IV cannulation steps procedure nursing technique

A detailed clinical flowchart showing all steps of IV (intravenous) cannulation procedure. The flowchart should flow top to bottom with arrows connecting each step. Include these sequential steps as labeled boxes: 1. PATIENT IDENTIFICATION & CONSENT - Introduce yourself, verify patient identity (name + DOB), explain procedure, gain informed consent, check allergies (latex, iodine) 2. GATHER EQUIPMENT - IV cannula (appropriate gauge), tourniquet, alcohol swab, gloves, sterile dressing/tegaderm, normal saline flush + syringe, extension set, tape, waste bin, sharps container 3. HAND HYGIENE - Wash hands / use alcohol gel (6-step technique) 4. POSITION PATIENT - Sit/lie comfortably, extend arm on pillow, place protective field under arm 5. SELECT SITE - Inspect and palpate both arms, prefer antecubital fossa / forearm / dorsum of hand, avoid areas of infection, phlebitis, or previous bruising 6. APPLY TOURNIQUET - Place 10-15 cm above chosen site, check distal pulse remains present, ask patient to clench fist 7. RE-ASSESS VEIN - Tap or stroke vein to dilate, confirm straight soft bouncy vein segment at least 1-2 cm long 8. DON GLOVES - Apply non-sterile gloves 9. CLEAN SITE - Wipe skin with 70% alcohol swab in concentric circles, allow 30 seconds to dry completely - DO NOT re-palpate 10. PREPARE CANNULA - Remove from packaging, remove needle cap, do not touch sterile parts, inspect for defects 11. ANCHOR VEIN - Stretch skin distally with non-dominant thumb to stabilize vein 12. WARN PATIENT - "You will feel a sharp scratch now" 13. INSERT NEEDLE - Bevel upwards, 10-30 degree angle, directly above vein 14. ADVANCE INTO VEIN - Watch for flashback of blood in the hub/chamber 15. LOWER ANGLE & ADVANCE - Reduce angle to 10 degrees, advance cannula 2mm further into vein lumen 16. THREAD CANNULA - Slide plastic cannula off needle into vein while withdrawing needle simultaneously; advance to hub 17. RELEASE TOURNIQUET - Apply gentle pressure 3cm above site with finger to prevent blood spillage 18. REMOVE STYLET (NEEDLE) - Withdraw fully, dispose immediately in sharps container 19. CONNECT EXTENSION SET - Attach primed extension set or bung to cannula hub 20. FLUSH WITH SALINE - Aspirate to confirm blood return, then flush with 5-10ml normal saline, check for swelling/pain 21. SECURE CANNULA - Apply sterile transparent dressing (Tegaderm), loop and tape tubing 22. LABEL - Write date, time, gauge, initials on dressing or label 23. PATIENT EDUCATION - Advise patient not to bend arm sharply, report pain/swelling/redness 24. DISPOSE & DECONTAMINATE - Dispose of sharps safely, remove gloves, perform hand hygiene 25. DOCUMENT - Record in patient notes: date, time, site, gauge, flush used, patient tolerance Include decision diamonds for: "Flashback seen?" (Yes -> advance; No -> withdraw slightly or reattempt), "Cannula flushes without resistance?" (Yes -> secure; No -> consider repositioning or new site), "Signs of infiltration/tissuing?" (Yes -> remove and restart at new site; No -> proceed). Use a clean professional medical style with blue header boxes, yellow decision diamonds, green confirmation boxes, and red warning boxes for failure points. Title at top: "IV CANNULATION - STEP-BY-STEP FLOWCHART"

IV cannulation fluid drug blood transfusion administration steps nursing procedure

A detailed clinical flowchart titled "IV FLUID ADMINISTRATION via Cannula - Step-by-Step Flowchart". Professional medical style, flowing top to bottom with arrows. Use blue header boxes, white process boxes with blue borders, yellow diamond decision shapes, green confirmation boxes, red failure/stop boxes. PHASE 1 - PRE-ADMINISTRATION (blue header): Box 1: VERIFY DOCTOR'S ORDER - Confirm: fluid type (NS/RL/D5W/D10W), volume (mL), rate (mL/hr), duration, route, indication Box 2: CHECK FLUID BAG - Expiry date, clarity (no particles/cloudiness), integrity (squeeze plastic bag for leaks), label matches order Box 3: GATHER EQUIPMENT - IV fluid bag, IV giving set (macrodrip 20 drops/mL or microdrip 60 drops/mL), IV pole, gloves, tape, label Box 4: HAND HYGIENE - 6-step technique PHASE 2 - PREPARE GIVING SET (blue header): Box 5: SPIKE THE BAG - Remove protective cap from bag port, remove spike cover, insert spike into port aseptically Box 6: PRIME THE GIVING SET - Fill drip chamber halfway (squeeze chamber), open roller clamp slowly, run fluid through tubing until no air bubbles, close clamp Box 7: HANG BAG ON IV POLE - At least 1 metre above patient's heart level Box 8: LABEL GIVING SET - Date/time of setup PHASE 3 - CONNECT TO PATIENT (blue header): Box 9: CONFIRM PATIENT ID - Two identifiers: name + DOB Box 10: EXPLAIN PROCEDURE - Gain consent Box 11: CONFIRM IV CANNULA PATENCY - Flush with 5mL normal saline; check for swelling, pain, resistance Decision diamond: "Cannula patent?" YES → continue | NO → re-site cannula first Box 12: DON GLOVES Box 13: CLEAN CANNULA PORT - Wipe with alcohol swab, let dry 15 seconds Box 14: CONNECT GIVING SET TO CANNULA HUB PHASE 4 - SET RATE & MONITOR (blue header): Box 15: OPEN ROLLER CLAMP - Start flow Box 16: SET INFUSION RATE - Manual: count drops/min (mL/hr ÷ 3 for macrodrip) OR use infusion pump: set mL/hr Box 17: CHECK FIRST 5 MINUTES - Inspect site for infiltration, check drip rate Decision diamond: "Signs of infiltration or reaction?" YES → stop infusion, assess, re-site | NO → continue Box 18: SECURE TUBING - Loop and tape, ensure no tension on cannula Box 19: LABEL BAG - Time hung, rate, nurse initials PHASE 5 - ONGOING & COMPLETION (blue header): Box 20: MONITOR EVERY 30-60 MINUTES - Drip rate, fluid level, site appearance, patient comfort, vital signs Box 21: NEAR END OF BAG - 50mL remaining: prepare next bag or prepare to discontinue Box 22: WHEN COMPLETE - Close roller clamp, disconnect giving set, flush cannula with saline, cap cannula Box 23: DOCUMENT - Fluid type, volume infused, start/end time, patient response, site condition

