IV Cannula Types and Best Practices

Medical practitioners use various types of devices and technologies to provide patients with effective treatment in the fast-paced world of healthcare. Intravenous (IV) cannulas are one such essential instrument. In this thorough guide, we'll examine various types of IV cannulas and go into the best ways to use them, with a focus on patient care and safety.

"IV Peripheral IV Cannula" Image By www.nurturenotes.blogspot.com

Understanding IV Cannula

What is an IV Cannula?

            A medical device used to access veins for the delivery of fluids, drugs, and blood products directly into a patient's bloodstream is referred to as an IV cannula, also known as an intravenous cannula. It comprises of a hollow plastic tube with wings on one end allowing simple insertion attachment. The tip is sharp and beveled. In order to deliver vital fluids, drugs, or blood products directly into a patient's circulation, an IV cannula is a tiny tube that is inserted into a vein. It enables medical practitioners to deliver medicines effectively and fast, ensuring that their substances enter the circulatory system for immediate action. Typically composed of flexible plastic, the cannula is meant to be placed and held in place with ease.

Importance of IV Cannulas in Medical Procedures

1.      Administration of Medications: Using IV Cannulas, medical practitioners may quickly and effectively deliver medication directly into the bloodstream. This is especially important in emergency situations or when quick treatment outcomes are required.

       

       Fluid Replacement: When a patient is dehydrated or unable to consume fluids orally, IV cannulas are essential for replenishing lost fluids. They allow careful control of fluid delivery, ensuring that patients get the hydration they require to maintain their physiological balance. 

      

       Blood Transfusions: Blood and blood products, such as packed red blood cells or platelets, are transfused directly into the patient's bloodstream via IV cannulas. This is crucial when a patient needs rapid blood replacement, such as when they are experiencing severe bleeding or anemia.

    

        Nutritional Support: IV cannulas are used to deliver specialized nutrition solutions directly into patients' bloodstreams when they are unable to consume food orally. This ensures that patients receive the nutrients they require to promote their recovery and maintain their nutritional condition.

       Continuous Monitoring: A patient's vital signs and hemodynamic parameters can be continuously monitored with the help of IV cannulas when connected to monitoring systems like central venous pressure lines or intravenous pressure monitoring systems. This aids in gauging their reaction to therapy and directing additional medical procedures.

       Emergency Situation: IV cannulas are essential in emergency medical situations for immediately establishing access to the patient's circulatory system. As a result, the patient's condition can be stabilized quickly with the introduction of life-saving drugs, fluids, or blood products.      

 

                IV cannulas significantly enhance the effectiveness and efficiency of medical treatments by allowing quick and direct access to the bloodstream. They allow medical practitioners to provide patients with necessary care, closely observe patients, and maintain their general wellbeing throughout various medical processes.

     Components of an IV Cannula

A patient's bloodstream can be safely and effectively delivered with fluids and medications with the help of an IV cannula, which is made up of a number of crucial parts. An IV cannula part are as follows:

1.      Cannula Body: The cannula body is a small, hollow tube that can be made of metal or plastic with a medical grade. It is made to be put into a patient's vein and serves as a conduit for the delivery of fluids and drugs.

2.      Needle: Attached to the cannula's front end is the needle, a pointy, sharp component. When inserting the device, it is used to puncture the skin and reach the vein. It is typical to remove the needle once the cannula has been successfully inserted, leaving the cannula only in the vein.

3.      Catheter: The extended portion of the cannula that stays in the vein after the needle is removed is called the catheter. It allows the bloodstream to receive fluids and medications. Depending on the type and purpose of the IV cannula, the flexible catheter might vary in length.

4.      Hub: The connector at the proximal end of the IV cannula is the hub. It acts as the point of attachment for various types of parts, including extension sets, syringes, and IV tubing. To make insertion and securement easier, the hub might include features like wings or grips.

5.      Injection Port: Some IV cannulas have an additional injection port on the hub or catheter.  By using this port, it is possible to take blood samples or administer drugs directly without interfering with the main IV line.

6.      Protective Cap: To ensure sterility and avoid contamination, IV cannulas include a protective cap covering the needle or catheter before insertion. Just before the procedure of implantation, the cap is removed.

