Pediatric intravenous cannulation

Pediatric IV cannulation is insertion of cannula into the vein for the purpose of administering medications / Infusion therapy / Transfusion of blood and its products /Nutrition to childrens

1. PEDIATRIC INTRAVENOUS CANNULATION BY :Mr.Ganesh V. Naik II year MSc (N) Pediatric Dept SDM Institute of Nursing Science’s Dharawad

2. INDEX Introduction Definition Indication Areas to avoid pediatric IV cannulation Color codes of Intravenous cannula Parts of IV cannula Sites for insertion of pediatric IV cannulation

3. CONT… Articles Procedure Do’s and Dont’s Complication of faulty pediatric IV cannulation Visual Infusion Phlebitis Score(VIP Score) Summary Conclusion

4. INTRODUCTION Pediatric Intravenous cannulation(IV) is complex procedure compare to adult IV cannulation. Because Pediatric veins are small and thin. The primary function of vein is to carry blood from body to the heart. IV cannula is flexible tube which when inserted into the body is used either to withdraw fluid or insert medication.

5. DEFINITION Pediatric IV cannulation is insertion of cannula into the vein for the purpose of administering medications / Infusion therapy / Transfusion of blood and its products /Nutrition to childrens  

6. INDICATION To administer fluids intravenously. To administer intravenous injections. To administer total parental nutrition.

7. CONT… To administer blood and blood products. Provide access for diagnostic purpose( eg . Dye injection prior to procedure)

8. AREAS TO AVOID PEDIATRIC IV CANNULATION Veins that feel hard and sclerosed Areas of flexion Veins in close proximity to arteries Limbs with fractures

9. CONT… Previously cannulated veins Avoid using the limb of a renal patient with an existing fistula. Sites close to existing wounds. Previous thrombus on that arm

10. COLOR CODES OF INTRAVENOUS CANNULA   Guage Colour Uses 22 Blue Blood transfusion 24 Yellow Medications, fragile veins

11. CONT….

12. PARTS OF IV CANNULA 1.Bevel 2.Needle 3.Catheter 4.Bushing 5.Injection Port Cap 6.Valve 7.Wings 8.Luer connector 9.Needle grip 10.Flashback chamber 11.Luer lock plug.

13. SITES FOR INSERTION OF PEDIATRIC IV CANNULATION A. Inner arm Radial vein Basalic vein Cephalic vein Median cubital vein of forearm B. Dorsal surface of hand Superficial dorsal vein. Basalic vein Cephalic vein. Dorsal venous arch.

14. CONT….. C. Dorsal surface of foot Dorsal arch Dorsal plexus Great saphnous vein. D. Scalp veins are easy to access and most appropriate in neonates; an older infant might dislodge a device placed there. Scalp vein can be used if no other veins are available.

15. CONT…..

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17. ARTICLES A Clean tray containing Gloves Alcohol Swabs Safety cannula of appropriate size Clipper / Scissors Tourniquet Syringe with needle Normal saline flush

18. CONT… Clave connector Transparent dressing Label Sheet protector Kidney tray

19. PROCEDURE   Preparation of child and parents Using an age appropriate developmental approach, explain procedure to child and parents. Furnish information on misconceptions and clarify their doubts. Play can be provided during preparation period to reduce stress and anxiety.

20. CONT…. Parents are told about the procedure including the reason for the procedure , how long the cannula must remain in place and what they can expect during and after the insertion. Encourage the parents to participate in procedure. One way to control pain during the procedure is by the use of controlled breathing. The children(Toddlers and young children) taught to inhale slowly and exhale through mouth. In case of infants encourage mother to breastfeed during IV insertion procedure

21. CONT… POSITION Toddlers and young childrens can be held in parents lap with the child’s legs touched between the parents legs and the arm behind the parents. Ask the parents to hug the child. Do not restrain the child unless its necessary. PROCEDURE Check the indications for IV cannulation. Use appropriate size of cannula as per age and procedure. Wash hands and keep the articles ready. Identify the patient using two identifiers . Ensure that the patient is in a comfortable position.

22. CONT…. Make sure that there is adequate light. Check the site and accessibility of the vein, ( sites ….) and patient’s preferences if feasible. Always use Vein from distal part of the hand (Metacarpal) so that proximal vein can be used later. Ensure the cannulation site is free from hair(clip hair in case of difficult cannulation). Spread the sheet protector to avoid any soilage . Apply the tourniquet around the patient’s arm above the intended cannulation site.

23. CONT… Ensure that tourniquet is tight enough to impede venous circulation but not too tight to obstruct arterial circulation The tourniquet should be placed about 7 – 8 cm above the venepuncture site. If difficulty is encountered in finding an appropriate vein, one of the following techniques may be used: Ask the patient to close the hand firmly with arm well supported till the vein is palpable.

