Presentation on theme: "INTRAVENOUS PERIPHERAL CANNULATION"— Presentation transcript:
1INTRAVENOUS PERIPHERAL CANNULATION Midwifery Practice 2
2INTRODUCTION What do you already know? What experiences have you had with iv cannulation?What are your thoughts on this midwifery role?What do you expect to gain from this session?Introduce myselfMy experience of IV cannulation, why & when I learnt, how I applied that in practice.The most important single factor influencing learning is what the learner already knows. Ascertain this and teach accordingly.I know that
3To introduce the procedure of peripheral intravenous cannulation AIM OF THE SESSIONTo introduce the procedure of peripheral intravenous cannulationHow are we going to achieve our learning outcomes:Firstly revise the anatomy in order to complete the skill competentlySet ground rules for the ‘hands on’ practical section of this session-sharps dangerous we need to be careful, understand and follow infection control proceduresAre those outcomes clear?Is there anything you would like to add?Outline session:Theory will include revision and exercisesPractical, working in pairs or small groups, trial & error, collaborative learning.
4LEARNING OUTCOMESUnderstand the purpose and indications of iv cannulationGain an overview of the techniqueFamiliarise yourselves with equipment and procedureGain some practiceUnderstand common complications and how to solve them.
5PURPOSE OF IV CANNULATION To have quick and easy access to the patient’s blood stream for rapid or more effective administration of a required or potentially needed treatment
6INDICATIONS Fluid administration or replacement (epidural, PPH..) Drug administrationin an emergencyin cases where it is required that a drug is absorbed and metabolised more effectively than it would be by any other route (ie.IV antibiotics, Syntocinon..)Administration of whole blood or blood productsIn preparation for a potential complication (multiparity, multiple births)
7ANATOMY & PHYSIOLOGY REVISION Veins return _______ blood to the _____ against the flow of gravity.This occurs under ____ pressure, therefore veins do not require ____ ______ walls like arteries. To maintain the direction of flow, veins are equipped with ___-___ valves.Veins tend to be located more ______ than arteries and do not _______ on palpation.DeoxygenatedHeartLowThick muscularOne-way valuesSuperficiallypulsate
8Tunica intima – smooth endothelial lining for easy flow Tunica media – mainly smooth muscle/elasticity for constriction/dilationTunica adventitia – connective tissue for support
9CHOICE OF VEIN Palpate using fingers (not thumb) Feels like elastic tube filled fullDoes not have a pulse!Ideally in the lower half of the arm or back of the handLocate the straightest portion of the veinThe veins should feel bouncy and refill when depressed and should be straight, have a large lumen, be well supported, visible, and free of valves to ensure easy advancement of the cannula into the vein.Valves can be felt as small lumps in the vein or may be visualized at bifurcations or more commonly seen in certain vessels.
10STRUCTURES TO AVOID Dominant arm Joints Flexure of the elbow Areas with compromised circulation, oedema or fractureValves in the veins (seen as bulges)ArteriesIt is best to avoid joints because:- this will lead to an increased risk of mechanical phlebitis and an infusion that will infuse intermittently due to the woman's movement.it can also be very awkward for the woman and may restrict her ability to carry out activities.Tends to be used in emergencies
11POINTS TO CONSIDEREvidence of altered anatomy or physiology? Burns, scars…Anticoagulant therapy, bleeding/clotting disorder (HELPP, liver disease…)?Vascular or circulatory problems, or vascular or lymphatic surgery?One arm or particular site being easier than any other?
12MATERIALS / EQUIPMENT Torniquete Sterile gloves Alcohol and/or clorhexidine wipesIV cannula (and sharps bin!!)IV dressingSwabs? LidocaineProtective cloth / pad for the bed
13DEVICES Butterfly - mainly in neonates - administration of small amounts of drugs- drawing up blood
14DEVICES - “Over the needle” cannula: - It’s the most commonly used device- Mounted over the needle:once device is pushed off of the needle into the vein, the stylet is removed- Drug, blood and fluid administration
15Colour Gauge Flow/Rate mls/min Type of infusion Orange 14 343 Grey 16 -Rapid blood transfusion-EmergenciesGrey16196Green1890Blood products, medicines, fluidsPink2061General crystalloid useBlue2236Paediatrics, oncologyYellow24Paediatrics, oncology, neonatology, elderlyIV cannulas come in many different sizes:The bigger the gauge size, the smaller the diameter of the catheter lumen isIn maternity, the ideal size used should be 14 or 16g.WHY?
