Biovalve™ - Vygon (UK)

Biovalve A Guide to Peripheral IV CannulationCANNULATIONvygon@vygon.co.ukwww.vygon.co.uk

Biovalve Peripheral IV Cannulation from Vygon (UK) LtdThe information provided here is intended as guidance inperforming intravenous cannulation. It does not dictatemedical practice, and you should always follow your localhospital or Trust policies.ContentsYou may also be interested in:Biovalve and Biovalve Cannulation Pack BrochureCANNULATIONE-Learning Cannulation Training PackageTO ORDER, PLEASE CALL US ON 01285 657051Useful InformationFoldout oppositeIV Cannulation Products from Vygon 2-3Handwashing Technique 4-5Preparation 6-7Aseptic Technique & Palpating of the Vein 8-9Aseptic Technique 10-11Cannulation 12-13Cannula Care 14Cannula Removal 15Complications & Recommendations 16-19e-Learning Cannulation Training Package 20-21Open for Useful Information

CANNULATIONUseful InformationSize/Colourguide22g 20g 18g 16g 14gCephalicA prominent vein of theforearm often used forcannulation as it is large,straight and easy toaccess.Median CubitalA prominent anticubital veinwhich should be avoidedexcept in an emergency.BiovalveOrdering InformationMetacarpalEasily accessible in mostpeople and should be theveins that you assess firstfor cannulation suitability.BasilicThe largest of the threeanticubital veins with theleast tortuous route to theheart. Only to be used in anemergency for cannulation.CodeSizeFlowRate(ml/min)Applications0106.08 22G 25 Neonates, paediatrics, elderly patients withfragile veins or patients on long term therapy.0106.10 20G 55 Patients receiving up to 2-3 litres of fluid perday, patients on longer term medication.0106.12 18G 90 Patients receiving blood components or largevolumes of fluid.0106.17 16G 170 Rapid transfusions of whole blood or bloodcomponents.0106.21 14G 265 Rapid transfusions of whole blood.

CANNULATIONIV Cannulation Products from VygonBiovalve (Code 106)A short ported IV cannula designedspecifically for peripheral access.Intraflon (Code 121)A short non-ported IV cannuladesigned specifically for peripheralaccess.Also available in a pack witheverything you need. Please referto our Biovalve literature for furtherinformation, available on request.A neonatal and paediatric cannulaspecifically developed for small veintherapy.2 Vygon UK Ltd | A Guide to Peripheral IV Cannulation Bioflow (Code 100)Vygon UK Ltd | A Guide to Peripheral IV Cannulation3

CANNULATIONHandwashing TechniqueSTEP ONEWet handsthoroughly beforeapplying washingagent.STEP TWORub palm to palm.STEP THREESTEP FOURPalm to palmfingers interlaced.STEP FIVEBacks of fingers toopposing palms withfingers interlocked.STEP SIXWash each thumb byclasping and rotatingin the palm of theopposite hand.STEP SEVENRotational rubbingback and forwardswith clasped fingersof right hand inleft palm and viceversa.STEP EIGHTRinse hands underrunning water.STEP NINEDry hands thoroughly.Vygon UK Ltd | A Guide to Peripheral IV CannulationVygon UK Ltd | A Guide to Peripheral IV Cannulation4 5

CANNULATIONPreparationSTEP ONEExplain the cannulationprocedure to the patient,check understanding andobtain consent. Ask thepatient about any allergiesto drugs, solutions oradhesive dressings. Checkwrist band for patientidentification against patientnotes.STEP THREEChoose the smallest practicalcannula size, taking intoaccount the patient’s fluidrequirements, the size ofvessel to be cannulatedand the timescale of IVtherapy.Please refer to the cannulaguide in the front coverfoldout.STEP TWOVarious intravenous sites shouldbe examined before a choice ismade. Take time to look atalternative sites. Commonsites are the dorsum of thehand, the forearm, themedian ante-cubital veins(emergency use only)and very occasionally theveins of the foot.STEP FOURAssemble all necessary equipmentrequired for cannulation inaccordance with hospital policy.When intermittent IV access isrequired, the use of a cannulaextension is recommended.Ideally, the top port of thecannula should only be usedin an emergency situation tominimise the risk of infection.CAUTION: Avoid placingcannula over points of flexion(e.g. the wrist).Please note: Hospitalpolicy may advocate the useof anon-ported cannula.Vygon UK Ltd | A Guide to Peripheral IV CannulationVygon UK Ltd | A Guide to Peripheral IV Cannulation6 7

