IV Cannulation.ppt

Peripheral Cannulation

1. Clinical
Perspective
IV Cannulation
By Ms.Ṇikethana R Nair,M.Sc, MBA, M.Sc, M.Phil,
NABH Assessor, Nursing Superintendent,
Meenakshi Mision Hospital & Research Center -
Madurai.

2. Definition
Intravenouscannulationisatechniquein
whichacannulaisplacedinsideaveinto
providevenousaccess.

3. 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

5. 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

6. Closed Cannulae Parts

7. Types of Fixator

8. Structure of Vein

9. 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

10. 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

11. Tips
No. Features Rational
1Smallest size of catheter
2EMR situation use a large
gauge catheter
3Upper Extremities
4Lower extremities
5Peripheral venous access
interfere less with pt's
6Recommended to choose a
straight portion of a vein
7Use the patient's non-dominant
arm
8For prolonged courses of
therapy it is recommended to
start distally & move
proximally as distal catheters
are replaced.

12. Tips
No. Features Rational
1Smallest size of catheter To prevent damage to the vessel intima
2EMR situation use a large
gauge catheter
To allow administration of large volumes
of fluid quickly
3Upper Extremities The superficial veins
4Lower extremities Peripheral venous access
5Peripheral venous access
interfere less with pt's
Mobility & pose a lower risk for
phlebitis
6Recommended to choose a
straight portion of a vein
To minimize the chance of hitting valves
7Use the patient's non-dominant
arm
Convenience, Further damage is been
prevented
8For 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

13. Indications
•Repeatedbloodsampling
•IVfluids
•Medications
•Chemotherapy
•NutritionalSupport
•BloodorBloodproductsadministration
•RadiologicalcontrastagentsforCT,MRIor
nuclearimaging

14. Contraindications
Avoid Peripheral Venous Access in
1.An injured,
2.Infected,
3.Burned extremity -if possible

16. Volar Wrist & Dorsal Wrist

17. Lower Limbs

18. Scalp Veins -PAEDIATRICS

20. 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

21. 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

22. Advance Techniques
Red -SP Saline Syringe
Blue -Xs Saline Syringe

23. Topical Anesthesia for IV Insertion
•Lidocaine
•Buffered lidocaine
•Bacteriostatic normal saline

24. Before The Procedure
•Introduceyourselftothepatient.
•Explaintheproceduretothepatient&gaininformed
consenttocontinue
•Makesurethereisadequatelight&thattheroomis
warmenoughtoencouragevasodilation
•Makesurethepatientisinacomfortableposition
•Thepatientsskinshouldbekeptcleanfortheprocedure

25. Standard Precautions

26. Steps of Procedure

27. Steps of Procedure

28. Steps of Procedure

29. Steps of Procedure

31. Stop & Remove

32. Cannula Placement

33. IV Cannulation in Fragile Veins
•Saynototourniquetasmuchaspossible
•Usethesmallestcatheterasmuchas
possible-20to22g
•UseBevelUp,LowAngle&Slowlybut
sureyapproach
•SecurethecatherterwithMicroporeor
Transparentdressing
•ProvideHealthEducation

34. 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

35. Documentation
•Date&Time
•Site&SizeoftheCannula
•AnyProblemsEncountered
•NotesEaxmple:
•22/8/19@3pm:Inserted16GNeedleunder
CleanTechiqueinasingleprickinRt
MetacarpelregionbyS/NXX,Ptcooperated,
BackFlowPresent,Flushedwith5mlPoshi
flushorNS,LineIntact&Patent,Line
Securedwithdynaplast&labelledwith
date&time.Score:I0/4&P0/5

36. •22/8/19@3pm:Inserted20GNeedleunderClean
TechiqueinLtanaesthetistvein.Firstprick
failedsincetherewasnobackflowor
infiltrationpresentinLftCephalicVeinby
S/Nxyz.
•By2ndpricklinewassecuredbyAnaesthetist
XXXX.Ptwasirritable.
•BackFlowPresent,Flushedwith5mlPoshiflush
orNS,LineIntact&Patent
•LineSecuredwithTegaderm&labelledwithdate
&time.
•Score:I0/4&P0/5

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

39. VIPS (Visual Infiltration Score)

40. Phebilitis Scale

41. Crub the Hub

42. Purpose
Toadministertheappropriateamountof
fluidtothepatient
Topreventfluidoverload&fluid
deficiency
Toprevent,treat&supportthe
patient’sconditionwiththehelpof
correctadministrationoffluid.

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

44. Macro Drops
1ml = 15 macro drops.
1macro drop = 4 micro drops.
15 macro drop = 15*4 = 60 micro drops.

45. 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
•125*15 = 1875 = 31.25
1*60 60

46. 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