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CANNULATION & VENESECTION. AMANDA HARPER CLINICAL SKILLS COORDINATOR. LEARNING OUTCOMES OF THE WORKSHOP. Assessment of patient Demonstrate the correct technique for performing cannulation & venesection as per SUHT policy & procedure Selection of the appropriate device

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cannulation venesection

CANNULATION & VENESECTION

AMANDA HARPER

CLINICAL SKILLS COORDINATOR

learning outcomes of the workshop
LEARNING OUTCOMES OF THE WORKSHOP
  • Assessment of patient
  • Demonstrate the correct technique for performing cannulation & venesection as per SUHT policy & procedure
  • Selection of the appropriate device
  • Identify and recognise the complications that are associated with cannulation & venesection
  • Correct documentation as per SUHT policy
the assessment consider the following points
THE ASSESSMENTCONSIDER THE FOLLOWING POINTS:
  • Age / size / history / condition / dependency of the patient
  • History of previous cannulation / venesection
  • Type / length of treatment required
  • Number of tests ordered
  • What medication is the patient on?
  • Fluid status
  • History of blood disorders
conditions that affect the position of the device
Conditions that affect the position of the device: -
  • Amputation
  • Stroke
  • Mastectomy or other Breast / Lymph Surgery
  • Renal Fistula
  • Lymphoedema or Cellulitsis
  • Diabetes / Vascular Disease / Arthritis
  • Trauma / Fractures / Burns
  • Social History
questions to ask the patient
Questions to ask the patient
  • OBTAIN CONSENT
  • Have you had a cannula / blood test before?
  • Were there any complications / adverse reactions?
  • Do you have any allergies?
  • Consider needle phobia
  • Would you like a local topical anaesthetic before I insert the cannula or take blood?
  • Which is your dominant arm?
attributes of an ideal vein are
Attributes of an ideal vein are: -
  • Be engorged, bouncy & soft
  • Refill after it has been depressed
  • Be visible
  • Feel round
  • Be well supported by surrounding structures
  • Be straight & ‘free of valves’
veins to be avoided
Veins to be avoided: -
  • Thrombosed, fibrosed or sclerosed
  • Inflamed or bruised or painful
  • Thin or fragile
  • Mobile
  • Near bony prominences and joints
  • Near sites of infection or oedema
  • AVOID THE VALVES
  • For venesectionavoid the arm with an IVline running
methods for improving venous access
Methods for improving venous access:
  • Apply a disposable tourniquet
  • Lower the level of the arm below the heart
  • Ask the patient to open and close their fist
  • Light tapping / rubbing of the veins
  • Warm compresses over the selected vein
  • Warm water
  • Relax the patient / consider the environment
slide10

WHICH

VEIN?

slide11

Antecubital Fossa

Cephalic

1st Intercostal

Brachial Artery

Basillic

Radial

Median Cubital Vein

Radial Artery

Median

Ulnar Artery

Ulnar

Veins

Arteries

Nerves

slide12

DIGITAL

DORSAL

VEIN

DORSAL

METACARPAL

VEINS

DORSAL

VENOUS

NETWORK

CEPHALIC

VEIN

BASILLIC

VEIN

veins to be used are
VEINS TO BE USED ARE:
  • METACARPAL VEINS
  • CEPHALIC VEIN
  • BASILIC VEIN
  • MEDIAN CUBITAL VEIN
group exercise
GROUP EXERCISE

In pairs, use a tourniquet to identify each others:

  • Veins
  • Arteries
  • Valves
  • Ligaments
selecting the right cannula two key points to consider
Selecting the right cannulaTwo key points to consider:
  • What is the cannula going to used for?
  • The condition, location and size of the vein selected?

You should try to select the smallest gauge possible that will accommodate the intravenous therapy that is prescribed.

venesection

VENESECTION

DEVICE SELECTION

vacutainer
VACUTAINER
  • Quicker collection than other methods
  • Closed system
  • Exact amount of blood obtained
  • Reduces the risk of haemolysis of the sample
  • Reduces the risk of needlestick injury
bottles blood forms
BOTTLES & BLOOD FORMS
  • E-QUEST SYSTEM for blood requests & results within SUHT
  • ALWAYS ensure that the GROUP &SAVEor CROSSMATCH request has been correctly completed & signed for by the requesting MEDICAL PRACTIONER
slide22

Serum

AB Levels

E.D.T.A.

FBC & ESR

Cross Match Group & Save

Coagulation INR / APTR

Glucose

Lithium Heparin, PST, U&E’s, Bone & Liver

Trace Elements

order of draw
ORDER OF DRAW
  • NO ADDITIVES (Green, Red, Dark Blue)
  • COAGULATION (Light Blue)
  • OTHER ADDITIVES (Gold, Lilac,Pink &Grey)

EXCEPTIONto this is when Blood Cultures have been requested, these MUST BEfilledfirst–aerobic (Blue)followed byanaerobic (Pink)

risks during insertion
Infection

Haemorrhage

Haematoma

Vaso-vagal episode

Needle phobias

Catheter embolism (cannulation)

Transfixation

Pain

Nerve damage

Arterial puncture

Allergies

Needlestick injury

Risks - During Insertion
slide26

Transfixation

SkinVein wallVein wall

haematoma bruising
Haematoma/Bruising
  • Transfixation
  • Tourniquet too tight / left on too long

/ use of RUBBER GLOVE!

  • Arterial puncture
  • Repeated insertion sites
future complications of cannulation
Future Complications of Cannulation
  • Phlebitis — septic / mechanical / chemical
  • Infection
  • Drug reaction / Allergy
  • Infiltration
  • Extravasation
  • Thrombosis / Embolism
  • Speed shock
  • Fluid overload
phlebitis
Phlebitis
  • TYPES OF:
infiltration
Infiltration
  • “The inadvertent administration of non-vesicant(non-toxic) solution/medication into surrounding tissues."

(Royal Marsden Manual, 2004)

  • The cannula may still appear to be patent, so early recognition is vital to avoid tissue damage.
  • Examplesof fluidinclude: Normal Saline &

5% Dextrose

extravasation
Extravasation
  • “the inadvertent administration of a vesicant substance(toxic) into the tissues surrounding a vein.”

(Royal Marsden Manual, 2004)

  • Examples of fluid include: 10% Dextrose, Chemotherapy & Potassium
thrombus formation
Thrombus Formation
  • Correct flushing technique - pulsated push-pause & positive pressure, prevents blood being left in the cannula & removes debris from the internal catheter wall (use 5mls of Normal Saline).
  • Flushing blocked cannula can lead to pulmonary embolus (30% PMs show undiagnosed PE).
slide33

Signs of Cannula Related Infection

  • Phlebitis
  • Pyrexia
  • Feeling unwell
  • Raised white blood cell count
site preparation
Site preparation
  • As cannulation / venesection is performed using an aseptic non-touch technique it is imperative that the vein is cleaned PRIORTO THEPROCEDURE, wearing clean non-latex gloves
  • Clean the vein for 30 seconds with 2% chlorhexidine in 70% alcohol solution, cleaning the vein in a criss-cross motion
  • Allow vein to air dry
  • DO NOTre-touch or palpatethe vein oncecleaned
  • Consider hair clipping if appropriate
documentation
DOCUMENTATION
  • SEE CANNULA CARE PLAN includes:
  • Time & date of blood sample / cannula insertion
  • Site of insertion
  • Gauge and batch number of the cannula
  • What blood samples have been taken
  • Number of attempts (MAX 2 per person)
  • Any complications noted (e.g. haematoma)
  • Print & sign your name
  • Evidence verbal consent has been obtained