CANNULATIONAseptic Technique & Palpating of the VeinSTEP FIVEStrict aseptic technique inaccordance with hospital policyis essential and the clinicianshould wash their handsusing a soap or soapsolution. Hands should bewashed vigorously for20-30 seconds.STEP SEVENGloves should be worn to minimisethe risk of infection to both theclinician and patient.Refer to the hand hygieneand handwashingsection on page 4-5.STEP SIXUse a tourniquet to helpidentify an appropriatevein. The tourniquetshould be applied abovethe intended site ofcannulation. Applicationof tourniquet should notimpede arterial blood flowand should not remain onpatient for longer than twominutes.STEP EIGHTGentle palpation over theintended cannulation sitewill assist vein location.Additionally, the patient maybe asked to aid vein locationby making a fist, releasingand repeating this action.Vygon UK Ltd | A Guide to Peripheral IV CannulationVygon UK Ltd | A Guide to Peripheral IV Cannulation8 9

CANNULATIONAseptic TechniqueCANNULATIONCannulationSTEP NINEThe intended cannulation siteshould be prepared usingan antiseptic solution (2%chlorhexidine in 70%isopropyl alcohol) or swab.Cleansing should start at theintended cannula insertionpoint and wiping shouldbe performed in a circularmotion, radiating outwards(follow manufacturer’s skincleansing guidelines).The skin must be allowed todry before proceeding.STEP TWELVESTEP ELEVENInsert the needle cannulaassembly through the skin atan angle of 10-45°.STEP TENStabilisation of the veinis the key to successfulcannulation. If necessaryplace thumb approx 2-5centimetres beneath theinsertion site to anchorthe vein. This red uces therisk of vein movement onneedle insertion.Penetrate the skin and advancethe needle cannula assemblyinto the vein. Successful entryinto the vein is confirmed byfree flow of blood into theflashback chamber.Slightly lower the needleuntil it is almost flushwith the skin. This anglereduces the risk of passingthe needle through thevein (transfixion). Advancethe entire needle and cannulaassembly a further half centimetreinto the vein.Vygon UK Ltd | A Guide to Peripheral IV CannulationVygon UK Ltd | A Guide to Peripheral IV Cannulation10 11

CANNULATIONCannulationSTEP THIRTEENThe introducer needle is nowwithdrawn a short distanceand blood should be seento enter the cannula. Thisconfirms the position in thevein. The needle must notbe reinserted as this candamage the cannula.STEP FIFTEENApply a pre-primed cannulaextension and attach a 10mlsyringe containing normalsaline. Draw blood back intothe syringe to confirm thecannula’s location in thevein. Flush from the cannulato remove any blood.STEP FOURTEENWhilst stabilising the needle,advance the cannula into thevein. Release the tourniquetand place a finger over thevein, distal to the cannulatip. Remove the introducerneedle and safely disposein an appropriate sharpscontainer.STEP SIXTEENThe cannula should be secured with atransparent, semi-permeable membranedressing in accordance with hospitalpolicy. This will reducethe risk of infection,cannula movement andaccidental cannuladisplacement, and willallow clear observationof the entry site. Recordthe cannula procedurein the patient’s notes.Vygon UK Ltd | A Guide to Peripheral IV CannulationVygon UK Ltd | A Guide to Peripheral IV Cannulation12 13

