Venepuncture
& Peripheral IV Cannulation
Study Day
June 2009
20.08.09
1
Aim
• Explore the legal and professional issues
in the extended role
• Discuss health and safety issues in
venepuncture and cannulation
• Describe infection control issues in
venepuncture and cannulation
• Explore practical aspects of venepuncture
and cannulation
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Venepuncture
Procedure of entering a vein with a needle
for the purpose of:
• Obtaining a representative sample of
blood for diagnostic purposes
• Monitoring levels of blood components
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Peripheral IV Cannulation
• The procedure of puncturing a patient’s
skin to allow insertion of a temporary
plastic tube into a vein for the purpose of:
• Bolus injection
• Short term infusion
• Blood transfusion
• Rapid infusion of medication or fluid.
(Jackson 2003)
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Legal and professional
• As a professional you are personally
accountable for actions and omissions in
your practice and must always be able to
justify your decisions.
• You must work within the limits of your
competence
•
NMC 2008
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NMC Code of Conduct
• Consent
• Keeping your
knowledge and skills
up to date
• Keeping clear and
accurate records
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Consent
• You must ensure that you gain consent
before you begin any treatment or care
• You must uphold peoples rights to be fully
involved in decisions about their care
• No adult can validly give consent for another
adult unless legally authorised to do so Adults with Incapacity Act (2000)
• It is not necessary to document consent to
routine and low-risk procedures e.g. taking a
blood sample.
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Four Arenas of Accountability
To the public
To the patient
To the employer
To the profession
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Health & Safety
•
•
•
•
H&S applicable to venepuncture and
cannulation includes:
Sharps injury procedures
Extended role training
Policy for the disposal of sharps
Prevention and protection from blood
borne viruses.
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Preparation for procedure
• The patient – explanations, education re cannula
care, assessment
• Equipment – integrity of packaging and expiry
dates
• Environment – clean, clear, clutter free, good
lighting
• Cannula – smallest cannula to suit purpose
• Veins – choose large veins for irritant drugs
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Technique
• Asepsis
• Vein stabilised
• Smooth accurate
placement
• Correct use of
tourniquet
• Correct vein
assessment
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•
•
•
•
For cannulation:
Stylet never be re
introduced
Cannula flushed
Connections secure
Cannula secure
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Visual inspection – veins should be
visible
• Sites to avoid
• on or near site of
infection
• Small superficial
veins
• Bruised areas
• Areas of scarring
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• Limb where IV
infusion is running
• Near phlebitis
• Oedematous areas
• Previous
Venepuncture sites
• Limb affected by
injury/disease
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Tourniquet
• Know how to use it
before approaching
patient!
• 10cm above site (3
finger breadths)
• 2 fingered gap
• Apply tourniquet to the
upper arm ensuring it
does not obstruct
arterial flow
• Check patient is
comfortable
• A latex glove must
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Palpation – veins should be bouncy
• Sites/veins to avoid
• Thrombosed hard
veins
• Fibrosed veins
• Sclerosed veins
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• Inflamed veins
• AV fistula
• Axillary Clearance/
Mastectomy
16
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Venepuncture
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Blood collection
• Collection bottles - Attach directly to
needle or butterfly using an adapter.
• Syringe – do not advocate. However if
you do then transfer blood to the
appropriate specimen bottles as soon as
possible ensuring the correct quantity is
placed in each container.
• Label bottles as soon as possible
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Via venous access device
• Peripheral catheters should not be used
for routine blood sampling
• If necessary – do not use a prevacuumed system.
• Use syringe 10mls or less.
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Cannulation
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Cannulation
Speed and
viscosity of
infusion
Size of
cannula
Site of vein
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Colour
Gauge Flow Rate Infusion
mls/min
Orange
14
343
Rapid blood transfusion
Emergencies
Grey
16
196
Rapid blood
transfusion.
Emergencies
Green
28
90
Pink
20
61
Blood products,
medicines, fluids
General crystalloid use,
Blue
22
36
Paediatrics, oncology.
Yellow
24
22
Paediatrics, oncology.
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Neonates, elderly
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Complications
Missed vein
Haematoma
Transfixation
Phlebitis
Blockage of cannula
Needlestick injury
Infection
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Cannula embolism
Pulmonary embolism
Damage to surrounding
nerves
Arterial puncture
Catheter fracture
Thromboembolism
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COMPLICATIONS
COMPLICATION
Extravasation occurs when
the infused fluid enters the
subcutaneous tissue rather
than the vessel as intended.
RECOMMENDATION
Re-site the cannula to prevent
tissue necrosis. Consider
alternative site.
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Infiltration / Extravasation
• Infiltration occurs when - a non vesicant
medication/solution leaks into the
subcutaneous tissue.
• Extravasation occurs when – a vesicant
medication/solution leaks into the
subcutaneous tissue.
• NB – Vesicant – any substance that causes blistering or tissue
necrosis and requires management to limit tissue damage
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Managing extravasation
•
•
•
•
•
•
Stop infusion at once
Withdraw drug
Leave cannula insitu
Elevate limb to reduce oedema
Apply hot/cold pack
Subsequent management depends upon
drug involved and degree of damage.
Maybe local extravasation policy i.e. use
of antidote.
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Preventing complications
•
•
•
•
Ensure staff are trained and supervised
Supervised practice and competence assessed
Practice continually updated
Ensure correct preparation of patient, equipment
and environment
• Aseptic non touch technique
• Managed aftercare
• Documentation
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Documentation
•
•
•
•
Venepuncture
Which bloods taken
Site
Adverse events
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• Cannulation
• Type and gauge – Vasofix
22g
• Site – left hand
• Date/time of insertion
• Dressing must be labelled
with date, time & initials
• Number and location of
attempts
• Name of person inserting
Cannula
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Aftercare
• Patient education
• Asepsis for all cannula manipulations such
as medicine administration and dressing
changes.
• Avoid over manipulation of cannula by
using needle free devices.
• Secure connections.
• Regular monitoring and flushing
• Planned removal of cannula
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Flushing
• All flushing solutions
should to be prescribed
• 10ml syringes used for
flushing
• Use a positive pressure
technique (push-pause
method injecting 1ml at a
time to create turbulent
flow)
• Compatibility of sodium
chloride with drug
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