Vascular access

Summary

Access to the venous system in its simplest form is indicated for fluid and medication administration; however central venous access has many more indications. Venous access can be divided into peripheral and central techniques.

Peripheral intravenous access

PERCUTANEOUS PERIPHERAL CANNULAE

Indications: fluid and medication administration.

Exceptions: potentially irritating solutions such as parenteral nutrition/certain antibiotics and sclerosing chemotherapeutic agents.

Sites: dorsal veins on the hands and feet are the preferred location +/- anticubital fossa.

Sizes: cannulae are sized in steel wire gauge, 14G, 16G, 18G etc. The lower the number the bigger the cannula.

Insertion

Equipment: cannulae, alcohol swabs, adhesive dressing, tourniquet, gloves.

Finding a vein: apply tourniquet, gentle tapping over vein, clean area with swab.

Insert the cannula with bevel uppermost through skin and into vein.

A flashback of blood will appear in the cannula chamber. Advance the needle another millimetre to ensure whole of bevel is within vein. Slide the plastic cannula over the needle into the vein. Remove the tourniquet, and while pressing on the cannula tip remove the needle. Then either put the white cap provided onto the cannula or attach to giving set of fluids bag. Date the dressing and change cannula every 72 hours to reduce infection risk.

Secure with adhesive and dispose of needle in sharps bin.

1. ▪ With larger cannulae inject local anaesthesia prior to insertion.

2. ▪ For children apply local anaesthetic cream.

PERIPHERAL VENOUS CUTDOWN CATHETER

Indication: surgical technique when attempts at percutaneous (peripheral + central) techniques have failed.