Peripheral Cannulation

1. Clinical
Perspective
IV Cannulation
By Ms.Ṇikethana R Nair,M.Sc, MBA, M.Sc, M.Phil,
NABH Assessor, Nursing Superintendent,
Meenakshi Mision Hospital & Research Center -
Madurai.

2. Definition
Intravenous cannulation is a technique in
which a cannula is placed inside a vein to
provide venous access.

3. Types of Cannula
• IV Cannula Pen Type Model
• IV Cannula with Wings Model
• IV Cannula with Injection Part Model
• IV Cannula Y Type Model
• Scalp Vein Cannula

5. Gauge Size & Shades
No. Colour Gauge Length
(mm)
Flow Rate
ml/min
1 Orange 14 2.0 (45) 270
2 Grey 16 1.7 (45) 180
3 Green 18 1.2 (45) 80
4 Pink 20 1.0 (32) 60
5 Blue 22 0.8 (25) 31
6 Yellow 24 0.9 (19) 19
7 Violet/Purple 26 0.6 (19) 14

6. Closed Cannulae Parts

7. Types of Fixator

8. Structure of Vein

9. Why Veins are Suitable for Insertion
• Superficial
• Palpabe
• Visible
• Blood at Low Pressure
• Relatively Large internal Diameter
• Tough Vasuclar Wall - Able to form a seal
around the cannula
• Offer a Rapid Route - Circulatory system

10. Signs of Good Vein
1. Bouncy
2. Soft
3. Above Previous Vein
4. Refills when Depressed
5. Visible
6. Has a Large Lumen
7. Well Supported
8. Staright
9. Easily Palpable

11. Tips
No. Features Rational
1 Smallest size of catheter
2 EMR situation use a large
gauge catheter
3 Upper Extremities
4 Lower extremities
5 Peripheral venous access
interfere less with pt's
6 Recommended to choose a
straight portion of a vein
7 Use the patient's non-dominant
arm
8 For prolonged courses of
therapy it is recommended to
start distally & move
proximally as distal catheters
are replaced.

12. Tips
No. Features Rational
1 Smallest size of catheter To prevent damage to the vessel intima
2 EMR situation use a large
gauge catheter
To allow administration of large volumes
of fluid quickly
3 Upper Extremities The superficial veins
4 Lower extremities Peripheral venous access
5 Peripheral venous access
interfere less with pt's
Mobility & pose a lower risk for
phlebitis
6 Recommended to choose a
straight portion of a vein
To minimize the chance of hitting valves
7 Use the patient's non-dominant
arm
Convenience, Further damage is been
prevented
8 For prolonged courses of
therapy it is recommended to
start distally & move
proximally as distal catheters
are replaced.
 Distal Damage - Proximal is available
for the further line
 Proximal As first Line - Distal u cant
get the line for the therapy

13. Indications
• Repeated blood sampling
• IV fluids
• Medications
• Chemotherapy
• Nutritional Support
• Blood or Blood products administration
• Radiological contrast agents for CT, MRI or
nuclear imaging

14. Contraindications
Avoid Peripheral Venous Access in
1.An injured,
2.Infected,
3.Burned extremity - if possible

16. Volar Wrist & Dorsal Wrist

17. Lower Limbs

18. Scalp Veins - PAEDIATRICS

20. Inappropriate Sites
• Edematous Site
• Haematous
• Scarred Sites
• Arms with Fistula's or Vascular Grafts
• Thrombosed
• Fibrosed
• Thin & Fragile
• Near Bony Prominises
• Have undergone Multiple Pricks

21. Equipment
• Non-sterile gloves
• Tourniquet
• Antiseptic or Alcohol wipes
• Anaesthetic Agent
• 5-ml syringe with NS or Poshi
Flush (3ml or 5ml)
• Sterile gauze
• Cannula
• Saline
• Tegaderm or Dynaplast or Easy
Fix
• Vein Deductor

22. Advance Techniques
Red - SP Saline Syringe
Blue - Xs Saline Syringe

23. Topical Anesthesia for IV Insertion
• Lidocaine
• Buffered lidocaine
• Bacteriostatic normal saline

24. Before The Procedure
• Introduce yourself to the patient.
• Explain the procedure to the patient & gain informed
consent to continue
• Make sure there is adequate light & that the room is
warm enough to encourage vasodilation
• Make sure the patient is in a comfortable position
• The patients skin should be kept clean for the procedure

25. Standard Precautions

26. Steps of Procedure

27. Steps of Procedure

28. Steps of Procedure

29. Steps of Procedure

31. Stop & Remove

32. Cannula Placement

33. IV Cannulation in Fragile Veins
• Say no to tourniquet as much as possible
• Use the smallest catheter as much as
possible - 20 to 22g
• Use Bevel Up, Low Angle & Slowly but
surey approach
• Secure the catherter with Micropore or
Transparent dressing
• Provide Health Education

34. IV Cannulation for the Geriatrics
• Extremely Challenging
• Avoid applying too much friction when
preparing the skin
• use the smallest catheter
• Know the veins depth
• If possible do not use tourniquet,
Incase use a soft material ones
• stabilise the vein & insert the
catheter on top of the vein
• Hypoallergic Tape tape to be used

35. Documentation
• Date & Time
• Site & Size of the Cannula
• Any Problems Encountered
• Notes Eaxmple:
• 22/8/19 @ 3pm: Inserted 16G Needle under
Clean Techique in a single prick in Rt
Metacarpel region by S/N XX,Pt cooperated,
Back Flow Present, Flushed with 5ml Poshi
flush or NS,Line Intact & Patent,Line
Secured with dynaplast & labelled with
date & time. Score: I 0/4 & P 0/5

36. • 22/8/19 @ 3pm:Inserted 20G Needle under Clean
Techique in Lt anaesthetist vein. First prick
failed since there was no back flow or
infiltration present in Lft Cephalic Vein by
S/N xyz.
• By 2nd prick line was secured by Anaesthetist
XXXX. Pt was irritable.
• Back Flow Present, Flushed with 5ml Poshi flush
or NS,Line Intact & Patent
• Line Secured with Tegaderm & labelled with date
& time.
• Score: I 0/4 & P 0/5

37. Complications
• Pain
• Cannula Clott
• Blood stops flowing into the flashback chamber
• Arterial puncture
• Hypersensitivity reaction
• Peripheral nerve palsy
• Thrombophlebitis
• Phebilitis
• Infiltration
• Extravasation

39. VIPS (Visual Infiltration Score)

40. Phebilitis Scale

41. Crub the Hub

42. Purpose
To administer the appropriate amount of
fluid to the patient
To prevent fluid overload & fluid
deficiency
To prevent, treat & support the
patient’s condition with the help of
correct administration of fluid.

43. Formula
Amt of fluid to be infused (X)DF
No. of hours to be flown (X) 60

44. Macro Drops
1ml = 15 macro drops.
1macro drop = 4 micro drops.
15 macro drop = 15*4 = 60 micro drops.

45. Example: Ordered Amount
• 6 pints for 24 hours
• One Pint = 24 / 6 = 4 Hours (500 ml /
4hour)
• Per hour = 500 / 4 = 125 ml / hour
• Amt of fluid to be infused * DF
No. of hrs to be flown * 60
• 125*15 = 1875 = 31.25
1*60 60

46. Ready Reckoner
• 50ml /hour = 12.5(13 drops/min)
• 75ml / hour = 18.7 (19 drops / min)
• 100ml / hour = 25 drops / min
• 125ml / hour = 31.2(31 drops / min)
• 150ml / hour = 37.5 ( 38 drops / min)
• 200ml / hour = 50 drops