IV Cannulation

Student Name: Azhar Khalid Safar Alghamdi

Student ID: 39-1-2-1-0357
Introduction to Anesthesia Technology – ANTC 201
Anesthesia Batch 5
Mr. Salem Alshammari
4 April 2020

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IV Cannulation
Introduction:
Intravenous (IV) cannulation is a method where a cannula

is placed inside a vein to give venous access. Intravenous

cannulation, among the most recognized clinical procedures, has

changed the act of medicine (1). Intravenous cannulation (IV)

catheters is commonly used in hospitals to allow rapid, accurate

and safe infusion of medications, hydration fluids, blood

products, and nutritional supplements (2). This topic will discuss

indications, equipment required, technique, complications, and sizes of Cannula.

IV cannulation Indications (2):

1. Repeated blood sampling

2. IV administration of fluid

3. IV administration of medications

4. IV administration of chemotherapeutic agents

5. IV nutritional support

6. IV administration of blood or blood products

7. IV administration of radiologic contrast agents for computed tomography (CT), magnetic

resonance imaging (MRI), or nuclear imaging.

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Equipment Required:

Gather all equipment required for the procedure and lay it within a safe and accessible distance

on a plate or tray, guaranteeing that all the things are clearly visible. For this, the equipment that will be

needed are (3):

2- Non Sterile Gloves /

1- Dressing Tray Apron 3- Cleaning Wipes

5- IV cannula (separate
4- Gauze swab slide) 6- Tourniquet

7- Dressing to secure 9- Saline flush and

cannula 8- Alcohol wipes sterile syringe

10- Sharps bin

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Technique (4):

Step One:

Acquaint yourself with the patient. Describe the procedure and

gain consent to proceed. Tell the patient that cannulation may

cause some distress; however, it will be for a short period of

time.

Step two:

Make sure that you have the equipment ready, and wash hands.

Step three:

Sanitize hands with alcohol cleanser.

Step four:

Position the patient appropriately and identify the non-

dominant hand / arm

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 Step five:

Apply Tourniquet and put on your gloves.

Step six:

Identify vein and clean the site over the vein with alcohol wipe,

allow to dry.

Step seven:

Remove the protective sleeve from the needle ensuring not to touch

the needle.

Step eight:

Stretch the skin over the vein and do not re palpate the vein.

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 Step nine:

Insert the needle, bevel side upwards at about 15° to 30° degrees.

Observer the needle until a flashback of blood is seen in the

flashback chamber.

Step ten:

Once the flashback of blood is seen, progress the cannula further

into the vein making sure not to puncture the vessel, gently

advance the cannula into the vein.

Step eleven:

Release the tourniquet and apply pressure over the vein (beyond

the cannula tip) remove the white cap from the needle.

Step twelve:

Remove the needle from the cannula and carefully dispose of it

into a sharp's container.

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 Step thirteen:

Apply an appropriate dressing to secure the cannula in place.

Step fifteen:

Flush the cannula with 2-5 mls 0.9% Sodium Chloride or attach

an IV giving set and fluid.

Step sixteen:

Document the procedure including:

(Date & time Site and size of cannula Any problems encountered)

(cannula should be in situ no longer than 72 hours)

Step seventeen:

Thank the patient and ensure their comfort.

Clean up and dispose equipment into clinical waste bin.

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Complications:

The procedure of establishing peripheral venous access carries the risk of potential complications

to the patient. Complications may include vasovagal attack, bruising, air embolism, hematoma,

extravasation, infiltration and phlebitis. Careful adherence to guidelines and procedures can minimize

these risks.

Complications Definition Types Corse of Action

1- Mechanical

It is acute inflammation
of the vein. It is
Phlebitis characterized by pain,
tenderness, redness,
swelling and warmth can
be felt at the insertion
site (5).
phlebitis: size of
Stop the infusion and remove
cannula is too big for
the IV. An affected limb should
the vein.
be elevated to minimize
2- Chemical
inflammation and a gel can be
phlebitis:
directly applied to the area.
medications irritate
Anti-inflammatory analgesics
vessel wall.
can be prescribed to treat
3- Bacterial
inflammation and pain (7).
phlebitis: poor

aseptic technique (6).