CANNULATIONCannula CareCANNULATIONCannula RemovalIn order to prevent infection the following should be included inthe management of all IV cannulae.l Follow aseptic technique when handling the cannula andother equipment.l The cannula should always be secured using a transparentsemi-permeable dressing to prevent movement.l To minimise cannula movement always use a cannulaextension to administer prescribed medication.l All connections should be checked for tightness.l Inspect the insertion site daily for signs of infection, i.e.inflammation, redness, tenderness. Consider the use ofVisual Infusion Phlebitis (VIP) scoring.l Wash your hands.l Apply a pair of gloves.l Remove all IV dressings and tape. Do not use scissors.l Hold a small sterile dressing over the site and slowly removethe cannula.l Immediately apply firm pressure for 2-3 minutes to ensurethere is no subcutaneous leakage of blood. Elevate the armif bleeding persists.l If necessary apply a new sterile dressing to site.l In order to maintain patency, regularly flush the cannulausing a cannula extension.l If any signs of inflammation or infection are found thecannula should be removed and a new one inserted at analternative site.l The cannula should be removed after 72-96 hours unlessclinically indicated otherwise.Vygon UK Ltd | A Guide to Peripheral IV CannulationVygon UK Ltd | A Guide to Peripheral IV Cannulation14 15

CANNULATIONComplications & Recom mendationsComplicationsRecommendationsAir embolism occurs when air enters the vein. Although ittakes a considerable amount of air to cause concern, it is bestprevented.Make sure all lines are well primed prior to use and connections secure. Alsoconsider using an air-eliminating filter in the line.Infiltration is the inadvertent administration of a non-vesicantmedication or solution into the surrounding tissue insteadof into the intended vascular pathway and will present withcoolness and blanching of the skin, as well as leaking at thesite.Extravasation occurs when an infusate of a vesicant nature entersthe subcutaneous tissue rather than the vessel as intended. Thiscan be extremely painful for the patient and detection is important,as some infusates are hypertonic solutions and cytotoxic drugs.The cannula must be removed immediately. To continue treatment insert a cannulain an alternative site away from the area of infiltration. The risk of infiltration can bereduced by using a cannula extension and a secure cannula dressing.Refer to local extravasation policies and procedures for treatment options.Thrombolism / Thrombophlebitis occurs when a blood clot(thrombus) becomes detached from the sheath of the cannulaor the vessel wall.Prevention is the greatest form of defence. Flush the cannula on a regular basisand consider re-siting the cannula if IV therapy is to continue for more than 3-4days.Haematomas occur when blood leaks out of the vessel wall.The common cause of this is using cannulae that are nottapered at the distal end. It will also occur if, on insertion, thecannula has penetrated through the other side of the vesselwall.Apply pressure to the site for approximately 2 minutes and elevate the limb.Vygon UK Ltd | A Guide to Peripheral IV CannulationVygon UK Ltd | A Guide to Peripheral IV Cannulation16 17