A detailed clinical flowchart titled "IV DRUG ADMINISTRATION via Cannula - Step-by-Step Flowchart". Professional medical style, flowing top to bottom with arrows. Use purple header boxes, white process boxes with purple borders, yellow diamond decision shapes, green confirmation boxes, red stop/warning boxes. PHASE 1 - PRE-ADMINISTRATION (purple header): Box 1: 5 RIGHTS CHECK (MANDATORY) - Right Patient, Right Drug, Right Dose, Right Route, Right Time (+2 more: Right Documentation, Right Reason) Box 2: VERIFY PRESCRIPTION - Drug name (generic + brand), dose (mg/mcg/units), diluent, volume, rate, frequency, allergies checked Box 3: CHECK DRUG COMPATIBILITY - Is drug compatible with existing IV fluids running? (e.g. no phenytoin in dextrose) Box 4: GATHER EQUIPMENT - Drug vial/ampoule, prescribed diluent (NS/D5W/WFI), appropriate syringes (1mL, 5mL, 10mL), drawing-up needle, filter needle if glass ampoule, labels, alcohol swabs, gloves, sharps container PHASE 2 - PREPARE DRUG (purple header): Box 5: HAND HYGIENE + DON GLOVES Box 6: CHECK DRUG VIAL - Expiry date, clarity, correct concentration, intact seal Box 7: RECONSTITUTE IF REQUIRED - Add diluent to powder vial, mix gently (do not shake unless instructed), confirm complete dissolution Box 8: DRAW UP CORRECT DOSE - Calculate dose: Volume = (Dose required ÷ Stock concentration) × Volume of stock. Expel air bubbles. Double-check calculation. Box 9: LABEL SYRINGE - Drug name, dose, concentration, date/time, nurse initials Decision diamond: "Two-nurse check required?" (for high-risk drugs: opioids, insulin, heparin, digoxin, KCl) YES → independent double-check by second nurse | NO → proceed PHASE 3 - PATIENT PREPARATION (purple header): Box 10: CONFIRM PATIENT IDENTITY - Two identifiers at bedside Box 11: EXPLAIN & GAIN CONSENT - Inform patient of drug name and expected effects Box 12: ASSESS PATIENT BASELINE - Vital signs, pain score, relevant parameters (e.g. BP before antihypertensive, HR before digoxin, blood glucose before insulin) Box 13: CHECK IV CANNULA PATENCY - Flush with 3-5mL normal saline, confirm no swelling/pain/resistance Decision diamond: "Cannula patent?" YES → proceed | NO → re-site before giving drug PHASE 4 - ADMINISTRATION (purple header): Box 14: CLEAN INJECTION PORT - Wipe with alcohol swab, allow 15 seconds to dry Box 15: SLOW IV BOLUS or IV INFUSION: - BOLUS: Inject slowly over stated time (e.g. morphine over 5 min, furosemide over 2 min); observe patient during injection - INFUSION: Connect to infusion pump, set correct rate (mL/hr), check drug label on pump Box 16: FLUSH POST-DRUG - Flush cannula with 5-10mL normal saline to clear drug from line (especially important for irritant drugs) PHASE 5 - POST-ADMINISTRATION MONITORING (purple header): Decision diamond: "Expected therapeutic effect seen? Adverse reaction?" - Therapeutic effect: YES → document and continue monitoring | NO → reassess dose/timing, inform prescriber - Adverse reaction/anaphylaxis: YES → STOP drug immediately, call emergency, manage reaction (adrenaline, O2, IV fluids) Box 17: MONITOR ACCORDING TO DRUG - Set specific monitoring intervals (e.g. BP every 5 min after antihypertensive, blood glucose 1hr after insulin) Box 18: DOCUMENT - Drug name, dose given, time, route, site, patient response, any adverse effects, nurse signature

