8. PERIPHERAL VENOUS CANNULATION

CHAPTER 8. PERIPHERAL VENOUS CANNULATION




Indications67


Contraindications68


Equipment68


Practical procedure69


Post-procedure care73


Complications73


Drugs, namely opium and Crocus metallorum, were first administered intravenously to dogs by Sir Christopher Wren (1632–1723) in 1656 by use of a quill and bladder. This was first performed in humans by Johann Daniel Major (1634–1693) in 1662. Intravenous indwelling cannulae were popularized in the 19th and 20th centuries and were entirely metallic until the 1960s, which saw the introduction of plastic cannulae inserted both through and over metal stylets.


INTRODUCTION


Peripheral venous cannulation is a basic skill routinely required of doctors on a daily basis, and as such is important to master above virtually any other skill. Try to practise firstly on dummy models and then on patients before you qualify. This should minimize the discomfort for patients and increase your chances of success.


INDICATIONS






• Intravenous fluids.


• Intravenous medication.


• Intravenous electrolyte correction.



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If blood is required for sampling in addition to intravenous access, withdraw blood from the newly sited cannula with a sterile syringe prior to flushing to avoid the need for a separate puncture.


CONTRAINDICATIONS






• Lack of consent.


• Cellulitis over the area of presumed cannula insertion.


• Superficial or deep venous thrombosis.


• Ipsilateral mastectomy, i.e. a limb with impaired lymphatic drainage.


• Ipsilateral hemiparesis or contractures.


• Ipsilateral arterio-venous fistula (or potential site of arterio-venous fistula formation in pre-dialysis patients).


EQUIPMENT






• Sterile alcohol swabs.


• Tourniquet.


• Cannula (see Fig. 8.1 and Table 8.1 for sizes/functions).






































TABLE 8.1 Cannula sizes and suitable uses
Colour Size (gauge) Flow rate (mL/min) Use
Blue 22 36 Patients with small veins (such as the elderly)
Pink 20 61 For routine i.v. fluids and medications
Green 18 90
White 17 140 Large-bore access for rapid volume replacement (e.g. acute haemorrhage) and peripheral administration of potentially phlebotoxic drugs (e.g. amiodarone)
Grey 16 200
Brown 14 300



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A cannula with a smaller lumen will permit better venous flow around the cannula, thus improving haemodilution of the administered drug. Larger-gauge cannulae can also cause venous occlusion and/or intimal damage. Therefore, when intravenous access is required for routine intravenous fluids or medications, insert smaller-gauge cannulae where possible.

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Apr 3, 2017 | Posted by in GENERAL & FAMILY MEDICINE | Comments Off on 8. PERIPHERAL VENOUS CANNULATION

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