CANNULATIONComplications & Recom mendationsPhlebitisVisual Infusion Phlebitis (VIP) ScoreIV site appears healthyOne of the following is evident:l Slight pain near IV site l Slight redness near IV siteTwo of the following are evident:l Pain at IV site l Swelling l ErythemaAll of the following are evidentl Pain along the path of the cannula l Erythemal SwellingAll of the following are evident & extensivel Pain along the path of the cannula l Erythemal Swelling l Palpable venous cordAll of the following are evident & extensivel Pain along the path of the cannula l Erythemal Swelling l Palpable venous cord l Pyrexia012345No signs of phlebitisl Observe cannulaPossible first signs of phlebitisl Observe cannulaEarly stage of phlebitisl Resite cannulaMedium stage of phlebitisl Resite cannula l Consider treatmentAdvanced stage of phlebitis(or start of thrombophlebitis)l Resite cannula l Consider treatmentAdvanced stage of Thrombophlebitisl Resite cannula l Initiate treatmentOxford Radcliffe Trust Infection Control Services. Updated from A Jackson. 1997 OM141067ComplicationsPhlebitis can be defined as the acute inflammation of the intima of thevein. It is characterised by pain and tenderness along the course of the vein.There are three main types of phlebitis: mechanical, chemical and infective.Mechanical Phlebitis occurs where the cannula itself irritates or injures the vein wall.Chemical Phlebitis occurs where the infusate (or particles in the infusate) damagesthe vein wall.RecommendationsTo prevent phlebitis - use aseptic insertion techniques, choose the smallest gaugecannula possible for the prescribed treatment, secure the cannula properly toprevent movement. It is important to do regular checks for the signs of phlebitis.Use the smallest gauge cannula neccessary for prescribed therapy in order tominimise catheter and vein wall contact. Stabilise the cannula with a transparent,semi-permeable dressing and assess the cannula site regularly.This can be avoided by ensuring the infusate is filtered, does not exceed a finalosmolarity of 500mmol/l, pH between 5 and 9, dextrose concentrations of >10%.Selecting the smallest gauge cannula and the largest vein possible will allow agreater volume of blood to flow around the cannula tip, thus diluting the infusate.Infective Phlebitis occurs where bacteria causes irritation to the vein wall.The principles of asepsis, including handwashing, minimal touch technique and thecleansing of access points prior to use are essential. This must also include the useof a sterile dressing to cover the cannula insertion site. Cannula changes of at least72-96 hours are recommended.Vygon UK Ltd | A Guide to Peripheral IV Cannulation18 19

CANNULATIONe-Learning CannulationTraining PackageVygon’s e-Learning Cannulation TrainingPackage is available to existing Biovalvecustomers either as a stand-aloneCD-ROM or available to use on theIntranet of an NHS Trust or workplace.Each of the eight sections contain abuilt-in assessment at the end to testthe student’s knowledge.The package will upload and track alluser progress for organisations thathave SCORM compliant e-LearningManagement systems.TOPICS COVERED IN THEPACKAGE3 Legal3 Anatomy & Physiology3 Site Selection3 Equipment Choice3 Principles & Practice ofCannulation3 Complications3 Post Insertion Care3 Infection Control“Good teaching is good teaching, nomatter how it’s done.” The old adage stillrings true, and e-Learning brings with itnew dimensions in education and training.Advantages of e-Learning overconventional trainingIt’s interactive and funTraining material that is designed to get the student to explore ideas then make choicesand decisions based on what they have been taught, will most certainly be effective. Beingfree to make mistakes and repeat the process until you get it right is an excellent way ofembedding information in our brains.It’s self-pacede-Learning programmes can generally be taken when needed. Most e-Learning materialcomes in a module-based design, allowing the learner to go through smaller chunks oftraining that can be used and absorbed for a while before moving on.Students can choose where and when they do theirtraininge-Learners can go through training sessions from anywhere, usually at any time. This benefitcan make learning possible for people who find it hard to work training into their busyschedules.It can lead to increased retention and a strongergrasp of the subjectThis is because of the many elements that are combined in e-Learning to reinforce themessage, such as video, audio, quizzes, interaction, etc. There is also the option to revisit orreplay sections of the training that might not have been clear the first time around.It builds confidenceStudents do not need to worry that they are holding the class up by asking questions. Theycan take their time to learn and understand before moving on to the next topic.It provides a consistent messagee-Learning eliminates the problems associated with different instructors teaching slightlydifferent material on the same subject. For ward-based training, this is often critical.It can be easily managed for large groups of staffe-Learning allows managers and others to keep track of the course offerings, scheduleor assign training for staff and track their progress and results. Managers can review astudent’s scores and identify any areas that need additional training.Vygon UK Ltd | A Guide to Peripheral IV CannulationVygon UK Ltd | A Guide to Peripheral IV Cannulation20 21

Vygon (UK) LtdWeb: www.vygon.co.ukEmail: vygon@vygon.co.uk0043.IV/CANN Content correct as of 07/09