Intravenous Cannulation
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Intravenous (IV) cannulation is a technique in which a cannula is placed inside a vein to provide venous access. Venous access allows sampling of blood, as well as administration of fluids, medications, parenteral nutrition, chemotherapy, and blood products. [1]
Veins have a three-layered wall composed of an internal endothelium surrounded by a thin layer of muscle fibers that is surrounded by a layer of connective tissue. Venous valves encourage unidirectional flow of blood and prevent pooling of blood in the dependent portions of the extremities; they also can impede the passage of a catheter through and into a vein. Venous valves are more numerous just distal to the points were tributaries join larger veins and in the lower extremities. [2]
This topic describes placement of an over-the-needle IV catheter, in which the catheter is mounted on the needle (see the first image below). Such devices are available in various gauges (16-24 gauge), lengths (25-44 mm), compositions, and designs (see the second image below).
In general, it is advisable to select the smallest gauge of catheter that can still be effectively used to deliver the prescribed therapy; this will minimize the risk of damage to the vessel intima and ensure adequate blood flow around the catheter, which reduces the risk of phlebitis. [3] However, if the situation is an emergency or if the patient is expected to require large volumes infused over a short period of time, the largest-gauge and shortest catheter that is likely to fit the chosen vein should be used.
Veins with high internal pressure become engorged and are easier to access. The use of venous tourniquets, dependent positioning, “pumping” via muscle contraction, and the local application of heat or nitroglycerin ointment can contribute to venous engorgement. [2]
The superficial veins of the upper extremities are preferred to those of the lower extremities for peripheral venous access because cannulation of upper-extremity veins interferes less with patient mobility and poses a lower risk for phlebitis. [4] It is easier to insert a venous catheter where two tributaries merge into a Y-shaped form. It is recommended to choose a straight portion of a vein to minimize the chance of hitting valves.
This article describes the placement of an IV catheter in an upper extremity. A similar technique can be used for placement of IV catheters in different anatomic sites.
Indications for IV cannulation include the following:
No absolute contraindications for IV cannulation exist.
Peripheral venous access in an injured, infected, or burned extremity should be avoided if possible.
Some vesicant and irritant solutions (pH <5, pH >9, or osmolarity >600 mOsm/L) can cause blistering and tissue necrosis if they leak into the tissue, including sclerosing solutions, some chemotherapeutic agents, and vasopressors. These solutions are more safely infused into a central vein. They should only be given through a peripheral vein in emergency situations or when a central venous access is not readily available.
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Rickard CM, Webster J, Wallis MC, Marsh N, McGrail MR, French V, et al. Routine versus clinically indicated replacement of peripheral intravenous catheters: a randomised controlled equivalence trial. Lancet. 2012 Sep 22. 380(9847):1066-74. [Medline].
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Gil Z Shlamovitz, MD, FACEP Associate Professor of Clinical Emergency Medicine, Keck School of Medicine of the University of Southern California; Chief Medical Information Officer, Keck Medicine of USC
Gil Z Shlamovitz, MD, FACEP is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association
Disclosure: Nothing to disclose.
Vincent Lopez Rowe, MD Professor of Surgery, Program Director, Vascular Surgery Residency, Department of Surgery, Division of Vascular Surgery, Keck School of Medicine of the University of Southern California
Vincent Lopez Rowe, MD is a member of the following medical societies: American College of Surgeons, American Surgical Association, Pacific Coast Surgical Association, Society for Clinical Vascular Surgery, Society for Vascular Surgery, Western Vascular Society
Disclosure: Nothing to disclose.
The author thanks Mark Scalzi, RN, BSN, for his help with producing the multimedia content associated with this article.
Medscape Drugs & Diseases also thanks Gil Z Shlamovitz, MD, FACEP, Associate Professor of Clinical Emergency Medicine, University of Southern California, and Chief Medical Information Officer, Keck Medicine of USC, Los Angeles, CA, for assistance with the video contribution to this article.
Intravenous Cannulation
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