Venous Cannulation
Simulation
The simulator enables you to practice and test your ability to insert an intravenous line for venous cannulation, with cross-sectional animations to enable understanding.
Video
The video guides you through a step-by-step demonstration on how to insert an intravenous line in a forearm vein.
Anatomy
The anatomy provides a 3D, 360-degree rotating image to illustrate the main veins of the forearm.
Text
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Step 1: Preparation
1.1. Tray preparation
Before embarking on this procedure, set up your tray with the necessary equipment and/or medication.
1.2. Patient preparation
Ensure the patient's privacy and that the patient feels comfortable and relaxed.
Position the patient according to the site chosen. Place the chosen limb lower than the level of the heart to facilitate venous filling.
1.3. Operator preparation
Take universal precautions.
Step 2: Select a site and apply a tourniquet
Select a suitable site for cannulation.
Apply a tourniquet proximal to the selected site to promote venous filling.
If you are using the hand or forearm, ask the patient to open and close the hand several times to aid filling.
Step 3: Cleanse the skin and infiltrate the local anesthetic
Cleanse the skin over the puncture site with the alcohol swab.
If the patient is conscious or semi-conscious, infiltrate a small amount of local anesthetic subcutaneously around the intended puncture site taking care not to distort the anatomy.
Step 4: Insert the needle
Hold the cannula with the bevel of the needle facing upwards.
Ensure that the cannula moves freely over the needle.
Stretch the skin distal to the site with your free hand. This will straighten the vein and reduce its movement.
Enter the skin at an angle of approximately 20 degrees (in a cephalad direction).
Advance the needle until the vein is entered. This will be recognized by the following:
- A "give" or a palpable change in pressure
- A flashback of blood within the cannula
Step 5: Advance the cannula into the vein
Lower the angle of approach and advance the needle and cannula a further 2 mm to ensure that the cannula tip has entered the vein.
Gently slide the cannula off the needle tip (with your free hand) and advance it fully into the vein.
Release the tourniquet.
Apply pressure over the vein proximally and remove the needle.
Attach the plug to the Luer lock on the cannula before releasing pressure on the vein.
NOTE
- Do not reinsert the needle after the cannula has been advanced as it may break off part of the cannula.
Step 6: Flush the cannula
Open the port on the cannula.
Inject 3 to 4 mL of saline (see reference) to confirm patency and flush blood out of the cannula. Watch for sudden local swelling, which implies extravasation. If this occurs, remove the cannula and insert a new one at a different site.
Close the port.
Step 7: Secure the cannula
Use a sterile transparent dressing to secure the cannula to the patient's forearm.
Write the date and time of insertion on the dressing.
If the cannula is in an antecubital vein, splint the elbow in an extended position.
References
Meta-analysis
1. Randolph AG, Cook DJ, Gonzales CA, Andrew M. Benefit of heparin in peripheral venous and arterial catheters: systematic review and meta-analysis of randomised controlled trials. BMJ. 1998 Mar 28;316(7136):969-75. PMID: 9550955
Randomized controlled trials
2. Garrelts JC, LaRocca J, Ast D, Smith DF Jr, Sweet DE. Comparison of heparin and 0.9% sodium chloride injection in the maintenance of indwelling intermittent i.v. devices. Clin Pharm. 1989 Jan;8(1):34-9. PMID: 2643500
3. Robertson J. Intermittent intravenous therapy: a comparison of two flushing solutions. Contemp Nurse. 1994 Dec;3(4):174-9. PMID: 7599468
Review articles
4. O'Grady NP, Alexander M, Dellinger EP, et al. Guidelines for the prevention of intravascular catheter-related infections. Centers for Disease Control and Prevention. MMWR Recomm Rep. 2002 Aug 9;51(RR-10):1-29. PMID: 12233868
