DEMONSTRATION

ON IV
CANNULATION
ANUSHA THOMAS
1ST YEAR MSc NURSING
 SPECIFIC OBJECTIVES
Describe the basic anatomy and physiology of skin, blood
vessels and the superficial veins of the arms and hands
Differentiate vein from artery
Define venipuncture
Enlist the purposes of IV cannulation
Enumerates the contraindication of IV cannulation.
Identify the proper site of IV cannulation
Discuss patient education and assessment prior to
venipuncture.
Locate and assemble required equipment for IV cannulation.
Describe the procedural techniques for a safe venipuncture.
Demonstrate critical thinking relevant to managing the risks
 ANATOMY
AND
PHYSIOLOGY
Blood vessel, a vessel in the human body in
which blood circulates.
The vessels that carry blood away from
the heart are called arteries, and its small
branches are arterioles.
Very small branches that collect the blood
from the various organs are called venules,
and they unite to form veins, which return the
blood to the heart. 
Capillaries are minute thin-walled vessels
that connect the arterioles and venules; it is
through the capillaries that nutrients and
wastes are exchanged between the blood and
body tissues.
 Vein Artery

Color of blood Dark red Bright red

Pulsation Absent Present

Valves Present Absent

Location Superficial and Deep only

deep
ANATOMY OF A VEIN
IV CANNULATION /
VENIPUNCTURE
DEFINITION OF VENIPUNCTURE-

The process of puncturing a vein, with a needle,

using aseptic technique.
 PURPOSES

1. To administer fluids intravenously.

2. To administer bolus medication for treatment.
3. To draw blood specimen.
4. To administer total parentral nutrition.
5. To administer blood and blood products.
6. Intravenous administration of radiological
contrast agents
CONTRAINDICATIONS
SITE FOR VENIPUNCTURE
a) Selection
 Site selection for venipuncture depends on:
(1) Accessibility of the vein- A vein should be relatively
easy to feel and to stabilize for venipuncture. If this task is
too difficult, select another vein.
(2) General condition of the vein- If the vein is in good
condition, it will easily take the venipuncture. If the vein is
poor, it may collapse upon puncture.
(3) Type of fluid to be infused- If the fluid used is
especially irritating, a different site will be suitable from the
sites, which can be used for non-irritating fluids.
(4) Period the intravenous line is expected to be in
place- Long-term intravenous therapy will often require a
different site from the ones that can be used if a single
bottle or bag of fluid will be used.
 b) Preferred Sites
The following sites are generally used and preferred for use
by most in the clinical setting it is possible to select
preferable veins for puncture.
(1) Distal to the antecubital area (that is, cephalic, basilic,
antebrachial veins in the lower arms).
(2) Veins on the back of the hand.
(3) Veins in the lower extremities when necessary although
danger of thrombophlebitis is considerably greater.
(4) The leg and foot veins may be used on children because
these vessels are not sclerosed.
(5) Scalp veins are used in infants.
CAUTION: Select the largest vein, if possible, when
injecting intravenous drugs that may produce
sloughing/necrosis injury to the tissues.
 Veins of the Hands and Wrist
1. Dorsal digital veins
Found along the lateral
portion of the fingers and thumb
Veins small & fragile
 
Clinical Considerations-
Last resort cannula site, as subject to mechanical
phlebitis.
To be cannulated only by an expert clinician.
If used, must be immobilized by a finger splint.
2. Dorsal metacarpal veins
Between the metacarpal bones on the back of the hand.
Superficial veins usually of good size and easily visualized.

Clinical Considerations-
Good site to start IV therapy for some patients Can accommodate 24-20g cannula.
Tip of catheter should not extend over wrist joint. Catheter should lie flat on the back of hand
Hub of catheter should not extend over knuckles.
Should not be used for vesicant medication/ fluids.
 
3. Dorsal venous network
Formed by the union of metacarpal veins, on the
dorsal aspect of the forearm.
Not always prominent.

Clinical Considerations-
Comfortable site for the patient.
Can accommodate 24-20g cannula
Angle of the vein may deter choice of site.
Avoid placement over the wrist/ prominent ulna
bone which can cause mechanical phlebitis or
dislodgement.
Should not be used for vesicant medication/ fluids.
Veins of the Forearm
1. Cephalic Vein
Location- Runs the entire length of the arm from
the wrist to the shoulder.
Located above antecubital fossa, may be difficult to
visualize.
Clinical Considerations-
Accommodates 22-18g cannula Excellent choice
for cannulation.
Should not be used for patient that require fistula
formation.
Radial nerve runs parallel so avoid wrist area.
2. Median Cubital Vein
Lies in antecubital fossa.
Large vein, easily visualised and accessed.

Clinical Considerations-
Usually used to draw blood.
Veins of choice for trauma or shocked patients
as they can accommodate a large bore cannula
16- 14g.
Limited use for short peripheral cannula due
to joint articulation, limit to patient mobility
and difficulty of detecting infiltration.
Complications at this site mean that veins
below this point are not recommended.
3. Accessory Cephalic Vein

Branches off the cephalic vein Located on the top

of the forearm.
Usually good size.

