How to Insert a Cannula

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Intravenous (IV) cannulation, also known as insertion of a peripheral venous catheter (PVC), is a fairly straightforward medical procedure. However, it does take some technique and preparation to complete safely. While different professionals may adapt the technique a bit to their own preferences, the basic procedure involves gathering appropriate materials and properly preparing the insertion site, inserting the needle, and performing appropriate maintenance and cleanup after the catheter is inserted. [1]

Part 1
Part 1 of 3:

Preparing to Insert a Cannula

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  1. Cannulation requires some basic preparation and precaution. You will need to protect yourself from contact with the patient’s body fluids, and protect the patient from injury or infection. To begin the procedure, make sure you have the following materials: [2]
    • Non-sterile gloves
    • Tourniquet
    • Alcohol wipe or antiseptic solution (2% chlorhexidine in 70% isopropyl alcohol)
    • Local anesthetic solution (optional)
    • Syringe with a needle of appropriate gauge
    • Venous access device
    • Transparent dressing
    • Paper tape
    • Sharps container
  2. The larger the gauge of the needle, the higher the maximum flow rate of fluid entering into the vein. [3] This means larger-sized needles have a smaller number, so a 14-gauge is large, while a 22-gauge is small. Choose a size that corresponds to the specific procedure but does not exceed ⅔ the size of the vessel being accessed. [4]
    • The size of the cannula depends on several factors, including the patient’s vein condition and the purpose of the infusion.
    • For routine procedures, a 20 to 22-gauge cannula is often suitable for adults, while a 22 to 24-gauge cannula is suitable for children. A 14 to 16-gauge cannula is typically reserved for emergency situations, such as a rapid blood transfusion. [5]
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  3. Before you begin the procedure, you must gain informed consent, which is usually verbal. Perform the following steps in order to build rapport with your patient and create a more comfortable experience: [6]
    • Introduce yourself to your patient.
    • Verify your patient’s identity, including their name and date of birth.
    • Explain the procedure to the patient and answer any questions they may have.
    • Check if your patient has any allergies or sensitivities. If they have a latex allergy, make sure your tourniquet, gloves, and cannula are latex free. [7]
  4. All medical professionals must follow the proper hygiene practices before coming into contact with a patient. To minimize the risk of your patient getting an infection, wash your hands with soap and water and wear gloves before touching them. [8]
  5. 5
    Use proper personal protective equipment. Using gloves will not only protect your patient, but will also protect you from exposure to bodily fluids and potentially infectious material. A single pair of non-sterile gloves will probably be sufficient for this task. [9]
    • Depending on your facility’s requirements, you can also wear an apron or protective eyewear when inserting an IV catheter. [10]
  6. In most cases, the patient’s non-dominant arm is preferable. Place the tourniquet about 5 to 10 cm above the cannulation site, then tighten it. [11] Other methods for locating a good vein include: [12]
    • Tapping on the vein to make it dilate.
    • Asking the patient to open and close their fist.
    • Using gravity to highlight the vein by holding the patient’s arm down.
    • Applying mild heat to the site of the vein.
    • If you have a difficult time finding a good vein on the arm you have selected, inspect the opposite arm. In some cases (e.g. if the patient has diabetes or a history of IV drug abuse), you may need to use an ultrasound to help you locate a good vein. [13]
  7. Rub the wipe or solution over the patient’s skin for at least 30 seconds, focusing on the area around the vein that will be used for cannulation. Allow the site to dry completely to prevent the risk of infection and reduce stinging. [14]
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Part 2
Part 2 of 3:

Inserting the Needle

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  1. The correct angle will depend on the size of the device and the depth of the vein. [15]
    • If you are trying to access a small, superficial vein, use a small catheter (with a gauge of 22-24) and insert at an angle of 10° to 25°. For a deeper vein, use a larger catheter and insert at an angle of 30° to 45°. [16]
    • Make sure you insert the needle bevel up (with its eye facing upwards). This means that the point of the needle is down against the skin. [17]
  2. Hold the cannula in the front of its wings with your pointer and middle finger and in the back with your thumb. Advance it slowly into the skin until blood enters the base of the cannula. This is called a flashback, and it signals that you have entered a vein. [18]
    • Once flashback occurs, reduce the angle of the needle to avoid puncturing the posterior wall of the vein. [19]
  3. The needle should now be held stationary while the plastic component of the cannula is advanced another 2 to 3 mm into the vein. [20] The goal is to get the plastic sheath into the vein, and keep it there, while the needle is removed. [21]
    • Keep advancing the plastic component of the cannula until the plastic tube is fully inserted. The "hub" of the plastic component will hit the skin when it is all the way in. [22]
  4. Release the tourniquet from the patient's arm, apply pressure to the vein at the top of the cannula, then remove the needle from the base of the cannula, leaving the plastic component in sight. [23] Allow blood to flow into the base of the cannula to reduce the risk of air going into the vein if something is injected through the cannula (air embolism). [24]
    • Then, cap the cannula or attach test tubes or other supplies.
  5. 5
    Recatheterize if your first attempt is unsuccessful. If you do not observe blood in the flashback chamber when you inspect the cannula, withdraw the device until it’s just below skin level and then attempt to recatheterize. Flashback may stop if you've punctured the posterior wall of the vein, or if your patient has hypotension (low blood pressure). [25]
    • If swelling develops at the site, remove the device and release the tourniquet, then apply direct pressure to the site for 5 minutes [26]
    • Do not remove the needle from the skin entirely and then reinsert it. This could result in fragmentation of the catheter and embolism in the patient. Instead, throw away the used needle in a sharps container and reattempt using a fresh needle. [27]
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Part 3
Part 3 of 3:

