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IV Cannulation - Detailed Step-by-Step Guide

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PHASE 1: PRE-PROCEDURE

• Introduce yourself (name + role)
• Verify patient identity: full name + date of birth
• Explain the procedure in simple terms ("a small plastic tube will be placed in your vein using a needle")
• Gain verbal/written informed consent
• Check allergies: latex, iodine, adhesive dressings

• Perform 6-step hand wash or alcohol gel technique (minimum 20 seconds)

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PHASE 2: SITE SELECTION

• Sit or lie comfortably
• Extend the arm on a pillow with a protective field underneath
• Apply dry warmth if veins are difficult to find

• Preferred sites (in order): antecubital fossa > forearm (cephalic/basilic) > dorsum of hand
• Look for: straight, soft, bouncy, 1-2cm of straight segment
• Avoid: infected skin, phlebitis, bruised areas, dominant arm (if possible), joints, feet (unless no other option)

• Place 10-15 cm above chosen site
• Confirm distal pulse is still palpable
• Ask patient to clench and unclench fist to engorge veins

• Tap or stroke vein gently to dilate
• Confirm your chosen vein is suitable

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PHASE 3: INSERTION

• Wipe with 70% alcohol swab using concentric circles
• Allow 30 seconds to air dry
• Do NOT re-palpate the site after cleaning

• Remove from sterile packaging
• Remove protective needle cap
• Inspect for defects - do not touch the needle

• Use non-dominant thumb to stretch skin 3-4 cm distal to insertion point
• This stabilizes the vein and reduces rolling

• "You will feel a sharp scratch now"

• Bevel facing upward
• Angle: 10-30 degrees to the skin
• Approach directly above the vein

• Advance slowly - watch the flashback chamber
• Blood appearing = needle tip is in the vein

Decision point: Flashback seen?

• YES → proceed to Step 15
• NO → withdraw slightly, re-angle; if unsuccessful, remove, apply pressure, choose new site

• Reduce angle to ~10 degrees
• Advance needle 2mm further so cannula tip fully enters the vein lumen

• Hold needle still and slide the plastic cannula off the needle into the vein
• Advance all the way to the hub - do not force
• Simultaneously withdraw the needle

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PHASE 4: POST-INSERTION

• Apply gentle digital pressure ~3cm above the site with the non-dominant finger to occlude the vein
• This prevents blood spillage when the needle is removed

• Withdraw the needle fully in one smooth motion
• Dispose immediately in the sharps container at the point of care

• Attach pre-primed extension set or sterile bung to the cannula hub

• Aspirate gently to confirm blood return
• Flush with 5-10mL normal saline
• Observe for: swelling (infiltration), pain, resistance

Decision point: Cannula flushes freely without pain/swelling?

• YES → secure the cannula
• NO → remove, apply pressure, restart at new site

• Apply sterile transparent dressing over the insertion site
• Loop and tape the extension set without covering the insertion point

• Write on label/dressing: date, time, gauge size, your initials

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PHASE 5: POST-PROCEDURE

• Advise patient to avoid bending the arm sharply
• Instruct to report: pain, swelling, redness, burning, or leaking at the site

• Dispose of all clinical waste
• Remove gloves and perform hand hygiene

• Date and time of insertion
• Site and limb used
• Cannula gauge and length
• Flush used and volume
• Patient tolerance
• Any complications

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COMMON COMPLICATIONS TO WATCH For

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1. IV FLUID ADMINISTRATION

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2. IV DRUG ADMINISTRATION

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3. BLOOD TRANSFUSION ADMINISTRATION

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DETAILED WRITTEN GUIDE

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PART A: IV FLUID ADMINISTRATION

Phase 1 - Pre-Administration

Phase 2 - Prime the Giving Set

Phase 3 - Connect to Patient

Phase 4 - Set Rate and Monitor

Phase 5 - Ongoing Monitoring and Completion

• Monitor every 30-60 minutes: drip rate, fluid level, site appearance, patient comfort, vital signs
• At 50mL remaining: prepare next bag or prepare to discontinue
• On completion: close clamp, disconnect, flush cannula with saline, cap port
• Document: fluid type, volume infused, start/end time, patient response, site condition

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PART B: IV DRUG ADMINISTRATION

The 7 Rights (Mandatory Check Before Every Drug)

1. Right Patient
2. Right Drug
3. Right Dose
4. Right Route
5. Right Time
6. Right Documentation
7. Right Reason

Phase 1 - Prescription Verification

Phase 2 - Drug Preparation

Phase 3 - Patient Preparation

Phase 4 - Administration

Phase 5 - Post-Administration Monitoring

• Therapeutic effect achieved? If not, reassess dose/timing, inform prescriber
• Adverse reaction? - STOP drug, manage reaction, notify doctor (anaphylaxis: adrenaline 0.5mg IM, O2, IV fluids)
• Set drug-specific monitoring: (BP post-antihypertensive, BGL post-insulin, HR post-digoxin)
• Document: drug, dose, time, route, site, patient response, adverse effects, signature

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PART C: BLOOD TRANSFUSION ADMINISTRATION

Phase 1 - Pre-Transfusion Preparation

Phase 2 - Bedside Identity Verification (CRITICAL - Two Nurses Required)

• Patient full name
• Date of birth
• Hospital ID number
• ABO and Rh blood group
• Crossmatch number
• Blood unit number
• Expiry date/time

Decision: Any mismatch? - DO NOT TRANSFUSE. Return to blood bank. Report discrepancy.

Phase 3 - Equipment and Setup

Phase 4 - Transfusion

Transfusion Reaction - Emergency Response

1. STOP transfusion immediately
2. Keep IV open with NEW 0.9% NS + NEW giving set (direct to cannula - do not flush blood through)
3. Take full vital signs
4. Notify doctor IMMEDIATELY
5. Send to blood bank: unit + original tubing, patient EDTA blood sample, clotted blood sample, urine sample
6. Manage reaction: antihistamine/hydrocortisone for mild allergic; adrenaline for anaphylaxis; IV fluids for hypotension
7. Document everything with exact times

Phase 5 - Completion

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Quick Comparison Summary

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