Clinical Considerations-
Easily stabilized.
Accommodates 22-18g cannula.
Avoid catheter tip placement at joint articulation.
 4. Basilic Vein
Runs the entire length of the arm from the wrist to
axilla.
Depicted in the diagram along medial aspect of
upper forearm.

Clinical Considerations-
Can accommodate 22-16g cannula.
Vein rotates around the arm and requires firm skin
tension to stabilise vein
Increased success can be achieved by placing the
patients arm across their chest and approaching
from the opposite side of the bed.
 5. Cephalic Vein
Clinical Considerations-
If accessing the cephalic vein, have the patient flex
the forearm at the elbow (this will also enhance
venous filling and minimize “rolling ‟) and face the
patients feet to work on the exposed underside of
the arm.
Alternatively have the arm fully extended and
supinate the arm with palm up.
 6. Median Antebrachial Vein
Arises from the palm of the hand, flows upward in
the centre of the underside of the forearm.
Medium size & generally easy to visualize.

Clinical Considerations-
Accommodates 24-20g cannula
May be difficult to palpate.
Runs in close proximity to the nerve.
Cannula size for IV cannulation
•16G - Rapid transfusion of whole blood or blood
components
• 18G - IV maintenance, NBM patients
• 20G - IV analgesia
• 22G - Paediatrics, elderly, chemotherapy patients
• 24G - Paediatrics, neonates
PRE- PREPARATION
Assessing & preparing the
patient
Check patient for baseline vital signs, diagnosis
and allergies to medications, cleansing fluids &
dressings
• Provide a clear explanation of the procedure
including potential complications.
• A relaxed patient is generally easier to
cannulate.
• Assess the dominant/non-dominant side and
check the veins for status and suitability.
Preparing equipment
• Equipment should be gathered on trolley in
treatment room with sharps container .
• IV fluids should be prepared by priming the
giving set .
• The equipment should not be opened until in
the patient’s room and patient education,
assessment of vein and appropriate positioning
has been attended
 Positioning the patient
• If possible use the non dominant arm.
Raise bed prior to procedure .
• Place the arm in a supported comfortable
position.
• Use a tourniquet to find vein but release it
while you are getting equipment ready.
• Position patient with pillows or towels. Have
IV trolley close by.
ARTICLES USED
A tray containing-
1. IV cannula (size depending on need)
2. Gloves (clean)
3. Cotton swabs in a bowl with antiseptics.
4. Tapes for fixing IV catheter.
5. Cannula (size depending on need)
6. Syringe 5ml with 0.9% Normal saline
7. Tourniquet
8. Mackintosh for protecting linen.
9. Sharp container and waste bag
PROCEDURE
1. Perform hand hygiene. ( Prevent transfer of micro-
organisms)
2. Select venipuncture site.
Unless contraindicated select the non-dominant arm of the
client.
Look for veins that are relatively straight. Consider catheter
length so that the wrist/elbow will be away from the catheter tip.
(It is difficult to initiate and maintain IV access if using sclerotic
veins. Joint flexion increases risk of irritation of the vein walls by
the catheter)
3. Dilate the vein
a) Place extremity in a dependent position (Gravity slows
venous return and distends the vein )
b) Apply a tourniquet firmly about 15 to 20cms above the
vein puncture site, explain that tourniquet will feel tight.
The tourniquet must be tight enough to obstruct the
venous flow but not tight enough to obstruct arterial
supply. ( Distending the vein makes insertion of needle
c) If the vein is not sufficiently dilated, massage/stroke the
vein distal to the site in the direction of venous flow
towards the heart. (This action helps in filling the veins)
d) Encourage the client to clench and unclench the fist
(Contracting the muscles compresses the distal veins, forcing blood
along the veins and distending them )
e) Lightly tap the vein (Tapping the vein may distend it )
f) If all the above steps fail, remove the tourniquet and apply
Warmth to the veins by • Rubbing • Washing client’s hands
under warm water • Apply warmed towel.
( Heat dilates superficial vein causing them to fill)
4. Don sterile gloves (Prevents infection and nurses from
exposure to blood)
5. Clean venipuncture site
a. Clean with antiseptic swab from the center out-ward in
circular motion for several inches. (This movement carries
micro-organisms away from site of entry)
b. Permit the solution to dry on the skin ( It avoids irritation of
the skin)
6. Insert the needle of the IV cannula
a. Use non-dominant hand to pull the skin taut below the
entry site (This stabilizes the vein and makes skin taut for
needle entry)
b. Hold catheter/needle at a 15 to 30 degree angle with
bevel up, insert the catheter through the skin and into.
(Holding the needle at 15 to 30 degree reduces the risk of
counter puncture)
c. Once blood is seen in the lumen or when a lack of
