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

• 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

• 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

• 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