A detailed clinical flowchart titled "BLOOD TRANSFUSION ADMINISTRATION via Cannula - Step-by-Step Flowchart". Professional medical style, flowing top to bottom with arrows. Use dark red header boxes, white process boxes with red borders, yellow diamond decision shapes, green confirmation boxes, bright red emergency stop boxes. PHASE 1 - PRE-TRANSFUSION PREPARATION (dark red header): Box 1: VERIFY DOCTOR'S ORDER - Blood product type (pRBC/FFP/Platelets/Cryoprecipitate), volume/units, rate, any pre-medications (e.g. antihistamine, paracetamol), consent obtained Box 2: CONFIRM BLOOD GROUPING & CROSSMATCH DONE - Group & Screen or Full Crossmatch, sample sent within 72 hours Box 3: COLLECT BLOOD PRODUCT FROM BLOOD BANK - Check: ABO/Rh group on unit matches patient, expiry date/time, unit intact (no leaks, clots, discolouration, gas bubbles), blood bank label attached Decision diamond: "Any discrepancy with blood unit?" YES → RETURN TO BLOOD BANK immediately | NO → proceed within 30 minutes Box 4: GATHER EQUIPMENT - Y-type blood administration set with 170-200 micron filter, 0.9% normal saline only, IV cannula 18-20G (or 20-22G for elective/elderly), gloves, vital signs equipment, transfusion record form PHASE 2 - PATIENT VERIFICATION (CRITICAL STEP) (dark red header): Box 5: BEDSIDE IDENTITY VERIFICATION - Two nurses required: verify at bedside using blood bank tag on unit, match all: Patient name, DOB, hospital ID number, ABO/Rh group, crossmatch number, expiry, blood unit number Decision diamond: "All identifiers match?" YES → proceed | NO → DO NOT TRANSFUSE - Return to blood bank, report discrepancy Box 6: ASSESS PATIENT BASELINE - Temperature, pulse, BP, respiratory rate, O2 saturation. Document on transfusion chart Box 7: EXPLAIN PROCEDURE - Tell patient to immediately report: chills, fever, rash, itching, chest pain, back pain, shortness of breath, feeling unwell PHASE 3 - SET UP ADMINISTRATION (dark red header): Box 8: CONFIRM IV ACCESS - 18-20G cannula for adults, confirm patency with NS flush. Note: NO medications in same line as blood Box 9: PRIME Y-SET WITH 0.9% NS - Spike NS bag, prime entire tubing including filter; close clamp Box 10: ATTACH BLOOD UNIT - Open clamp on blood side of Y-set, prime filter with blood, ensure no air bubbles; close NS side Box 11: CONNECT TO PATIENT - Attach primed blood administration set to cannula hub; open clamp PHASE 4 - TRANSFUSION (dark red header): Box 12: START SLOWLY - First 15 minutes: 25-50 mL total (2 mL/min or 25-30 drops/min). NURSE MUST REMAIN AT BEDSIDE Box 13: VITAL SIGNS AT 15 MINUTES - Repeat temp, pulse, BP, RR, SpO2; compare with baseline Decision diamond: "Any signs of transfusion reaction?" (fever >1°C rise, chills, rigors, rash, urticaria, dyspnoea, chest/back pain, hypotension, haemoglobinuria) YES → EMERGENCY: STOP TRANSFUSION IMMEDIATELY (see reaction box) NO → Increase to prescribed rate TRANSFUSION REACTION EMERGENCY BOX (bright red): STOP TRANSFUSION | Keep IV line open with NEW 0.9% NS + NEW giving set directly into cannula | Take vital signs | Notify doctor IMMEDIATELY | Send: unit + tubing to blood bank, patient blood sample (EDTA + clotted), urine sample | Document everything | Manage reaction per protocol (antihistamine/adrenaline/hydrocortisone as needed) Box 14: INCREASE TO FULL RATE - Set prescribed rate (typically pRBC: 150-300 mL/hr unless restricted). Must complete within 4 hours of issuing Box 15: MONITOR DURING TRANSFUSION - Vital signs every 30 minutes during transfusion; observe site for infiltration; observe patient for symptoms PHASE 5 - COMPLETION (dark red header): Box 16: NEAR END OF UNIT - Flush blood through filter with 0.9% NS (small volume from NS side of Y-set) to clear line Box 17: COMPLETION - Close clamp, disconnect set, flush cannula with saline, cap or continue IV as ordered Box 18: VITAL SIGNS POST-TRANSFUSION - Document final observations 1 hour post completion Box 19: DISPOSE SAFELY - Discard blood bag + giving set together in biohazard waste (or return to blood bank per policy if reaction occurred) Box 20: DOCUMENT FULLY - Product type, unit number, volume, start/end time, vital signs, any reactions, patient response, nurse signature. Return bottom copy of blood bank form to blood bank

ls -la /home/daytona/workspace/ 2>/dev/null || echo "workspace does not exist ye…

mkdir -p /home/daytona/workspace/iv-complications && echo "Directory created"

~/iv-complications/generate_pdf.py

from reportlab.lib.pagesizes import A4
from reportlab.lib import colors
from reportlab.lib.units import mm
from reportlab.platypus import (
    SimpleDocTemplate, Paragraph, Spacer, Table, TableStyle,
    HRFlowable, KeepTogether
)
from reportlab.lib.styles import getSampleStyleSheet, ParagraphStyle
from reportlab.lib.enums import TA_CENTER, TA_LEFT, TA_JUSTIFY
from reportlab.platypus import PageBreak

OUTPUT = "/home/daytona/workspace/iv-complications/IV_Complications_Quick_Reference.pdf"

# ── Colour palette ────────────────────────────────────────────────
NAVY       = colors.HexColor("#1a3557")
TEAL       = colors.HexColor("#1a7f8e")
RED        = colors.HexColor("#c0392b")
ORANGE     = colors.HexColor("#e67e22")
GREEN      = colors.HexColor("#1e8449")
PURPLE     = colors.HexColor("#6c3483")
DARK_RED   = colors.HexColor("#922b21")
LIGHT_BLUE = colors.HexColor("#d6eaf8")
LIGHT_RED  = colors.HexColor("#fce4e4")
LIGHT_GRN  = colors.HexColor("#d5f5e3")
LIGHT_ORG  = colors.HexColor("#fef9e7")
LIGHT_PRP  = colors.HexColor("#f5eef8")
LIGHT_GREY = colors.HexColor("#f2f3f4")
WHITE      = colors.white
BLACK      = colors.HexColor("#1c1c1c")
GOLD       = colors.HexColor("#d4ac0d")

doc = SimpleDocTemplate(
    OUTPUT,
    pagesize=A4,
    topMargin=14*mm, bottomMargin=14*mm,
    leftMargin=14*mm, rightMargin=14*mm,
)

W = A4[0] - 28*mm   # usable width

styles = getSampleStyleSheet()

def S(name, **kw):
    return ParagraphStyle(name, **kw)

# Custom styles
TITLE_S = S("Title", fontSize=22, textColor=WHITE, alignment=TA_CENTER,
            fontName="Helvetica-Bold", leading=28)
SUBTITLE_S = S("Subtitle", fontSize=11, textColor=colors.HexColor("#d6eaf8"),
               alignment=TA_CENTER, fontName="Helvetica", leading=16)
SECTION_S = S("Section", fontSize=12, textColor=WHITE, fontName="Helvetica-Bold",
              leading=16, alignment=TA_CENTER)
BODY_S = S("Body", fontSize=8.5, textColor=BLACK, fontName="Helvetica",
           leading=13, alignment=TA_JUSTIFY)
BOLD_S = S("Bold", fontSize=8.5, textColor=BLACK, fontName="Helvetica-Bold", leading=13)
SMALL_S = S("Small", fontSize=7.5, textColor=BLACK, fontName="Helvetica", leading=11)
SMALL_BOLD = S("SmallBold", fontSize=7.5, textColor=BLACK, fontName="Helvetica-Bold", leading=11)
WARN_S = S("Warn", fontSize=8, textColor=RED, fontName="Helvetica-Bold", leading=12)
HEAD_S = S("Head", fontSize=9, textColor=WHITE, fontName="Helvetica-Bold",
           leading=13, alignment=TA_CENTER)
FOOT_S = S("Foot", fontSize=7, textColor=colors.HexColor("#555555"),
           fontName="Helvetica", alignment=TA_CENTER, leading=10)

story = []

