Peripheral venous cannulation

Introduction

• Wash hands
• Introduce self
• Patient’s name, DOB and wrist band
• Explain procedure and obtain consent
• Check for allergies (including chlorhexidine)
• Ask preferred (or non-dominant) arm 

Preparation 

• Wash hands 
• Clean tray
• Gather equipment around tray (think through what you need in order)

Equipment list

• Gloves x 2
• Disposable tourniquet
• Alcohol 70%/chlorhexidine 2% skin-cleansing wipe
• Cannula (a pink 20G cannula is appropriate for most average sized adult patients)
• Sterile gauze
• Cannula dressing
• Pre-prepared saline flush (or 10ml 0.9% saline + 10ml syringe + blunt fill 18G drawing-up needle) – CHECK DATE
• Cannula IV extension set (+ alcohol 70%/chlorhexidine 2% device disinfection wipe)
• Tape

• Wash hands
• Open packets and place neatly in tray, keeping items in plastic parts of packets (without touching the instruments themselves)
• If flush is not pre-prepared:
  • Wash hands, put on apron and 1^st pair of gloves 
  • Put needle on 10ml syringe and draw up the 10ml 0.9% saline (holding the saline bottle upside down) 
  • Remove needle (to sharps bin), expel air and place back into syringe packet
  • Place in tray 
• Priming cannula IV extension set
  • Wash hands, put on apron and 1^st pair of gloves (or leave on previous ones if you had to prepare flush)
  • Prime cannula IV extension set by flushing 1ml saline flush in to each lumen (ensure no air in any part of lumens)
  • Lock all lumens and place cannula IV extension set and flush back into packets
  • Place in tray 
  • Discard waste; then discard gloves and apron; wash hands
• Return to patient (with tray and a sharps bin)

Procedure 

Vein identification

• Wash hands 
• Expose arm and place a pillow beneath it
• Place tourniquet around patient’s arm 4-5 finger widths above intended cannulation site (dorsum of hand/antecubital fossa/forearm)
• Identify a suitable vein (i.e. one you can feel, not necessarily one you can see). NB: take sufficient time to find the best vein – this is the main determinant of whether you will be successful or not.
• Remove tourniquet

Cannulation

• Wash hands
• Put on gloves
• Sterilise area using skin-cleansing wipe (clean for 30 seconds, then allow to air-dry for 30 seconds)
• Re-apply tourniquet
• Anchor the skin distally with your non-dominant hand and insert the cannula at 10-30˚ to the skin with your dominant hand
• When flashback is observed, advance a further 2mm into the vein (to ensure the cannula tubing is in the vein and not just the needle tip)
• Hold the end of the introducer needle steady with your non-dominant hand while fully advancing the cannula tubing into the vein without the introducer needle 

Now keep your dominant hand on the cannula (with the needle still partially in) while resting against the patient’s arm to keep it steady. Occlude the vein proximal to the cannula with your dominant hand’s middle finger. While doing this, use your non-dominant hand to:

• Remove tourniquet
• Place gauze underneath the cannula opening
• Remove the needle fully and immediately drop it in the sharps bin 
• Attach the cannula IV extension set on the end of the cannula
• Remove gauze and clean any spilt blood 

Securing

• Remove the two steristrips from the cannula dressing and stick them on the wings of the cannula
• Apply the rest of the dressing
• If the dressing has a third sticky strip for filling in the date and time, do this and stick it on top

Flushing

• Holding the proximal part of the administration ports of the cannula IV extension set
• Clean the ports with the device disinfection wipe
• Unlock the lumens
• Slowly flush ~5mls 0.9% saline in each lumen (in pulsating manner)
• Lock the lumens

To complete

• Thank patient and restore clothing
• Discard waste and clean tray; then discard gloves and apron; wash hands
• Complete a peripheral cannula observation chart (or document with time, date, cannula size, site used and your role in notes)

Try the cannulation OSCE station!

1. Venous cannula insertion
2. Find lots more procedural stations here