IV Cannulation

Amplified
Checklist

IV Cannulation - Amplified

Equipment

  • IV cannula, bung, 10mL syringe, saline flush
  • Tourniquet, chlorhexidine wipe, transparent dressing
  • Sharps bin within reach

Site Selection

Start distal, work proximal (preserves options). Non-dominant arm preferred.

  • Cephalic: lateral forearm - reliable first choice
  • Dorsal hand: more painful but always accessible
  • Avoid: joints, infected areas, AV fistula limbs

Prep

Consent: Explain procedure, ask about previous difficult access - patients know their good veins.

Tourniquet: Apply 10-15cm proximal. Tight enough for venous distension, loose enough to feel radial pulse.

If veins aren't visible: lower arm, warm compress, have patient pump fist.

Clean: Chlorhexidine with friction. Let dry completely - don't re-palpate after.

Execute

Anchor: Pull skin taut 2-3cm distal to entry. Stops vein rolling.

Insert: Bevel up, ~30°. Watch entry point, not vein.

Flashback: Blood in chamber = you're in. Stop. Drop angle to 5-10°, advance 1-2mm more to get plastic tip in (not just needle).

Advance cannula: Hold needle still, slide plastic off into vein. Should glide easily - if resistance, don't force.

Tourniquet off → occlude → withdraw: Release tourniquet first. Press proximal to cannula tip to prevent bleeding. Withdraw needle straight to sharps. Never recap.

Attach bung: Activate port valve, attach needleless connector.

Finish

Secure: Transparent dressing so site stays visible. Write date.

Flush: 10mL saline, flush briskly. Watch for pain/swelling = extravasation → remove immediately.

Document: date, time, site, gauge, flushes well.

Troubleshooting

No flashback: Slowly withdraw watching for flash (may have gone through). Can redirect once under skin - never withdraw to skin level and re-advance.

Difficult access: Warm arm, lower below heart, BP cuff instead of tourniquet (inflate to just below diastolic), ultrasound-guided, or IO in emergency.

Complications:

  • Haematoma → pressure, elevate
  • Arterial (pulsatile bright red) → remove, firm pressure 5 min
  • Phlebitis (pain/redness along vein) → remove, warm compress
  • Extravasation → remove, elevate