Clinical Perspective - IV Cannulation

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Clinical Perspective IV Cannulation

• By Ms.?ikethana R Nair,M.Sc, MBA, M.Sc, M.Phil,
• NABH Assessor, Nursing Superintendent,
• Meenakshi Mision Hospital Research Center -
  Madurai.

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Definition

• Intravenous cannulation is a technique in which a
  cannula is placed inside a vein to provide venous
  access.

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Types of Cannula

• IV Cannula Pen Type Model
• IV Cannula with Wings Model
• IV Cannula with Injection Part Model
• IV Cannula Y Type Model
• Scalp Vein Cannula

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Gauge Size Shades
No. Colour Gauge Length (mm) Flow Rate ml/min
1 Orange 14 2.0 (45) 270
2 Grey 16 1.7 (45) 180
3 Green 18 1.2 (45) 80
4 Pink 20 1.0 (32) 60
5 Blue 22 0.8 (25) 31
6 Yellow 24 0.9 (19) 19
7 Violet/Purple 26 0.6 (19) 14
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Closed Cannulae Parts
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Types of Fixator
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Structure of Vein
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Why Veins are Suitable for Insertion

• Superficial
• Palpabe
• Visible
• Blood at Low Pressure
• Relatively Large internal Diameter
• Tough Vasuclar Wall - Able to form a seal around
  the cannula
• Offer a Rapid Route - Circulatory system

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Signs of Good Vein

1. Bouncy
2. Soft
3. Above Previous Vein
4. Refills when Depressed
5. Visible
6. Has a Large Lumen
7. Well Supported
8. Staright
9. Easily Palpable

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Tips
No. Features Rational
1 Smallest size of catheter
2 EMR situation use a large gauge catheter
3 Upper Extremities
4 Lower extremities
5 Peripheral venous access interfere less with pt's
6 Recommended to choose a straight portion of a vein
7 Use the patient's non-dominant arm
8 For prolonged courses of therapy it is recommended to start distally move proximally as distal catheters are replaced.
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Tips
No. Features Rational
1 Smallest size of catheter To prevent damage to the vessel intima
2 EMR situation use a large gauge catheter To allow administration of large volumes of fluid quickly
3 Upper Extremities The superficial veins
4 Lower extremities Peripheral venous access
5 Peripheral venous access interfere less with pt's Mobility pose a lower risk for phlebitis
6 Recommended to choose a straight portion of a vein To minimize the chance of hitting valves
7 Use the patient's non-dominant arm Convenience, Further damage is been prevented
8 For prolonged courses of therapy it is recommended to start distally move proximally as distal catheters are replaced. Distal Damage - Proximal is available for the further line Proximal As first Line - Distal u cant get the line for the therapy
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Indications

• Repeated blood sampling
• IV fluids
• Medications
• Chemotherapy
• Nutritional Support
• Blood or Blood products administration
• Radiological contrast agents for CT, MRI or
  nuclear imaging

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Contraindications

• Avoid Peripheral Venous Access in
• An injured,
• Infected,
• Burned extremity - if possible

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Volar Wrist Dorsal Wrist
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Lower Limbs
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Scalp Veins - PAEDIATRICS
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Inappropriate Sites

• Edematous Site
• Haematous
• Scarred Sites
• Arms with Fistula's or Vascular Grafts
• Thrombosed
• Fibrosed
• Thin Fragile
• Near Bony Prominises
• Have undergone Multiple Pricks

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Equipment

• Non-sterile gloves
• Tourniquet
• Antiseptic or Alcohol wipes
• Anaesthetic Agent
• 5-ml syringe with NS or Poshi Flush (3ml or 5ml)
• Sterile gauze
• Cannula
• Saline
• Tegaderm or Dynaplast or Easy Fix
• Vein Deductor

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Advance Techniques
Red - SP Saline Syringe Blue - Xs Saline Syringe
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Topical Anesthesia for IV Insertion

• Lidocaine
• Buffered lidocaine
• Bacteriostatic normal saline

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Before The Procedure

• Introduce yourself to the patient.
• Explain the procedure to the patient gain
  informed consent to continue
• Make sure there is adequate light that the room
  is warm enough to encourage vasodilation
• Make sure the patient is in a comfortable
  position
• The patients skin should be kept clean for the
  procedure

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Standard Precautions
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Steps of Procedure
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Steps of Procedure
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Steps of Procedure
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Steps of Procedure
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Stop Remove
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Cannula Placement
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IV Cannulation in Fragile Veins

• Say no to tourniquet as much as possible
• Use the smallest catheter as much as possible -
  20 to 22g
• Use Bevel Up, Low Angle Slowly but surey
  approach
• Secure the catherter with Micropore or
  Transparent dressing
• Provide Health Education

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IV Cannulation for the Geriatrics

• Extremely Challenging
• Avoid applying too much friction when preparing
  the skin
• use the smallest catheter
• Know the veins depth
• If possible do not use tourniquet, Incase use a
  soft material ones
• stabilise the vein insert the catheter on top
  of the vein
• Hypoallergic Tape tape to be used

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Documentation

• Date Time
• Site Size of the Cannula
• Any Problems Encountered
• Notes Eaxmple
• 22/8/19 _at_ 3pm Inserted 16G Needle under Clean
  Techique in a single prick in Rt Metacarpel
  region by S/N XX,Pt cooperated, Back Flow
  Present, Flushed with 5ml Poshi flush or NS,Line
  Intact Patent,Line Secured with dynaplast
  labelled with date time. Score I 0/4 P 0/5

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• 22/8/19 _at_ 3pmInserted 20G Needle under Clean
  Techique in Lt anaesthetist vein. First prick
  failed since there was no back flow or
  infiltration present in Lft Cephalic Vein by S/N
  xyz.
• By 2nd prick line was secured by Anaesthetist
  XXXX. Pt was irritable.
• Back Flow Present, Flushed with 5ml Poshi flush
  or NS,Line Intact Patent
• Line Secured with Tegaderm labelled with date
  time.
• Score I 0/4 P 0/5

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Complications

• Pain
• Cannula Clott
• Blood stops flowing into the flashback chamber
• Arterial puncture
• Hypersensitivity reaction
• Peripheral nerve palsy
• Thrombophlebitis
• Phebilitis
• Infiltration
• Extravasation

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VIPS (Visual Infiltration Score)
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Phebilitis Scale
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Crub the Hub
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Purpose

• ?To administer the appropriate amount of fluid to
  the patient
• ?To prevent fluid overload fluid deficiency
• ?To prevent, treat support the patients
  condition with the help of correct administration
  of fluid.

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Formula

• Amt of fluid to be infused (X)DF
• No. of hours to be flown (X) 60

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Macro Drops

• 1ml 15 macro drops.
• 1macro drop 4 micro drops.
• 15 macro drop 154 60 micro drops.

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Example Ordered Amount

• 6 pints for 24 hours
• One Pint 24 / 6 4 Hours (500 ml / 4hour)
• Per hour 500 / 4 125 ml / hour
• Amt of fluid to be infused DF
• No. of hrs to be flown 60
• 12515 1875 31.25
• 160 60

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Ready Reckoner

• ?50ml /hour 12.5(13 drops/min)
• ?75ml / hour 18.7 (19 drops / min)
• ?100ml / hour 25 drops / min
• ?125ml / hour 31.2(31 drops / min)
• ?150ml / hour 37.5 ( 38 drops / min)
• ?200ml / hour 50 drops

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