resistance is felt, reduce the angle of the catheter till it is
almost parallel to the skin and advance the needle and
catheter appropriately 0.5 to 2cm. ( Reducing the angle of
catheter lowers the risk of counter puncture)
d. Release the tourniquet
e. Put pressure on the vein proximal to the catheter to
eliminate or reduce blood oozing out of the catheter. Stabilize
the hub with thumb and index finger of the non-dominant
hand.
 e. Remove needle from inside the angiocath completely
and attach syringe with 0.9% NaCl. (To check the patency of
the cannula)
g. Carefully remove the needle, engage the needle safety device.
7. Tape the catheter using 3 strips of adhesive tapes.
(prevents dislodgement of needle)
- Place one strip with the sticky side up under the catheter
hub.
- Fold over each side so that sticky sides are against the skin.
- Place 2nd strip sticky side down over catheter hub.
- Place 3rd strip sticky side down over the catheter hub.
8. Dress and label the venipuncture site as per agency
policy. (reduces the risk of infection)
a. Place a sterile gauze piece with povidone-iodine over the
venipuncture site. Apply occlusive dressing over the site.
b. Label the dressing with date, time of insertion , size of
needle, catheter used and initials.
9. Remove gloves and wash hands.
AFTER PROCEDURE
1. Ask the patient if he is comfortable.
2.Explain the patient about the
complications of IV cannulation.
3. Instruct the client to immediately report
if he experience any discomfort at the IV
cannulation site.
CARE OF ARTICLES POST
PROCEDURE
1. Discard the sharps and
syringes into puncture proof
container.
2. Discard the soiled cotton
swabs into dustbin.
3. Discard the soiled gloves into
dustbin.
4. Send the mackintosh if soiled
for disinfection.
 DOCUMENTATION
Proper documentation should be done in Nurses
Notes of the client which includes-
Site of insertion-vein and arm/hand
Type and gauge of cannula
Date and time of insertion
Reason for IV therapy
COMPLICATION
 Extravasation -The infiltration of a drug
from an I.V. line into surrounding tissue.
CAUSES
• Catheter erodes through the vessel wall at a second point
• Increased venous pressure causes leakage around the venepuncture site
• When a needle pulls out of the vein.
• Vesicant drugs/solutions may cause severe tissue injury
SIGNS & SYMPTOMS
• Oedema and changes in the site's appearance
• Coolness of the skin.
• Slowing of infusion
• Pain or a feeling of tightness around the site.
• Possible consequences include necrotic ulcers, infection, disfigurement, and loss of
function.
INTERVENTION
• Remove cannula
• Elevate affected arm
• Apply ice pack (early) or warm compress (late)
 Hematoma- Localised collection of extravasated
blood, usually clotted, in an organ or tissue
Cause
• Blood leaking out of the vein into the tissue due to puncture
or trauma
Signs & Symptoms
• Swelling, tenderness and discolouration
Prevention • Proper device insertion • Pressure over site on
removal of cannula
Intervention • Apply appropriate pressure bandage,
monitor the site
Phlebitis -Inflammation of the vein
Cause
• Poor aseptic technique
• High osmolarity I.V. infusions or drugs
• Trauma to the vein during insertion/incorrect cannula gauge
• Prolonged use of the same site
Signs & Symptoms
• Tenderness, redness, heat and oedema
• Advanced-induration, palpable venous cord
Intervention
• Remove cannula
• Apply warm compress
• Observe for signs of infection
• If phlebitis is advanced antibiotics may be required
 Venous spasm - Spasm of the vein wall
Cause
• Patient anxiety
• Cold I.V. fluids
• Drug irritation
• Trauma to the vein during cannula insertion
Signs & Symptoms
• Pain
• Slowing of the I.V. infusion
• Blanching at the insertion site
• Vein difficult to palpate
Intervention
• Apply warm compress • Slow the infusion rate • Reassure the patient
Occlusion Slowing or cessation of fluid
infusion due to:
• Fibrin formation in or around the tip of the
cannula
• Mechanical occlusion (kink) of the cannula
Cause
• Cannula not flushed
• Kinking of the cannula
• Back flow or interrupted flow
Signs & Symptoms
• I.V. not running
• Blood in the line • Discomfort
Intervention • Check for kinks in cannula • Raise IV higher •
Remove cannula.
 Thrombophlebitis -Formation of a thrombus
and inflammation in the vein, usually occurs
after phlebitis.
Cause
• Injury to the vein
• Infection
• Chemical irritation
• Prolonged use of the same vein
Signs & Symptoms
• Tenderness/redness
• Heat/oedema
• Cordlike appearance of the vein
• Slowing of the IV infusion
Intervention • Remove cannula • Observe for signs of infection •
Change cannula frequently (48-72hrs)
Infection- Pathogen in the surrounding tissue
of the I.V. site.
Cause
• Lack of asepsis
• Prolonged use of the same site
Signs & Symptoms
• Tenderness and swelling
• Erythema/purulent drainage
Intervention • Remove cannula • Antibiotics may be
required.
BIBLIOGRAPHY
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