2. INTRODUCTION
IV cannulation is the second most invasive
procedure for patients in hospital.
Today -85% - 95% of all hospitalised patients
receive IV’s in one form or another
3. INDICATIONS
• Administration of anaesthesia.
• Administration of fluids.
• Administration of medications.
• Administration of blood or blood products.
• Radiological imaging using IV contrast
4. CONTRAINDICATION
• Sites close to infection
• Veins of fractured limbs
• Where there is an AV fistula present
• Oedema
• Affected side of CVA
• Side of Mastectomy
Extra care to be taken on patients with bleeding, clotting disorders & on
warfarin.
5. SITE
VEIN SELECTION
Where:
- Back of hand
- Forearm
- Antecubital fossa
What:
- Patent - Palpable
- Distal - Straight
- Avoid bifurcations
6. AREAS TO BE AVOIDED
• Areas of joint flexion
• Hardened/sclerosed veins
• Major veins near arteries
• Veins in lower extremities
• Areas of surgery
• Small veins
• Previously cannulated veins
7. LOCATION OF VEINS IN ARM & FOREARM
Veins of the Hand
1. Digital Dorsal veins
2. Dorsal Metacarpal veins
3. Dorsal venous network
4. Cephalic vein
5. Basilic vein
Veins of the Forearm
1. Cephalic vein
2. Basilic vein
3. Median Cubital
8. CANNULA TYPES
Size Colour Coding Flow Rate Uses
14G Orange 240ml/min
Trauma Patients. Rapid, Large-volume
replacement
16G Grey 180ml/min
Trauma Patients, Major Surgery, Intra
partum/Post partum, GI bleeds, Multiple
blood transfers, High volume of fluids
17 G White 125ml/min Newly added
18G Green 90ml/min
Blood products, delivery of irritant
medications, major surgery, contrast study
20G Pink 60ml/min
General use,IV maintenance, IV antibiotics,
IV analgesia
22G Blue 36ml/min Small or Fragile veins, Cytotoxic therapy
24G Yellow 20ml/min For paediatric usage
26G Violet 13ml/min Newly added
9. SUGGESTED EQUIPMENT FOR PIVC INSERTION
• Cleaned procedural trolley.
• Sterile dressing pack or IV starter pack.
• Tourniquet: either a single use disposable or single patient use.
• Gloves
• Alcohol swab
• Appropriate sterile adhesive butterfly strips
• 10mL syringe or commercially available prefilled syringe for flush
• 2ml hep-lock syringe
• Sterile gauze squares
• Sharps disposal bin.
• It is the responsibility of the clinician inserting the PIVC to ensure items have not
passed their expiry dates and that the integrity of the packaging has been maintained.
10. PROCEDURE
Explain procedure to the patient.
Wear personal protection equipments, i.e. gloves, apron (if required)
Select the location according to the procedure
Apply tourniquet
Make the selected vein prominent & clean the area with betadine solution.
Clean the area with alcohol swab
Stretch the skin and fix the vein
Insert the cannula at 45 degree to the vein.
Once cannula is inserted check the patency by using an IV flush.
Fix the cannula by using Tagaderm/ butterfly sticking.
Dispose the biological and plastic waste
11. NEW METHODS
AccuVein’s Illumination is the new infra-red device used
for venipuncture in the patients with difficult venous
access that include Elderly, Dark-skinned and Obese
individuals.
