PERIPHERAL INTRAVENOUS CANNULATION
- 20 gauge for most adults
- 22 gauge if for quick IV ABs or for children
- 18/16 if bleeding internally
- 1 for blood (10mls usually adequate unless for blood cultures = 20mls)
- 1 for flushing with saline
- Persist Plus (chlorhexidine) swab
- Dressings Kit / Gauze
- Find appropriate vein
- Keep Arm in dependent position
- Apply tourniquet or blood pressure cuff inflated to 80-100mmHg for large arms.
- Apply proximally over mid to distal humerus; there is a vein running between the radius and ulna so applying over forearm will not work
- Tapping veins can help to become more prominent
- Using Persist Plus, swab over and around (using circular sweeps) area around the vein(s) you wish to use
- Stabilise arm / skin distal to vein (ensure that hand / thumb NOT near needle)
- Hold needle with bevel facing UP and needle pointing downwards on 30 degree angle, stab needle through skin into vein approximately 1-2mm until blood seen to move up needle and into plastic base (“flashback”). If no flashback seen, may need to stab again a little deeper (particularly if patient elderly / atherosclerotic. Might also need to jiggle slightly to ensure in vein)
- Once happy with position of needle, stabilise the needle end with one hand to prevent movement. Push the plastic cannula forwards off the needle and into position.
- Press on vein proximally
- Retract the needle
- Take blood using syringe, release tourniquet and flush with saline (5-10mls)
- Cap end
- Clean blood from around area and using apply tegaderm to hold cannula down = work quickly as blood clots quickly and need to get blood from syringe into tubes
- Only try twice – if unsuccessful, get someone else to try.
DECANTING OF BLOOD
- After taking blood, syringe some blood into the plastic container in the dressings kit to remove clotted blood. This can be used to test BSL (opportunistic).
- Then, removing cap from specimen tubes (except blood cultures which require injecting of blood into the appropriate tubes. Generally this would require about 5mls of blood for most tubes.
- ESR and Coagulopathy are exception, which the tube (black in this case) to be filled to the line