# ═══════════════════════════════════════════════════════════════════
# COVER / HEADER BANNER
# ═══════════════════════════════════════════════════════════════════
banner_data = [[Paragraph("IV ADMINISTRATION COMPLICATIONS", TITLE_S)],
               [Paragraph("Quick Reference Guide for Nurses & Healthcare Professionals", SUBTITLE_S)]]
banner = Table(banner_data, colWidths=[W])
banner.setStyle(TableStyle([
    ("BACKGROUND", (0,0), (-1,-1), NAVY),
    ("TOPPADDING",    (0,0), (-1,-1), 10),
    ("BOTTOMPADDING", (0,0), (-1,-1), 10),
    ("LEFTPADDING",   (0,0), (-1,-1), 8),
    ("RIGHTPADDING",  (0,0), (-1,-1), 8),
    ("ROUNDEDCORNERS", [6]),
]))
story.append(banner)
story.append(Spacer(1, 4*mm))

# ── Info strip ──────────────────────────────────────────────────
info_data = [[
    Paragraph("<b>Scope:</b> Peripheral IV cannula (adult &amp; paediatric)", SMALL_S),
    Paragraph("<b>Includes:</b> Local &amp; Systemic complications", SMALL_S),
    Paragraph("<b>Emergency actions highlighted in red</b>", WARN_S),
]]
info_tbl = Table(info_data, colWidths=[W*0.38, W*0.38, W*0.24])
info_tbl.setStyle(TableStyle([
    ("BACKGROUND", (0,0), (-1,-1), LIGHT_BLUE),
    ("BOX", (0,0), (-1,-1), 0.5, TEAL),
    ("TOPPADDING",    (0,0), (-1,-1), 5),
    ("BOTTOMPADDING", (0,0), (-1,-1), 5),
    ("LEFTPADDING",   (0,0), (-1,-1), 6),
    ("RIGHTPADDING",  (0,0), (-1,-1), 6),
    ("VALIGN", (0,0), (-1,-1), "MIDDLE"),
]))
story.append(info_tbl)
story.append(Spacer(1, 5*mm))

# ═══════════════════════════════════════════════════════════════════
# Helper: section header
# ═══════════════════════════════════════════════════════════════════
def section_header(text, color):
    tbl = Table([[Paragraph(text, SECTION_S)]], colWidths=[W])
    tbl.setStyle(TableStyle([
        ("BACKGROUND", (0,0), (-1,-1), color),
        ("TOPPADDING", (0,0), (-1,-1), 6),
        ("BOTTOMPADDING", (0,0), (-1,-1), 6),
        ("LEFTPADDING", (0,0), (-1,-1), 8),
        ("RIGHTPADDING", (0,0), (-1,-1), 8),
    ]))
    return tbl

# Helper: colour-coded complication table
def comp_table(rows, header_color, row_bg):
    """rows = list of [Complication, Signs/Symptoms, Cause, Action]"""
    headers = [
        Paragraph("COMPLICATION", HEAD_S),
        Paragraph("SIGNS & SYMPTOMS", HEAD_S),
        Paragraph("CAUSES", HEAD_S),
        Paragraph("NURSING ACTION", HEAD_S),
    ]
    col_w = [W*0.18, W*0.28, W*0.22, W*0.32]

    data = [headers]
    for r in rows:
        data.append([Paragraph(r[0], BOLD_S),
                     Paragraph(r[1], SMALL_S),
                     Paragraph(r[2], SMALL_S),
                     Paragraph(r[3], SMALL_S)])

    tbl = Table(data, colWidths=col_w, repeatRows=1)
    style = [
        ("BACKGROUND", (0,0), (-1,0), header_color),
        ("TEXTCOLOR",  (0,0), (-1,0), WHITE),
        ("GRID", (0,0), (-1,-1), 0.4, colors.HexColor("#aaaaaa")),
        ("VALIGN", (0,0), (-1,-1), "TOP"),
        ("TOPPADDING", (0,0), (-1,-1), 4),
        ("BOTTOMPADDING", (0,0), (-1,-1), 4),
        ("LEFTPADDING", (0,0), (-1,-1), 4),
        ("RIGHTPADDING", (0,0), (-1,-1), 4),
        ("ROWBACKGROUNDS", (0,1), (-1,-1), [row_bg, WHITE]),
    ]
    tbl.setStyle(TableStyle(style))
    return tbl

# ═══════════════════════════════════════════════════════════════════
# SECTION 1 – LOCAL COMPLICATIONS
# ═══════════════════════════════════════════════════════════════════
story.append(section_header("SECTION 1 — LOCAL / SITE COMPLICATIONS", TEAL))
story.append(Spacer(1, 2*mm))

local_rows = [
    [
        "Infiltration\n(Non-vesicant)",
        "Swelling, puffiness, pallor, coolness around site; slower drip rate; patient reports mild discomfort",
        "Cannula tip displaced outside vein; vein perforated; poor fixation",
        "STOP infusion immediately. Remove cannula. Elevate limb. Apply warm compress (non-vesicant fluids). Re-site at new location (other arm preferred). Document and reassess hourly.",
    ],
    [
        "Extravasation\n(Vesicant drug)",
        "Burning, stinging, blistering at site; tissue necrosis may develop; erythema then blanching",
        "Vesicant drug (e.g. chemo, vasopressors, hypertonic solutions, Ca gluconate) leaks into tissue",
        "<b>EMERGENCY.</b> STOP infusion. Do NOT remove cannula immediately — aspirate residual drug first. Notify doctor/pharmacist urgently. Apply specific antidote if available (e.g. hyaluronidase). Elevate limb. Cold/warm compress per drug protocol. Plastic surgery referral if necrosis suspected. Photograph and document meticulously.",
    ],
    [
        "Phlebitis\n(Inflammation)",
        "Redness, warmth, pain, swelling along vein track; palpable cord; VIP score ≥2",
        "Mechanical (movement), Chemical (irritant drug/osmolarity), Bacterial (poor asepsis). PIVC >72–96 hrs",
        "Remove cannula. Apply warm moist compress 3–4×/day. Document VIP score. Insert new cannula at fresh site (opposite arm). Report if score ≥3. Consider IV antibiotics if bacterial phlebitis suspected.",
    ],
    [
        "Thrombophlebitis",
        "Pain, hardness, erythema along vein; palpable clot/cord; area hot to touch",
        "Phlebitis + thrombus formation; prolonged cannulation; endothelial damage",
        "Remove cannula immediately. Warm compresses. Elevate limb. Notify doctor. Anti-inflammatory cream (e.g. diclofenac gel) per order. Doppler USS if extensive. Anticoagulation rarely needed for peripheral.",
    ],
    [
        "Haematoma",
        "Bruising, swelling, discolouration at insertion site; tenderness",
        "Vein punctured through-and-through; poor technique; anticoagulated patient",
        "Apply firm direct pressure for 3–5 minutes (longer if anticoagulated). Elevate limb. Cold pack first 24 hrs. Warm pack after 24 hrs. Do not attempt re-cannulation at same site. Monitor for compartment syndrome if large.",
    ],
    [
        "Local Infection\n/ Site Infection",
        "Redness, warmth, purulent discharge at site; induration; fever after 48–72 hrs",
        "Breach in aseptic technique; contaminated equipment; prolonged dwell time (>72–96 hrs)",
        "Remove cannula. Clean site with antiseptic. Culture purulent discharge and cannula tip. Apply sterile dressing. Notify doctor. Monitor for progression to systemic sepsis. Re-insert at fresh site.",
    ],
    [
        "Occlusion\n(Blockage)",
        "Slow/absent flow; resistance on flushing; pump alarm; no blood return",
        "Kinking of cannula; blood clot in hub; drug precipitation; positional blockage",
        "Check for kinks/positional issues first. Attempt gentle flush with 10mL NS using push-pause technique. Do NOT force flush. If persistent — remove and re-site. Never use heparin flush routinely (per evidence-based guidelines).",
    ],
    [
        "Nerve Injury",
        "Shooting pain, tingling, numbness, paraesthesia at/around insertion site",
        "Inadvertent needle contact with nerve during insertion; haematoma pressure on nerve",
        "Remove cannula immediately. Assess neurological function of affected area. Document symptoms carefully. Notify doctor. Physiotherapy referral if symptoms persist >24 hrs. Incident report.",
    ],
]

