quizzes- cannulation

veins

thin walled

fibrolus

have a large diameter and low pressure

veins __ to propel blood through the vein towards the _

contract, heart

veins consist of the following three layers:

tunica externa - outer layer

tunica media- elastic smooth muscle fibres and nerve supply

tunica intima- innermost, epithelial lining

veins in arm and hand

veins of upper limb are divided into 2 groups:

1.superficial v- located just under the skin and often are visible

2- deep v- run closely to arteries and have more valves than superficial veins

veins of the hand

• The ___ ____ veins run along side of the fingers and join to form the 3 dorsal metacarpal veins

dorsal Digital

 Veins of the hand should be avoided as the vessels have

thinner walls and so they can easily collapse.

Major Superficial Veins of the Arm are as follows:

Dorsal

Cephalic

Basilic

Medial Cubital Fossa

Sites for Peripheral IV Cannulation

General Principals when choosing a vein for

peripheral IV Cannulation

Assessment factors for IV cannulation

Other Factors to be aware of:

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)

• Syringe 10ml with 0.9% Normal saline

• Tourniquet

Assessing and Preparing the patient

1 Check patient for baseline vital signs, diagnosis and allergies to

medications, cleansing fluids & dressings

2 Provide a clear explanation of the procedure including potential

adverse and side effects

3 A relaxed patient is generally easier to cannulate

4 Assess the dominant/non-dominant side and check the veins for

status and suitability

Preparing equipment

 1 Equipment should be gathered on trolley in treatment room with

sharps container

2 IV fluids should be prepared by priming the giving set

3The equipment should not be opened until in the patient’s room and patient education, assessment of vein and appropriate positioning has been attended

Positioning the patient

 If possible use the non dominant arm

• Raise bed prior to procedure

• Place the arm in a supported comfortable position

• Use a tourniquet to find vein but release it while you are getting

equipment ready

• Position patient with pillows or towels

• Have IV trolley close by

Preparing vein

 Warm veins by

• Rubbing

• Washing client’s hands under warm water

• Apply warmed towel

• If limb is warm ask the patient to gently clench and unclench their

hand

• Or gently rub up and down the vein

Before inserting cannula

The tourniquet is applied above the IV insertion site and should not

be left on for more than 2-3 minutes

• Don gloves and clean site with appropriate solution using a circular

outward movement

• Allow site to air dry or dry with sterile swab

Inserting the cannula

• Hold cannula and rotate the barrel 360 degrees

• Apply skin traction to immobilize the vein

• Ensure cannula has bevel side UP and insert at approximately 30 degree angle

• You will see a flashback of blood in the chamber once you have pierced the vein

• Then advance the cannula a few more millimetres and then flatten the cannula, stabilise

the device and advance the cannula until at skin level

• Remove the stylet and apply pressure just beyond the catheter tip

• Gently stabilise the cannula hub

• Release the tourniquet

• Attach the extension line

• Apply dressing and secure cannula

• Flush cannula with 5-10ml 0.9% sodium chloride to ensure patency

• Connect to IV fluid

• Dispose of sharps and waste

• Document in patient notes

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

Things to know before inserting a Cannula

Sites to Avoid:

 Previous IV Sites

• Bruised Areas

• Patients Dominate arm- if possible

• Flexion or Joint areas due to increased risk of mechanical damage

• Veins below a previous IV site

• Median Cubital vein should be reserved for venous blood sampling

and emergency fluid resuscitation

Veins of the hand should be avoided as they have thinner walls and

may collapse more easily

• The skin of the hand is also more sensitive than the arm, so IV

cannulation may be painful

• Skin at the back of the hand can be very loose or very tough, this may

make it difficult to cannulate

• Cannulas in the back of the hand should only be used for short term

and reserved for small gauge cannulas only

Sites NOT to be used

1. Avoid using AV fistula site for venepuncture.

2. Avoid scarred, burned, sutured, or fractured areas.

3. Avoid damaged veins or sites with phlebitis.

4. Avoid infected areas.

5. Avoid sites with skin conditions.

6. Avoid hard, sclerotic, or thrombosed veins.

7. Avoid arm on side of mastectomy or axillary surgery.

8. Avoid areas with reduced sensation.

9. Avoid veins close to arteries.

10. Always palpate for arterial pulse before venepuncture.

Why is it NOT ok to cannulate the side of a

mastectomy?

Why is it NOT okay to cannulate the side of a mastectomy?

1. Lymph nodes are often removed during mastectomy.

2. This can cause lymphostasis (blocked lymph flow).

3. Reduced drainage increases infection risk.

4. Tourniquet pressure may cause injury.

Why is it NOT ok to cannulate an artery

1. too large cannula- Risk of occlusion, pseudoaneurysm, or haematoma.

2. Accidental arterial injection of medications can cause ischaemia, necrosis, gangrene, or limb loss.

Signs of arterial cannulation:
Bright red, pulsatile blood flowing backward into the cannula.

Complications of IV Cannulation

Extravasation

• Haematoma

• Phlebitis

• Venous Spasm

• Occlusion

• Thrombophlebitis

• Infection

Extravasation

 The infiltration of a drug from an I.V. line into surrounding tissue.

Causes

• Catheter erodes through the vessel wall at a second point,

• Increased venous pressure causes leakage around the venepuncture

site

• When a needle pulls out of the vein.

Signs & Symptoms of Extravasation

• Oedema and changes in the site's appearance

• Coolness of the skin.

• Slowing of infusion

• Pain or a feeling of tightness around the site.

• Possible consequences include necrotic ulcers, infection,

disfigurement, and loss of function

Intervention Extravasation

 Remove cannula

• Elevate affected arm

• Apply ice pack (early) or warm compress (late)

haematoma

Localised collection of extravasated blood, usually clotted, in an organ or tissue.

haematoma cause

Cause

• Blood leaking out of the vein into the tissue due to puncture or trauma

haematoma signs and symptoms

Signs & Symptoms

• Swelling, tenderness and discolouration

haematoma prevention

Prevention

• Proper device insertion

• Pressure over site on removal of cannula Intervention

• Apply appropriate pressure bandage, monitor the site

Phlebitis

Inflammation of the vein

Phlebitis cause

 Poor aseptic technique

• High osmolarity I.V. infusions or drugs

• Trauma to the vein during insertion/incorrect

cannula gauge

• Prolonged use of the same site

Phlebitis signs and symptoms

• Tenderness, redness, heat and oedema

Phlebitis intervention

Occlusion

Slowing or cessation of fluid infusion due to:

Fibrin formation in or around the tip of the cannula

• Mechanical occlusion (kink) of the cannula Cause

• Cannula not flushed

• Kinking of the cannula

• Back flow or interrupted flow

occlusion signs and symptoms

 I.V. not running

• Blood in the line

• Discomfort

occlusion intervention

Infection

Pathogen in the surrounding tissue of the I.V. site.

pathogen cause

• Lack of asepsis

• Prolonged use of the same site

infection signs and symptoms

Tenderness and swelling

• Erythema/purulent drainage

infection intervention

Other Complications