WHO best practices peripheral intravenous catheter insertion equipment aseptic technique guideline

peripheral intravenous catheter AND insertion

https://www.who.int/publications/i/item/9789240093829

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peripheral intravenous cannula over-the-needle catheter diagram insertion technique

https://www.who.int/publications/i/item/9789240093829

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mkdir -p "/tmp/workspace/iv-injection-handout/src" "/tmp/workspace/iv-injection-handout/output" && python - <<'PY' from pathlib import Path p=Path('/tmp/workspace/iv-injection-handout/src/create_pdf.py') p.write_text(r'''from reportlab.lib import colors from reportlab.lib.enums import TA_CENTER, TA_LEFT from reportlab.lib.pagesizes import A4 from reportlab.lib.styles import getSampleStyleSheet, ParagraphStyle from reportlab.lib.units import cm from reportlab.platypus import SimpleDocTemplate, Paragraph, Spacer, Table, TableStyle, PageBreak, KeepTogether from reportlab.pdfbase.pdfmetrics import stringWidth from reportlab.pdfgen import canvas OUT='/tmp/workspace/iv-injection-handout/output/Intravenous_Injection_and_Cannulation_Guide.pdf' NAVY=colors.HexColor('#17365D'); BLUE=colors.HexColor('#1F5A99'); PALE=colors.HexColor('#EAF2F8'); TEAL=colors.HexColor('#0F766E'); RED=colors.HexColor('#B42318'); GREY=colors.HexColor('#505A64') styles=getSampleStyleSheet() styles.add(ParagraphStyle(name='Title2',parent=styles['Title'],fontName='Helvetica-Bold',fontSize=22,leading=27,textColor=NAVY,alignment=TA_CENTER,spaceAfter=10)) styles.add(ParagraphStyle(name='Sub',parent=styles['Normal'],fontSize=10.3,leading=14,textColor=GREY,alignment=TA_CENTER,spaceAfter=16)) styles.add(ParagraphStyle(name='H1x',parent=styles['Heading1'],fontName='Helvetica-Bold',fontSize=15,leading=19,textColor=NAVY,spaceBefore=12,spaceAfter=8)) styles.add(ParagraphStyle(name='H2x',parent=styles['Heading2'],fontName='Helvetica-Bold',fontSize=11.5,leading=14,textColor=BLUE,spaceBefore=7,spaceAfter=5)) styles.add(ParagraphStyle(name='Bodyx',parent=styles['BodyText'],fontSize=9.2,leading=12.3,spaceAfter=5)) styles.add(ParagraphStyle(name='Smallx',parent=styles['BodyText'],fontSize=7.8,leading=10,spaceAfter=3)) styles.add(ParagraphStyle(name='Box',parent=styles['BodyText'],fontSize=8.8,leading=12,textColor=colors.HexColor('#12344D'))) def P(txt, style='Bodyx'): return Paragraph(txt,styles[style]) def bullets(items): return [P('&bull; '+x) for x in items] def box(text, color=PALE, border=BLUE): t=Table([[P(text,'Box')]],colWidths=[17.4*cm]); t.setStyle(TableStyle([('BACKGROUND',(0,0),(-1,-1),color),('BOX',(0,0),(-1,-1),.5,border),('LEFTPADDING',(0,0),(-1,-1),9),('RIGHTPADDING',(0,0),(-1,-1),9),('TOPPADDING',(0,0),(-1,-1),7),('BOTTOMPADDING',(0,0),(-1,-1),7)])); return t def footer(c,doc): c.saveState(); c.setStrokeColor(colors.HexColor('#B9C5D1')); c.line(1.7*cm,1.25*cm,19.3*cm,1.25*cm) c.setFont('Helvetica',7.5); c.setFillColor(GREY); c.drawString(1.7*cm,.83*cm,'IV injection and cannulation guide | Educational use only') c.drawRightString(19.3*cm,.83*cm,f'Page {doc.page}') c.restoreState() doc=SimpleDocTemplate(OUT,pagesize=A4,rightMargin=1.7*cm,leftMargin=1.7*cm,topMargin=1.45*cm,bottomMargin=1.65*cm) story=[] story += [P('Apparatus and Technique of Intravenous Injection','Title2'),P('Selection of materials for intravenous injection and the different types of IV needles and cannulae','Sub')] story.append(box('<b>Scope and safety.</b> This is a study handout for trained health professionals and students working under supervision. Intravenous access and IV drug administration require local policy, patient identification, prescription review, competency assessment, aseptic technique, and immediate access to help for complications. Do not use this handout as a substitute for institutional protocols.',colors.HexColor('#FFF4E5'),colors.HexColor('#D97706'))) story.append(Spacer(1,10)) story += [P('1. Purpose and core principles','H1x'),P('Peripheral intravenous (IV) access permits administration of prescribed medicines, fluids, blood products, and contrast agents. A safe procedure matches the device, vein, and infusion to the patient and