2. Mannikins

2.5. IV Cannulation

Scenario 1

You are FY2 in the ED where you see Miss Laura 32 year old who presented with c/o sudden onset of RIF pain and 1 episode of vomiting. Please Take a brief history, discuss the management and perform IV cannulation. At the end tell your examiner how you investigate this patient.

Scenario 2

Mr Mathews is a 69 year old gentleman who is transferred from the operation theatre this evening following escharotomy as he was involved in a house on fire. Patient is in severe pain and appears dehydrated. During the transit his cannula is tissued and the night nurse calls you to speak to the patient, do the necessary procedure and talk to the examiner regarding further management.

IV Cannulation

Intravenous (IV) cannulation is a medical procedure in which a thin plastic tube called a catheter is inserted into a vein through the skin. The catheter is used to provide direct access to the bloodstream for the purpose of administering medications, fluids, blood products, or nutrition. IV cannulation is a common procedure used in hospitals, clinics, and other healthcare settings, and it is typically performed by trained healthcare professionals such as nurses, paramedics, or doctors. The procedure is usually performed on the back of the hand, wrist, forearm, or antecubital fossa (the bend of the elbow), depending on the patient's age, medical condition, and the type of treatment required.

Precautions for IV cannulation

Before performing an IV cannulation, it is important to take the necessary precautions to ensure the safety and well-being of the patient. Here are some precautions to consider:

  1. Wash your hands and wear sterile gloves: Wash your hands thoroughly with soap and water or use an alcohol-based hand sanitizer. Wear sterile gloves to prevent contamination of the procedure.

  2. Prepare the patient: Explain the procedure to the patient and obtain their informed consent. Ensure that the patient is in a comfortable position and that the selected site is appropriate for the patient's age, medical condition, and the type of treatment required.

  3. Check for allergies: Ask the patient if they have any allergies to latex, adhesive, or antiseptic solutions. Choose appropriate equipment and supplies based on the patient's allergies.

  4. Assess the patient's medical history: Review the patient's medical history and current medications to identify any factors that may affect the IV cannulation procedure, such as bleeding disorders, vascular diseases, or allergies.

  5. Use proper infection control measures: Use proper infection control measures, including wearing sterile gloves, cleaning the site with antiseptic solution, using sterile equipment, and following aseptic technique.

  6. Ensure adequate lighting and visibility: Ensure that the area is well-lit and that you have adequate visibility of the site. This will help you to identify the vein and perform the procedure safely and accurately.

  7. Use appropriate equipment: Choose an appropriate size and type of catheter based on the patient's age, medical condition, and the type of treatment required. Use sterile equipment and check the expiration date of the supplies.

By taking these precautions, you can reduce the risk of complications and ensure the success of the IV cannulation procedure.

Steps of IV cannulation

Please follow the steps below:

Step 1: Prepare the patient

Before starting the procedure, explain it to the patient and obtain their informed consent. Position the patient in a comfortable position, typically supine or sitting with their arm extended and the hand supported on a flat surface.

Step 2: Select the site

Assess the patient's veins to find a suitable site for cannulation. Common sites include the antecubital fossa (the bend of the elbow), the dorsal surface of the hand, the forearm, or the wrist. Choose a vein that is visible, palpable, and straight, and that has good blood flow.

Step 3: Prepare the equipment

Gather all the necessary equipment, including gloves, an IV catheter, a tourniquet, sterile gauze or adhesive dressing, alcohol swabs or chlorhexidine, and a saline flush or heparin lock. Ensure that the catheter is appropriate for the patient's age, medical condition, and the type of treatment required.

Step 4: Apply the tourniquet

Apply a tourniquet to the patient's arm, about 3 to 4 inches above the selected site. Tighten it enough to slow the venous blood flow but not so much that it causes pain or stops arterial blood flow.

Step 5: Clean the site

Clean the site with an antiseptic solution, such as alcohol swabs or chlorhexidine. Use a circular motion to clean the area around the site and then move inward, using a fresh swab for each circular motion. Allow the site to air dry or use sterile gauze to dry the area.

Step 6: Insert the catheter

Using sterile gloves, hold the catheter at a 10 to 30-degree angle and advance it gently into the vein, bevel up. Once the flash of blood is seen in the flashback chamber, lower the angle to 5 to 10 degrees and advance the catheter further into the vein. Hold the catheter stable while removing the needle.

