IV Cannulation: Indications & Contraindications

• IV cannulation involves inserting a catheter into a peripheral vein for administering fluids, medications, or blood products.

Indications

• Fluid replacement is indicated in cases of dehydration, shock, or blood loss.
• Medication administration includes antibiotics, pain relievers, or chemotherapy.
• Blood product transfusion addresses anemia or clotting disorders.
• Nutritional support includes Total Parenteral Nutrition (TPN).
• Diagnostic testing involves obtaining blood samples.

Contraindications

• Relative contraindications include:
• Skin infection at the insertion site.
• Thrombosis or thrombophlebitis.
• Extensive scarring or burns.
• Limb with impaired circulation.
• Presence of a dialysis fistula or graft.

Equipment

• Gloves maintain aseptic technique and protect healthcare providers.
• Antiseptic solution: Chlorhexidine, povidone-iodine, or alcohol cleans the insertion site.
• Tourniquet distends the veins for easier visualization and cannulation.
• Catheter sizes range from 14-24 gauge, depending on the patient and infusion needs.
• Transparent dressing secures the catheter and allows visual inspection of the insertion site.
• Extension tubing provides additional length for administering fluids or medications.
• Saline flush assesses patency of the catheter.
• Tape or securement device further stabilizes the catheter.
• Sharps container safely discards the needle.

Procedure

• Preparation:
  • Verify the order.
  • Gather necessary equipment.
  • Explain the procedure to the patient.
  • Obtain informed consent.
• Site Selection:
  • Choose a suitable vein.
  • Upper extremities are preferred, starting distally.
  • Avoid areas of flexion, valves, or bifurcations.
• Vein dilation:
  • Apply a tourniquet proximal to the insertion site.
  • Instruct the patient to open and close their fist.
  • Gently tap or stroke the vein to encourage dilation.
• Skin antisepsis:
  • Clean the insertion site with antiseptic solution using friction.
  • Allow to air dry completely.
• Cannulation:
  • Stabilize the vein with the non-dominant hand.
  • Insert the catheter at a shallow angle (10-30 degrees) with the bevel up.
  • Advance the catheter until a flashback of blood is observed in the catheter hub.
  • Lower the angle of the catheter and advance it slightly further into the vein.
  • Thread the catheter off the needle into the vein.
  • Activate the safety mechanism on the needle and discard it into a sharps container.
• Securement:
  • Release the tourniquet.
  • Attach the extension tubing to the catheter hub.
  • Aspirate gently to confirm blood return and flush with saline to ensure patency.
  • Apply a transparent dressing over the insertion site.
  • Secure the catheter and tubing with tape or a securement device.
• Documentation:
  • Date and time of insertion.
  • Location of the insertion site.
  • Type and gauge of catheter used.
  • Number of attempts.
  • Patient's tolerance of the procedure.
  • Any complications encountered.

Potential Complications

• Infiltration: Leakage of fluid into the surrounding tissue, causing swelling, pain, and coolness.
• Extravasation: Infiltration of vesicant (irritating) medication into the surrounding tissue, causing tissue damage.
• Phlebitis: Inflammation of the vein, causing pain, redness, warmth, and swelling along the vein's course.
• Thrombophlebitis: Formation of a blood clot in the vein, causing pain, redness, swelling, and palpable cord.
• Infection: Local or systemic infection due to improper technique or contamination of the catheter.
• Hematoma: Collection of blood outside the vessel, causing bruising and swelling.
• Nerve damage: Injury to a nearby nerve, causing pain, numbness, or tingling.
• Air embolism: Introduction of air into the venous system, which can be life-threatening.
• Catheter embolism: Breakage of the catheter, with a fragment entering the bloodstream.

Prevention of Complications

• Strict aseptic technique during insertion and maintenance is critical.
• Proper site selection and catheter stabilization are essential.
• Regular assessment of the insertion site for signs of complications is necessary.
• Prompt removal of the catheter if complications occur is important.
• Use of appropriate catheter size and material helps prevent complications.
• Adequate education and training of healthcare providers is key.
• Following established protocols and guidelines ensures best practices.

Catheter Maintenance

• Regular flushing: Flush the catheter with saline at regular intervals (e.g., every 8-12 hours) to maintain patency.
• Dressing changes: Change the transparent dressing every 5-7 days or as needed if soiled or loose.
• Site assessment: Monitor the insertion site for signs of complications (e.g., redness, swelling, pain).
• Patient education: Educate the patient about the signs and symptoms of complications and when to notify a healthcare provider.

Catheter Removal

• Verify the order for removal.
• Gather necessary equipment (e.g., gloves, gauze, antiseptic solution, bandage).
• Explain the procedure to the patient.
• Perform hand hygiene and don gloves.
• Gently remove the dressing and tape.
• Inspect the insertion site for signs of complications.
• Gently withdraw the catheter, applying pressure to the site with sterile gauze.
• Apply a bandage to the site.
• Document the date and time of removal, condition of the insertion site, and patient's tolerance of the procedure.