tips and tricks of iv cannulation

1. Unknown Facts About
IV Cannulation
Dr. Tushar Chokshi
M.D. (Anesthesiology)

2. Intravenous (IV) Cannulation
Is a technique in which a cannula is
placed inside a vein to provide venous
access

4. Scalp vein cannula.

9. Scalp Vein sets

10. Length of Cannula

14. No 26 violet
IV Cannula
No 17 white
IV Cannula
Recently Introdeuced

19. Anatomy of Veins
in Upper Limb

26. For IV cannulation
radical

27. for IV cannulation

28. Tips and Tricks for IV Cannulation
Introduction And Overview
Vein Selection
Making the Vein More Visible
For Insertion of the IV Catheter
Securing the IV Line
Special Considerations for IV Therapy
Post-Cannulation

29. Introduction
And
Overview
• Introduce Yourself
• Explain the Procedure
• Stay calm and be
prepared
• Get your confidence
• Assess for needle phobia
• Observe Infection control
measures
• Assess the vein
• Feel rather than look
• Ask your patient any
previous experience
• Use appropriate cannula
size
• Consider the use
• Insert at the non-
dominant hand first

30. Vein Selection
• Start with distal veins and
work proximally
• Hand should be lower than
the patient’s heart
• Use a BP cuff rather than a
tourniquet
• Apply the
tourniquet correctly
• Puncture without a
tourniquet in adequately
filled but fragile veins
Making the Vein More
Visible
• Gravity is your friend
• Use warm compress
• Do not slap the vein
• Flick or tap the vein
• Feel the vein
• Fist clenching and Release
• Use the multiple tourniquet
technique ( Arm & Forearm)
• Vein dilation using
nitroglycerine
• Flow where you want it to
go ( Alcohol Swab)
• Clean vigorously and widely
• Use a vein finder if needed

31. For Insertion of the IV
Catheter
• Stabilize the vein
• Insert the IV catheter directly atop
the vein
• Prevent kinking
• Twirl the catheter hub
• Bevel up
• Make the shot at a 15-30 degree
angle over the skin
• Feel for any resistance
• The Flashback (backflow of blood)
• Don’t go all in
• Do not pass cannula through valve,
as it is very painful
• Don’t rush into starting the IV fluid
• Release the tourniquet first
Securing the IV Line
• Limbs in motion inside an
ambulance
• On taping the IV tubing
• Go with the flow when
taping
• Stress tape to prevent
accidental yanking between
cannula and IV fluid tubing
• If it leaks, change taping
• Do not probe for a vein also
called “fishing” or “vein
searching”, it will damage
surrounding muscle and
tendon

32. Special Considerations for IV
Therapy
• For older patients and
pediatric patients
• For patients who have dark
skin tone
• For veins with valves, use the
floating technique
• Bifurcating veins (highest
success)
• Call the “vein whisperer” or
experts, after some
reasonable unsuccessful
attempts to insert the IV
catheter
• On the use of restraints
• Do not shave site, shaving
can cause micro abrasions,
just remove hair with
scissors or clippers only
Post-Cannulation
Labelling with date-time,
type-length of catheter,
rate calculation & initials

33. Common Problems During Cannulation

36. 9.

38. movie

39. movie

40. IV cannulation in Pediatric
• One of the most difficult
tasks
• Determine the child’s
developmental stage
• Perform cannulation in a
neutral place
• Avoid applying restraints
as much as possible or
Restraining using Papa or
Mummy wrap
• Use creative forms of
distraction or Learn the
art of distraction for
children IV cannulation
• Use a tourniquet
appropriate for the size
of your patient
• Choose age-appropriate
IV sites
• Let the parents be with
their child
• Don’t give false
expectations
• Choose the smallest
gauge catheter
• Protect the IV site to
prevent dislodgement
with transparent
protective devices or
stockinette bandages

43. CoolSense
Local anesthetic device
Hand-held device that anesthetizes
the site of injections by a Cryo
system with no chemicals and no
after effects
Numbs the site of injection
within 3-5 seconds
suitable for babies, children,
adults and the elderly
For painless injection procedures
in Clinics, Hospitals and at Home

44. Loacal Spray

45. IV cannulation in Very Fragile Veins
• Say NO to tourniquet as much as
possible
• Use the smallest catheter available
• Use “bevel-up”, “low angle”
and “slowly but surely” approach
• Secure the catheter with a paper-
type tape
• Provide health education to
improve patient’s condition
• Patient with fragile veins only use
gauge 20 or 22 for cannulation

46. IV Cannulation in Geriatric Patients
• Can be extremely
challenging
• Avoid applying too much
friction when preparing
the skin
• Use the smallest catheter
workable
• Know the vein’s depth
• If possible, do not use a
tourniquet, if needed,
only use those that are
made of soft materials
• Stabilize the vein and
insert the catheter ON
TOP of the vein
• Insert the catheter
“slowly but steadily”
• Hypoallergenic tape
• Apply pressure, after you
have removed the
needle, you may need to
apply pressure long
enough until the
bleeding stops
• Immobilize the catheter
properly

48. IV Cannulation in Obese/Edematous
Patients
• Biggest challenges and can turn the simple IV
cannulation procedure into a Herculean task
• Use warm compress
• Use multiple tourniquet
• Use palpation techniques
• Use longer cannula and an illuminating equipment
• Know the anatomy
• If available, use visualization devices, Vein Finder
• Once in a while, you will experience a “dry spell” with
IV Cannulation. If it’s not your day, let it go and ask
help from your colleagues

49. Ultrasound-Guided IV Cannulation
• Be Prepared
• Position the Patient
and the Ultrasound
• Use a Waterproof
Transparent Dressing to
Cover the Ultrasound
Probe
• Place the Tourniquet
High and Tight, or
Possibly Place Two
• Place the Ultrasound
on Shallowest Depth
for the Vascular Probe
• Short Axis Versus Long
Axis Approach
• Do the Math
• Be Cognizant of
Compression
• Look Before You Leap
• Verify Your Success

51. Different types of IV Canuula Fixators

54. Different types of
Vein finders

55. Vein Finder Used in
• Elderly people
• Patients with dark skin tones
• Obese people
• Patients who undergo many diagnostic or
intravenous therapeutic procedures
• People who were burn victims
• Patients who are restless, agitated, or won’t stay
still
• Oncology patients undergoing chemotherapy
• Drug abusers

56. Vein Finders
• A Vein Finder
Is exactly what it sounds like, It
is a device that is used to reduce
the amount of time it takes to
find a vein on a patient
• How Do Vein Finders Work?
An infrared vein finder uses a
specific type of light, which is
able to penetrate the skin by a
few millimetres to illuminate the
targeted veins
Other types of vein finders,
usually in the form of glasses,
which work by altering the color
of the light visible to the eye
• Types of Vein Finders
Passive and Active
Passive Vein Finders
called passive vein finders
because they do not require any
power to work
Active Vein Finders
most popular vein finders, use
infrared light, they can be
battery-operated or run with
electricity
movie

57. https://www.youtube.com/watch?v=OkbobnEHy0s

59. 3 D Goggles
Vein Finder

61. OptiVein

62. VeinSeek App

63. HaemoBot
Robotic IV Catheter Insertion

64. Portable robot for autonomous venipuncture
using 3D near infrared image guidance

65. Complications of
IV Cannulation