8. PERIPHERAL VENOUS CANNULATION

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Last modified 21/06/2015

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CHAPTER 8. PERIPHERAL VENOUS CANNULATION

Introduction67

Indications67

Contraindications68

Equipment68

Practical procedure69

Post-procedure care73

Complications73

Drugs, namely opium and Crocus metallorum, were first administered intravenously to dogs by Sir Christopher Wren (1632–1723) in 1656 by use of a quill and bladder. This was first performed in humans by Johann Daniel Major (1634–1693) in 1662. Intravenous indwelling cannulae were popularized in the 19th and 20th centuries and were entirely metallic until the 1960s, which saw the introduction of plastic cannulae inserted both through and over metal stylets.

INTRODUCTION

Peripheral venous cannulation is a basic skill routinely required of doctors on a daily basis, and as such is important to master above virtually any other skill. Try to practise firstly on dummy models and then on patients before you qualify. This should minimize the discomfort for patients and increase your chances of success.

INDICATIONS

• Intravenous fluids.

• Intravenous medication.

• Intravenous electrolyte correction.

Tip Box

If blood is required for sampling in addition to intravenous access, withdraw blood from the newly sited cannula with a sterile syringe prior to flushing to avoid the need for a separate puncture.

CONTRAINDICATIONS

• Lack of consent.

• Cellulitis over the area of presumed cannula insertion.

• Superficial or deep venous thrombosis.

• Ipsilateral mastectomy, i.e. a limb with impaired lymphatic drainage.

• Ipsilateral hemiparesis or contractures.

• Ipsilateral arterio-venous fistula (or potential site of arterio-venous fistula formation in pre-dialysis patients).

EQUIPMENT

• Sterile alcohol swabs.

• Tourniquet.

• Cannula (see Fig. 8.1 and Table 8.1 for sizes/functions).

Fig. 8.1

Different-sized cannulae have different indications (see Table 8.1).

**TABLE 8.1** Cannula sizes and suitable uses
Colour	Size (gauge)	Flow rate (mL/min)	Use
Blue	22	36	Patients with small veins (such as the elderly)
Pink	20	61	For routine i.v. fluids and medications
Green	18	90
White	17	140	Large-bore access for rapid volume replacement (e.g. acute haemorrhage) and peripheral administration of potentially phlebotoxic drugs (e.g. amiodarone)
Grey	16	200
Brown	14	300