16A LATEX GLOVE MUST NEVER BE USED TOURNIQUET- Know how to use it before approaching patient!- 5 cm above site (3 finger breadths)- 2 fingered gap- Apply tourniquet to the upper arm ensuring it does not obstruct arterial flow- Check patient is comfortableA LATEX GLOVE MUST NEVER BE USED
17In these diagrams - Veins are blue – arteries red and nerves are yellow Look at the diagram on the left we are going to focus on the anatomy of the arm
18THE CEPHALIC VEIN It readily accommodates a large-gauge cannula and, by its position on the forearm, provides a natural splint.However, its position at a joint may increase complications such as mechanical phlebitis and even general discomfort.The tendons controlling the thumb obscure the vein during insertion and care must be taken not to touch the radial nerve.
19THE BASILIC VEINThe basilic vein is a large vessel, which is often overlooked due to its inconspicuous position on the ulnar border of the hand and forearm. Cannulation can be awkward due to its position, its tendency to have many valves and to roll easily.
20METACARPAL VEINS Ideal position for IV; primary choice in pregnancy although veins are thin with inadequate tissue and muscle support in the elderly
21Dorsal venous network Not very stable: Usually easily visualized and palpated but can only accommodate smaller gauge cathetersLast resort for short-term therapy
22CONSIDERATIONS-Appropriate preparation of environment – including consent and adequate lighting / client comfort.-Use equipment designed for the specific purpose /task e.g. a proper tourniquet, skin prep, small sharps bin-Awareness of woman’s history-Good technique – including assessment of vessel and woman throughout, and insertion of cannula along the line of the vein NOT across.-Adequate infection control/skin cleansing and wearing of gloves. Beware of sharps!!
23TECHNIQUE Introduce yourself and explain procedure Wash hands Apply tourniquetAsk the woman to clench her fistIdentify veinPut on glovesClean the skin-5 cm above antecubital fossa (avoid obsttructing arterial flow)-a few times: this will promote venous engorgement-chosen site with alcohol and/or clorhexidine, for 30 secs, in a circular motion starting at the entry site and extending outward about 2 inches. Allow 30 seconds to dry
24CANNULA INSERTION Hold catheter in dominant hand “Anchor” vein Bevel up, quick, short, jabbing motion to enter skin (at about a degree angle in the direction of the vein)As you enter the vein, you will see flashbackAdvance catheter whilst simultaneously withdrawing needle to enter vein until 2nd flashback is seen along cannula
25ONCE INSIDE THE VEIN Advance plastic catheter Should slide easily: do not force itRelease tourniquet, ask the woman to bend arm and apply pressure at the distal end on the catheter.Withdraw needle ensuring the catheter stays in veinNever insert a needle into the catheter while it is in the woman’s arm
26YOU HAVE DONE IT!! Dispose of needle in sharps container Secure the cannula as per hospital policyDraw bloods if you need to or connect purged giving setWrite date and time of insertion of cannula on dressingDocument: location of insertion, type and gauge, date and time, bloods taken, number and location of attempts, adverse events.
27TROUBLESHOOTINGIf you don’t get flashback, do not remove cannulaSlowly withdraw while watching for flashbackIf not in vein, change direction of the needle slighltlyIf still unsuccessful, do not panic: we all have failed at some point!Release tourniquet, place gauze over puncture, remove catheter, tape down gauze?Try on another arm / ?Ask another team memberIf you hit an artery, remove catheter and apply firm pressure for at least 5 minutes
28PRINCIPLES OF CARETo prevent morbidity - infection and trauma. To maintain a ‘closed’ IV system with few connections to reduce the risk of contamination. To maintain a patent device. To prevent damage to the device and associated equipment
29CANNULA CARE Change catheter site every 48-72 hrs Inspection and documentation of status of cannula and area on each shift? Flush device prior to administering a drug or connecting fluids
30RISKS & COMPLICATIONS- Damage to nerves and local tissue caused by poor technique- Fibrosis of vessels caused by intima layer of vessel becoming roughened by scarring with the cannula.- Haematoma – caused by ‘overshooting’ the vessel.- Alcohol must be allowed to dry to avoid irritation to tissuesAssociated with rotation of the cannula and application of pressure whilst stylet still in place.
31COMPLICATIONS- Extravasation: inadvertent administration of a vesicant solution or drug into the tissues- Phlebitis caused by inadequate cleansing or poor infection control technique allowing entry of bacteria or micro-organismsTissue necrosis may follow
32COMPLICATIONS: Phlebitis SIGNS & SYMPTOMS:Redness or tenderness at tip of catheter or along infusion sitePuffy tissue over veinElevated temperatureWHAT TO DO:Stop infusionRemove catheterCall for helpDocument