8. Upper limb veins
Cephalic vein - Close to ;
Radial artery at wrist
Brachial artery at elbow
Basilic vein - Close to ;
Brachial artery at elbow and arm
9. Upper limb veins
Cephalic vein - Close to ;
Radial artery at wrist
Brachial artery at elbow
Basilic vein - Close to ;
Brachial artery at elbow and arm
11. Cannula Insertion Procedure
Explain the procedure
Select the appropriate size cannula
Get all the equipment ready
12. The sites to avoid
Wrist, feet, ankle
Veins below a previous IV infiltration
Phlebitic area or thrombosed veins
Inflamed skin
An arm with oedema, DVT, infection
Arm with AVF
13. Cannula Insertion
Surgical spirit
Gloves
Tourniquet
An IV cannula
Plaster
A syringe
Saline ,IV set and prime
Kidney tray
14. Cannula Insertion
Position the patient keep arm in a comfortable position
Look for any abnormalities at the cannulation site , variations
Apply tourniquet identify the vein
Wear the glove and clean the site
15. Cannula Insertion
Take the cannula open the wings of the cannula and hold the
cannula between the thumb index and middle fingers
Stretch the skin distal to the site of insertion and insert the
cannula at 30°
16. Cannula Insertion
Inspect for the flashback of blood in the hub
Then insert the cannula a little more and then
withdraw the needle and advances cannula into vein
Keep the pressure at the tip of the cannula and put
the cap to the hub
Check for function
18. Complications of cannulation
Accidental intra arterial cannulation
Infection
Extravasation and compartment syndrome
Fracture and retention of part of the cannula
/embolisation
21. INFECTION PREVENTION
Hand disinfection
Sterile gloves
Disinfect the skin insertion site.
Cover with sterile dressing
Remove catheter if signs of infection occur
Change dressing only when necessary
Close ports that are not needed with sterile caps
25. Intra-arterial cannulation / injection of
drugs
Results in thrombosis by;
Spasm
Trauma to the vessel wall and thrombosis
Occlusion of the vessels by particles in the drug
Crystallization of the drug after injection
Endothelial injury - chemical arteritis resulting in platelet
adhesions
High osmolarity causing vessel injury
26. Prevention of intra-arterial
cannulation / injection
Knowledge about the anatomical variations ·
Avoiding cannulation close the known neurovascular bundle
e.g. cubital fossa
27. Prevention of intra-arterial
cannulation / injection
Recognition of intra-arterial cannulation in
case of accidental insertion of a cannula.
When the cannula is within the artery -
flashback of bright red blood
28. If the cannula is within the artery …………………..
There will be a pulsatile back bleeding of bright red blood
There may be a hematoma formation
If the cannula is connected with the infusion set or a syringe there will
be back flow of blood into these under high pressure
Pain along the arm to fingers with injection
31. If the cannula is within the artery …………………..
If accidental intra-arterial cannulation is recognised
Cannula should be immediately removed
Apply local pressure
The distal circulation should be monitored.
Arudchelvam J, Marasinghe A (2019) Accidental Intra-Arterial Injection of a Drug in a Patient with Radial Artery Variation; A
Rarity Leading to a Disaster. J Clinical Case Rep Case Stud 2019: 66-68.
32. In case of accidental intra-arterial
injection
Do not remove the cannula
the same cannula which was used for injection can be
used………..
to flush the artery with heparin saline
for injection of thrombolytic agents
for injection of vasodilators
can also be used to perform an angiography
33. In case of accidental intra-arterial
injection
Treatment options
Analgesics
systemic heparinization
Catheter directed intra-arterial thrombolysis (with
streptokinase, urokinase)
systemic use of dextran and steroids
Surgical interventions - thrombectomy or bypass
36. CANNULA TIP (CATHETER) FRACTURE
The migration and embolization - both towards
and against the flow of blood.
Results in
Thrombosis
Infection
Embolisation
Arrhythmia
39. Cannula tip (catheter) fracture
Associated with
Insertion at mobile sites
longer duration of use
Poor technique of insertion
Multiple attempts at cannulation
Repeated reinsertion of needle
40. Prevention
Avoid Insertion at mobile sites
Avoid longer duration of use
Poor technique of insertion
Repeated reinsertion of needle
Detect and inform