Fundamentals

of
IV Cannulation

Wilfredo II P. Laberinto, MAN, LPT, RN

Level IV Faculty, College of Nursing
University of Cebu – Banilad, Cebu City
GENERAL OBJECTIVES

After interactive discussion,

the Level 4 students will
enhance their capability on
facilitating Intravenous
therapy.
 SPECIFIC OBJECTIVES

❏ Describe what is Intravenous therapy

and its indication.
❏ Discuss different types of IV therapies.
❏ Classify IV solutions and its effects on
fluid shifting up to the cellular level.
❏ Enumerate common IVT complications.
❏ Identify all the equipment or devices
that are used.
 SPECIFIC OBJECTIVES

❏ Demonstrate the step by step

procedure of IVT.
❏ Recognize the significance of IVT in
the nursing field.
❏ Promote awareness of the legal
implications & protocols pertaining to
its application in the nursing practice.
 OBJECTIVE: 1. Describe IV therapy.

Intravenous
“within a vein”

Therapy -
“treatment to cure”
 OBJECTIVE: 1. Describe IV therapy.

INTRAVENOUS THERAPY

- giving medications or fluids

through a needle or tube inserted
into a vein.

- This allows immediate access to

the blood supply. It involves the
injection of fluids directly into
veins.
 OBJECTIVE: 1. Describe IV therapy.

Historical Background
•Established in 1993 by Association of the
Nursing Service Administrators of the
Philippines, Inc. (ANSAP)

•PRC BON No. 08 series Feb 4 1994

ANSAP Board Members and Advisers

•Training for trainors at PHC on Oct 1993
•First used in Cagayan De Oro City
•Training for Trainors – June 9 – 11, 1994
•Another revision was required May 1995
 OBJECTIVE 2: Types of IV therapies.

Antineoplastic
Parenteral Therapy Operative
Procedures
Nutrition

Diagnostic reagents -
Fluid and Electrolyte monitor hemodynamic
Balance functions

Transfusion Pharmacologic
Therapy Therapy
 OBJECTIVE 3 : Classify IV solutions
& its effects in fluid shifting.

Common IV
Solutions:
(Label Color)

• Green – PNSS
• Pink – D5 LR
• Blue – PLR
• Violet – D5 IMB
 OBJECTIVE 4 : IVT Complications

• Infusion Phlebitis
- Inflammation of
vein associated
with infusion
phlebitis.
• Careful/regular
monitoring of
intravenous
access sites is
recommended.
 OBJECTIVE 4 : IVT Complications

Infection -
Adhering to
aseptic technique
is vital in the
prevention of
intravenous
related infections.
Asepsis should be
maintained at
insertion, during
clinical use and at
removal of the
device.
 OBJECTIVE 4 : IVT Complications

BRUISING
(HEMATOMA)

Occur at any
time during
an episode of
IVT.
 OBJECTIVE 4 : IVT Complications

EXTRAVASATION

the inadvertent
administration of
a vesicant
substance into
the tissues can
have disastrous
outcome.
 OBJECTIVE 4 : IVT Complications

INFILTRATION
regular
monitoring of
infusion sites,
choice of
correct access
device/intraven
ous dressing
and the use
in-line pressure
monitors.
OBJECTIVE 4 : IVT Complications

Potential Complications:

• Cellulitis
• Thrombosis
• Catheter fragment
embolism
• Air embolism
 OBJECTIVE 5 : Equipments/devices

IV DEVICES:
✔ 5 alcohol swab
✔ 1 betadine swab
✔ Tourniquet
✔ IV catheter (Gauge 22)
✔ 1 inch Hypoallergenic tape (Transpore)
✔ Nonsterile gloves
✔ 2 x 2 sterile gauze pad
✔ Pre-filled NSS (Posiflush)
✔ TSM dressing (Transparent)
✔ Q-syte (Heparine lock or needleless port 10 ml)
OBJECTIVE 5 : Equipments/devices

a. Steel Needle
OBJECTIVE 5 : Equipments/devices

b. Over-the-needle Catheters
OBJECTIVE 5 : Equipments/devices

Over-the-needle Catheters
OBJECTIVE: 6. Steps in Cannulation
 OBJECTIVE: 6. Steps in Cannulation

PRE-CATHETERIZATION

Step 1 : Check physician’s order

• Type of solution
• Route of administration
• Amount to be infused either hourly
or 24-hour volume
• Rate of infusion
• Duration of infusion
• Physician’s signature
 OBJECTIVE: 6. Steps in Cannulation