story.append(comp_table(local_rows, TEAL, LIGHT_BLUE))
story.append(Spacer(1, 4*mm))

# ── VIP Score box ───────────────────────────────────────────────
vip_rows = [
    [Paragraph("VIP SCORE (Visual Infusion Phlebitis Scale)", BOLD_S), Paragraph("Action Required", BOLD_S)],
    [Paragraph("0 — No symptoms", SMALL_S), Paragraph("Continue cannula. Observe.", SMALL_S)],
    [Paragraph("1 — Slight pain or redness near site", SMALL_S), Paragraph("Observe cannula. Document.", SMALL_S)],
    [Paragraph("2 — Pain, redness and/or swelling", SMALL_S), Paragraph("Re-site cannula.", SMALL_S)],
    [Paragraph("3 — Pain, redness, swelling; palpable cord ≤3cm", SMALL_S), Paragraph("Re-site. Consider treatment.", SMALL_S)],
    [Paragraph("4 — Pain, redness, swelling; palpable cord >3cm", SMALL_S), Paragraph("Re-site. Initiate treatment.", SMALL_S)],
    [Paragraph("5 — As above + pyrexia, purulent discharge", SMALL_S), Paragraph("<font color='red'><b>Remove. Treat infection. Report.</b></font>", SMALL_S)],
]
vip_tbl = Table(vip_rows, colWidths=[W*0.5, W*0.5])
vip_tbl.setStyle(TableStyle([
    ("BACKGROUND", (0,0), (-1,0), NAVY),
    ("TEXTCOLOR", (0,0), (-1,0), WHITE),
    ("GRID", (0,0), (-1,-1), 0.4, colors.HexColor("#aaaaaa")),
    ("VALIGN", (0,0), (-1,-1), "MIDDLE"),
    ("TOPPADDING", (0,0), (-1,-1), 4),
    ("BOTTOMPADDING", (0,0), (-1,-1), 4),
    ("LEFTPADDING", (0,0), (-1,-1), 5),
    ("RIGHTPADDING", (0,0), (-1,-1), 5),
    ("ROWBACKGROUNDS", (0,1), (-1,-1), [LIGHT_BLUE, WHITE]),
]))
story.append(vip_tbl)
story.append(Spacer(1, 5*mm))

# ═══════════════════════════════════════════════════════════════════
# SECTION 2 – SYSTEMIC COMPLICATIONS
# ═══════════════════════════════════════════════════════════════════
story.append(section_header("SECTION 2 — SYSTEMIC COMPLICATIONS", RED))
story.append(Spacer(1, 2*mm))