Step 7: Secure the catheter

Hold the catheter in place while removing the needle and apply pressure with sterile gauze or an adhesive dressing to stop bleeding. Secure the catheter in place with tape or a transparent dressing, ensuring that it is not too tight or loose.

Step 8: Flush and connect

Flush the catheter with saline to ensure patency and remove any air bubbles. Connect the tubing to the catheter, taking care to prevent any contamination. Prime the tubing with fluid, clamp the tubing, and adjust the rate of infusion according to the prescribed order.

Step 9: Monitor the patient

Monitor the patient's vital signs, including blood pressure, pulse, and respiration rate, for any signs of complications such as infiltration, phlebitis, or infection. Educate the patient on how to care for the IV site and what to do if they experience any discomfort or complications.

Following these steps will ensure a safe and successful IV cannulation procedure for your patient.

Color codes for cannulas

Cannula sizes are typically indicated by the gauge of the needle, which is a measurement of its diameter. The gauge is often color-coded to make it easier to identify the size at a glance. However, it's important to note that there may be variations in color codes depending on the manufacturer or region.

Here is a general guide to the color codes for common cannula sizes:

  • 14 gauge - Orange
  • 16 gauge - Gray
  • 18 gauge - Green
  • 20 gauge - Pink
  • 22 gauge - Blue
  • 24 gauge - Yellow

Post procedure care

After an IV cannulation procedure, it is important to provide appropriate post-procedure care to ensure that the site remains clean, secure, and free from complications. Here are some steps to consider:

  1. Observe the site: Observe the site for any signs of complications, such as redness, swelling, pain, or drainage. Check the catheter dressing frequently and replace it if it becomes soiled or loosened.

  2. Keep the site clean: Keep the site clean and dry. Avoid getting the site wet while showering or bathing. If the dressing becomes wet, replace it with a clean, dry dressing.

  3. Monitor for infiltration: Monitor the site for any signs of infiltration, which occurs when the IV fluid leaks into the surrounding tissue. Signs of infiltration include swelling, pain, and coolness or tightness of the skin around the site. If infiltration occurs, stop the infusion, remove the catheter, and elevate the affected limb.

  4. Prevent dislodgment: Ensure that the catheter is secure and not at risk of dislodging. Advise the patient to avoid pulling on the tubing or catheter and to keep the arm or limb immobilized.

  5. Assess for infection: Monitor the site for any signs of infection, such as redness, warmth, tenderness, or pus. If signs of infection occur, notify the healthcare provider immediately.

  6. Educate the patient: Educate the patient on how to care for the site, including how to clean and dress the site, how to prevent infection and complications, and when to seek medical attention.

  7. Remove the catheter: Remove the catheter as soon as it is no longer needed or if complications arise. Ensure that the site is clean and that the catheter is removed smoothly to minimize pain and discomfort.

By following these steps, you can help to ensure that the IV site remains clean, secure, and free from complications, and that the patient receives appropriate care after the procedure.

Complications of IV cannulation

Although IV cannulation is a common and relatively safe procedure, there are some potential complications that can occur. Here are some examples:

  1. Infection: The insertion site can become infected if proper sterile techniques are not followed or if the site is not properly cleaned and dressed.

  2. Phlebitis: Phlebitis is the inflammation of the vein, which can be caused by the catheter or the medications being infused. This can cause redness, swelling, and pain around the insertion site.

  3. Infiltration: Infiltration occurs when the IV fluid leaks into the surrounding tissue, which can cause swelling, pain, and coolness or tightness of the skin around the site.

  4. Extravasation: Extravasation is the leakage of medication or fluid into the surrounding tissue, which can cause pain, burning, and tissue damage.

  5. Air embolism: Air embolism occurs when air enters the bloodstream, which can cause respiratory distress, chest pain, and even cardiac arrest.

  6. Nerve damage: Nerve damage can occur if the catheter is placed too close to a nerve, which can cause pain, numbness, and tingling in the affected area.

  7. Dislodgement: The catheter can become dislodged if it is not properly secured, which can result in the loss of access to the bloodstream.

  8. Bleeding: Bleeding can occur if the vein is punctured or if the catheter causes trauma to the vein.

It is important to monitor the IV site for any signs of complications and to take appropriate action if complications arise. Healthcare professionals should follow proper sterile techniques and ensure that the catheter is placed correctly and secured properly to minimize the risk of complications.

Tags: