Intravenous Canulation BPKIHS, Dharan Nepal

1. INSERVICE NURSING EDUCATION
2/2/2015 1
Preparedby
Mrs. Heera
K.C.
Parajuli,BN

2. Guess what we will be studying
about?

3. Welcome to the session
of
2/2/2015 3
INTRAVENOUS
CANULATION

4. During our work experiences
2/2/2015 4
I may not be
wrong to say
“All of us have
gone through
this phase”
Even the most
seniors and
most
experienced of
us.

5. Cont…..
2/2/2015 5
The broad smile that hollers around us
when we succeed at first attempt. We said
at that time Yes! I got succeed to insert a
canula today.
But
we don’t know on which part of vein we
insert the canula. And
Still we may not know.

6. brainstorming
2/2/2015 6
1.
2.
3.
Q. Name the veins from
question 1 and 2.
Q. What is the size of the
canula coded in different colors
as shown in question 3.?

7. background
2/2/2015 7
Venepuncture is the most commonly
performed invasive procedures in hospitals.
IV cannulation is the second most invasive
procedure for patients in hospital.
Today 80 -95% of all hospitalised patients
receive IV’s in one form or another.

8. Cont…..
2/2/2015 8
 Obtaining peripheral intravenous
access is an essential skill for all health
care providers.
 Although it is considered one of the
simplest procedures, mastering this
potentially lifesaving interventions
requires refined skills and experiences.

9. introduction
2/2/2015 9
Intravenous cannulation
is a technique in which
a cannula is placed
inside a vein to provide
venous access.
Venous access allows sampling of blood as well
as administration of fluids, medications,
parenteral nutrition, chemotherapy, and blood
products.

10. indication
2/2/2015 10
Intravenous Drug administration.
Intravenous hydration.
Transfusion of blood or blood
components.
Intravenous cannulation is required in a broad
range of clinical application.
1. Therapeutic
2. Diagnostic To administer radio opaque dye for
scanning purposes .

11. Cont……
2/2/2015 11
3. Emergency To obtain access in patients
who have the potential to
become very unwell.

12. contraindication
2/2/2015 12
Infection
Phlebitis
Sclerosed veins
Previous intravenous infiltration
Burns or traumatic injury proximal to the insertion
sites
Arteriovenous fistula in an extremity
Surgical procedure affecting an extremity.
Relative contraindication to insertion of an intravenous
cannula to an specific sites in the body includes:

13. Cont…..
2/2/2015 13
 Other contraindication may include
difficult in obtaining intravenous access.
A patient with extreme dehydration,
shock render collapsed peripheral veins.
Insertion of a central venous catheter
or intravenous catheter peripheral
venous cutdown maybe required when
access to Peripheral veins is impossible.

14. Understanding the anatomy of the veins
2/2/2015 14
• Basilic veins
• Cephalic veins
Upper
extremities
• Greater
saphenous vein
• Lesser
saphenous vein
Lower
extremities

15. Cont……
2/2/2015 15

16. Site selection
2/2/2015 16
 The choice of a site for an intravenous
canulation depends on many factors,including
the intended use of the catheter,accessibility of
the vein, patients’ age and discomfort and the
urgency of the situation.
 Generally, upper extremity veins are preferred,
since they are more durable and are associated
with fewer complications than of lower
extremities.

17. Cont……
2/2/2015 17
The preferred
canulations
sites are the
veins of the
forearm.
Veins of the wrist –basilic and cephalic vein and of the
back of the palm.
The median cubital vein which crosses the antecubital fossa in
case of very emergency situation to introduce large amount of
fluids.

18. Cont…..
2/2/2015 18
When upper extremities veins are inaccessible, the
dorsal veins of the saphenous veins of the lower
extremities may be used.
However, cannulation at this
site is associated with higher
incidence of thrombosis and
embolism in adult and older
patients.

19. Cont……..
2/2/2015 19
Before inserting a cannula, Ensure if
the vein is patent palpable straight
and has no bifurcation.

20. equioments
2/2/2015 20
Gather the equipments at bed site
A tray containing
cotton, gloves, nonlatex tournequet,
antiseptic solution, a saline flush, a
transparency occlusive dressing and tape, a
cannula of an appropriate size,an intravenous
fluid bag with tubing and medications to be
given.