It is a disorder that

causes a rapid drop in

Call for help and continue IV
Vasovagal heart rate and blood
‫ـــــ‬ cannulation then administer
Attack pressure, resulting in
medications (8).
decreased blood flow to

the brain and fainting (8).

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 Results from failed IV
Bruising
placement in elderly and
those on
anticoagulant therapy (5).
Infiltration It is accidental leakage of
IV fluids into the
surrounding tissue (10).
It is accidental leakage of
Extravasation
IV medications from the
vein into the surrounding
tissue (10).
Hematoma It occurs when there is
leakage of blood from
vessel into surrounding
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Apply a pressure bandage to the
‫ــــ‬
site (9).
1- Re-site cannula immediately
2- Elevate the limb.
3- Check the patient's pulse and
capillary refill time.
‫ــــ‬
4- Check the site frequently.
5- Document interventions
performed (11).
Stop infusion immediately.
Medical staff should be
informed immediately. It may
require extensive intervention to
‫ــــ‬ prevent skin damage.
Potential skin necrosis,
compartment syndrome and the
potential need for plastic
surgery (10).
Remove catheter then apply
‫ــــ‬
pressure to the site for 4
 soft tissue. This can minutes and elevate the limb

occur when IV passes (10).

through more than one

wall of a vessel or if

pressure was not applied

to the IV site when the

catheter was removed (5).

Turn the patient onto

Trendelenburg position. If the

route of air entry is obvious,

attempts should be made to

immediately occlude the

It occurs as a result of opening. A wet cloth should be

large volume of air applied over the exposed

entering the vein via the lumens to prevent further air

Air Embolism I.V. It can be prevented ‫ــــ‬ entry. At all times, monitor and

by making sure that all support vital signs. Emergency

the air bubbles are out of medical services should be

the I.V (5). notified. Administer oxygen via

mask at 100%. Closed-chest

cardiac massage has been found

beneficial in breaking apart the

emboli to facilitate diffusion

(12).

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Sizes of Cannula (5):

Size Color Flow Rate

14 G Orange 300 ml/min

16 G Grey 200 ml/min

18 G Green 100 ml/min

20 G Pink 50 ml/min

22 G Blue 30 ml/min

24 G Yellow 20 ml/min

26 G Purple 10 ml/min

Conclusion:

In conclusion, peripheral intravenous cannulation believed to be a life-saving procedure. This

procedure requires a doctor’s knowledge of the equipment and sizes of cannula to avoid multiple failed

attempts at IV cannulation and cause unnecessary complications to the patient.

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References:

1. Robert L Frank, MD, FACEP. Peripheral venous access in adults. https://www.uptodate.com/

(accessed Mar 26, 2020).

2. Gil Z Shlamovitz, MD, FACEP. Intravenous Cannulation. https://emedicine.medscape.com

(accessed Mar 26,2020).

3. Dr Lewis Potter. Intravenous Cannulation (IV) – OSCE Guide. https://geekymedics.com (accessed

Mar 26, 2020).

4. OSCE. Intravenous Cannulation (IV). https://www.medistudents.com (accessed Mar 26, 2020).

5. Clinical Skills Education Center. http://www.qub.ac.uk/cskills/index.htm (accessed Mar 26, 2020).

6. Paula Wallis, IVNNZ Inc. Phlebitis. https://ivnnz.co.nz (accessed Mar 26, 2020).

7. Ray Higginson, Andrew Parry. Phlebitis: treatment, care and prevention.

https://www.nursingtimes.net/ (accessed Mar 26, 2020).

8. Healthgrades Editorial Staff. Vasovagal Attack - Symptoms, Causes, Treatments.

https://www.healthgrades.com/ (accessed Mar 26, 2020).

9. Patrick Tunney. Bruising. https://medschool.co (accessed Mar 26, 2020).

10. Medical Emergencies and Complications IV Complications. http://ccnmtl.columbia.edu/ (accessed

Mar 26, 2020).

11. Lisa Bonsall, MSN, RN, CRNP. Complications of Peripheral I.V. Therapy.

https://www.nursingcenter.com (accessed Mar 26, 2020).

12. Cook LS. Infusion-Related Air Embolism. Journal of Infusion Nursing. 2013;36(1):26–36.

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