treatment plan. Use the <b>smallest gauge and shortest appropriate device</b>, select a healthy vein, preserve future sites, and use aseptic non-touch technique.')] story.append(box('<b>Key distinction:</b> a needle is a rigid steel device. A peripheral IV cannula is a flexible plastic catheter mounted over an introducer needle; after successful placement, the steel needle is withdrawn and only the plastic catheter remains in the vein. For ongoing infusion, a cannula is normally preferred to a simple needle.')) story += [P('2. Apparatus: standard peripheral IV cannulation set','H1x')] items=[ '<b>Order and identity:</b> prescription/medication chart; two patient identifiers; allergy status; explanation and consent according to policy.', '<b>Personal protection and asepsis:</b> alcohol-based hand rub or soap and water, clean gloves for routine peripheral insertion using non-touch technique, and appropriate additional PPE when indicated.', '<b>Skin preparation:</b> antiseptic compatible with the patient and local policy, sterile gauze/swab, and time for the skin to air-dry. Do not re-palpate the prepared site unless asepsis is maintained.', '<b>Access equipment:</b> tourniquet, selected safety IV cannula, optional local anaesthetic as prescribed, extension set/needle-free connector, 0.9% sodium chloride flush in a sterile syringe where locally approved, and compatible infusion set or syringe.', '<b>Securement:</b> sterile transparent semipermeable dressing, stabilization/securement device or tape, label (date/time, gauge, initials as local policy), and limb board only when needed.', '<b>Safety and disposal:</b> sharps container within reach, waste receptacle, and documentation system.' ] story += bullets(items) story += [P('For IV injection through an existing cannula, also prepare the correctly labelled medication syringe, a compatible flush, a disinfectant for the needle-free connector, and a means to control injection rate. Check drug compatibility, dilution, route, rate, and extravasation risk before administering.', 'Bodyx')] story += [P('3. Choosing the vein, site, and device','H1x'),P('<b>Preferred approach:</b> use an upper-limb vein when suitable, begin distally and preserve proximal veins. Straight, palpable, adequately filled veins away from joints are easier to secure and less prone to occlusion. The dorsal hand veins and cephalic vein are common options; antecubital veins are readily accessible but movement at the elbow can impair catheter function.')] site_data=[[P('<b>Consider</b>','Smallx'),P('<b>Why it matters</b>','Smallx')], [P('Distal before proximal','Smallx'),P('Preserves more proximal veins if another attempt or longer therapy is needed.','Smallx')], [P('Vein diameter and straightness','Smallx'),P('Choose a vein that accommodates the catheter without forcing; a straight segment supports advancement.','Smallx')], [P('Planned therapy','Smallx'),P('High flow, blood products, irritant/vesicant drugs, expected duration, and poor access may require a different device or specialist review.','Smallx')], [P('Avoid when possible','Smallx'),P('Infection, burn, phlebitis, infiltration, hematoma, impaired circulation, or sites affected by local contraindications. Follow policy for limb restrictions, dialysis access, lymphoedema risk, and post-surgical considerations.','Smallx')]] t=Table(site_data,colWidths=[5.0*cm,12.4*cm]);t.setStyle(TableStyle([('BACKGROUND',(0,0),(-1,0),NAVY),('TEXTCOLOR',(0,0),(-1,0),colors.white),('VALIGN',(0,0),(-1,-1),'TOP'),('GRID',(0,0),(-1,-1),.3,colors.HexColor('#B9C5D1')),('ROWBACKGROUNDS',(0,1),(-1,-1),[colors.white,PALE]),('LEFTPADDING',(0,0),(-1,-1),6),('RIGHTPADDING',(0,0),(-1,-1),6),('TOPPADDING',(0,0),(-1,-1),5),('BOTTOMPADDING',(0,0),(-1,-1),5)]));story.append(t) story += [P('4. Types of IV needles and cannulae','H1x')] types=[[P('<b>Device</b>','Smallx'),P('<b>Features and usual role</b>','Smallx')], [P('<b>Hypodermic needle</b>','Smallx'),P('Rigid hollow steel needle. May be used for a single IV injection in selected settings, but not suited to prolonged infusion because it can move, infiltrate, and injure the vein. Safety-engineered versions reduce needlestick injury.','Smallx')], [P('<b>Winged