21. Cannula types and sizes
2/2/2015 21

22. preparation
2/2/2015 22
 Explain the procedure to
the patient.
 Discuss potential
complications such as
bleeding, bruising, and
infection.
 Always follow standard
precautions when placing a
peripheral venous catheter.

23. positioning
2/2/2015 23
When the selected site is
an upper extremity the
patient should be placed
in an supine position, with
the arm supported.
A comfortable position for
the practitioner and
proper lighting are
important for successful
intravenous cannulation.

24. procedure
2/2/2015 24
 Tie the tourniquet
with a half-knot 8 to
10 cm above the
targeted insertion site.
 Place the tourniquet
flat against the skin
and bring the
tourniquet ends
together,overlapping
one another.

25. Cont……
2/2/2015 25
 When evaluating a vein,inspect and palpate
the available veins.
 To palpate a vein, place one or two fingertips
over the selected vein and gently apply
pressure.
 Release the pressure to watch and feel the
rebound of the vein on refilling.

26. Cont….
2/2/2015 26
 Once you have selected the vein, clean the
site with an antiseptic solution(spirit swab),
using a back and forth motion.
 Allow the area to dry completely. And do
not repalpate the area.
 To prepare the catheter, inspect the
cannula for any damage or contaminants.

27. Cont……..
2/2/2015 27
 Spin the hub of the plastic cannula to
verify that it moves easilly off the metal
needle.
 Do not move the tip of the cannula over
the bevel of the metal needle, since this
could damage the end of the needle.

28. Cont….
2/2/2015 28
 Superficial hands are displaced easilly
and therefore need to be stabilised.
 Use your non dominant hand to apply
traction to distal to the venipuncture site.

29. 2/2/2015 29
 If catheter is to be placed in dorsum, grasp
the patients’ hand with your nondominant
hand,fingers beneath the palm.
Pull
downward to
flex the wrist
and use your
thumb to keep
the skin taut.

30. Cont….
2/2/2015 30
 If a forearm is selected, use you
nondominant hand to encircle the patient’s
arm.
 Place your thumb on the skin distal to the
venipuncture site and pull down.
 Always maintain a firm grip on the patients’
hand throughout the procedure.

31. Cont…..
2/2/2015 31
 With your dominant
hand, insert the
catheter with the
metal needle bevel
up,at a 5-30 degree
angle through the skin
and into the vein.
For superficial veins, lesser angle is required
.

32. Cont….
2/2/2015 32
 Once the metal needle and plastic cannula
are in the lumen, lower the catheter so that it
is almost parallel to the skin.
 Hold the end of the catheter with the thumb
and index finger of your dominant hand
 Maintain tension on the vein and the skin,
stabilize the needle, and carefully advance the
catheter into the vein.

33. Cont….
2/2/2015 33
When the catheter has entered the lumen
completely, remove the tourniquet.
To prevent blood loss from the plastic cannula hub
place the pressure over the proximal to the end of
the catheter and place a gauze pad beneath the
canula hub.
Remove the metal needle from the plastic cannula
and dispose it.

34. Cont…..
2/2/2015 34
Never attempt to reinsert the metal
needle into the plastic cannula.
Doing so may shear off the plastic
cannula, releasing it into the
bloodstream, resulting in a possible
embolus.

35. Cont…..
2/2/2015 35
Make sure the tourniquet has been released and
confirm that the cannula is patent by flushing
with normal saline. Check that there is no
redness, swelling, leakage or discomfort
around the insertion site.
Attach the intravenous fluid tubing to the
cannula and start the fluid infusion.

36. Cont….
2/2/2015 36
After securing the cannula with the tape, loop the
intravenous tubing and secure it away from the
insertion site.
Looping the tube may prevent from accidental
displacement of the cannula.
It is recommended to write the date and time of
insertion to determine how long cannula has been
in place.

37. Cont……
2/2/2015 37
To reduce the risk of infection, continue to
review the indications for peripheral
intravenous caatheterization. And remove as
soon as possible.
When it is unsuccessful in one attempt, the
subsequent attempt should be performed in a
vein proximal to the puncture site.

38. complications
2/2/2015 38
• Pain
• Bruising
• Bacterial infection
• Extravasation

39. Cont….
2/2/2015 39
• Phlebitis
• Thrombosis
• Embolism and
• Nerve damage

40. 2/2/2015 40
Thank you