Oten tested in
using plastic arms. You get marks
for all the little things like washing your hands and putting on
technique is very important
some patients cannulation is extremely difficult.
Fluid, drugs, emergency situations, feeding.
Cotton wool and tape (in case you miss the vein)
Saline and syringe to flush
Prepare the equipment. Remove the cap of the cannula and
in your tray,
Introduce & explain. Say that no needle is left in
a bit of plastic, and that the patient needs to be careful.
Set up drip stand with a bag of fluid (checked by nurse)
Put some tissues underneath the arm
Palpate a vein. The most convenient site fot the patient
usually the back of the hand.
Apply the tourniquet about 20cm above the site of insertion.
Wipe with steret
Slowly insert the cannula through the skin at an angle of about 30 degrees until you get a flashback of blood. When you see this flashback, gently flatten the cannula so it is at 0 degrees to the skin and advance another minimally 0.5 cm. Loosen the tourniquet. Now start to slide the plastic cannula whilst withdrawing the trocar (so effectively the metal trocar does not move relative to the skin) until it is fully in the vein.
Remove the trocar, blood should start to exit the cannula.
the plastic cap to the cannula.
Flush cannula with 5-10ml of 0.9% saline
Secure the cannula with a VacuFix/Tagaderm.
Connect fluid tube.
Bandage a loop of the tube to the arm.
Write up the cannula care chart if available
and believe you can do it. Never rush a cannula as you will miss it.
The easiest vein is probably in the
However this is uncomfortable for the patient as they have to keep their arm straight. Another good vein is just below the thumb on the radial wrist, known as the
this is probably the first place you should look. Other veins (in order of easiness) are on the back of the hand, further up the dorsum of the wrist on the radial side, the feet, the legs, the ventral surface of the arm, above the elbow.
You can ask the patient where people have inserted cannulas in the past - they may well know the easiest places. 90% of patients will say they are hard to cannulate, this is probably because there are a lot of bad cannulators out there.
Good veins are
large, easily palpable, immobile, with thick walls.
If you can see but not feel the vein it is not a good vein. If it is very mobile (like the ones further up the arm) it will move as you attempt to put the needle in. To avoid this
pull the skin taut,
and go in initially at an angle of 30 degrees. Veins which come off at the junction of two veins are also usually quite immobile. If the vein looks big but thin the risk is of puncturing the other side causing an unsightly haematoma and preventing insertion. If you think this is likely to happen puncture and advance the cannnula very slowly.
If you keep easily getting in to the vein (with a flashback) but find you cannot advance the cannula you are probably not in far enough. Once you get a flashback you must
flatten the cannula against the skin and insert the trocar a little more
to ensure that it is not just the bevel that is within, but the end of the plastic cannula tube.
cannulas are easier to insert. Blue is the
get in followed by pink, green, orange, and white.
the vein lightly, wiping with
and getting the patient to
their wrist all make the vein more prominent
the patients arm below the heart, or apply a
No veins: some people use
tourniquets, one about 10cm above the other
Oedemeatous veins: apply a
on the insertion site for a few minutes to create an indentation (temporarily removing the oedema from that area)
Large "ropy" veins in the elderly are easily ruptured. Try and insert the cannula
using a tourniquet
Veins with valves are hard to insert cannulas in. You can attach a
filled with saline and inject whilst inserting to open up the valves.
. The majority will not do them, but some friendly ones will.
Don't give up
if you don't get it first time, try at least 3 or 4 times. Remember that the cannula does need to be inserted and somebody has to get it in - another person will likely have as much trouble as you.
Go and have a
and come back half an hour later. Most cannulas are not urgent (although remember that some are)
Nursing Link: IV therapy.
The best resource I have found on the web for cannulation. Cannula tips are few and far between for some reason. Ironically and unfortunately the majority of UK nurses will not cannulate.