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Cannulation in adults

Intravenous cannulation is a technique that involves the insertion of a fine, flexible hollow tube, with an inner retractable needle, into a peripheral vein.

Article by Claire Ford

First published: Last updated:
Purpose

Intravenous cannulation is a widely practised invasive procedure globally, involving the insertion of a slender, flexible tube containing a retractable needle into a peripheral vein (Boyd, 2022). This technique serves as a gateway for various medical interventions, including the delivery of fluids, medications, dyes, contrast agents and blood products, as well as the collection of blood for diagnostic purposes (Helm et al, 2015). Nonetheless, conducting cannulation involves inherent risks. Hence, it becomes crucial for health professionals to ensure safe practice by recognising their own limitations, comprehending the theoretical foundations of the insertion procedure, and maintaining awareness of the associated risks in this clinical skill (Nursing and Midwifery Council (NMC), 2018; 2023).

When performing cannulation on individuals with compromised immune systems, it is of utmost importance to take additional precautions to reduce the risk of infection and safeguard their health. Immunocompromised individuals possess weakened immune defences, making them more susceptible to

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Assessment

The National Institute for Health and Care Excellence (NICE) (2017) recommends that, before insertion of a cannula, a clinical decision in relation to the site and choice of vein needs to be undertaken by the health professional performing this task, in order to reduce the risk of cannula failure and associated complications. The decision should take into consideration the patient's preferences, their level of acuity, vein accessibility, medical history and cannulation history.

Sites and veins to avoid include those affected by the patient's clinical condition. For example, post-mastectomy, using the side associated with breast surgery is contraindicated due to the complications associated with potential lymphoedema development post-node removal (Thomas, 2015). Veins that are small, superficial, sclerosed, pulsate or close to arteries should also be avoided, in order to reduce the risks of complications developing during and after the insertion period (Rickard et al, 2012). Complications can also be avoided by

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Procedure

To carry out the procedure, additional equipment is required, all of which should be checked prior to carrying out the procedure. The procedure is as follows:

  1. Communicate with the patient and provide them with relevant information in order for them to provide informed consent. This will also provide you with the opportunity to talk about previous experiences with cannulation, ascertain if the patient has any allergies to dressings, assess for potential complications and physically prepare the patient and the environment prior to collecting the equipment.
  2. Decontaminate hands. With the patient's arm in a comfortable and appropriate position, apply the tourniquet 7-10 cm above the chosen site. To encourage venous filling and vein distention, ask the patient to open and close their fist, use gravity by asking the patient to hang their arm down, apply a warm compress, or lightly stroke the vein in a downward motion (Phillips and Gorski, 2014).

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Equipment

The required equipment includes:

  • Non-sterile gloves

  • Alcohol gel

  • Procedural tray

  • Disposable tourniquet

  • Alcohol-based cleansing product

  • Cannula

  • Needle-free connector

  • Extension set (if required)

  • Saline flush

  • Sterile film dressing

  • Sterile gauze

  • Sharps disposal bin

  • Cannula care plan

  • Pillow

  • Sterile field or cannula pack (Lister et al, 2021)

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Risks and complications
Insertion complications
  • Nerve injury: this can occur through poor vein choice and often results in shooting or burning pain, or sharp tingling. If this occurs, the needle and tourniquet must be removed
  • Haematoma: infiltration of blood into the surrounding tissues is often caused by poor insertion technique, inappropriate vein selection, inadequate pressure upon removal, incorrect use of the tourniquet or of a cannula size that is too large for the chosen vein. The risk of this occurring is increased in a patient who is receiving anticoagulant therapy
  • Arterial puncture: the inadvertent puncture of an artery rather than a vein can occur if there has been an inadequate assessment of the site and the vein chosen is very close to an artery. This can result in the formation of a haematoma and other symptoms such as numbness, pain, paleness and coldness of the limb or hand. If an arterial puncture occurs,

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NMC proficiencies

Nursing and Midwifery Council: standards of proficiency for registered nurses

Part 1: Procedures for assessing people’s needs for person-centred care

2.2 undertake venepuncture and cannulation and blood sampling, interpreting normal and common abnormal blood profiles and venous blood gases

Part 2: Procedures for the planning, provision and management of person-centred nursing care

9.3 use effective aseptic, non-touch techniques

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Resources

Boyd C. Clinical skills for nurses. 2nd edn. Chichester: Wiley. 2022

Ford C, J Park L. How to apply and remove medical gloves. Br J Nurs. 2019;28(1):26–28. https://doi.org/10.12968/bjon.2018.27.20.1164 

Health and Safety Executive. Sharp instrument in healthcare regulations 2013: guidance for employers and employees. 2013. https://www.hse.gov.uk/pubns/hsis7.htm (accessed 31 October 2023)

Helm RE, Klausner JD, Klemperer JD, Flint LM, Huang E. Accepted but unacceptable. J Infus Nurs. 2015;38(3):189–203. https://doi.org/10.1097/NAN.0000000000000100

Lister SE, Hofland J, Grafton H, Wilson C. The Royal Marsden manual of clinical nursing procedures. 10th edn. Chichester: John Wiley & Sons; 2021

National Institute for Health and Care Excellence. Intravenous fluid therapy in adults in hospital. 2017. https://www.nice.org.uk/guidance/cg174 (accessed 31 October 2023)

Nursing and Midwifery Council. Standards framework for nursing and midwifery education. 2023. https://www.nmc.org.uk/standards-for-education-and-training/standards-framework-for-nursing-and-midwifery-education/https://tinyurl.com/4duz65p5 (accessed 31 October 2023)

Nursing and Midwifery Council. The code. London: NMC; 2018

Phillips LD, Gorski LA. Manual of IV therapeutics: evidence-based practice for infusion

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