Venous Cannula Insertion

Introduction

• Introduction, Ensure correct patient, Explain and Consent.
• Check no AV Fistula. Wash hands, ensure name badge visible
• Ask if you may insert a cannula. Explain why it is necessary
• Ensure verbal consent obtained.
• In a patient without capacity it may be needed in best interests

Equipment

• Sterile Gloves, Tourniquet, Alcohol wipes or equivalent
• Pink or Green Cannulas. Grey for large bleed.

Choosing the Cannula

Technique

• Place tourniquet around upper arm and wait until veins dilated
• Find a decent vein
  • Often in the forearm
  • Skin over the anatomical snuffbox
  • Back of the hand
• Clean the skin with several alcohol wipes. Warn patient they will feel a sharp scratch. Insert cannula into vein and watch for flash back. Push remaining plastic tubing over needle into vein usually at a more shallow angle near the skin
• Secure in place with vecafix/tegaderm and strips. Flush cannula with 10 ml sterile saline. If cannula not sited properly then remove and redo

General Advice

• Upper limbs should be used in preference to lower limbs
• 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

Finally

• Dispose of sharps and tidy up
• Answer any questions from patient

Complications

• Failure: try 2-3 times and if failing ask for help or come back later
• Haematoma: usually because needle removed from vein before tourniquet removed
• Arterial puncture: remove needle and apply pressure