Medical student life-part 5

salam alaik..

Today,i feel so excited as i have learned about something amazing during my practical courses,that is; IV cannulation.first,i thought this procedure are somewhat similar to injection but it is totally wrong..my practical classes was guarded by a very famous and expert anaesthesiologist- Dr Amel Abdul who has further her career as a great doctor for 6 years in London..although she’s Egyptian,but her English was amazed-like a European women tounge!!

our class today started by briefing lectures for half an hour in a very well-conditioned class..and after that,we’re divided by small groups,4 person for each group in order to have a very dramatic practical session!hehe..the time for inserting the needle to the patient..here,i wanna share some tips with all of you on how to do this procedure..

Peripheral venous iv cannulation is an essential skill for all junior doctors. Indications for iv cannulation include:

* Administration of iv fluids
* Administration of certain iv therapy
* Administration of iv blood products

The superficial veins in the upper limbs are the most commonly used in practice, particularly those in the forearm and dorsum of the hand. The commonest type of iv cannula used in practice is the ‘cannula-over-needle’ device. Such cannulas have a Luer-lock component for the attachment of a giving set and a valved injection port for the administration of drugs.

Peripheral intravenous cannulation

1. introduction and consent
introduce yourself to the patient and identify their correct details. If the patient is conscious & has the capacity to understand – explain the procedure to the patient and gain their consent. It is important to gain full consent from the patient and warn them that they may feel some discomfort during this procedure. Patient preference, including dominant handedness, should be discussed.

2.Patient position and clinical assesment
Prior to any procedure it is important to perform a full clinical assessment (including a drug and allergy history). It is important to ascertain the indication and any potential contraindication. If at any stage you are unsure whether or not to perform the procedure – always seek expert advice

Ideally the patient should be lying in bed (some patients have been known to faint during this procedure!)

Ensure that their forearm is below the level of their heart, exposed and well supported.

3.Equipment

*
Gloves
*
Range of iv cannulas
*
Tourniquet
*
Dressing to secure cannula
*
Cotton wool balls
*
Alcohol wipes
*
Saline flush and sterile syringe
*
Sharps bin & clinical Waste bag

4. before you start your procedure,you must have first wash your hands in order to get rid of infectious bacteria

5.Apply a torniquet
A tourniquet should be applied to the patients upper arm. The tourniquet should be applied at a pressure which is high enough to impede venous distension but not to restrict arterial flow.

6.location of suitable veins
Consider a site away from infected, bruised or thrombosed veins or you risk further tissue necrosis or infection. Use the non dominant arm or hand.
•

Check if patient has had lymph node dissection with lymph stasis as you may run risk of phlebitis or cellulitis.
•

Best to choose a vessel previously unused, easily detected by inspection and palpation which is patent, not close to a valve and is healthy.

Generally distended veins that you can feel are better than veins that you can see. A distended vein should feel ‘firm and bouncy’. Remember that over arteries, you should feel a pulsation. Note the brachial artery is near the median cubical vein.

If you do not feel any particularly good distended veins, there are a few tips of how to help distend cutanous veins:

*
Ask the patient to clench and open their fist
*
Make sure the patients arm is below the level of the heart
*
Place the patients arm in luke warm water (which may cause venous distension )
*
Gently tapping the veins may encourage venous distension – but this usually is not recommended as it may cause patient discomfort.
*
There is increasing evidence that topical GTN ointment may also dilate peripheral superficial veins.
*
It is usually worth while asking the patient “Do you have a good vein?”
*
Applying the tourniquet for a minute and then letting it down, waiting about 30 secs and then re-applying it also helps distend poor veins.

7. cleansing of site
Now that you have located the ‘best vein’ wipe the site once, with an alcohol swab. Make sure you give the alcohol enough time to dry off.

8. inserting the canula
Prior to inserting the cannula, inform the patient that they may feel some discomfort. Evidence has shown that if the patient coughs at the same time – this may decrease the degree of pain experienced by the patient. Insert the cannula, at a shallow angle, into the vein in one assertive movement. A tip here is think more about where the tip of the needle is in the vein – rather than where the needles punctures the skin

9 flash back

Insert cannula at 30 degree angle and reduce angle when flashback occurs.

Advance cannula complete with stylet into the vein

As you advance further withdraw stylet with a smooth action of separation

NEVER reintroduce the stylet if the cannula does not feed into the chosen vein

10. remove needle
Apply pressure at the proximal location of the cannula tip (this helps to prevent leakage of blood when the needle is removed) and elevate the arm above heart level

11. apply cap to canula
Apply the cap to the end of the cannula. Make sure that it is secure.

Secure cannula

Secure the cannula in position with dressing. A well secured line will last for longer and then you are less likely to have to replace it. An important consideration for the busy foundation doctor.

12. Flush
Cleanse the injection port with alcohol wipes. Now flush the cannula with saline. Some guidelines would suggest that you use an extension when introducing medication via this port – therefore always adhere to guidelines in the healthcare trust that you work in. This allows you to check the patency of the cannula.

reference :

Queen’s universityBelfast website