PRE-CATHETERIZATION
Step 2: Hand hygiene
Step 3: Prepare and inspect equipment
Step 4: Assessment & psychological
preparation
• Provide privacy
• Evaluate the patient preparedness
• Know medical diagnosis.
• History of chronic disease that
subjected to complications.
 OBJECTIVE: 6. Steps in Cannulation

Step 5: Site Selection and Vein Dilation

FACTORS TO CONSIDER BEFORE VENIPUNCTURES:

• Type of solution
• Condition of vein
• Duration of therapy
• Catheter size
• Patient age & activity
• Disease or previous surgery
• shunts or graft
• Anticoagulation therapy
 OBJECTIVE: 6. Steps in insertion

PRECAUTIONS:

✔ Minimal tourniquet pressure;

✔ use the smallest catheter that is
appropriate for therapy
✔ use care in removing dressing.

PATIENT WITH ALLERGIES

✔ Iodine—avoid povidone-iodine as skin
preparation
✔ Latex—set up latex allergy cart
 OBJECTIVE: 6. Steps in Cannulation

VEIN DILATION TECHNIQUES

• TOURNIQUET - Latex or nonlatex used most

frequently. Placed 6–8 inches above the venipucture site.
If BP high, move farther from venipuncture site. If BP low,
move as close as possible without risking site
contamination.

• GRAVITY - Position the extremity lower than the heart.

• FIST CLENCHING - Instruct patient to open and close
his/her fist.
 OBJECTIVE: 6. Steps in Cannulation

VEIN DILATION TECHNIQUES

• TAPPING VEIN - Using thumb and second finger,

flick the vein; this releases histamines beneath the
skin and causes dilation (do not slap vein).

• WARM COMPRESSES - 10 minutes maximum. Do

not use microwave!

• BLOOD PRESSURE CUFF - Inflate to 300 mm Hg;

great for fragile veins
 OBJECTIVE: 6. Steps in Cannulation

CATHETERIZATION
Step 6: Needle selection

Recommended gauges
• 16–18 g: Trauma
• 18–20 g: Infusion of hypertonic or isotonic solutions
• 18–20 g: Blood administration (18 g preferred)
• 22–24 g: Pediatric patients
• 22 g: Fragile veins in elderly person
(if unable to place 20 g)
• Only two attempts at venipuncture are recommended
 OBJECTIVE: 6. Steps in Cannulation

CATHETERIZATION

Step 7: Gloving
Step 8: Prepare site

Key points:
• Do not shave site—Remove hair with scissors or
clippers only
• Cleanse insertion site with one of the following
solutions:
• 2% Chlorhexidine gluconate (preferred)
• Iodophor (povidone-iodine)
• 70% Isopropyl alcohol
• Tincture of iodine 2%
 OBJECTIVE: 6. Steps in Cannulation.

CATHETERIZATION

STANDARD OF PRACTICE:
• Do not apply 70% isopropyl alcohol after
povidone-iodine

TECHNIQUE: Apply antimicrobial solution,

working from center outward in a circular
motion for 2–3 inches for 20 seconds, using
friction.
OBJECTIVE: 6. Steps in IV Cannulation.
 OBJECTIVE: 6. Steps in Cannulation.

a. Direct: One-Step Method

• Insert catheter directly over vein;

• penetrate all layers of vein in one motion

 OBJECTIVE: 6. Steps in Cannulation.

b. Indirect: Two-Step Method

• Insert catheter at a 30-45 degree angle to
skin alongside vein;
• gently insert catheter distal to point at which
needle will enter vein; maintain parallel
alignment and advance through the
subcutaneous tissue
• Relocate the vein and decrease the angle as
the catheter stylet enters vein.
OBJECTIVE: 6. Steps in Cannulation

CATHETER STABILIZATION
AND DRESSING
MANAGEMENT

• U method
• H method
• Chevron method
 OBJECTIVE: 6. Steps in Cannulation.

DRESSING MANAGEMENT
•Types of dressings acceptable for peripheral
catheter:
1. Gauze dressing with tape
2. Transparent semipermeable dressing

STANDARDS OF PRACTICE
•Gauze dressings should be changed every 48
hours
•TSM dressing can be changed when catheter is
changed (72–96 hr)
 OBJECTIVE: 6. Steps in Cannulation.

