Presentation by

Dr. Vishal Kr. Kandhway

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

INDICATIONS

• Administration of anaesthesia.

• Administration of fluids.

• Administration of medications.

• Administration of blood or blood products.

• Radiological imaging using IV contrast

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.

SITE

VEIN SELECTIONWhere:

- Back of hand

- Forearm

- Antecubital fossa

What:

- Patent - Palpable

- Distal - Straight

- Avoid bifurcations

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

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

CANNULA TYPES

Size Colour Coding Flow Rate Uses

14G Orange 240ml/minTrauma Patients. Rapid, Large-volume replacement

16G Grey 180ml/minTrauma 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/minBlood products, delivery of irritant medications, major surgery, contrast study

20G Pink 60ml/minGeneral 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

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.

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

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.

COMPLICATIONS

• Hematoma

• Haemorrhage

• Infection

• Phlebitis

• Thrombophlebitis

• Puncturing an artery

• Puncturing a nerve

• Infiltration

• Extravasation

A VIDEO GUIDE