Finishing the Procedure

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  1. Using transparent dressing and tape, or a specialized dressing that comes with the cannula, secure the venous access device to the skin. [28] Attach the cannula to the skin so that it’s comfortable for the patient but stays in place in the vein. Then, place a label over the transparent dressing with the date, time, and any other information required by your facility. [29]
    • You may need to tape attachments to the skin as well, such as a tube leading to another attachment point. [30]
  2. First, pull back on the syringe to withdraw a little blood and confirm that the cannula is still in place inside the vein. [31] Then, flush the cannula with a saline or heparin solution. This will assure that the site is clean and that the cannula is correctly positioned within the vein. [32]
    • To flush the cannula, fill a syringe with 5 mL of saline, inject it into the cannula port, detach the syringe, and then close the port. [33]
    • If you are returning to put an injection into a cannula, flush it with saline solution again. This will assure that the cannula is still in place.
  3. Dispose of the needle in a sharps container to reduce the risk of a needle stick. Then, document the procedure in the appropriate set of notes. [34]
    • If you’re removing the cannula, place a piece of gauze on the injection site and keep it in place with medical tape or a bandage. This will assure that the patient is not bleeding after the procedure. [35]
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      Warnings

      • Never perform this procedure unless you are trained. This article is intended for reference only and should not be used by untrained persons to perform this procedure.
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      • If you accidentally puncture your skin with a used needle, thoroughly wash the wound with soap and water, then visit your doctor or the nearest emergency department as soon as possible. [36]
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      References

      1. ↑ https://www.nhsggc.org.uk/media/221327/PIL%20-%20PVC%20-%20MI268796.pdf
      2. ↑ https://emedicine.medscape.com/article/1998177-periprocedure
      3. ↑ https://www.cetl.org.uk/learning/print/cannulation-venepuncture-print.pdf
      4. ↑ https://www.sciencedirect.com/topics/nursing-and-health-professions/cannula
      5. ↑ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9226746/
      6. ↑ https://www.jpaget.nhs.uk/media/406339/intravenous-cannulation-procedure.pdf
      7. ↑ https://www.rch.org.au/clinicalguide/guideline_index/Intravenous_access_Peripheral/
      8. ↑ https://www.jpaget.nhs.uk/media/406339/intravenous-cannulation-procedure.pdf
      9. ↑ https://emedicine.medscape.com/article/1998177-technique
      1. ↑ https://www.jpaget.nhs.uk/media/406339/intravenous-cannulation-procedure.pdf
      2. ↑ https://www.cetl.org.uk/learning/print/cannulation-venepuncture-print.pdf
      3. ↑ https://emedicine.medscape.com/article/1998177-technique#c2
      4. ↑ https://emedicine.medscape.com/article/1998177-technique#c2
      5. ↑ https://www.cetl.org.uk/learning/print/cannulation-venepuncture-print.pdf
      6. ↑ https://emedicine.medscape.com/article/1998177-technique#c2
      7. ↑ https://emedicine.medscape.com/article/1998177-technique#c2
      8. ↑ https://pubmed.ncbi.nlm.nih.gov/16280942/#:~:text=Objective%3A%20Intravenous%20catheters%20are%20usually,insertion%20using%20these%202%20methods .
      9. ↑ http://www.cetl.org.uk/learning/print/cannulation-venepuncture-print.pdf
      10. ↑ https://emedicine.medscape.com/article/1998177-technique#c2?form=fpf
      11. ↑ https://emedicine.medscape.com/article/1998177-technique#c2?form=fpf
      12. ↑ https://www.safercare.vic.gov.au/best-practice-improvement/clinical-guidance/neonatal/peripheral-intravenous-iv-catheter-insertion-for-neonates#goto-procedure
      13. ↑ https://www.cetl.org.uk/learning/print/cannulation-venepuncture-print.pdf
      14. ↑ https://emedicine.medscape.com/article/1998177-technique#c2?form=fpf
      15. ↑ https://www.ccjm.org/content/87/12/718
      16. ↑ https://emedicine.medscape.com/article/1998177-technique#c2
      17. ↑ https://emedicine.medscape.com/article/1998177-technique#c2
      18. ↑ https://emedicine.medscape.com/article/1998177-technique#c2
      19. ↑ https://www.cetl.org.uk/learning/print/cannulation-venepuncture-print.pdf
      20. ↑ https://emedicine.medscape.com/article/1998177-technique#c2
      21. ↑ https://www.safercare.vic.gov.au/best-practice-improvement/clinical-guidance/neonatal/peripheral-intravenous-iv-catheter-insertion-for-neonates#goto-procedure
      22. ↑ https://emedicine.medscape.com/article/1998177-technique#c2
      23. ↑ https://www.cetl.org.uk/learning/print/cannulation-venepuncture-print.pdf
      24. ↑ https://www.jpaget.nhs.uk/media/406339/intravenous-cannulation-procedure.pdf
      25. ↑ https://www.cetl.org.uk/learning/print/cannulation-venepuncture-print.pdf
      26. ↑ https://www.cetl.org.uk/learning/print/cannulation-venepuncture-print.pdf
      27. ↑ https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/needlestick-injury#

      About This Article

      Article Summary X

      To insert a cannula, first locate a suitable vein, using a tourniquet on the patient's arm if necessary. Then, insert the needle at an angle of 10-25 degrees for a superficial vein or 30-45 degrees for a deeper one. Next, advance the cannula until you have entered a vein and blood enters the base. Now, advance the plastic component another 2-3 millimeters while holding the needle stationery. Once you've done that, remove the tourniquet if you used one, and remove the needle from the base. Allow blood to flow in to avoid the risk of air going into the vein first. Finally, secure the cannula with an appropriate dressing. For more tips from our Medical co-author, including how to hygienically prepare for the procedure, read on!

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