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
ƒ Venepuncture is the most commonly performed
invasive procedure in hospitals.

ƒ IV cannulation is the second most invasive

procedure for patients in hospital.
ƒ 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

ƒ Sites close to infection

ƒ Veins of fractured limbs
ƒ Where there is an AV fistula present
ƒ Oedema
ƒ Affected side of CVA
ƒ Side of Mastectomy

Extra care to be taken on patients with bleeding,

clotting disorders & on warfarin.
 POTENTIAL COMPLICATIONS

ƒ Haematoma ƒ Puncturing an artery

ƒ Haemorrhage ƒ Puncturing a nerve
ƒ Infection ƒ Infiltration
ƒ Phlebitis ƒ Extravasation
ƒ Thrombophlebitis

(Dehn and Asprey,2007)

 VEINS vs. ARTERIES
ƒ Bluish & superficial ƒ Not seen

ƒ No pulsation ƒ Pulsation

ƒ Thin muscular wall ƒ Thick muscular wall

ƒ Valves ƒ 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 Veins of the Forearm

1. Digital Dorsal veins 1. Cephalic vein
2. Dorsal Metacarpal veins 2. Basilic vein
3. Dorsal venous network 3. Median Cubital
4. Cephalic vein 4. Medial Cutaneous nerve
5. Basilic vein 5. Lateral Cutaneous nerve
 HAND
Advantages Disadvantages
ƒEasy to access ƒSmall veins - small
ƒMore prominent in volumes.
obese patients. ƒDifficult to secure
Note ƒIncreased risk of
ƒSite most frequently thrombo-phlebitis.
chosen for IV ƒLimits wrist mobility
cannulation. ƒInsertion painful –
ƒUse non-dominant large number of
hand if possible. nerve endings.
 FOREARM
Advantages Disadvantages

ƒHand can be freely used ƒIf cannula is placed near

the wrist, can restrict
ƒLarger and straighter wrist movement
veins - more rapid
infusion

ƒEasier to secure
 ANTECUBITAL FOSSA
Advantages Disadvantages

ƒEasy to access ƒSitemost frequently

chosen to carry out
ƒThe median cubital is venepuncture
preferred as it most ƒFlexion
stable, close to surface ƒMovement Limited
and overlying skin less ƒBrachial artery
sensitive ƒOften not visible
 COMMON ISSUES

ƒ Anxiety

ƒ Needle phobia

ƒ History of fainting

ƒ Obesity

ƒ Allergies

ƒ Aggressive & confused

 Learning Points

ƒ Hypovolaemia -use larger veins as small veins

collapse.
ƒ In difficult cases - ensure maximum venous
dilation before inspection.
ƒ Large vein - high infusion rate.
ƒ Use veins of non-dominant side- consult with
patient.
ƒ If in doubt – consult.
ƒ 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.