The document outlines the intravenous (IV) cannulation procedure, including the identification of common insertion sites, types of cannulae, and steps for performing the procedure safely and effectively. It also addresses contraindications, potential complications, and the use of ultrasound guidance for difficult venous access. Key points include proper patient care, equipment handling, and ensuring the safety and comfort of the patient throughout the process.

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Intravenous Cannulation (IV)
Dr. Shamshad
Majmaah university
KSA

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Objectives
1. Identify the common sites of IV cannula insertion
(peripheral & central).
2. Identify the different sizes and shapes of IV cannulae.
3. Insert an IV cannula (peripheral), in a manikin in a
professional way.

3. • Intravenous (IV) cannulation:
A technique in which a cannula is placed inside a
vein to provide venous access.
 Venous access allows sampling of blood, as well as
administration of fluids, medications, parenteral
nutrition, chemotherapy, and blood products.
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4. Patient and Site selection
Depends on : Duration of IV therapy, patient’s activity level,
condition of the extremities.
Avoid Veins: Not resilient , feel hard or cordlike (often
thrombosed).
Avoid arms : Patients who have undergone radical mastectomy,
same side as the surgery (circulation may be impaired , edema and
complications like thrombosis) .
Pediatric patients: Lower extremities veins used
Neonates patients : Scalp veins sets are commonly.
.
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Ease of access:
• Use of the non-dominant extremity
• Avoiding joint areas
• Avoiding use of the lower extremities
Contraindications:
• Pre-existing Vascular Compromise Lymphatic or venous
drainage has been compromised, i.e. lymph node dissection
accompanying mastectomy, A-V fistulas, injured extremities,
thrombosis.
• Regional Infections - overlying cellulitis or infection

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Common sites: Peripheral IV cannula insertion
Head Upper limb Lower limb
External
jugular
vein
Cephalic vein Greater saphenous vein
Basilic vein Dorsal digital vein
Median vein
Metacarpal vein

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Common sites: Central IV cannula insertion
Neck Internal jugular vein
Chest & upper limb subclavian vein & axillary vein
Lower limb: Groin Femoral vein

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Different types of iv cannulation
Scalp vein set

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Color Gauge Size Recommended Uses
14G Trauma, Rapid blood transfusion, Surgery.
16G Rapid fluid replacement, Trauma, Rapid
blood transfusion
18G Rapid fluid replacement, Trauma, Rapid
blood transfusion
20G Most infusions, Rapid fluid replacement,
Trauma, Routine blood transfusion
22G Most infusions, Neonate, Pediatric, Older
adults, Routine blood transfusion
24G Most infusions, Neonate, Pediatric, Older
adults, Routine blood transfusion, Neonate
or Pediatric blood transfusion
26G Pediatrics, Neonate
Orange
Grey
Green
Pink
Blue
Yellow
Purple

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Different parts of iv cannula
1 2
3

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Adhesive plaster
Disposable bin for needle

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1. Introduce yourself to the patient and
clarify the patient’s identity.
2. Explain the procedure to the patient
and gain informed consent to continue.
3. Explain that cannulation may cause
some discomfort but for short period
of time.
Procedure

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4. Sanitize our hands using alcohol cleanser.

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5. Put on your gloves, clean the patient’s skin with the alcohol wipe and let it
dry
6. Position the arm so that it is comfortable for the patient and identify a vein.
7. Apply the tourniquet and re-check the vein.

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8. Remove the cannula from its packaging and remove
the needle cover ensuring not to touch the needle.

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9. Stretch the skin distally and tell the patient to expect a sharp
scratch.
10. Insert the needle, bevel upwards at about 30 degrees.
11. Advance the needle until a flashback of blood is seen in the
hub at the back of the cannula

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12. Once this is seen, progress the entire cannula a further 2mm,
then fix the needle, advancing the rest of the cannula into the
vein.

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13. Release the tourniquet, apply pressure to the vein at the tip of
the cannula and remove the needle fully. Remove the cap
from the needle and put this on the end of the cannula.

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14. Carefully dispose of the needle into the sharps box.
15. Apply the dressing to the cannula to fix it in place and ensure
that the date sticker has been completed and applied.

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16. Check that the use-by date on the saline has not passed.
If the date is ok, fill the syringe with saline and flush it
through the cannula to check for patency.
17. If there is any resistance, if it causes any pain, or you
notice any localized tissue swelling; immediately stop
flushing, remove the cannula and start again.

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18. Dispose of your gloves and
equipment in the clinical waste
bin, ensure the patient is
comfortable and thank them

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Complications :Peripheral IV cannulation
 Infection
 Phlebitis
 Infiltration
 Artery / nerve damage
 Dislocation
 Stenosis

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Complications :Central IV cannulation
 Pneumothorax
 Hemothorax
 Air embolism
 Venous thrombosis
 “Pinch off” syndrome
 Infection
 Artery / nerve damage

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Ultrasound guided venipuncture
• An established technique for both peripherally
inserted central catheters & central venous cannulation.
• With the increasing availability of portable ultrasound facilities,
this may become an option in the future for difficult peripheral
venous cannulations.
• A hand held Doppler probe has been used to identify accurately
forearm veins of more than 2 mm diameter in patients with invisible
and impalpable veins.

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Ultrasound guided venipuncture

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Vein Finders: Optical devices use the behavior of Infrared light to
create an image & superimpose project it onto the viewing area.
Infrared light is projected onto the viewing area and is absorbed at
the locations where blood (veins) reside. Where light is absorbed
there is less light reflected.