Intravenous cannulation is a process by which a small plastic tube (a cannula) is inserted into a peripheral vein. The subsequent venous access can be used for the administration of fluids, medication and nutrition. In some cases, blood samples can also be obtained from the cannula.
The process of cannulation can be divided into four steps; explanation and consent, preparation, procedure and aftercare. We shall now look at these stages in more detail.
Explanation and Consent
Confirm the patients identification
Check full name, DOB, and hospital number
Confirm against patients wristband
Explain rationale for the procedure
Describe the procedure
State the importance of the procedure
Explain the risks of the procedure to the patient
Infection (can be minimised by sterile equipment and aseptic non-touch technique)
Structure missed or another structure hit (nerve, artery, or bone)
Haematoma or phlebitis may develop
Ask about relevant past medical history
Blood clotting disorders or medication that affects blood clotting (e.g. warfarin)
Arterio-venous fistula present
Previous breast surgery or lymph node removal
Ask about needle phobia
Ask about preferred location of cannula
Check that the patient is happy to go ahead with the procedure. Ask the patient if they would like a chaperone present
Preparation
When in the treatment room, prepare your equipment on an appropriate equipment trolley
Decontaminate your hands
Clean your trolley and plastic tray with appropriate aseptic agent (e.g. Chlor-clean), allowing to dry fully. Decontaminate your hands
Check expiry date of saline solution with another member of staff. Clean the top of the saline vial with chlorhexidine wipe and open. Draw up saline into sterile syringe and discard the needle
Open the bionector packaging, flush it, and place in the tray
Gather the rest of the equipment into the plastic tray on the trolley and move to the patients bedside
Equipment required cannula pack, 2 chlorhexidine wipes, pre-primed bionector, saline-filled syringe, tourniquet, inco pad, and sharps bin
Cannula pack should contain at least cannula, gauze, sterile dressing, absorbent pad, and cannula assessment record
Once at the patient’s bedside
Re-confirm the patients identification
Decontaminate your hands and position the patient’s arm underneath a pillow with the inco pad
Apply the tourniquet, select a suitable vein, remove the tourniquet and carry on with the procedure
Procedure
Don your gloves and apron
Clean the puncture site with the chloraprep wipe (in a cross-hatch formation) and allow to air dry
Apply the tourniquet and do not repalpate the cleaned skin
Placing traction on the skin below the intended puncture site, insert the cannula with the bevel up at an angle of 30o into the puncture site
Advance the cannula and observe flashback
Hold the needle introducer still whilst advancing the cannula forward, over the needle and fully into the vein
Release the tourniquet and dispose the needle into the sharps bin
Connect your bionector to the cannula
Secure the cannula in place with the sterile dressing
Ensure not to cover the puncture site with the tape when securing down, as this can cover up any possible phlebitis developing
Flush the bionector and cannula with 5ml of saline
No resistance should be felt
Check for any signs of extravasation / tissuing around the cannula site. Remove cannula if suspected
Discard all waste into the correct disposal bins and ensure the patient is comfortable
Remove your gloves and decontaminate your hands
Aftercare
Instruct the patient to inform the nursing staff if:
Cannula site becomes painful, red, hot, or swollen
The area around the cannula feels wet or the dressing is coming loose
The cannula is limiting their self-care
Thank the patient and leave the patient’s bedside. Ensure the correct cannula insertion documentation is filled out completely and placed in the patients notes. Inform the nursing staff and place any cannula care pathway stickers into the nursing notes
Ideally, the cannula should be checked and flushed 3 times a day, and should be removed after 72hrs.
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