1. Intravenous cannulation

2. What is IV cannulation? Intravenous cannulation is a technique in which a cannula is placed inside a vein to provide venous access. Venous access allows: sampling of blood administration of IV fluids and medications,

3. Cannula This device is available in various gauges (16-24 G), lengths (25-44 mm), compositions, and designs.

4. Cannula Gauge Size 22 Gauge: 0.8 mm 20 Gauge: 1.0 mm 18 Gauge: 1.2 mm 16 Gauge: 1.7 mm

5. Tips Routinely, use the smallest size (largest gauge number) of catheter if possible to prevent damage to the vessel intima In an emergency situation use a large gauge catheter to allow administration of large volumes of fluid quickly

6. Tips The superficial veins of the upper extremities are preferred to those of the lower extremities for peripheral venous access they interfere less with patient mobility and pose a lower risk for phlebitis.

7. Tips It is recommended to choose a straight portion of a vein to minimize the chance of hitting valves. Use the patient’s non- dominant arm (if possible) For prolonged courses of therapy, it is recommended to start distally and move proximally as distal catheters are replaced.

8. Indication Repeated blood sampling Intravenous administration of IV fluids Medications Chemotherapy Nutritional support Blood or blood products administration Radiological contrast agents for computed tomography, magnetic resonance imaging, or nuclear imaging

9. Contraindications No absolute contraindications to intravenous cannulation exist Avoid peripheral venous access in an injured, infected, or burned extremity if possible

10. Equipment Non-sterile gloves Tourniquet Antiseptic wipes 5-ml syringe Sterile gauze Cannula Saline Adhesive Plaster

11. Before the procedure 1.Introduce yourself to the patient. Explain the procedure to the patient and gain informed consent to continue 2.Make sure there is adequate light and that the room is warm enough to encourage vasodilation 3.Make sure the patient is in a comfortable position and place a pillow or a rolled towel under the patient’s extended arm 4.The patient’s skin should be washed with soap and water if visibly dirty

12. Before the procedure 5.If difficulty is encountered in finding an appropriate vein, one of the following techniques may be used: Inspection of the opposite extremity Opening and closing the fist Using gravity (holding the arm down) Gentle tapping or stroking of the site Applying heat (warm towel/pack)

13. Technique 1.Apply tourniquet and select the appropriate vein 2.Apply an antiseptic solution with friction for 30-60 seconds, allow to air dry for up. Once cleaned, do not touch or repalpate the skin 3.Remove the cannula from its packaging and remove the needle cover ensuring not to touch the needle 4.Stretch the skin distally and tell the patient to expect a sharp scratch

14. Technique 5.Insert the needle, bevel upwards at about 30 degrees 6.Advance the needle until a flashback of blood is seen in the hub at the back of the cannula 7.Once this is seen, progress the entire cannula a further 2mm, then fix the needle, advancing the rest of the cannula into the vein

15. Technique 5.Insert the needle, bevel upwards at about 30 degrees 6.Advance the needle until a flashback of blood is seen in the hub at the back of the cannula 7.Once this is seen, progress the entire cannula a further 2mm, then fix the needle, advancing the rest of the cannula into the vein

16. Technique 8.Release the tourniquet, apply pressure to the vein at the tip of the cannula and remove the needle fully 9.Remove the cap from the needle and put this on the end of the cannula 10.Carefully dispose of the needle into the sharps box

17. Technique 11.Check function by flushing with saline. 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 12.Apply the plaster to the cannula to fix it in place 13.Finally, ensure that the patient is comfortable and thank them

18. Complications Pain Failure to access the vein Blood stops flowing into the flashback chamber Arterial puncture Thrombophlebitis Hypersensitivity reaction Peripheral nerve palsy Skin and soft tissue necrosis When some irritant solutions leak into the tissue e.g. chemotherapeutic agents More safely infused into a central vein

19. Complications Thrombophlebitis

20. Complications Thrombophlebitis Hypersensitivity reaction Peripheral nerve palsy

21. Complications Thrombophlebitis Hypersensitivity reaction Peripheral nerve palsy Skin and soft tissue necrosis When some irritant solutions leak into the tissue e.g. chemotherapeutic agents More safely infused into a central vein

22. Intravenous fluid

23. Indications Maintain or replace body store Restore acid abase balance Restore the volume of blood component Administer of medication Provide Nutrition Monitor CVP

24. Equipment Tray Sterile syringes Spirit swabs Drip stand Drip + set

25. Technique Introduce yourself to the patient. Check the patient’s name and the type of fluid to be given Explain the procedure to the patient and gain informed consent Prepare your equipment Assemble the tubing solution according to the manufacturer’s instruction

26. Technique Let out the air from the tubing by letting some of the fluids run down the tubing Close the drip set to prevent fluid from flowing out Hang the bag in the drip stand Open the cannula and connect it to the drip Adjust the drips according to the appropriate dose (X drops per minute) Check regularly to see that the fluid is dripping at the same rate and that fluid is going in to the vein properly and that the puncture site is not swollen.

27. Types Of IV Fluids 1. CRYSTALLOIDS Isotonic 0.9% Sodium Chloride (NS) Lactated Ringers Dextrose 5% in Water (D5W) Hypotonic 0.45% Sodium Chloride Hypertonic 5% Dextrose in NS 5% Dextrose in Lactated Ringers 5% Dextrose in 0.45% ½ NS 10% Dextrose in water 2. COLLOIDS (plasma expanders) Albumin Plasma Protein fraction Dextran Hetastarch

28. Blood Transfusion

29. Indications Treatment of anaemia Treatment of coagulation, platelet disorders Treatment of hypovolemia

30. Before the procedure Two people to check details (name, blood group and compatibility) Blood transfusion report form; Unit(s) of blood Patient with IV access and wrist ID band Sterile blood giving set Prepare adrenaline, antihistamine and hydrocortisone beside the patient Warm the blood

31. Technique Introduce yourself to the patient Explain the procedure and indication Gain verbal consent Ensure patient has patent venous access by running NS through Check equipment – Correct unit of blood and blood giving set With a partner – check patient’s name, blood group and number of units of blood to be given

32. Technique -2 Put on gloves Attach unit of blood to giving set and run through blood correctly emptying the air in the set Connect the blood giving set to cannula; Secure the giving set and cannula with bandaging. Ensure blood is flowing and set at correct rate Inform nurses blood is running and to make sure routine observations are made. If any reaction has occurred the nurse should stop the transfusion and call the doctor on call immediately

33. Calculating the rate Drip Rate (drop/min) = Volume to be infused (ml) x Drop Factor (drp/ml) Time (minutes)

34. Blood products Whole Blood Packed Cells Platelets Fresh Frozen Plasma (FFP) Cryoprecipitate

35. Complications A. Acute complications: Acute intravascular hemolysis Febrile non-hemolytic reactions Allergic reaction and anaphylaxis Septicemia Transfusion Related Acute Lung Injury (TRALI) Hypothermia (why? – How to avoid?) Volume overload

36. Complications B. Delayed complications Delayed haemolytic transfusion reaction Transfusion associated Graft versus Host disease Post Transfusion Purpura Citrate Intoxication and Hyperkalemia Infectivity-Hepatitis B & C, HIV, CMV, Syphilis and malaria

37. Summary IV cannulation is a very common daily procedure Used to obtain blood samples, insert IV fluids, medications, nutrients, and blood transfusion and blood products Could be life-saving Should be performed following proper procedure to avoid problems and complications