it and finally wash your hand.
What Are The Differences Between IV
Push, IV Infusion and IV Bolus?

• What Is An IV Push?
• There are timely situations, and then there are critical, life-or-death
situations where a second can’t be wasted, such as when someone is
suffering a heart attack or an anaphylactic allergic reaction. These are
circumstances that call for an IV push.
 Intravenous Bolus
• The bolus is a type of IV therapy administration. It involves receiving a single dose of a
medication over a short time. In IV bolus, two critical things are specified:

• (1) the volume of fluid to be administered, like 100 ml, 200 ml, or 250 ml, and
• (2) the time duration to infuse it, like 15 minutes, 30 minutes, etc.

• For example, a medical doctor will order that 10 ml of Drug A be admixed in 100 ml of
saline water and then infused for 30 minutes. A set volume was specified (100 ml), and
the time duration of administration was also specified (30 minutes). This is an IV bolus.
 Intravenous (IV) infusion
• Intravenous (IV) infusion refers to fluid administration through the IV canula Infusion implies
that either the flow rate is slow or the total time duration of administration is not fixed.

• For instance, a medical doctor will order that one liter of fluid be infused for 8 hours.
After infusing the first liter of fluid, another one will follow, and so on, for as long as
the patient needs it. In this situation, the flow rate is slow and to be infused for an
indeterminate period. This is an IV infusion.
 Uses

• Intravenous infusion
• To replace losses in fluids and electrolytes and to maintain them.
• To provide nutritional support to patients who cannot absorb their foods
through their intestines.
• To deliver intermittent medications or fluid.
• To administer blood and blood products.

• IV bolus
• To provide rapid delivery of a particular medication through the IV route,
thereby achieving its peak level in the patient’s system in a short time and
thereby benefiting from the intended results after a short time.
• To inject a certain amount of contrast medium to increase the visibility of blood
vessels in x-ray procedures.
infusion pump and set
• An external infusion pump is a medical device used to deliver fluids
into a patient’s body in a controlled manner.
 Documentation
• Site of insertion-vein and arm/hand
• Type and gauge of cannula
• Date and time of insertion
• Type and amount of IV solution
• Reason for IV therapy
Potential complications
• Extravasation
• Haematoma
• Phlebitis
• Venous Spasm
• Occlusion
• Thrombophlebitis
• Infection
• Embolus
 complications
Extravasation Extravasation occurs when – a
vesicant medication/solution leaks into the
subcutaneous tissue.

Infiltration occurs when - a non vesicant

medication/solution leaks into the subcutaneous
tissue.

RECOMMENDATION
Re-site the cannula to prevent tissue necrosis.
Consider alternative site. 42
 Preventing complications
• Know your organisation’s policy on IV therapy
• Check and inspect the IV site regularly as per your facility policy
• Ask the patient how the IV site feels
• Document
• Troubleshoot at first sign
• Report any problems
 Nursing Aftercare
• Patient education
• Asepsis for all cannula manipulations such as medicine
administration and dressing changes.

• Avoid over manipulation of cannula by using needle free devices.

• Secure connections.
• Regular monitoring and flushing
• Planned removal of cannula
44
 Venous cut down
Venous cut down is an emergency procedure in which the vein is
exposed surgically and then a cannula is inserted into the vein under
direct vision.

It is used to get vascular access in trauma and hypovolemic shock

patients when peripheral cannulation is difficult or impossible.

The saphenous vein is most commonly used.

STOP!
CHECK
. FAIL!
 References
• https://www.kmedhealth.com/what-are-the-differences-between-intra
venous-infusion-and-intravenous-bolus/
• https://rockymountainivmedics.com/iv-bolus-vs-iv-push/
• https://www.healthywa.wa.gov.au/Articles/F_I/Intravenous-cannula-IV
• https://emedicine.medscape.com/article/1998177-overview
• https://teachmesurgery.com/skills/clinical/cannulation/
• https://www.rch.org.au/rchcpg/hospital_clinical_guideline_index/Perip
heral_Intravenous_IV_Device_Management/
• https://www.medistudents.com/osce-skills/intravenous-cannulation
• https://www.medicalnewstoday.com/articles/cannula
• https://www.youtube.com/watch?v=vE99rZ7JT3Q
 Any
question?
THANK U