venous cannulation learning resource

Venous CannulationLearning Resource

•Aim and Learning Outcomes•Overview – what do you need to do•NDHB Learning Handout•BD Interactive Learning Module•Resource Articles•Self Test•Competency Assessment Tool

Version 1 – February 2009

Aim: To provide registered nurses with the knowledge and skills to safely perform venous cannulation

Learning OutcomesOn completion of the readings and practice session the nurse will be able to:

– Describe rationale for selection of cannulation device– Discuss criteria for vein selection– Demonstrate selection of veins– Discuss potential complication, causes and nursing

actions– Demonstrate safe cannulation technique


OverviewWhat do you need to do?

•Discuss with your manager and educator

– is this right for you right now?•Read through the training handout•Work through the “Interactive learning module – produced by

BD Medical - Medical Surgical Systems •Read the resource articles•Complete the Self Test•Book in for a practise and training session with your Venous

Cannulation Link nurse•Develop expertise by performing cannulation supported by

your Link nurse or a credentialed peer•Be signed off as competent, using the competency assessment

Tool

CHECKLIST – PRINT AND TAKE TO YOUR TRAINING SESSIONVersion 1 – February 2009

BD Interactive Learning ModuleClick here

•Scroll down•Double click on “InteractiveInservice Module•Click “next” at bottom to go to next slide•Note: video may take a minute to load – be patient


Resource Articles•Hadaway, L.C., & Millam, D.A. (2003).On the road to successful I.V. starts. Nursing2003, 33 (1), 1-14.

•Ingram, P., & Lavery, I. (2007).Peripheral intravenous cannulation: safe insertion and removal technique. Nursing Standard, 22 (1), 44-48.

•Lavery, I., & Ingram, P. (2005). Venepuncture:best practice. Nursing Standard. 19, (49) 55-65.

•Lavery, I., & Ingram, P. (2006). Prevention of infrection in peripheral intravenous devices. Nursing Standard. 20, (49) 49-56.

•Scales, K. (2005). Vascular access: a guide to peripheral venous cannulation. Nursing Standard, 19 (49), 48-52.


Version 1 - February 2009

Self Test1 When determining the type and size

of cannulation device to use, you need to consider the expected use over:

The next 6 hours

The next 24 hours

The next 48 hours

The next 72 hours

a

b.

c.

d.


• No, when determining size, consider the fluid type expected to be used over the next 72 hours. This may prevent an additional venepuncture. Always use the smallest needle/cannula that you can to reduce the risk of phlebitis


• Yes!

When determining size, consider the fluid type expected to be used over the next 72 hours. This may prevent an additional venepuncture. Always use the smallest needle/cannula that you can to reduce the risk of phlebitis


2 For an adult patient going to surgery, who may require blood, your best choice of cannula size would be:

22 g 24 g

20 g 18 g

b.

c.

d.

a.


• No, an 18g is recommended for surgical patients and for blood administration (Although blood can be given through smaller catheters, it flows better through a larger lumen).


• Yes!

• An 18g is recommended for surgical patients and for blood administration (Although blood can be given through smaller catheters, it flows better through a larger lumen).


3 Veins below a previous IV insertion site should be avoided for:

12 hours

24 hours

48 hours

72 hours

a.

b.

c.

d.


No, veins below a previous IV insertion sites should be avoided for 72 hours


Yes!

Veins below a previous IV insertion site should be avoided for 72 hours


4 A vein should be at least ______of the diameter of the cannula to be used.

the same diameter

twice the diameter

three times the diameter

as large as possible

a.

b.

c.

d.


No, the vein should be twice the diameter of the cannula to be used.

First determine the size of cannula required, and then choose the vein.


Yes!

The vein should be twice the diameter of the cannula to be used.

First determine the size of cannula required, and then choose the vein.


5 When choosing a vein to cannulate, avoid:

Joints, straight veins, areas of skin inflammation

Joints, distal veins, arms with an artreriovenous shunt

Joints, areas of skin inflammation, veins below previous IV insertion sites, arms with an artreriovenous shunt

Distal veins, straight veins, hand veins

a.

b.

c.

d.


• No, straight, distal veins are recommended. Hand veins, being distal, can be used if they are large enough to accommodate the cannula required.


Yes!

AVOID– Veins below a previous IV site (for 72 hours).– Veins below a phlebotic area.– Areas of skin inflammation, bruising.– Joints.– Arms affected by mastectomy, arteriovenous shunt.– Anterior aspect of forearm.


6. Tourniquets should be placed _________above the intended insertion site.

2 cm

as close as possible

5 cm

10-15 cm

a.

b.

d.

c.


• No, apply the tourniquet 10 - 15 cm above intended insertion site. Apply snugly to trap venous blood, without occluding the pulse.


Yes!

Apply the tourniquet 10 - 15 cm above intended insertion site. Apply snugly to trap venous blood, without occluding the pulse.


7 The BD cannula should be inserted through the skin at an angle of_______.

5-10º

15-30º

45º

90º

a.

b.

c.

d.


No, insert over the needle cannula at 15-30° angle with bevel up. As soon as flash back of blood observed, lower the angle to skin level.


Yes!

Insert over the needle cannula at 15-30° angle with bevel up. As soon as flash back of blood observed, lower the angle to skin level.


8 Potential causes of phlebitis include:1. tourniquet applied incorrectly2. puncturing the back of vein3. site not changed regularly (72-96hr)4. vein too small for cannula

1 and 22 and 31 and 33 and 4

a.

b.

c.

d.


No,

PhlebitisPotential Causes

• Needle/cannula size inappropriate

• Site not changed regularly

Nursing Action

• Use large cannula/needle for caustic medication. Choose vein twice the diameter of cannula/needle.

• Peripheral IV sites should be changed every 72-96 hours. DO NOT wait for redness to appear, by then it is too late.


Yes!

PhlebitisPotential Causes

• Needle/cannula size inappropriate

• Site not changed regularly

Nursing Action

• Use large cannula/needle for caustic medication. Choose vein twice the diameter of cannula/needle.

• Peripheral IV sites should be changed every 72-96 hours. DO NOT wait for redness to appear, by then it is too late.


9 Nursing actions that can reduce the potential for extravasation (tissuing) include:

Stablising the cannula well

NOT placing over a joint

Entering the vein at 15-30º

All of the above

a.

b.

c.

d.


Yes

Potential Causes• Needle/Cannula

dislodged from vein

• Vein doesn’t seal around cannula/needle

Nursing Action• Don’t place over a joint.• Stabilise cannula well.• Observe regularly for

oedema, coolness, tenderness.

• Enter vein at 15-30° angle to reduce cutting of vein wall fibres.


10 Peripheral IV site and dressing should be changed every:

24 – 48 hours

72 – 96 hours

5 – 7 days

only when redness appears

a.

b.

c.

d.


No, Change IV site and dressing Q 72 - 96 hours. Observe site 8 hourly, change dressing as needed. Change IV site at first sign of redness, inflammation even if less than 72 hours.


Yes!

Change IV site and dressing Q 72 - 96 hours. Observe site 8 hourly, change dressing as needed. Change IV site at first sign of redness, inflammation even if less than 72 hours.


The end• Have you read the resource articles?• Have you read through the BD interactive

learning module?• Have you booked into a practice session?• Print off check list• Fill in• Take with you to your practice session

venous cannulation learning resource

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