Intravenous cannulation

Intravenous Cannulation

Sarah Stewart 2012

http://www.flickr.com/photos/24782931@N00/3341006811

Intravenous cannulation

Looking at four key points:

Reasons why midwives need to

be able to cannulate

Preparation

Technique

Troubleshooting tips


Purposes of IV therapy

Fluid replacement

Delivery of medicine

Delivery of blood

or blood products

Consider situations in midwifery practice when this would be necessary.


Reasons why midwives need to be able to cannulate

PPH

Epidural

Drug treatment

Blood transfusion

Induction/augmentation

Premature labour/PIH/diabetes

LSCS/manual removal/repair of tear

Correct ketosis/?fetal tachycardia/distress


Preparation

Choice of site – choose veins in hand or

lower arm– non-dominant side

Avoid wrist or arm joints, small, visible veins, areas of recent inflammation or cannulation. Selected vein should feel round, elastic, firm and engorged – not hardened, bumpy or flat


Preparation

Choice of cannula– Suitable for both the vein and the

fluid

– 16g -18g

Communication –

-explanation /informed consent

Local anaesthetichttp://www.flickr.com/photos/44312356@N04/5246179138

Technique

Plenty of lightMake sure woman is comfortable – look at what she is wearingEquipment at hand Tourniquet - place around the limb 2 – 3 inches

below elbow jointavoid pulling skin or hairpull it tight enough to trap venous flow but not to occlude arterial flowplace “blue sheet” under arm and ? pillow

Cleaning

Clean with alcohol swab and allow to dry naturally

Do not re-palpate after cleaning

Approaching vein

Ask woman to flex wrist

Bend thumb under fingers (if placing cannula in basilic vein)

Pull skin below site of insertion

Veins of the Hand1. Digital Dorsal veins2. Dorsal Metacarpal veins3. Dorsal venous network4. Cephalic vein5. Basilic vein

Veins of the Forearm1. Cephalic vein

2. Median Cubital vein3. Accessory Cephalic vein

4. Basilic vein5. Cephalic vein

6. Median antebrachial vein

Inserting cannula Insert cannula at low angle (notice flash back of blood into chamber of cannula)Reduce angle of cannula slightly and advance cannula along another 2 – 3 mmWithdraw needle 5 – 10 mm so it does not go through wall of vein and then advance plastic cannula along veinRemove needle and disposeTake blood samples for FBC and group and holdRelease tourniquetPress on vein above cannula to avoid blood spillageAttach to IVI or flush with saline before screwing on injection cap(if needle-less system, attach rubber bung before connecting IVI or flush)

Applying dressing Apply transparent dressing so that cannula and infusion tubing is secure and insertion site can be observedTape tubing further up the arm so that it is secure and not pulling on cannulaMake sure tape is not interfering with transparent dressing or injection capImmobilize arm if insertion site is in wrist or elbow jointMake sure woman is comfortable and can mobilise fingers and arm

Troubleshooting tips Backflow stops when you remove the

stylet? Oh dear! You may have pushed the stylet through the opposite wall of the vein. In this case, retract the stylet slightly until blood flashback appears again, then advance the cannula into the vein and release the tourniquet. Do not reintroduce the needle.


Don’t panic if you are unable to withdraw blood for sample. The final test is whether the IVI runs properly.

If haematoma forms; insertion site is very painful; IVI doesn’t flow; cannulation has not been successful, so stop procedure.



Have two attempts

then call for help.


Do not pass cannula through valve (which looks like a bump in the vein) as it is very painful. Use bifurcated vein when possible (looks like inverted V). It is easier to cannulate than a single vein as it is more stable and less likely to roll. Be positive. Don’t forget to reassure woman.


Common problems during cannulation procedure

Tourniquet too tight, too loose, too high, too lowFailure to release tourniquet promptly after vein is sufficiently cannulatedStopping too soon after insertion of the stylet so that only the needle goes into the veinFailure to recognise the cannula has gone through the vein wallinserting the cannula too deep so that it is under the vein – very painful for woman and cannula won’t move freelyfailing to penetrate the vein – angle of needle is too steep or not steep enough causing needle to ride along the vein or on top the vein

Local complications

Thrombosis – obstruction to flow due to platelet formation at site if injury (by cannula)

Thrombophlebitis – thrombus plus accompanying inflammatory response

Local complications

Phlebitis – inflammation of inner lining of vein usually due to mechanical or chemical trauma. More susceptible to infection.

- redness, swelling, pain, warm to touch, tender, palpable venous cord (if left too long), possible pulmonary embolism

- diagnosis: flow stops when apply pressure above cannula tip

Phlebitis

http://www.nova.edu/~stmartin/IV/IVTherapyPrintout.html

Local complications

Treatment – stop infusion, remove cannula, resite, apply warm compress, elevate and rest arm

Prevention – regular monitoring of IV site & cannula, appropriate choice of site, secure taping, ask woman to report any discomfort

Local complications

Infiltration / Extravasation / Tissueing - leakage of IV fluid into surrounding tissues - signs - pain, tightness, skin cool to touch, oedema, IV

rate slowed- Diagnosis – flow continues when apply pressure

above cannula tip or halo appears when shine torch on oedema

- Treatment – stop, remove, re-site, warm, elevate

Local complications

Clotted cannula due to --Inadequate flushing or --fluids run dry or --Increased venous pressure above site (BP cuff)--Turning off to allow mobilisation

Noted by blood backing up tube or flow stoppedIntervention – first check height of bag, clamps, position

- aspirate, irrigate if no return, resite if need

Local complications

Air embolism

Catheter embolism

– do not re-introduce needle

Women should have no more than 2 ½ litres in 24 hoursA pregnant woman already carries extra body fluid. Anti-diuretic hormone is increased in labour by fear and anxiety, as does oxytocinIncreased fluid volume cause water intoxication\Mother – oedema, headache, vomiting, convulsionsBaby – convulsions, apneoa, resp. distress, neonatal weight lossEpidural – if hypotension persists, use ephidrine instead of large volumes of fluid


Sodium chloride 0.9%isotonic

Most commonly used - administer drugs, eg syntocinin, magnesium sulphate. Replaces H20, Na, C in dehydration.

Haemodilution can occur. Overload.

Hartmann's(lactated Ringer's solution)isotonic

Epidural - pre-loading dose to counter-act hypotension. Replaces H2O and electrolytes. If in doubt, use Hartmanns.

Watch for overload. Ephedrine should be used if hypotension persists.

Dextrose 5%isotonic

Rarely used Increases maternal blood sugar - increases fetal insulin - fetal hypoglycaemia - jaundice.

Haemaccel Synthetic polygeline colloid

Plasma volume expander Not so commonly used as was.

Whole blood Plasma volume replacement, replaces red blood cells (hb), replaces clotting factors, source of fresh blood.

Increases O2-carrying capacity, administer through blood filter, do not infuse cold, risk of blood borne infections.

Packed cells Treat anaemia, used with women with low hb but adequate blood volume.

Increases O2-carrying capacity, replaces low hb without extra plasma volume preventing overload, administer through blood filter, risk of blood borne infections.

References

Johnson R, & Taylor W. (2006). Skills for midwifery practice. Elsevier: Edinburgh.Chapman V.(2003). The midwife’s labour and birth handbook. Blackwell Publishing: Oxford.London, G. (1990). Nutrition and hydration in labour. In:

Intrapartum care: a research-based approach. J. Alexander, V. Levy, S. Roch (Eds.). London:

Macmillan.

Intravenous cannulation

Health & Medicine

Transcript of Intravenous cannulation