Peripheral Venous Cannulation

Clinical SkillsSchool of Medicine

2015/16

Aim & Objectives

Aim:

‒ The student will be confident and competent in the assessment and performance of Peripheral Venous Cannulation (PVC).

Objectives: Student should be able to

‒ Identify the principals of PVC and asepsis.

‒ Identify indications, contraindications and complications of PVC.

‒ Demonstrate the correct technique of PVC.

Indications

‒ Administer Fluids.

‒ Rapid administration of medications.

‒ Administer blood or blood products.

Contraindications

‒ Sites close to infection

‒ Veins of fractured limbs

‒ Where there is an AV Fistula present or planned for that site.

‒ Graft

‒ Oedema

Contraindications Continued

‒ Affected side of CVA

‒ Side of Mastectomy

‒ Avoid veins in lower extremities where possible.

Consideration

‒ Extra care to be taken on patients with bleeding, clotting disorders & warfarin.

Potential Complications

‒ Haematoma

‒ Haemorrhage

‒ Infection

‒ Phlebitis

‒ Thrombophlebitis

‒ Puncturing an artery

‒ Puncturing a nerve

‒ Infiltration

‒ Extravasation

(Dehn and Asprey,2007)

Veins Vs Arteries

‒ Bluish & superficial

‒ No pulsation

‒ Thin muscular wall

‒ Valves

‒ Not seen

‒ Pulsation

‒ Thick muscular wall

‒ No valves

Vein Selection

‒ Non-dominant forearm is preferred.

‒ The basilic or cephalic veins on the posterior forearm are the preferred site.

‒ Initial sites should be in the distal areas of the upper extremities; subsequent PVCs should be proximal to the previous PVC.

(SARI, 2010)

Veins of the Hand

Advantages

‒ Easy to access and visualise

‒ The dorsum of the hand should be used in patients with chronic renal failure.

Disadvantages

‒ Small veins - small volumes.

‒ Prone to infusate or medication induced vessel damage.

‒ Difficult to secure

‒ More liable to block

‒ Insertion painful – large number of nerve endings.

Veins of the Forearm

Advantages

‒ Hand can be freely used

‒ Larger and straighter veins -more rapid infusion

‒ Easier to secure

Disadvantages

‒ Difficult to stabilise vein

Antecubital Fossa

Advantages

‒ Easy to access

‒ Large veins, suitable for infusing large volumes quickly

Disadvantages

‒ Site most frequently chosen to carry out venepuncture

‒ Flexion

‒ Movement Limited

‒ Brachial artery

‒ Often not visible

(Should be reserved for emergencies)

Lower Extremities

‒ Greater risk of thrombophlebitis and thrombosis than the upper limbs and should only be used for the short term or in emergencies.

‒ Always consult with most senior member of team before cannulating a lower extremity.

Choice of Cannula

It is recommended that the smallest gauge cannula for the treatment that is required should be used.

(SARI, 2010)

When to Remove?

‒ It is recommended that replacement of PVCs is considered in adults every 72-96 hours to prevent phlebitis (refer to local policy).

‒ In situations where peripheral venous access is limited, the decision to leave the PVC dwelling beyond 96 hours should depend on assessment of the PVC, skin integrity, length and type of prescribed therapy and should be clearly documented.

(Sari, 2010)

Common Issues

‒ Anxiety

‒ Needle Phobia

‒ History of Fainting

‒ Obesity

‒ Allergies

‒ Aggressive & Confused

References

‒ Lavery, I. Venepuncture: best practice. Nursing Standard. 2005 19, 49, 55-65.

‒ Dehn, R.W. and Asprey, D.P. (2007) Essential Clinical Procedures. 2nd ed. Saunders Elsevier, Philadelphia.

‒ SARI (2011) Prevention of Intravascular Catheter-related Infection in Ireland. HSE Health Protection Surveillance Centre.

‒ http://www.hpsc.ie/hpsc/AZ/MicrobiologyAntimicrobialResistance/InfectionControlandHAI/Guidelines/File,4115,en.pdf

Thank You