infusion set (butterfly/scalp-vein set)</b>','Smallx'),P('Short steel needle with flexible wings and tubing. Useful for brief venepuncture or single-dose access in small or fragile veins. It is not a routine substitute for an indwelling plastic cannula.','Smallx')], [P('<b>Peripheral IV cannula, catheter-over-needle</b>','Smallx'),P('The common short peripheral device. A flexible plastic catheter advances over a steel introducer needle; the needle is removed after flashback. Safety cannulae incorporate shielding or automatic retraction.','Smallx')], [P('<b>Midline catheter</b>','Smallx'),P('Longer peripheral catheter, usually inserted under ultrasound into an upper-arm vein. Chosen for selected therapies of intermediate duration under local vascular-access criteria. Tip remains outside the central circulation.','Smallx')], [P('<b>PICC / central venous catheter</b>','Smallx'),P('Long catheter with tip in central venous circulation. Requires specialist insertion and central-line infection-prevention measures. Consider when therapy characteristics or duration exceed peripheral suitability.','Smallx')]] t=Table(types,colWidths=[5.2*cm,12.2*cm],repeatRows=1);t.setStyle(TableStyle([('BACKGROUND',(0,0),(-1,0),NAVY),('TEXTCOLOR',(0,0),(-1,0),colors.white),('VALIGN',(0,0),(-1,-1),'TOP'),('GRID',(0,0),(-1,-1),.3,colors.HexColor('#B9C5D1')),('ROWBACKGROUNDS',(0,1),(-1,-1),[colors.white,PALE]),('LEFTPADDING',(0,0),(-1,-1),6),('RIGHTPADDING',(0,0),(-1,-1),6),('TOPPADDING',(0,0),(-1,-1),5),('BOTTOMPADDING',(0,0),(-1,-1),5)]));story.append(t) story.append(PageBreak()) story += [P('5. Cannula gauge and material selection','H1x'),P('Gauge is inversely related to diameter: a <b>smaller gauge number means a wider bore</b>. Catheter selection should balance required flow against vein size and risk of trauma. Use local device specifications because colour codes and flow ratings can vary by manufacturer.')] gauges=[[P('<b>Gauge</b>','Smallx'),P('<b>Typical colour*</b>','Smallx'),P('<b>Common use</b>','Smallx')], [P('14 G','Smallx'),P('Orange','Smallx'),P('Very rapid resuscitation or massive transfusion when a large vein permits.','Smallx')], [P('16 G','Smallx'),P('Grey','Smallx'),P('Trauma/resuscitation, major surgery, rapid fluid or blood administration.','Smallx')], [P('18 G','Smallx'),P('Green','Smallx'),P('Blood products, contrast in many settings, surgery, and higher-volume fluid therapy.','Smallx')], [P('20 G','Smallx'),P('Pink','Smallx'),P('Routine adult IV fluids and many medications; common general-purpose choice.','Smallx')], [P('22 G','Smallx'),P('Blue','Smallx'),P('Smaller or fragile veins, older adults, and paediatric use where appropriate.','Smallx')], [P('24 G','Smallx'),P('Yellow','Smallx'),P('Neonates, infants, and very small fragile veins.','Smallx')]] t=Table(gauges,colWidths=[2.0*cm,3.5*cm,11.9*cm],repeatRows=1);t.setStyle(TableStyle([('BACKGROUND',(0,0),(-1,0),NAVY),('TEXTCOLOR',(0,0),(-1,0),colors.white),('GRID',(0,0),(-1,-1),.3,colors.HexColor('#B9C5D1')),('ROWBACKGROUNDS',(0,1),(-1,-1),[colors.white,PALE]),('VALIGN',(0,0),(-1,-1),'TOP'),('LEFTPADDING',(0,0),(-1,-1),6),('RIGHTPADDING',(0,0),(-1,-1),6),('TOPPADDING',(0,0),(-1,-1),5),('BOTTOMPADDING',(0,0),(-1,-1),5)]));story += [t,P('*Colours are a common convention, not a universal standard. Verify the packaging and local inventory.', 'Smallx')] story.append(box('<b>Flow principle:</b> a wider and shorter catheter has lower resistance and permits higher flow. A 16 G peripheral catheter can deliver fluid much faster than a 22 G catheter. This does not mean “bigger is always better”: larger catheters can reduce insertion success and increase mechanical irritation in small veins.')) story += [P('Material and design considerations','H2x')]+bullets([ '<b>Polyurethane versus fluoropolymer:</b> manufacturers use different catheter polymers. Selection should follow local procurement guidance, intended dwell time, therapy, and patient factors.', '<b>Safety mechanism:</b> use safety-engineered cannulae where provided. Activate the safety feature immediately after removal and discard the needle directly into a sharps container. Never recap.', '<b>Length:</b> choose a length