Intravenous cannulation
IV cannulation is required for the
infusion of fluids or drugs. Any blood sampling necessary may also be done at
the time of insertion. This ‘com-bined’ technique will save puncturing the
child twice.
•
An
alcohol impregnated swab.
•
IV cannula: 24G in newborns, 21G in older
children.
•
IV
extension set and 3-way tap with Luer lock flushed with 0.9% saline.
•
Tourniquet
(older children).
•
Fixing
tape or transparent occlusive dressing to fix cannula in site.
•
Carefully
identify a suitable vein. The dorsum of the hand or foot or antecubital fossa
is ideal. Other suitable sites include the anatomical snuff box, volar aspect
of forearm, great saphenous vein at the medial malleolus or knee. Whilst not
ideal, scalp veins can be used, but the hair usually needs to be shaved. If
possible, avoid larger veins if a percutaneous central line insertion is likely
to be needed later.
•
Tip: transillumination of hand or foot
with a ‘cold’ light source can be very useful for locating ‘hidden’ veins,
particularly in the newborn. In an emergency, or if one or more normal sites have
been used, scour the whole body and use whatever vein you can find!
•
Consider
at least 45min of local anaesthetic cream applied under an occlusive dressing
over the intended vein before starting. Remove the cream before starting.
•
Ensure
good vein perfusion, e.g. warm extremity before cannulation.
•
If
needed, ask an assistant to help with keeping the child’s limb steady. This may
require wrapping a young child in a towel or sheet.
•
In
older children, apply a tourniquet proximal to the vein. In infants, if attempting
the hand dorsum, apply compression and immobilization by flexing the wrist,
then grasping with the index and middle fingers over the dorsum, whilst the
thumb is placed over the child’s fingers.
•
Clean
site with an alcohol impregnated swab.
•
Insert
cannula at an angle of 10–15° to the skin with the bevel upright, just distal
and along the line of the vein.
•
When
the stylet tip penetrates into the vein lumen blood will flash back (not always
if the vein is small!).
•
Once
vein lumen is entered advance 1–2mm, to ensure the cannula is also in vein, and
then advance the cannula over stylet up into the vein.
•
Remove
stylet, and collect any blood required from the cannula hub.
•
Flush
cannula with 0.9% saline to confirm IV placement (fluid should infuse without
resistance) and to prevent clotting, then connect IV line.
•
Secure
cannula with appropriate adhesive tape or dressing leaving the skin over the
cannula tip visible so that extravasation can be observed.
•
Splint
extremity to prevent the cannula kinking.
•
This
is a difficult procedure to master, particularly in the newborn. Do not
be afraid to ask for senior help if unsuccessful after 2 or 3 attempts.
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