1. CANNULATION & VENESECTION
AMANDA HARPER
CLINICAL SKILLS COORDINATOR

2. LEARNING OUTCOMES OF THE WORKSHOP
Assessment of patient
Demonstrate the correct technique for performing cannulation & venesection as per SUHT policy & procedure
Selection of the appropriate device
Identify and recognise the complications that are associated with cannulation & venesection
Correct documentation as per SUHT policy

3. Patient Assessment & Vein Selection

4. THE ASSESSMENT CONSIDER THE FOLLOWING POINTS:
Age / size / history / condition / dependency of the patient
History of previous cannulation / venesection
Type / length of treatment required
Number of tests ordered
What medication is the patient on?
Fluid status
History of blood disorders

5. Conditions that affect the position of the device: -
Amputation
Stroke
Mastectomy or other Breast / Lymph Surgery
Renal Fistula
Lymphoedema or Cellulitsis
Diabetes / Vascular Disease / Arthritis
Trauma / Fractures / Burns
Social History

6. Questions to ask the patient
OBTAIN CONSENT
Have you had a cannula / blood test before?
Were there any complications / adverse reactions?
Do you have any allergies?
Consider needle phobia
Would you like a local topical anaesthetic before I insert the cannula or take blood?
Which is your dominant arm?

7. Attributes of an ideal vein are: -
Be engorged, bouncy & soft
Refill after it has been depressed
Be visible
Feel round
Be well supported by surrounding structures
Be straight & ‘free of valves’

8. Veins to be avoided: - Thrombosed, fibrosed or sclerosed
Inflamed or bruised or painful
Thin or fragile
Mobile
Near bony prominences and joints
Near sites of infection or oedema
AVOID THE VALVES
For venesection avoid the arm with an IV line running

9. Methods for improving venous access:
Apply a disposable tourniquet
Lower the level of the arm below the heart
Ask the patient to open and close their fist
Light tapping / rubbing of the veins
Warm compresses over the selected vein
Warm water
Relax the patient / consider the environment

10. WHICH
VEIN?

11. Antecubital Fossa Cephalic 1st Intercostal Brachial Artery Radial
Basillic
Median Cubital Vein
Radial Artery
Median
Ulnar Artery
Ulnar
Veins
Arteries
Nerves

12. DIGITAL
DORSAL
VEIN
DORSAL
METACARPAL
VEINS
DORSAL
VENOUS
NETWORK
CEPHALIC
VEIN
BASILLIC
VEIN

13. VEINS TO BE USED ARE: METACARPAL VEINS CEPHALIC VEIN BASILIC VEIN
MEDIAN CUBITAL VEIN

14. GROUP EXERCISE In pairs, use a tourniquet to identify each others:
Veins
Arteries
Valves
Ligaments

15. CANNULA SELECTION

16. Selecting the right cannula Two key points to consider:
What is the cannula going to used for?
The condition, location and size of the vein selected?
You should try to select the smallest gauge possible that will accommodate the intravenous therapy that is prescribed.

17. Colour Size Flow Ml/min Uses Brown 14 275 Grey 16 173 Green 18 100
Rapid transfusions of whole blood. Emergency situations.
Grey 16
173
Rapid transfusions of whole blood. Emergency situations
Green 18
100
Blood transfusions
Pink 20 60
IV infusions. Bolus’
Blue 22 25
Bolus’. Maintenance infusions
Yellow 24 13
Bolus medications. Short term infusions. Neonates
Purple 26
Neonates

18. SGH, exceptions to this rule: -
Patients Condition
Cannula Size
All obstetric patients
Grey
Active gastrointestinal
(GI bleed)
Brown or Grey
At risk of GI bleed
At risk of epileptic fit
Green
At risk of cardiac event
At risk of neurological event

19. VENESECTION
DEVICE SELECTION

20. VACUTAINER Quicker collection than other methods Closed system
Exact amount of blood obtained
Reduces the risk of haemolysis of the sample
Reduces the risk of needlestick injury

21. BOTTLES & BLOOD FORMS
E-QUEST SYSTEM for blood requests & results within SUHT
ALWAYS ensure that the GROUP & SAVE or CROSSMATCH request has been correctly completed & signed for by the requesting MEDICAL PRACTIONER

22. Serum
AB Levels
E.D.T.A.
FBC & ESR
Cross Match Group & Save
Coagulation INR / APTR
Glucose
Lithium Heparin, PST, U&E’s, Bone & Liver
Trace Elements

23. ORDER OF DRAW NO ADDITIVES (Green, Red, Dark Blue)
COAGULATION (Light Blue)
OTHER ADDITIVES (Gold, Lilac, Pink & Grey)
EXCEPTION to this is when Blood Cultures have been requested, these MUST BE filled first – aerobic (Blue) followed by anaerobic (Pink)

24. Risks and Complications of Cannulation & Venesection

25. Risks - During Insertion
Transfixation
Pain
Nerve damage
Arterial puncture
Allergies
Needlestick injury
Infection
Haemorrhage
Haematoma
Vaso-vagal episode
Needle phobias
Catheter embolism (cannulation)

26. Transfixation
Skin Vein wall Vein wall

27. Haematoma/Bruising Transfixation
Tourniquet too tight / left on too long
/ use of RUBBER GLOVE!
Arterial puncture
Repeated insertion sites

28. Future Complications of Cannulation
Phlebitis — septic / mechanical / chemical
Infection
Drug reaction / Allergy
Infiltration
Extravasation
Thrombosis / Embolism
Speed shock
Fluid overload

29. Phlebitis
TYPES OF:

30. Infiltration
“The inadvertent administration of non-vesicant (non-toxic) solution/medication into surrounding tissues."
(Royal Marsden Manual, 2004)
The cannula may still appear to be patent, so early recognition is vital to avoid tissue damage.
Examples of fluid include: Normal Saline &
5% Dextrose

31. Extravasation
“the inadvertent administration of a vesicant substance (toxic) into the tissues surrounding a vein.”
(Royal Marsden Manual, 2004)
Examples of fluid include: 10% Dextrose, Chemotherapy & Potassium

32. Thrombus Formation
Correct flushing technique - pulsated push-pause & positive pressure, prevents blood being left in the cannula & removes debris from the internal catheter wall (use 5mls of Normal Saline).
Flushing blocked cannula can lead to pulmonary embolus (30% PMs show undiagnosed PE).

33. Signs of Cannula Related Infection
Phlebitis
Pyrexia
Feeling unwell
Raised white blood cell count

34. Site preparation
As cannulation / venesection is performed using an aseptic non-touch technique it is imperative that the vein is cleaned PRIOR TO THE PROCEDURE, wearing clean non-latex gloves
Clean the vein for 30 seconds with 2% chlorhexidine in 70% alcohol solution, cleaning the vein in a criss-cross motion
Allow vein to air dry
DO NOT re-touch or palpate the vein once cleaned
Consider hair clipping if appropriate

35. DOCUMENTATION SEE CANNULA CARE PLAN includes:
Time & date of blood sample / cannula insertion
Site of insertion
Gauge and batch number of the cannula
What blood samples have been taken
Number of attempts (MAX 2 per person)
Any complications noted (e.g. haematoma)
Print & sign your name
Evidence verbal consent has been obtained