that remains stable in the selected vein. Deeper ultrasound-guided veins may need a longer peripheral catheter; short devices can dislodge when only a small portion lies within the vessel.', '<b>Single versus multiple lumen:</b> short peripheral IV cannulae are usually single lumen. Multiple lumens are central-device considerations and increase handling complexity.' ]) story += [P('6. Technique: peripheral IV cannulation','H1x'),P('Follow the product instructions and your local insertion bundle. This sequence is a learning framework, not a replacement for supervised clinical competency.')] steps=[ ('<b>1. Prepare</b>','Confirm indication, prescription, identity, allergies, and equipment. Explain the procedure, position the patient safely, perform hand hygiene, and prepare a clean working area.'), ('<b>2. Select and dilate</b>','Apply the tourniquet proximal to the chosen site. Inspect and palpate for a suitable vein. Position the limb; warmth or dependent positioning may help. Release and reapply the tourniquet if needed.'), ('<b>3. Antisepsis</b>','Perform hand hygiene, use gloves as appropriate, clean the site with approved antiseptic, and allow it to dry fully. Do not touch the site after antisepsis unless asepsis is preserved.'), ('<b>4. Insert</b>','Reapply the tourniquet. Stabilize the skin and insert the catheter bevel-up at a shallow angle, commonly about 10 to 20 degrees. Look for flashback. Lower the angle, advance a small distance, then advance the plastic catheter into the vein without forcing.'), ('<b>5. Release and connect</b>','Release the tourniquet. Occlude the vein proximal to the catheter tip if needed to limit blood leakage. Withdraw the introducer needle, immediately activate its safety mechanism, and discard it in the sharps container. Connect the primed extension/needle-free connector using aseptic non-touch technique.'), ('<b>6. Check patency and secure</b>','Gently flush according to policy and observe for pain, resistance, leakage, swelling, or blanching. Secure the catheter, apply a sterile transparent dressing, label it, and ensure tubing is supported.'), ('<b>7. Document and monitor</b>','Record site, gauge, attempts, date/time, indication, device, and patient response. Reassess at each use and remove promptly when no longer clinically indicated or if complication is suspected.')] for h,b in steps: story.append(P(h+' - '+b)) story += [P('7. Technique: giving a medication by IV injection through a cannula','H1x')] story += bullets([ 'Check the medicine against the prescription and local medication-administration policy: correct patient, medicine, dose, route, time, dilution, compatibility, rate, expiry, and allergies. Obtain an independent check when required.', 'Assess the cannula site and patency. Do not inject through a painful, swollen, erythematous, leaking, or resistant line.', 'Perform hand hygiene. Scrub/disinfect the needle-free connector using the approved product and contact time, then allow it to dry. Maintain non-touch technique.', 'Use a syringe and rate appropriate to the medicine. Inject at the prescribed rate, observing the patient and site continuously. Never force an injection.', 'Flush before and after administration only when indicated and compatible with the medicine and local policy. Restart the infusion if prescribed, secure the system, and document the administration and response.' ]) story.append(box('<b>Stop immediately</b> if there is pain, burning, swelling, blanching, coolness, leakage, unexpected resistance, loss of blood return when this is clinically relevant, or systemic symptoms. Do not attempt to “flush through” suspected infiltration or extravasation. Follow the local extravasation protocol and escalate promptly.',colors.HexColor('#FFF1F0'),RED)) story.append(PageBreak()) story += [P('8. Complications, prevention, and response','H1x')] comp=[[P('<b>Problem</b>','Smallx'),P('<b>Possible signs</b>','Smallx'),P('<b>Immediate action</b>','Smallx')], [P('Infiltration','Smallx'),P('Swelling, coolness, discomfort, slowed infusion, leakage.','Smallx'),P('Stop infusion, remove device as appropriate, elevate, and follow local protocol.','Smallx')], [P('Extravasation','Smallx'),P('Pain/burning, swelling, blanching