Prevention of iv complication

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1. Prevention of IV Complications Sr Rosemarie Chung B. Sc. Hons Degree in Nursing Practice Development 07/03/2018

2. Appropriate Cannula Sizes Use the smallest, shortest gauge cannula A s the ratio of cannula external diameter to vessel lumen increases, vascular complications increase.

3. Influential Factors in Choices of Cannulation P urpose of the cannulation ; P roposed drug administration; E xpected duration of cannula placement S ize of the vein to be cannulated .

4. Each cannula allows different volume of fluid for infusion. For administration of viscous fluids/drugs, use larger gauge needles. In emergency situations, larger gauge needles are also used routinely.

5. Size Color Ext. diameter (mm) Catheter Length (mm) Flow Rate (ml/min) Function 16 G Grey 1.8 45 180 Rapid infusion of fluids, blood and drugs 18 G Green 1.3 45/32 90 Blood transfusion, patient going for op 20 G Pink 1.1 32 60 IV fluids and medications 22 G Blue 0.9 25 36 For c hildren 24 G Yellow 0.7 19 20 For p ediatrics

6. Proper Techniques Insert cannula at an angle of between 5-10 degrees. When there is a flashback of blood in the cannula chamber, level off the cannula and advance a few millimetres into the vein. Withdraw introducer approximately 5mm.

7. Advance the cannula further into the vein, observing for continued flashback of blood along the cannula. Release the tourniquet. When the cannula end is secured with a sterile bung, flush the cannula with 5mls of sterile saline (0.9% Sodium Chloride )

8. Flush the IV line with 5mls of sterile saline (0.9% Sodium Chloride) too after giving medication especially if the drugs or IV fluids are concentrated. Cannula also can be attached with an extension if on continuous IV drip. Do give IV medication for IV site that is used for blood transfusion.

9. Apply a sterile transparent dressing to allow visible entry site for monitoring. If an infusion set is being used, ensure this is secured in a double loop on the patient’s arm using hypo-allergenic adhesive tape . Secure the IV site properly to prevent dislodge

10. Notice that the IV tube injection port is secured near the IV site and the tubing is secured again above the wrist.

11. One practitioner is allowed 2 attempts of IV insertion for one patient.

12. Suitable Site for Cannulation Accessible and unused veins are easily detected by and/or visual inspection and appear healthy and patent. Such veins feel soft and bouncy to the touch and refill quickly following compression. Ideal veins are long , straight veins with a large lumen.

13. Rely on anatomy and experience to determine the best site for cannulation if suitable veins are not visible. Most common veins are basilic or cephalic veins of the forearm. Such veins allow variety of different sized cannulae in an area. They are easily immobilised and less restriction in patient’s activity.

14. For last resort, use ante-cubical fossa because the effect of extravasation are more devastating Furthermore, it is difficult to immobilise , uncomfortable for the patient and may hamper other procedures such as venepuncture and blood pressure.

15. Despite of many choices of site, most importantly patient is able to carry out normal activities while a cannula is in situ. The IV site is secured and dressed appropriately. Patient has few interruptions in receiving their intravenous therapy and there is no unnecessary delays. Avoid dominant arm whenever possible.