IV cannulation and IV infusion

 Parts of IV Cannula

 Color coding of IV cannula

HOW DOES A 3 WAY STOPCOCK WORK - https://youtu.be/4TXQyv5_lGI

Usual sites of cannula insertion 

Dorsum of hand (Most commonly done), forearm, dorsum of foot in paediatric patients

Order of preferred vein for cannulation - the more distal the better, the straighter the better, the lesser on the joint the better. Your very last option on the arm should be the antecubital vein. 

REQUIREMENTS:

An appropriate size iv cannula (blue used usually for adults), a tourniquet, sterile gloves, alcohol swab, 3-way stopcock attached to 5ml syringe filled with normal saline (keep the 3- way such that one side-port is open and one is closed, as shown in the image below), dressing for the cannula.  If blood collection has to be done – vacutainers.

 

PROCEDURE: 

1. Wash hands and wear sterile gloves. 

2.  Apply a tourniquet proximal to the site of cannula insertion and ask the patient to close and open the fist a few times to make the veins visible. 

3.  The selected site is cleaned with an alcohol swab. 

4.  The cannula is opened from the sterile pack and held with two wings together with the bevel of the needle pointing upward. 

5. The vein to be punctured is steadied by slightly stretching the skin over it (also helps to see the direction of the vein clearly) and the skin is punctured with the cannula keeping the cannula at about 15 degrees to the skin. While doing this, decrease the angle between it and the hand (tilt needle upwards slightly) so that the vein is not counter-punctured. 

6. The needle with the cannula is advanced through the subcutaneous tissue into the vein.  As the cannula enters the vein blood will be seen flushed into the distal end of the cannula. 

7. The needle is further advanced few millimetres inside the vein. 

8. The cannula is held steady. The needle is withdrawn slightly and the plastic cannula is advanced into the vein over the metal needle. The metal needle and the tourniquet are removed. 

9. Blood collection from the open end of the cannula can be done at this point if it is required.

10. ** FLUSHING THE CANNULA – Immediately, the open end of the cannula is connected to the 3-way stopcock which is already attached to a 5ml saline syringe. Flush the cannula by injecting the normal saline.

11. ** ‘Turn off’ the 3 way (by aligning the blunt end of the 3 way knob with the iv cannula end), detach the syringe and close the ports of the 3 way stopcock with the caps.

12. The cannula is secured in place by an iv dressing.

** = DONE DIFFERENTLY FROM WHAT IS SHOWN IN THE VIDEO. 

PRACTICAL TIPS & TRICKS

1. As is mentioned before, keep the saline filled syringes already attached to the 3-way stopcocks during emergency. You won’t have time to attach them midway during the procedure. 

2. Tourniquet usually not available, so use a glove instead. 

3. During blood collection from the open end of the cannula, to prevent blood spillage between successive collections in different vacutainers, maintain a slight pressure with your hand over the end of the cannula which is entering the vein. This will prevent the blood from coming out. 

4. Remove vacutainer caps and keep the bulbs ready to collect blood in. Won’t have time to open and close each. 

5. During summer due to sweat, the iv dressing is more likely to come off and displace the iv cannula. Which will lead to repeated iv cannulations. So, make the cannula extra secure by additionally using micropore tape to keep it in place. 

6. Before putting IV sticking, put sanitiser on your gloves so that the sticking doesn't stick to your gloves.

7. Lower down the hand to be cannulated to make the vein more prominent.

8. Cannulate at the bifurcation point of the vein preferably (to prevent vein from rolling).

9. Vein may be tapped to make it more prominent (as it warms the area and releases vasodilators).

10. While stretching the skin over the vein, do it so by using your non-dominant hand's thumb placed below the patient's knuckle ridge.

 

VIDEO LINK:

https://youtu.be/h8DlRtqgh8c  (HAS SOME DIFFERENCES FROM WHAT IS DONE IN KEM HOSPITAL where I study. Those steps are highlighted above)

 

SETTING UP AN IV INFUSION 

Flow controller/Roller ball clamp: controls the rate of flow

Uppermost position: fastest flow

Lowermost position: CLOSED – no flow

REFERENCE VIDEO LINK:

https://youtu.be/Siy2cEMICE4

PROCEDURE OF SETTING UP THE I.V. INFUSION:

1. Collect all the requirements – bag containing the fluid/drug to be administered, iv set, pair of gloves

2. Explain the procedure to the patient and gain their consent

3. Check the fluid bag for any cloudiness or particulate matter present; do not use the bag if any such impurities are present

4. Remove the outer packing of the bag and hang it up on a drip stand

5. Wear sterile gloves

6. Open the iv set and keep the flow ‘off’ using the roller-ball clamp on the line

7. Remove the cover from the port on the bag containing the fluid/drug by twisting and breaking it off. Insert the spike (piercer) into the port, without touching the end of the spike

8. Half fill the drip chamber by squeezing it. Insert a needle at the top end of the bag and let it remain there.

9. Then release the roller ball clamp to allow the fluid to run through the giving set. Let the fluid come out through the open end of the line. Ensure there are no air bubbles in the line (to prevent air embolism). 

10. Attach the luer lock connector end of the iv set to the 3 way stopcock attached to the iv cannula which is already inserted in the patient’s arm

11. Set the infusion rate (as per instructions from the resident) by adjusting the roller ball.

Stopping the i.v. infusion:

1. Adjust the roller ball clamp to turn off the flow

2. Before disconnecting the iv set from the iv cannula, ‘switch off’ the 3-way stopcock

3. Disconnect the iv set from its insertion into the 3-way stopcock

 

 

Written by our guest author Mitali Shroff

Illustrations by Devi Bavishi
#Ae(ONE)INTERN