INSERVICE NURSING EDUCATION

2/2/2015

Prepared by Mrs. Heera

K.C. Parajuli,BN

Guess what we will be studying about?

Welcome to the session of

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INTRAVENOUS CANULATION

During our work experiences

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I may not be wrong to say “All of us have gone through this phase” Even the most seniors and most experienced of us.

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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.

brainstorming

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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.?

background

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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.

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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.

introduction

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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.

indication

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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 .

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3. Emergency To obtain access in patients who have the potential to become very unwell.

contraindication

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InfectionPhlebitisSclerosed veinsPrevious intravenous infiltrationBurns or traumatic injury proximal to the insertion sitesArteriovenous fistula in an extremitySurgical procedure affecting an extremity.

Relative contraindication to insertion of an intravenous cannula to an specific sites in the body includes:

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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.

Understanding the anatomy of the veins

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Upper extremities

• Basilic veins• Cephalic veins

Lower extremities

• Greater saphenous vein

• Lesser saphenous vein

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Site selection

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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.

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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.

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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.

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Before inserting a cannula, Ensure if the vein is patent palpable straight and has no bifurcation.

equioments

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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.

Cannula types and sizes

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preparation

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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.

positioning

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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.

procedure

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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 .

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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.

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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.

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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.

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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.

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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.

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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.

complications

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• Pain

• Bruising

• Bacterial infection

• Extravasation

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• Phlebitis

• Thrombosis

• Embolism and

• Nerve damage

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Thank you