Peripheral Intravenous (PIV) Cannulation: Best Practices
Peripheral intravenous (PIV) cannulation is one of the most common invasive procedures performed in healthcare settings. It is essential for the administration of medications, fluids, blood products, and contrast agents. Mastering the technique for both insertion and removal is critical for patient safety and the prevention of complications such as phlebitis, infiltration, and infection.
Preparation and Equipment
Before beginning the procedure, ensure that all necessary equipment is gathered to minimize movement and maintain sterility:
- Appropriate cannula size (gauge)
- Tourniquet
- Antiseptic wipes (e.g., chlorhexidine/alcohol)
- Sterile dressing (transparent semi-permeable membrane)
- Saline flush (for patency check)
- Sharps container
- Gloves and personal protective equipment
Insertion Procedure
2. Preparation: Apply the tourniquet 1015 cm above the intended site. Clean the skin using a back-and-forth motion with the antiseptic agent and allow it to air dry completely.
3. Venipuncture: Stabilize the vein by pulling the skin taut. Hold the cannula at a 1530 degree angle and insert it into the vein. Once a "flash" of blood appears in the hub, lower the angle and advance the catheter slightly off the needle.
4. Securing: Release the tourniquet, apply pressure above the site to minimize bleeding, remove the needle (sharps), and attach the primed extension set or bung. Flush with saline to ensure the line is patent and no swelling occurs. Secure with a transparent dressing.
Complications to Monitor
Post-insertion, the site must be regularly assessed. Common complications include:
- Infiltration: The leakage of non-vesicant fluid into surrounding tissue. Symptoms include cool skin, swelling, and tenderness.
- Extravasation: Similar to infiltration but involves vesicant drugs, which can cause tissue necrosis.
- Phlebitis: Inflammation of the vein, often presenting as redness, warmth, and a palpable cord-like vein.
- Infection: Characterized by purulent drainage or systemic signs of infection.
Removal of the PIV Cannula
The PIV should be removed when it is no longer required, if it becomes blocked, or if complications arise. Follow these steps for safe removal:
- Perform hand hygiene and put on clean gloves.
- Gently remove the transparent dressing while stabilizing the cannula to avoid pulling the vein.
- Place a piece of sterile gauze over the insertion site.
- Withdraw the cannula smoothly and steadily, following the angle of insertion.
- Apply immediate firm pressure to the site until hemostasis (the stopping of blood flow) is achieved.
- Apply a fresh bandage or adhesive strip to the site.
- Inspect the removed cannula tip to ensure it is intact. If the catheter tip is missing, notify a clinician immediately.
- Dispose of the cannula in the sharps container and perform hand hygiene.
Conclusion
Aseptic non-touch technique (ANTT) is the gold standard for all PIV procedures. By adhering to standardized protocols for both insertion and removal, healthcare providers significantly reduce the risk of bloodstream infections and improve the overall patient experience.
Insertion & Removal Of A Peripheral Intravenous Cannula and Reference File Download Link
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