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CDHB

Intravenous Cannula Insertion and Care

Any procedure that 'breaks' the protective skin surface has the potential to introduce infection. It is important for RMOs to be skilled in IV line insertion. Observation of the following procedure is essential.

• Insertion
  • Explain the procedure and why it is being done to the patient. Verbal consent should be obtained.
  • Wash hands. Soap and water is adequate. Non-sterile gloves are recommended in all cases and essential if there is significant risk of infection from blood contamination (e.g., severe dermatitis, open wounds).
  • Choose an upper limb vein if possible. Avoid antecubital fossa if you can. Use a tourniquet or sphygmomanometer.
  • Prior to insertion, prepare site with antiseptic solution. We recommend 2% chlorhexidine and 70% isopropyl alcohol. Alcohol alone is not adequate. Hirsute arms may need clipping. The antiseptic must remain in contact with the skin for at least 30 seconds before inserting cannula. Make sure you can still feel arterial pulsation after the tourniquet has been applied. If veins are poor, warm the limb and use a sphygmomanometer inflated to 70 - 80 mm Hg.
  • Insert cannula into vein. Avoid touching puncture site. Obtain flashback and advance further to ensure that the plastic cannula is in the vein. Remove stylet and connect previously primed administration set or luer plug. Ensure puncture site is clean and dry (using sterile gauze swab) before covering site.
  • To stabilize the cannula, use a sterile prepackaged transparent dressing with sterile tapes which will stabilize the cannula and act as a dressing (these are found on the IV trolley).

    Note: The insertion date and time must be written in the clinical notes and on the dressing. Convenient green labels are available for this and should be used.

    IV Cannula Insertion date          /          / Time

• Failure to insert an IV line
  • It is important to recognize that on occasions you will find it difficult or impossible to insert an IV line. Under these circumstances make a maximum of 2-3 attempts and then seek help and advice from a more senior / experienced member of your medical/nursing team.
• Care of IV Cannula
  • Examine daily. Replace routinely every 48-72 hours, or at the first signs of phlebitis. Clinical examination detects only some infected catheters. Septic thrombophlebitis may cause ongoing bacteraemia after removal of the catheter, and may need surgical drainage.
  • Both nursing and medical staff are responsible for assessing the need for cannula change.
• Suspected Cannula Infection
  • Disconnect giving set from the cannula.
  • Remove dressing and take swab of cannula site.
  • Remove the catheter and cut off subcutaneous portion using sterile scissors. Place in a sterile container. Send to Microbiology Laboratory.
  • Clean the cannula exit site with antiseptic solution as above, leave for 30 seconds, and apply dressing.
  • Consider whether infusion solution may be infected. If this is suspected, send solution and giving set to Microbiology. If related to blood transfusion, send to Blood Bank. See Tranfusion Reactions.
  • In the event of a needle stick injury, if the patient is known to be HIV positive, or there is reason to suppose that there is an increased risk of HIV positivity, contact the on-call Infectious Diseases Physician (not the Registrar) immediately.
  • For further information, refer to the CDHB Peripheral Cannulation Handbook 2010.

Topic Code: 1279