systemic_rows = [
    [
        "Septicaemia\n/ Bloodstream\nInfection (BSI)",
        "Fever >38°C or <36°C; rigors; tachycardia; hypotension; confusion; high WCC; positive blood cultures",
        "Contaminated IV equipment; poor ANTT; prolonged cannula dwell; immunocompromised patient",
        "<b>EMERGENCY.</b> Remove cannula and culture tip. Draw 2 sets of blood cultures from different sites. Commence broad-spectrum IV antibiotics per protocol. Fluid resuscitation. Notify senior doctor. Complete sepsis 6 bundle within 1 hour. ICU referral if septic shock.",
    ],
    [
        "Fluid Overload\n(Hypervolaemia)",
        "Dyspnoea, orthopnoea; raised JVP; peripheral oedema; crackles on auscultation; hypertension; weight gain",
        "Excessive fluid rate; incorrect fluid choice; renal/cardiac failure; inadequate monitoring",
        "Slow or stop IV infusion. Sit patient upright. O2 therapy. Notify doctor. IV furosemide as ordered. Strict fluid balance chart. Weigh daily. Cardiac/renal review if recurrent. Review all IV fluid orders.",
    ],
    [
        "Air Embolism",
        "Sudden dyspnoea; chest pain; hypotension; tachycardia; 'mill-wheel' murmur; cyanosis; loss of consciousness",
        "Air entering IV system — during connection/disconnection, empty IV bag, cannula insertion/removal",
        "<b>EMERGENCY.</b> Place patient in left lateral Trendelenburg position (air traps in right ventricle, away from pulmonary circulation). High-flow O2 via non-rebreather mask. Call resuscitation team. Do NOT remove IV access. Aspirate air via central line if present. Document time and amount of air estimated.",
    ],
    [
        "Speed Shock",
        "Flushing, headache, tightness in chest; hypotension; loss of consciousness; cardiac arrest in extreme cases",
        "Too-rapid administration of IV drug (especially concentrated bolus); accidental free-flow",
        "STOP IV immediately. Assess ABCDE. Call for help. Treat symptomatically per drug antidote/reversal if available. Check infusion pump settings and anti-siphon valves. Incident report. Prevention: always use infusion pump for high-alert medications.",
    ],
    [
        "Allergic Reaction\n/ Anaphylaxis",
        "Urticaria, pruritus, flushing (mild); bronchospasm, stridor, angioedema, hypotension, loss of consciousness (severe)",
        "Drug allergy; latex allergy; blood product reaction; contrast media; solution additives",
        "<b>ANAPHYLAXIS EMERGENCY.</b> STOP infusion immediately. Call resuscitation team. Adrenaline (epinephrine) 0.5mg IM (1:1000) into anterolateral thigh. Lay flat, raise legs. High-flow O2. IV fluid bolus (500mL–1L NS rapidly). Chlorphenamine 10mg IV + hydrocortisone 200mg IV. Monitor every 5 min. ICU referral. Complete incident report.",
    ],
    [
        "Pulmonary\nEmbolism (PE)",
        "Sudden-onset dyspnoea; pleuritic chest pain; haemoptysis; tachycardia; hypoxia; raised D-dimer",
        "Thrombophlebitis extending to deep veins; prolonged immobility; hypercoagulable state",
        "Stop IV if thrombus related to line. High-flow O2. Urgent medical review. CTPA to confirm. Anticoagulation (LMWH/UFH) as prescribed. Thrombolysis if massive PE with haemodynamic instability. DVT prophylaxis for all admitted patients.",
    ],
    [
        "Electrolyte\nImbalance",
        "Varies: muscle cramps, weakness (hypo-K); confusion, seizures (hypo-Na); cardiac arrhythmias; tetany (hypo-Ca)",
        "Inappropriate IV fluid selection; excessive NS causing hyperchloraemic acidosis; potassium errors",
        "Stop infusion. Urgent U&E, blood gas. Notify doctor. Replace electrolytes per protocol (never give KCl IV undiluted — NEVER >40mmol/hr peripheral). Cardiac monitoring if arrhythmia. Re-check levels after replacement.",
    ],
]

story.append(comp_table(systemic_rows, RED, LIGHT_RED))
story.append(Spacer(1, 5*mm))

# ═══════════════════════════════════════════════════════════════════
# SECTION 3 – BLOOD TRANSFUSION REACTIONS
# ═══════════════════════════════════════════════════════════════════
story.append(section_header("SECTION 3 — BLOOD TRANSFUSION REACTIONS", DARK_RED))
story.append(Spacer(1, 2*mm))

transfusion_rows = [
    [
        "Acute Haemolytic\nReaction (ABO\nIncompatibility)",
        "Fever, chills, rigors within minutes; severe back/flank pain; chest pain; haemoglobinuria (red/brown urine); hypotension; DIC; oliguria",
        "ABO incompatible blood transfused — most common cause: patient ID error or blood bank error",
        "<b>LIFE-THREATENING EMERGENCY.</b> STOP transfusion immediately. Keep IV open with new NS + new tubing. Call doctor immediately. Send: unit + original tubing, 2× patient blood samples (EDTA + clotted), urine sample to blood bank. Monitor urine output hourly (target >1mL/kg/hr). ICU admission likely.",
    ],
    [
        "Febrile\nNon-Haemolytic\nReaction (FNHTR)",
        "Temperature rise ≥1°C above baseline; chills; headache; flushing; no haemolysis",
        "Cytokines in stored blood; recipient antibodies against donor leucocytes",
        "STOP transfusion. Take vital signs. Notify doctor. Rule out haemolytic reaction. If confirmed FNHTR: paracetamol 1g PO. Restart transfusion slowly if doctor approves. Pre-medicate future transfusions with paracetamol. Use leucodepleted blood going forward.",
    ],
    [
        "Allergic\nTransfusion\nReaction",
        "Urticaria (hives); pruritus (itching); flushing. Severe: bronchospasm, angioedema, hypotension",
        "IgE-mediated reaction to donor plasma proteins",
        "STOP transfusion. Chlorphenamine 10mg IV (antihistamine). If mild urticaria only and resolves — may restart per doctor's order. If severe (anaphylaxis): adrenaline 0.5mg IM + standard anaphylaxis protocol. Future pre-medication with antihistamine.",
    ],
    [
        "TACO\n(Transfusion-\nAssociated\nCirculatory\nOverload)",
        "Dyspnoea; hypertension; tachycardia; raised JVP; bilateral crackles; pulmonary oedema within 6 hrs of transfusion",
        "Rapid/excessive volume transfused; underlying cardiac/renal impairment",
        "STOP or slow transfusion. Sit patient upright. O2. IV furosemide 20–40mg per doctor. Strict fluid balance. Chest X-ray. Consider ECG. High-risk patients: transfuse slowly (1mL/kg/hr), give furosemide between units.",
    ],
    [
        "TRALI\n(Transfusion-\nRelated Acute\nLung Injury)",
        "Acute hypoxia (SpO2 <90%); bilateral pulmonary infiltrates on CXR; hypotension; fever. Onset within 6 hours of transfusion",
        "Donor antibodies (anti-HLA/anti-neutrophil) activate recipient neutrophils, causing non-cardiogenic pulmonary oedema",
        "<b>MEDICAL EMERGENCY.</b> STOP transfusion. High-flow O2. Mechanical ventilation may be required. Supportive care (ICU). No diuretics (not fluid overload). Notify blood bank — report unit for investigation. Corticosteroids controversial.",
    ],
    [
        "Bacterial\nContamination",
        "High fever (>39°C); rigors; severe hypotension; nausea/vomiting within 1–4 hrs (platelets more common than RBCs)",
        "Bacterial contamination during collection/processing; improper storage temperature",
        "<b>EMERGENCY.</b> STOP transfusion. Broad-spectrum IV antibiotics immediately. Blood cultures × 2 (patient). Send unit to blood bank for culture. Fluid resuscitation. Vasopressors if septic shock. ICU referral. Notify blood bank and transfusion committee urgently.",
    ],
]

story.append(comp_table(transfusion_rows, DARK_RED, LIGHT_RED))
story.append(Spacer(1, 4*mm))

