COMMON EQUIPMENTS INDICATIONS CONTRAINDICATIO COMPLICATIONS

MEDICAL NS
EMERGENCY
PROCEDURES
IV INSERTION  Cannula  Repeated blood  Inflammation  Phlebitis
Dressing sampling or infection of  Cellulitis
 Alcohol  IV administration of the insertion  Sepsis
Swab fluid site.  Tissue Necrosis
 Pre-filled  IV administration  Obstructed  Air Embolus
Saline Flush of medications vein (eg. clot) (Incorrect
 Gauze  IV administration  Stenosis of the Priming)
 Tourniquet of chemotherapeutic vein  Extravasation
 Cannula agents  Severe
 Extension  IV nutritional support coagulopathy
Set  IV administration  Contaminated
 Gloves of blood or blood site
 Field products  Burned site
 IV administration of  Uncooperative
radiologic contrast awake patient
agents for computed
tomography (CT),
magnetic resonance
imaging (MRI), or
nuclear imaging

Choice of cannula
The flow rate through a cannula is proportional to the height of the fluid reservoir and the fourth
power of the cannula’s radius. Thus, doubling the cannula’s diameter increases the flow by 24
(16-fold). For infusions of viscous fluids such as blood, and for rapid infusions, the largest cannula
(14–16 gauge) should be used. Smaller sizes (18–20 gauge) should suffice for crystalloids. The
smallest cannula (20–24 gauge) are adequate for the intermittent administration of drugs, except
those that must be given by rapid infusion.
Selection of a vein
Veins on the non-dominant forearm are most suitable, especially if the cannula has to remain in
position for any length of time. Veins on the dorsum of the hand are easiest to cannulate, but are
more uncomfortable for the patient and more liable to block. Veins in the lower limb should be
avoided where possible because of the increased incidence of thrombophlebitis and thrombosis.
Distance of a tourniquet
A tourniquet should be placed 3 to 4 inches above the site of collection.
Indications for peripheral versus central venous access
In general, peripheral catheters are preferred when IV access is required for shorter periods,
when direct access to the central circulation is unnecessary, and when smaller gauge catheters
suffice. Peripheral access is generally safer, easier to obtain, and less painful than central access.
In patients taking anticoagulants, peripheral access allows for direct compression of puncture
sites and fewer hematoma-related complications compared with the sites used for central
venous catheters.

Central venous catheters are often preferred in patients receiving sclerosing medications that
can damage peripheral veins or being treated with vasopressors, which can cause injury if
extravasated. Central venous access may also be preferable in patients with severe volume
depletion or in whom peripheral venous catheter placement has a low likelihood of success (ie,
frequent users of illicit IV drugs).

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.

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
o 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
o No resistance should be felt
o 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.

Best Veins for IV Insertion and Blood Draws

 Median cubital
 Accessory cephalic vein
 Median vein of forearm
 Dorsal venous network

Medial Cubital: it’s located in the bend of the arm where the cephalic and basilic veins connect.
This vein is a gold standard for blood draws. In most patients, it is very large and easy to access.
Problems with this vein: It’s in the bend of the arm, so it’s not that great for IVs. IVs in this site
will be very uncomfortable for the patient and infiltration can occur. I only use this site for an IV
when I have to. For instances, I use this site if this is the only IV site the patient has (or the patient
refuses to have an IV anywhere else) OR the patient needs an 18 gauge IV in a large vein for a
test (ex: CT PE Protocol).

Accessory Cephalic Vein: this vein comes off the cephalic vein (hence its name) and is easy to
stabilize.

It is relatively large so this vein can hold an 18 gauge and easily a 20 or 22 gauge IV. Tip: when
going for this vein for an IV go below the bend of the arm rather than in the bend. This vein
extends down below the bend.

Median Vein of the Forearm (median antebrachial vein): this vein comes out of the palm of the
hand and runs along of the inner part of the forearm.

Problem: it is not as large as the previous two veins so it may not hold an 18 gauge. In addition,
watch for this vein rolling and being deep on patients who have a lot of subcutaneous fat.

Dorsal Venous Network: these are the superficial veins found on the top of the hand. These veins
are great for blood draws and IVs. However, these veins will easily roll if not stabilized. To help
prevent this, have the patient make a light fist to keep the veins from moving.