✔ Verify the written prescription for IV therapy;

check prepared IVF and other things needed.
✔ Explain the procedure to reassure the patient.
✔ Do hand hygiene before and after the
procedure.
✔ Choose site for IV.
✔ Apply tourniquet 2-6 inches above venipuncture
site depending on condition of the patient.
✔ Disinfect the chosen venipuncture site with
alcohol swab.
 OBJECTIVE: 6. Steps in Cannulation

✔ Using the appropriate cannula, pierce skin with the

correct technique.
✔ Upon backflow visualization, continue inserting the
catheter into the vein.
✔ Position the IV catheter parallel to the skin.
✔ Hold stylet stationary and slowly advance the
catheter until the hub meets the site.
✔ Do the H-Taping Method
✔ Slip a sterile gauze under the hub. Release the
tourniquet; remove the stylet while applying digital
pressure over the catheter with one finger about 1-2
inches from the tip of the inserted catheter.
 OBJECTIVE: 6. Steps in IV Cannulation.

✔ Connect the needleless port (Q syte) aseptically

to the IV catheter.
✔ Dress the Site with TSM, anchor properly.
✔ Disinfect injection port
✔ Flush and LOCK using pre-filled NSS (Posiflush)
✔ Discard sharps and waste according to Health
Care Waste Management (DOH/DENR).
✔ Place time, date and sign at the paper label (if it is
included in the venipuncture set otherwise, place
these details in your documentation.
✔ Document the procedure
OBJECTIVE 7 :
Significance in the nursing field. 
 OBJECTIVE 8 : Legal implication

ANSAP NURSING STANDARDS ON IVT PRACTICE

DUTIES AND RESPONSIBILITIES

•Physician’s prescriptions for IV therapy.
•Prepare, initiate and terminate IV therapy based
on physician’s WRITTEN ORDER.
•Perform peripheral venipuncture (all types of
needles and cannulas). Excluding the insertion of
subclavian and cut down catheter.
•Determine solution and medication
incompatibilities.
 OBJECTIVE 8 : Legal implication

ANSAP NURSING STANDARDS ON IVT PRACTICE

DUTIES AND RESPONSIBILITIES
•Administer RIGHT DOSE, chemotherapeutic drugs, flow
rates of solutions, compatible blood/blood components and
parenteral nutrition as prescribed by the physician.
•Assess all adverse reactions related to IV therapy and
initiate appropriate nursing interventions.
•Establish nursing care plan related to IV therapy.
•Adhere to established infection control practices.
•Maintain proper care of IV equipments.
•Document relevant date in the preparation, administration,
and termination of all forms of IV therapy.
 LEGAL BASIS: Legal Implications

• R.A. 7164 – the Philippine Nursing Act of

1991 Section 28 states that in
administration of IV injections, special
training shall be required.

• IV Nursing Standards of Practice

developed by the ANSAP should be used.

• In giving IV injections, nurses should follow

the policies of their agencies.
 LEGAL BASIS: Legal Implications

• Board of Nursing Resolution No.8 Sec. 30

Article VII or administratively under Sec. 21
Article III – states that any RN without training
and who administers IV injections to patients shall
be held liable, either criminally,
administratively, or both.
• R.A. 9173 – the Philippine Nursing Act of 2002,
article VI Nursing (a) provide nursing care through
the utilization of the nursing process.
 LEGAL BASIS: Legal Implications

Administration of written presentation for

treatment, therapies, oral, topical, and
parenteral medications…
that in the practice of nursing in all settings, the
nurse is duty-bound to observe the Code of
Ethics for nurses and uphold the standards of
safe nursing practice.
 OBJECTIVE 8 : Legal protocols

REQUIREMENTS TO BECOME AN IV THERAPIST

A. Entrance Requirements
• Level of academic preparation a BSN, graduate, RN,
with current license from PRC
• Behavioral characteristics: honesty, reliability, initiative,
flexibility, and judgment
• Demonstrates communication and technical skills.

B. Completion Requirement
• 3 days Basic IV therapy Training Program must have
successfully participated
 OBJECTIVE 8 : Legal protocols

PROCESS CRITERIA

• The IV Therapy Program consists of

discussions of concepts in IV therapy and
demonstration of skills in access-related
situations. It has 24-hour didactic lecture and a
practicum with the following evaluation
methods.
• Written examinations: pre and post tests
 OBJECTIVE 8 : Legal protocols

PROCESS CRITERIA

• Completion of the required number of actual

cases for each of the following competencies:
• Initiating and maintaining peripheral IV infusion
(3 cases)
• Administering IV drugs (3 cases)
• Administering and maintaining blood and blood
components (2 cases)
• The participants will be rated as follows:
• Didactic – 50%
• Practicum – 50%
OBJECTIVE 8 : Legal protocols

RECENT UPDATES
Thank You
for
Listening