# ═══════════════════════════════════════════════════════════════════
# SECTION 4 – PREVENTION STRATEGIES
# ═══════════════════════════════════════════════════════════════════
story.append(section_header("SECTION 4 — PREVENTION STRATEGIES", GREEN))
story.append(Spacer(1, 2*mm))

prev_data = [
    [Paragraph("PREVENTION STRATEGY", HEAD_S), Paragraph("DETAILS", HEAD_S)],
    [
        Paragraph("Aseptic Non-Touch Technique (ANTT)", BOLD_S),
        Paragraph("Protect all Key-Parts (needle tips, cannula hub, injection ports) and Key-Sites (insertion site). Never touch Key-Parts. Use alcohol swabs on all ports for 15 seconds before access.", SMALL_S)
    ],
    [
        Paragraph("Optimal Site Selection", BOLD_S),
        Paragraph("Prefer forearm veins over hand. Avoid antecubital for infusions (restricts arm movement, high risk of occlusion). Avoid lower extremities in adults. Avoid sites of infection, phlebitis, or previous bruising.", SMALL_S)
    ],
    [
        Paragraph("Correct Cannula Gauge", BOLD_S),
        Paragraph("Use the smallest gauge that meets clinical need. Oversized cannula = vein trauma and phlebitis. 20–22G for most adults. 18G for blood transfusion/rapid infusion. 14–16G for trauma/massive haemorrhage.", SMALL_S)
    ],
    [
        Paragraph("Dwell Time Monitoring", BOLD_S),
        Paragraph("Inspect site every 8–12 hours. Complete VIP score each shift. Replace cannula every 72–96 hours (or per clinical indication). Do not routinely replace if no signs of complications — evidence-based practice (RCT evidence supports clinically-indicated replacement).", SMALL_S)
    ],
    [
        Paragraph("Drug Compatibility Checks", BOLD_S),
        Paragraph("Check drug compatibility with IV fluid before mixing. Never mix medications in IV bags without pharmacist guidance. Know vesicant vs. non-vesicant drugs. Use dedicated lines for vesicants when possible.", SMALL_S)
    ],
    [
        Paragraph("High-Alert Medication Safety", BOLD_S),
        Paragraph("Always use infusion pumps for opioids, insulin, heparin, KCl, vasopressors, chemotherapy. Two-nurse independent double-check mandatory. Label all syringes and infusion lines. Anti-siphon valves on pumps.", SMALL_S)
    ],
    [
        Paragraph("Blood Product Safety", BOLD_S),
        Paragraph("Two-nurse bedside identity check before every transfusion. Use only 0.9% NS with blood products. Transfuse slowly for first 15 minutes. Complete each unit within 4 hours. Never return unused blood to blood bank refrigerator.", SMALL_S)
    ],
    [
        Paragraph("Hand Hygiene", BOLD_S),
        Paragraph("Perform 6-step hand hygiene before and after every IV access, dressing change, or drug preparation. WHO 'My 5 Moments for Hand Hygiene' applies at every IV interaction.", SMALL_S)
    ],
]

prev_tbl = Table(prev_data, colWidths=[W*0.28, W*0.72])
prev_tbl.setStyle(TableStyle([
    ("BACKGROUND", (0,0), (-1,0), GREEN),
    ("TEXTCOLOR", (0,0), (-1,0), WHITE),
    ("GRID", (0,0), (-1,-1), 0.4, colors.HexColor("#aaaaaa")),
    ("VALIGN", (0,0), (-1,-1), "TOP"),
    ("TOPPADDING", (0,0), (-1,-1), 5),
    ("BOTTOMPADDING", (0,0), (-1,-1), 5),
    ("LEFTPADDING", (0,0), (-1,-1), 5),
    ("RIGHTPADDING", (0,0), (-1,-1), 5),
    ("ROWBACKGROUNDS", (0,1), (-1,-1), [LIGHT_GRN, WHITE]),
]))
story.append(prev_tbl)
story.append(Spacer(1, 4*mm))

# ═══════════════════════════════════════════════════════════════════
# SECTION 5 – EMERGENCY QUICK REFERENCE CARD
# ═══════════════════════════════════════════════════════════════════
story.append(section_header("SECTION 5 — EMERGENCY QUICK-ACTION CARDS", ORANGE))
story.append(Spacer(1, 2*mm))

def emergency_card(title, steps, color, bg):
    rows = [[Paragraph(f"⚑  {title}", S("ch", fontSize=9, textColor=WHITE, fontName="Helvetica-Bold", leading=13))]]
    for i, step in enumerate(steps, 1):
        rows.append([Paragraph(f"{i}. {step}", SMALL_S)])
    tbl = Table(rows, colWidths=[W*0.49])
    tbl.setStyle(TableStyle([
        ("BACKGROUND", (0,0), (-1,0), color),
        ("BACKGROUND", (0,1), (-1,-1), bg),
        ("BOX", (0,0), (-1,-1), 1, color),
        ("TOPPADDING", (0,0), (-1,-1), 4),
        ("BOTTOMPADDING", (0,0), (-1,-1), 4),
        ("LEFTPADDING", (0,0), (-1,-1), 5),
        ("RIGHTPADDING", (0,0), (-1,-1), 5),
    ]))
    return tbl

card1 = emergency_card("ANAPHYLAXIS", [
    "STOP infusion immediately",
    "Call resuscitation team / 2222",
    "Adrenaline 0.5mg IM (1:1000) anterolateral thigh",
    "Lay flat, elevate legs",
    "High-flow O2 via non-rebreather mask (15L/min)",
    "IV access — large bore if not in situ",
    "IV NS 500mL–1L rapid bolus",
    "Chlorphenamine 10mg IV + Hydrocortisone 200mg IV",
    "Monitor every 5 minutes",
    "Admit to HDU/ICU",
], RED, LIGHT_RED)

card2 = emergency_card("ACUTE HAEMOLYTIC TRANSFUSION REACTION", [
    "STOP transfusion IMMEDIATELY",
    "Keep IV open — NEW NS + NEW giving set direct to cannula",
    "Call doctor immediately",
    "Take full set of vital signs",
    "Send: unit + tubing + 2× blood samples + urine to blood bank",
    "Maintain urine output >1mL/kg/hr (catheterise if needed)",
    "IV fluid resuscitation",
    "Monitor for DIC: PT, APTT, fibrinogen, D-dimer",
    "ICU referral if haemodynamic instability",
    "Complete serious incident report",
], DARK_RED, LIGHT_RED)

