If two of the follow are evident: Pain at IV site, Erythema or Swelling with Early stage of phlebitis then remove cannula and consider treatment
General Advice
- Upper limbs should be used in preference to lower limbs
- Dorsal veins of the foot and long saphenous veins are acceptable in infants and young children.
- Distal veins should be used in preference to proximal veins.
- Consider avoiding dominant limb
- All cannulae inserted into a lower limb should be changed as soon as a satisfactory site can be found elsewhere
- Avoid siting cannula in the forearm of patients who may need renal dialysis
Choosing the Cannula
| Color | Size | Flow rates | Uses |
|---|---|---|---|
| Yellow | 24 gauge | 13 ml/min | Paediatrics, Cytotoxic therapy |
| Blue | 22 gauge | 31 ml/min | Paediatrics, Cytotoxic therapy, Small fragile veins |
| Pink | 20 gauge | 67 ml/min | Maintenance fluids, Antibiotics, Contrast for CT scan |
| Green | 18 gauge | 103 ml/min | Blood and blood products, Large volume fluids |
| Grey | 16 gauge | 236 ml/min | Multi trauma, Multiple blood transfusions, High volume fluid replacement, Major surgery, Labour and elective LSCS |
| Orange | 14 gauge | 270 ml/min | Multi trauma, Rapid high volume fluid replacement, Major surgery |
Technique
- Introduction, Ensure correct patient, Explain and Consent. Check no AV Fistula
- Thoroughly clean the insertion site with 2% chlorhexidine /70% alcohol wipe and allow to dry completely. Always maintain an aseptic no-touch technique throughout.
- Position cuff proximal to above-proposed venepuncture site and tighten. Ensure vein dilation has occurred. Stabilise vein by drawing skin taut over the vessel
- Insert prepared cannula smoothly with the bevel of the introducer uppermost. Observe for a flashback of blood in the chamber. Decrease the angle of the cannula until almost parallel with the skin. Advance the whole unit to ensure the cannula tip is in the vein. Hold the introducer still and maintain skin tension. Handling the sides of hub only advance supported cannula fully into the vein up to the hub
- Release tourniquet. Place gauze swab under the hub of the cannula to keep the site dry while removing the introducer. Apply pressure to tip-end of the cannula with one hand and remove the introducer, placing it immediately into a sharps container
- Attach needle-free device or short extension set. Establish patency of cannula by flushing with sodium chloride 0.9%. Adults use 5mls. Secure with sterile tape included with the dressing as required and apply sterile, transparent, semi-permeable, occlusive IV dressing. Secure IV tubing.
- Apply a splint to immobilise limb joint as required
- If cannulation unsuccessful, a total of 3 attempts may be made before the escalating procedure to a staff member with significant expertise in IV cannulation.