24. CONT….. Inspection of the opposite extremity. Opening and closing the fist. Using gravity (holding the arm down). Gentle tapping or stroking of the site. Ask the patient to close the hand firmly with arm well supported till the vein is palpable. In case of doubt do not prick and escalate to team leader/ IV Team. Rub hands with alcohol rub and wear gloves. Ensure the site is cleaned with alcohol swabs.

25. CONT….. Stabilize the vein using your no dominant hand (thumb) to apply traction to the skin distal to the chosen site of insertion. This will prevent superficial veins from rolling away from the needle Swiftly insert the needle through the skin, bevel side up at a 15 – 30 degree angle with the skin into the lumen of the vein. Check the backflow of the blood into the cannula /in the flush back chamber. If present pull back the needle 1/4 th from tip of the cannula /Hold the needle steady and, advance the cannula into the vein carefully to prevent puncturing the posterior wall of the vein which may cause Hematoma.

26. CONT….. Release the tourniquet and take out the needle keeping the cannula in site Flush the cannula with normal saline and apply the needle less connector Secure the cannula with transparent dressing and mark the date and time of the cannulation Administer medication / IV fluid / Blood if any - as per prescription Ensure patient is kept in comfortable position post the procedure Check the comfort of the arm Replace the articles and dispose the waste as per policy

27. CONT….. Remove gloves and wash hands Document the procedure Look for signs of Phlebitis/Infiltration / Hematoma / Extravasations if the cannula has to be left in situ and document in the VIP SCORE. For 72 hours IV cannula can be kept in situ. Change cannula if discomfort or pain persists. Follow hospital policy for TAT ( Turn Around Time for removal).

28. DO’S & DON’TS DO’S Use safety cannula to avoid Needle stick injuries. For pre-operative patients cannulate on the left arm unless difficult / contraindicated ( this is for easy access of anesthetist). Remove cannula if any redness / swelling / discomfort is seen / reported. Remove cannula before discharge of the patient.

29. CONT… DON’TS Do not puncture the arm with an AV fistula / Shunt / Lymph Edema / Burns / Surgery etc Do not use dynaplast for securing cannula Do not forget to remove the tourniquet Do Not re-puncture using same needle in case of a difficult access. Do Not apply tourniquet too tightly .

30. COMPLICATION OF FAULTY PEDIATRIC IV CANNULATION 1. Mechanical phlebitis : This is associated with injury to the tunica intima from a cannula rubbing against the inside of the vein wall. 2. Chemical phlebitis : This is associated with injury to the tunica intima by solutions infused into the venous system.

31. CONT….. 3. Infective phlebitis : This is associated with injury to the tunica intima caused by bacteria irritating the vein wall. 4. Cannula occlusion : This is associated with the cannula being partially or completely blocked. 5.Infiltration : This is the inadvertent administration of a non-vesicant medication or solution into the surrounding tissue

32. CONT….. Infiltration

33. CONT….. 6. Extravasation : This is the inadvertent administration of a vesicant medication or solution into the surrounding tissue. 7. Haematoma : This is associates with blood leaking out of the vessel wall

34. VISUAL INFUSION PHLEBITIS (VIP) SCORE 0 = IV site appears healthy: Action: observe cannula site 1  =  One of the following is evident: slight pain near IV site or slight redness near IV site . Action: caution 2 = Two of the following are evident: pain at IV site, with erythema , swelling or both Action: re-site cannula 3 = All of the following signs are evident: pain along path of the cannula , erythema , induration or a palpable venous cord less than 5cm above the IV site Action: re-site cannula

35. CONT… 4 = All of the following signs are evident and extensive: pain along the path of the cannula , erythema , induration or a palpable venous cord more than 5cm above the IV site Action: re-site cannula , consider treatment 5 = All of the following signs are evident and extensive: pain along the path of the cannula , erythema , induration , a palpable venous cord and pyrexia  Action:re -site cannula , consider treatment   The VIP score improves the process of checking the cannula site .

36. SUMMARY Pediatric IV cannulation is one of the most common invasive procedure perform in Hospital. I have explained regarding pediatric IV cannulation which includes Introduction, Definition, Indication, Areas to avoid, different sizes of cannula and its parts, sites, procedure do’s and don’ts during pediatric IV cannulation, complication of faulty IV cannulation and VIP score. So the nurses gained knowledge regarding pediatric IV cannulation.

37. CONCLUSION: Pediatric IV cannulation is a skill that nurses should encompasses. The nurse as a primary care provider must seek adequate knowledge and practice of IV cannulation. Pediatric IV cannulation is not part of basic training but requires training and practice. To remain competent and expert, the nurse must keep uptodate with the knowledge and practice. Hence Structured Teaching Programme regarding pediatric IV cannulation helpful for nurses to gain knowledge.

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