Patient Education and Consent
Explain the procedure to the patient and/or the patient’s representative, and obtain verbal consent.
Equipment
This topic describes the use of the over-the-needle type of intravenous (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 (25-45 mm), compositions, and designs (see the second image below).
In general, the smallest gauge of catheter should be selected for the prescribed therapy, with the aims of preventing damage to the vessel intima and ensuring adequate blood flow around the catheter so as to reduce the risk of phlebitis. [4]
Necessary equipment includes the following (see the images below):
-
Nonsterile gloves
-
Tourniquet
-
Antiseptic solution (2% chlorhexidine in 70% isopropyl alcohol)
-
Local anesthetic solution
-
1-mL syringe with a 30-gauge needle
-
2 × 2 gauze
-
Venous access device
-
Vacuum collection tubes and adaptor
-
Saline or heparin lock
-
Saline or heparin solution
-
Transparent dressing
-
Paper tape
-
Padded arm board
-
1/2-in. gauze bandage roll
The patient’s skin should be washed with soap and water if it is visibly dirty.
Because infants and young children are unlikely to cooperate, it is recommended that an assistant aid in stabilizing the extremity during the procedure.
Patient Preparation
Anesthesia
Both intradermal injection of a topical anesthetic agent just prior to IV insertion and topical application of a local anesthetic cream about 30 minutes prior to IV insertion have been shown to significantly reduce the pain associated with IV catheterization. One or the other should be used unless the situation is an emergency. [5, 6, 7]
Positioning
Make sure that there is adequate light and that the room is warm enough to encourage vasodilation. Adjust the height or position of the bed or chair to make sure that you are comfortable and to prevent unnecessary bending. Make sure that the patient is in a comfortable position, and place a pillow or a rolled towel under the patient’s extended arm.
-
Various sizes of over-the-needle IV catheters.
-
Over-the-needle IV catheter.
-
Partial selection of equipment required for pediatric IV cannulation.
-
Partial selection of equipment required for pediatric IV cannulation.
-
Vein palpation for pediatric IV cannulation.
-
Application of antiseptic solution for pediatric IV cannulation.
-
Angle of insertion with bevel up for pediatric IV cannulation.
-
Flashback of blood into venous access device for pediatric IV cannulation.
-
Sliding hub of catheter over needle and into vein in pediatric IV cannulation.
-
Securing venous access device in place using transparent dressing in pediatric IV cannulation.
-
Using nondominant hand to secure venous access device in vein, while using dominant hand to remove and secure needle.
-
Blood sampling in pediatric IV cannulation.
-
Flushing venous access device in pediatric IV cannulation.
-
Securing pediatric venous access device.
-
Securing pediatric venous access device.
-
Securing pediatric venous access device.
-
Pediatric IV cannulation. Video courtesy of Gil Z Shlamovitz, MD.
