2LEARNING OUTCOMES OF THE WORKSHOP Assessment of patientDemonstrate the correct technique for performing cannulation & venesection as per SUHT policy & procedureSelection of the appropriate deviceIdentify and recognise the complications that are associated with cannulation & venesectionCorrect documentation as per SUHT policy
4THE ASSESSMENT CONSIDER THE FOLLOWING POINTS: Age / size / history / condition / dependency of the patientHistory of previous cannulation / venesectionType / length of treatment requiredNumber of tests orderedWhat medication is the patient on?Fluid statusHistory of blood disorders
5Conditions that affect the position of the device: - AmputationStrokeMastectomy or other Breast / Lymph SurgeryRenal FistulaLymphoedema or CellulitsisDiabetes / Vascular Disease / ArthritisTrauma / Fractures / BurnsSocial History
6Questions to ask the patient OBTAIN CONSENTHave you had a cannula / blood test before?Were there any complications / adverse reactions?Do you have any allergies?Consider needle phobiaWould you like a local topical anaesthetic before I insert the cannula or take blood?Which is your dominant arm?
7Attributes of an ideal vein are: - Be engorged, bouncy & softRefill after it has been depressedBe visibleFeel roundBe well supported by surrounding structuresBe straight & ‘free of valves’
8Veins to be avoided: - Thrombosed, fibrosed or sclerosed Inflamed or bruised or painfulThin or fragileMobileNear bony prominences and jointsNear sites of infection or oedemaAVOID THE VALVESFor venesection avoid the arm with an IV line running
9Methods for improving venous access: Apply a disposable tourniquetLower the level of the arm below the heartAsk the patient to open and close their fistLight tapping / rubbing of the veinsWarm compresses over the selected veinWarm waterRelax the patient / consider the environment
16Selecting 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.
17Colour Size Flow Ml/min Uses Brown 14 275 Grey 16 173 Green 18 100 Rapid transfusions of whole blood. Emergency situations.Grey16173Rapid transfusions of whole blood. Emergency situationsGreen18100Blood transfusionsPink2060IV infusions. Bolus’Blue2225Bolus’. Maintenance infusionsYellow2413Bolus medications. Short term infusions. NeonatesPurple26Neonates
18SGH, exceptions to this rule: - Patients ConditionCannula SizeAll obstetric patientsGreyActive gastrointestinal(GI bleed)Brown or GreyAt risk of GI bleedAt risk of epileptic fitGreenAt risk of cardiac eventAt risk of neurological event
20VACUTAINER Quicker collection than other methods Closed system Exact amount of blood obtainedReduces the risk of haemolysis of the sampleReduces the risk of needlestick injury
21BOTTLES & BLOOD FORMSE-QUEST SYSTEM for blood requests & results within SUHTALWAYS ensure that the GROUP & SAVE or CROSSMATCH request has been correctly completed & signed for by the requesting MEDICAL PRACTIONER
22SerumAB LevelsE.D.T.A.FBC & ESRCross Match Group & SaveCoagulation INR / APTRGlucoseLithium Heparin, PST, U&E’s, Bone & LiverTrace Elements
23ORDER 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)
24Risks and Complications of Cannulation & Venesection
30Infiltration“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
31Extravasation“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
32Thrombus FormationCorrect 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).
33Signs of Cannula Related Infection PhlebitisPyrexiaFeeling unwellRaised white blood cell count
34Site preparationAs 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 glovesClean the vein for 30 seconds with 2% chlorhexidine in 70% alcohol solution, cleaning the vein in a criss-cross motionAllow vein to air dryDO NOT re-touch or palpate the vein once cleanedConsider hair clipping if appropriate
35DOCUMENTATION SEE CANNULA CARE PLAN includes: Time & date of blood sample / cannula insertionSite of insertionGauge and batch number of the cannulaWhat blood samples have been takenNumber of attempts (MAX 2 per person)Any complications noted (e.g. haematoma)Print & sign your nameEvidence verbal consent has been obtained