CANNULATION

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CANNULATION VENESECTION
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LEARNING OUTCOMES OF THE WORKSHOP

• To be able to assess the patient
• To be able to take a blood sample using a
  vacutainer system
• To be able to site / change a cannula
• To be able to name the complications of
  cannulation and venesection

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Patient Assessment Vein Selection
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THE ASSESSMENTCONSIDER 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

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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

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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?

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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

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Veins to be avoided are -

• 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

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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

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WHICH VEIN?
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Antecubital Fossa
Cephalic
1st Intercostal
Brachial Artery
Basillic
Radial
Median Cubital Vein
Radial Artery
Median
Ulnar Artery
Ulnar
Veins
Arteries
Nerves
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DIGITAL DORSAL VEIN
DORSAL METACARPAL VEINS
DORSAL
VENOUS NETWORK
CEPHALIC VEIN
BASILLIC VEIN
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VEINS TO BE USED ARE

• METACARPAL VEINS
• CEPHALIC VEIN
• BASILIC VEIN
• MEDIAN CUBITAL VEIN

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GROUP EXERCISE

• In pairs, use a tourniquet to identify each
  others
• Veins
• Arteries
• Valves
• Ligaments

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CANNULA SELECTION
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Selecting the right cannulaTwo 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.

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Colour Size Flow Ml/min Uses
Brown 14 275 Rapid transfusions of whole blood. Emergency situations.
Grey 16 173 Rapid transfusions of whole blood. Emergency situations / Obstetrics
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
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VENESECTION

• DEVICE SELECTION

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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

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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

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Serum AB Levels
E.D.T.A. FBC ESR
Cross Match Group Save
Coagulation INR / APTR
Glucose
Lithium Heparin, PST, UEs, Bone Liver
Trace Elements
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ORDER OF DRAW

• No Additives ( Green, Red, Dark Blue)
• Coagulation Screen (Light Blue)
• Other Additives (Gold, Grey, Lavender Pink)
• EXCEPTION
• Blood Cultures always FILL FIRST

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• Risks and Complications of Cannulation
  Venesection

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Risks - During Insertion

• Transfixation
• Pain
• Nerve damage
• Arterial puncture
• Needlestick injury

• Infection
• Haemorrhage
• Haematoma
• Vaso-vagal episode
• Needle phobias
• Allergies

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Transfixation
SkinVein wallVein wall
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Haematoma/Bruising

• Transfixation
• Tourniquet too tight / too long / use of RUBBER
  GLOVE!
• Arterial puncture
• Repeated insertion sites

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Future Complications of Cannulation

• Phlebitis septic / mechanical / chemical
• Infiltration
• Extravasation
• Thrombosis / Embolism
• Speed shock / Fluid overload

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Phlebitis

• TYPES OF

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Infiltration

• The inadvertent administration of non-vesicant
  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.

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Extravasation

• the inadvertent administration of a vesicant
  substance into the tissues surrounding a vein.
• (Royal Marsden Manual, 2004)

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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

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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