or colour change during vesicant/irritant administration.','Smallx'),P('Stop infusion. Do not flush. Leave device in place initially if local protocol requires aspiration/antidote; urgently follow extravasation pathway.','Smallx')], [P('Phlebitis','Smallx'),P('Pain, warmth, erythema, tenderness, palpable venous cord.','Smallx'),P('Stop use, remove device, assess and document; treat/escalate per policy.','Smallx')], [P('Hematoma/bleeding','Smallx'),P('Bruising, swelling, continued bleeding.','Smallx'),P('Remove if necessary and apply gentle direct pressure.','Smallx')], [P('Infection','Smallx'),P('Local erythema, discharge, fever or systemic illness.','Smallx'),P('Stop using device and seek urgent clinical review according to local policy.','Smallx')], [P('Needlestick injury','Smallx'),P('Sharps exposure.','Smallx'),P('Immediate first aid and urgent occupational-exposure reporting pathway. Do not recap needles.','Smallx')]] t=Table(comp,colWidths=[3.2*cm,6.4*cm,7.8*cm],repeatRows=1);t.setStyle(TableStyle([('BACKGROUND',(0,0),(-1,0),NAVY),('TEXTCOLOR',(0,0),(-1,0),colors.white),('GRID',(0,0),(-1,-1),.3,colors.HexColor('#B9C5D1')),('ROWBACKGROUNDS',(0,1),(-1,-1),[colors.white,PALE]),('VALIGN',(0,0),(-1,-1),'TOP'),('LEFTPADDING',(0,0),(-1,-1),5),('RIGHTPADDING',(0,0),(-1,-1),5),('TOPPADDING',(0,0),(-1,-1),4),('BOTTOMPADDING',(0,0),(-1,-1),4)]));story.append(t) story += [P('9. Infection prevention essentials','H1x')]+bullets([ 'Perform hand hygiene before and after catheter insertion, assessment, access, dressing, and removal.', 'Use aseptic technique throughout. For routine peripheral IV insertion, clean gloves may be used if the prepared site is not touched; follow local policy.', 'Prepare intact skin with an approved antiseptic and allow it to dry. CDC recommendations list 70% alcohol, tincture of iodine, or alcoholic chlorhexidine gluconate for peripheral venous catheter insertion.', 'Use a sterile transparent dressing so the site can be inspected. Replace dressing if damp, loose, visibly soiled, or compromised, using aseptic technique.', 'Review need and site regularly. Remove the peripheral IV catheter when it is no longer essential or if there are signs of complication.' ]) story += [P('10. Checklist before you finish','H1x')] check=['Indication and prescription verified','Appropriate vein, gauge, length, and device selected','Aseptic non-touch technique maintained','Needle disposed safely with no recapping','Patency assessed without force','Site secured, labelled, and visible','Patient informed about symptoms to report','Documentation complete'] for x in check: story.append(P('&#9633; '+x)) story += [P('References','H1x'),P('Roberts and Hedges’ Clinical Procedures in Emergency, “Peripheral Venous Catheterization: Percutaneous,” pp. 440-441 (equipment, site selection, and technique); Gray’s Anatomy for Students, “Venipuncture,” p. 936 (common venous-access sites).','Smallx'),P('Current infection-prevention principles were checked against the <link href="https://www.cdc.gov/infection-control/hcp/intravascular-catheter-related-infections/summary-recommendations.html" color="#1F5A99">CDC intravascular catheter recommendations</link> and the <link href="https://www.who.int/publications/i/item/9789240093829" color="#1F5A99">WHO peripheral-catheter guideline</link>. Manufacturer instructions and institutional policy govern the exact device, antiseptic, flush, medication administration, and extravasation procedures.','Smallx')] doc.build(story,onFirstPage=footer,onLaterPages=footer) print(OUT) ''') PY python "/tmp/workspace/iv-injection-handout/src/create_pdf.py" && ls -lh "/tmp/workspace/iv-injection-handout/output/Intravenous_Injection_and_Cannulation_Guide.pdf"

python - <<'PY' from pypdf import PdfReader p='/tmp/workspace/iv-injection-handout/output/Intravenous_Injection_and_Cannulation_Guide.pdf' r=PdfReader(p) text=''.join(page.extract_text() or '' for page in r.pages) print('pages=',len(r.pages),'chars=',len(text)) print('required headings:', all(s in text for s in ['Apparatus and Technique','Types of IV needles and cannulae','Technique: peripheral IV cannulation','Complications'])) PY