Putting in IV cannula and starting a drip

Used to give IV fluids AND/OR medicines. IV cannula connected to

  • Bung — if no fluids needed
  • Drip — if fluids needed

Attention

  • Make sure you are putting needle into vein not into artery or nerve
  • Always lie person down in case they faint
  • If person has had mastectomy or dialysis fistula — use other side
  • If person critically unwell or in cardiac arrest and putting in IV cannula likely to be difficult or take too long — consider intraosseous needle
  • Big veins sometimes not the best as they can roll
  • Avoid areas of flexion
  • Biggest veins usually found
    • On inner forearm — common in men
    • On back of hand and side of wrist —Figure 4.11
    • Just in front of inside ankle bone — Figure 4.12

Figure 4.11   

Figure 4.12   
  • Look at the vein and then feel vein
  • Lower arm/leg below level of the heart to help fill veins
  • If cold — warm body part by using a warm compress or warm water to help find vein

What you need

  • Helper if possible
  • Bluey
  • Tourniquet
  • Sterile dressing pack — to use as sterile area (optional)
    • 10mL normal saline in syringe
    • Chlorhexidine 2% in isopropyl alcohol 70% swab or solution
    • Tape
    • 8cm x 6cm transparent IV site dressing
    • IV bag sticker and drip stand or somewhere to hang fluid bag if needed
    • Sterile bung, prepared and primed intravenous giving set, short extension and IV fluids
  • Intravenous cannula of right size
    • 22–24G infants and children
    • 20G adults
    • 16G adult trauma, resuscitation or shock — for rapid fluid resuscitation

What you do

  • If drip needed — write date and time on IV bag sticker
    • Connect IV fluids to line, prime line with fluid and let out any air bubbles
    • Choose vein you are going to use and put bluey underneath
  • Lay out dressing pack and equipment. Wash hands and put on gloves
  • Clean site with skin cleanser as per local guidelines
  • Put on tourniquet OR use helper’s hands to squeeze child's limb
    • Wait for vein to swell
    • Pull person’s skin down to hold vein still — Figure 4.13

Figure 4.13     
  • Hold IV cannula with needle bevel facing upward at a 20–30° angle to skin. 20° for superficial vein, 30° for deep vein. Put into vein and see flashback of blood
    • Lower cannula to nearly level with skin and gently push 6–12mm into vein
    • Slide teflon cannula fully up vein while holding trocar still
  • Press firmly on skin above plastic cannula. Press with your thumb or arch made by your thumb and forefinger around limb — Figure 4.14

Figure 4.14   
  • Undo tourniquet then take out needle/trocar
    • Use piece of tape to secure cannula and label with date and time inserted
    • Flush with 5–10mL normal saline to make sure you are in vein. Should be no swelling above cannula site
    • Connect bung or IV line to cannula and run IV fluids as needed
    • Put on see-through dressing — to check site for redness or swelling
    • Tape IV line to skin in a loop, bandage lightly over cannula and tubing
    • May need to splint area to stop movement
  • If person complains of pain or pressure — check cannula is in vein not tissue