     Together, these components establish a secure and dependable pathway for injecting fluids, medicines, or blood products directly into patients' bloodstreams. IV cannulas are made with a focus on patient comfort, convenience of use for healthcare professionals, and the prevention of IV therapy-related issues.

Types of IV Cannulas

Peripheral IV Cannulas

    Peripheral IV cannulas are commonly used for administering patients' fluids, medications, and blood products. The cannula's size is an important consideration because it affects the infusion's flow rate and its suitability for use with different medications.

    A peripheral IV cannula's size is defined by the needle's diameter. The needle's diameter increases as the gauge number decreases. The gauges 18, 20, and 22 are the most commonly used for peripheral IV cannulas. Here is an explanation of each colour, gauge size and uses:

"Peripharel IV Cannual Size" Imaged By www.nurturenotes.blogspot.com

14 Gauge (1.83 mm) Colour - Orange:

• This larger size is typically used for patients with large veins or for emergency situations requiring rapid fluid resuscitation.

16 Gauge (1.65 mm) Colour - Gray:

• This size is commonly used for trauma cases and situations requiring rapid fluid administration.

18 Gauge (1.27mm) Colour - Green:

• This size is the largest gauge and is used for rapid fluid resuscitation or blood transfusions.
• It is ideal for patients who need a high flow rate, such as those who are hypotensive or experiencing shock.
• 18-gauge cannulas are not recommended for children or patients with small veins as they can cause significant discomfort.

20 Gauge (0.91mm) Colour - Pink:

• This size is the most common used gauge for peripheral IV cannulas.
• It is suitable for administering most medications and fluids.
• 20-gauge cannulas are preferred for patients with average vein size.

22 Gauge (0.71mm) Colour - Blue:

• This size is the smallest gauge and is suitable for patients with small veins.
• It is ideal for pediatric patients and those with fragile veins.
• 22-gauge cannulas are not recommended for patients who require a high flow rate or those receiving blood products.

24 Gauge (0.55 mm) Colour - Yellow:

• This size is used for delicate veins, such as those found in infants and small children, and for patients requiring precise medication administration.

26 Gauge (0.45 mm) Colour - Violet:

•  This smaller size is used for specialized situations that require very delicate or small veins.

    The right gauge size for a peripheral IV cannula is determined by a number of variables, including the patient's age, health, vein health, and infusion requirement. Before selecting the gauge size of the cannula, it is crucial to assess the patient's accessibility and vein size. While employing a smaller gauge can slow the flow rate and raise the danger of infiltration, using a bigger gauge than necessary can be uncomfortable and increase the risk of problems. In conclusion, the gauge size of a peripheral IV cannula is critical in regulating the flow rate of the infusion and its compatibility with different medications. In order to ensure patient comfort and safety, healthcare professionals must choose the proper gauge size based on the patient's characteristics and infusion requirements.

Central Venous Cannula:

    Known as central venous catheters (CVCs), these intravenous access devices are inserted into a large vein in the body, typically in the neck or chest. CVCs are intended for long-term usage, unlike peripheral IV cannulas, and allow the delivery of medications, fluids, blood products, and other treatments. For healthcare personnel involved in their insertion and treatment, comprehension of the function and appropriate positioning of CVCs is crucial.

Purpose of Central Venous Cannula:

• Purpose of Central Venous Cannula: Administration of specialized medications. When medications need to be administered in high concentrations or require a dilution quickly, CVCs are commonly used. Parenteral nutrition, chemotherapy, and specific antibiotics are a few examples.
• Frequent blood sampling: Multiple venipunctures can be avoided by using CVCs as a dependable entry site for recurrent blood sample.
• Hemodynamic monitoring: CVCs make it possible to continuously evaluate central venous pressure (CVP), providing valuable information about a patient's fluid balance and heart function.
• Hemodialysis and plasmapheresis: Renal replacement treatments are especially intended for some CVC types, such as hemodialysis catheters.

Placement of Central Venous Cannula:

• Subclavian vein: The most typical location for CVC installation is here. The subclavian vein is stable, has a high diameter, and is simple to reach. It is appropriate for long-term catheterization.
• Internal jugular vein: Alternative installation sites for CVCs include the internal jugular vein. It provides direct access to the central circulation and is preferred when subclavian access is contraindicated or difficult.
• Femoral vein: When the internal jugular vein and subclavian vein are not acceptable or accessible, the femoral vein is the last option. Due to the greater risk of infection and deep vein thrombosis, it is usually only used for short-term access.