card3 = emergency_card("AIR EMBOLISM", [
    "STOP infusion — clamp all lines",
    "Place in LEFT LATERAL TRENDELENBURG position",
    "High-flow O2 (15L/min non-rebreather)",
    "Call resuscitation team",
    "Do NOT remove IV access",
    "Aspirate air via central line if available",
    "Monitor SpO2, ECG, BP continuously",
    "Hyperbaric O2 may be considered",
    "Document estimated air volume and time",
    "Complete incident report",
], NAVY, LIGHT_BLUE)

card4 = emergency_card("EXTRAVASATION (VESICANT)", [
    "STOP infusion IMMEDIATELY",
    "Do NOT remove cannula yet — aspirate residual drug first",
    "Estimate volume of drug extravasated",
    "Notify doctor and pharmacist urgently",
    "Apply specific antidote per drug protocol",
    "Elevate the affected limb",
    "Cold compress (most vesicants) or warm (vinca alkaloids)",
    "Mark the extravasation border with a pen",
    "Photograph and document",
    "Plastic surgery referral if necrosis developing",
], PURPLE, LIGHT_PRP)

cards_row = [[card1, Spacer(2*mm, 0), card2]]
card_tbl_1 = Table(cards_row, colWidths=[W*0.49, 2*mm, W*0.49])
card_tbl_1.setStyle(TableStyle([("VALIGN", (0,0), (-1,-1), "TOP")]))
story.append(card_tbl_1)
story.append(Spacer(1, 3*mm))

cards_row2 = [[card3, Spacer(2*mm, 0), card4]]
card_tbl_2 = Table(cards_row2, colWidths=[W*0.49, 2*mm, W*0.49])
card_tbl_2.setStyle(TableStyle([("VALIGN", (0,0), (-1,-1), "TOP")]))
story.append(card_tbl_2)
story.append(Spacer(1, 5*mm))

# ═══════════════════════════════════════════════════════════════════
# SECTION 6 – DOCUMENTATION REQUIREMENTS
# ═══════════════════════════════════════════════════════════════════
story.append(section_header("SECTION 6 — DOCUMENTATION REQUIREMENTS", NAVY))
story.append(Spacer(1, 2*mm))

doc_rows = [
    [Paragraph("WHEN", HEAD_S), Paragraph("WHAT TO DOCUMENT", HEAD_S), Paragraph("WHERE", HEAD_S)],
    [Paragraph("Cannula insertion", BOLD_S),
     Paragraph("Date, time, site, gauge, attempts, flush used, patient tolerance", SMALL_S),
     Paragraph("Patient chart / cannula dressing label", SMALL_S)],
    [Paragraph("Each IV infusion", BOLD_S),
     Paragraph("Fluid type, volume, rate, start/end time, site appearance, patient response", SMALL_S),
     Paragraph("Fluid balance chart + nursing notes", SMALL_S)],
    [Paragraph("IV drug given", BOLD_S),
     Paragraph("Drug, dose, time, route, site, response, any adverse effects", SMALL_S),
     Paragraph("Medication administration record (MAR)", SMALL_S)],
    [Paragraph("Blood transfusion", BOLD_S),
     Paragraph("Product, unit number, volume, start/end time, vital signs series, reactions, nurse signature", SMALL_S),
     Paragraph("Transfusion chart + return bottom copy to blood bank", SMALL_S)],
    [Paragraph("Any complication", BOLD_S),
     Paragraph("Complication type, time identified, VIP score, actions taken, doctor notified, outcome", SMALL_S),
     Paragraph("Nursing notes + incident reporting system", SMALL_S)],
    [Paragraph("Cannula removal", BOLD_S),
     Paragraph("Date, time, reason for removal, site condition, cannula tip sent for culture (if infection suspected)", SMALL_S),
     Paragraph("Patient chart", SMALL_S)],
]
doc_tbl = Table(doc_rows, colWidths=[W*0.22, W*0.52, W*0.26])
doc_tbl.setStyle(TableStyle([
    ("BACKGROUND", (0,0), (-1,0), NAVY),
    ("TEXTCOLOR", (0,0), (-1,0), WHITE),
    ("GRID", (0,0), (-1,-1), 0.4, colors.HexColor("#aaaaaa")),
    ("VALIGN", (0,0), (-1,-1), "TOP"),
    ("TOPPADDING", (0,0), (-1,-1), 5),
    ("BOTTOMPADDING", (0,0), (-1,-1), 5),
    ("LEFTPADDING", (0,0), (-1,-1), 5),
    ("RIGHTPADDING", (0,0), (-1,-1), 5),
    ("ROWBACKGROUNDS", (0,1), (-1,-1), [LIGHT_BLUE, WHITE]),
]))
story.append(doc_tbl)
story.append(Spacer(1, 4*mm))

# ═══════════════════════════════════════════════════════════════════
# FOOTER
# ═══════════════════════════════════════════════════════════════════
footer_data = [[
    Paragraph("This guide is for educational reference only. Always follow your institution's policies and protocols. "
              "Clinical decisions must be made in context by qualified healthcare professionals.", FOOT_S),
]]
footer_tbl = Table(footer_data, colWidths=[W])
footer_tbl.setStyle(TableStyle([
    ("BACKGROUND", (0,0), (-1,-1), LIGHT_GREY),
    ("BOX", (0,0), (-1,-1), 0.5, colors.HexColor("#999999")),
    ("TOPPADDING", (0,0), (-1,-1), 6),
    ("BOTTOMPADDING", (0,0), (-1,-1), 6),
    ("LEFTPADDING", (0,0), (-1,-1), 8),
    ("RIGHTPADDING", (0,0), (-1,-1), 8),
]))
story.append(footer_tbl)

# ── Build ──────────────────────────────────────────────────────────
doc.build(story)
print(f"PDF generated: {OUTPUT}")

cd /home/daytona/workspace/iv-complications && python generate_pdf.py 2>&1

~/iv-complications/generate_pdf.py

Successfully replaced 1 instance(s) of the string in '/home/daytona/workspace/iv-complications/generate_pdf.py'

~/iv-complications/generate_pdf.py

Successfully replaced 1 instance(s) of the string in '/home/daytona/workspace/iv-complications/generate_pdf.py'

cd /home/daytona/workspace/iv-complications && python generate_pdf.py 2>&1

ls -lh /home/daytona/workspace/iv-complications/IV_Complications_Quick_Reference…