    To minimize the possibility of difficulties, CVC placement requires expertise and proper sterile procedures. In order to ensure accurate placement and lower the chance of inadvertent vessel puncture or injury, it is often carried out under ultrasound supervision. Following catheter implantation, chest X-rays are frequently taken to check the catheter's location and rule out any possible issues, such as pneumothorax.

    Maintaining good hygiene and avoiding catheter-related bloodstream infections (CRBSIs) require careful consideration. The continued maintenance of CVCs requires regular sterile dressing changes, flushing of the catheter on a regular basis, and adherence to stringent infection control procedures.

    In conclusion, central venous catheters are essential devices for administering specialised treatments, monitoring hemodynamic parameters, and allowing blood samples. For healthcare personnel engaged in their insertion and administration, understanding their function and appropriate location is essential. Following best practices and infection control procedures improves patient outcomes and reduces problems related to CVC use.

Midline Cannula

    Midline Cannulas are inserted into the veins of the upper arm, but unlike central venous cannulas, they can't reach the central veins. They offer a middle ground between central and peripheral venous access. These are the main points about midline cannulas:

• Insertion Site: The basilic or cephalic vein of the upper arm is normally where midline cannulas are put, and they are then progressed until the tip is in the proximal axillary vein.
• Gauge Sizes: Midline cannulas usually come in larger gauge sizes, ranging from 20G to 24G, which enable better flow rates and greater medication compatibility.
• Duration of Use: Midline cannulas can remain in place for several weeks, providing longer-term venous access compared to peripheral cannulas.
• Applications: Patients requiring intravenous treatment that goes beyond what a peripheral cannula can provide frequently utilise midline cannulas since they do not need the features or dangers of central venous access.

Factors to Consider for IV Cannula Selection

1  Patient Characteristics and Medical Condition.

    The patient's age, general health, medical history, and any particular illnesses or comorbidities that may have an impact on vein health, such as diabetes, peripheral vascular disease, or coagulation disorders, should all be taken into account.

2  Infusion Requirements

    Analyse the infusion or therapy being administered's individual requirements. Included in this are the kind of fluid or medication, the preferred flow rate, and the duration of therapy. A suitable gauge must be used since different treatments may need variable flow rates.

3. Vein Conditions and Accessibility

    Examine the patient's veins to determine their size, accessibility, and integrity. The choice of an acceptable cannula may be influenced by elements including vein fragility, depth, and tortuosity. For the purpose of choosing the proper gauge, length, and design, vein evaluation is essential.

Best Practices for IV Cannula Insertion

1.      Pre-insertion Assessment and Patient Preparation

• Go through the patient's allergies, prescriptions, and medical history.
• Check the patient's veins for accessibility, integrity, and size.
• Based on the patient's vein condition and the therapy required, choose the right cannula size and length.
• Inform the patient about the surgery, allay any worries, and get their informed permission.
• Place the patient in a comfortable position, making that the insertion location has sufficient light and exposure.

  Aseptic Techniques and Infection Control

• Use an alcohol-based hand sanitizer or correct handwashing procedures practices good hand hygiene.
• Wear sanitized gloves and other suitable personal protective equipment (PPE) in accordance with the rules of the organization.
• Use an antibacterial solution to clean the insertion site while according to the approved procedure.
• Use sterile drapes or sterile barriers to keep the area sterile.
• After the cleaning procedure, refrain from touching sterile surfaces, cannulas, or the insertion site to prevent needless contamination.

 Proper Cannula Insertion Techniques and Tips

• Apply light traction below the planned insertion point to stabilize the vein.
• Use the best procedure for the cannula type (over the needle, through the needle, or catheter over the needle) in light of your knowledge.
• Smoothly and at the proper angle (often 10 to 30 degrees for superficial veins and 30 to 45 degrees for deeper veins), insert the cannula.
• Advance the cannula until you observe blood returning through the needle hub or the flashback chamber.
• While carefully and smoothly removing the needle or stylet, secure the cannula in place.
• While ensuring that the insertion site is still visible for monitoring, secure the cannula using a transparent dressing or other securement tools.
• Indicate on the cannula the date, time, gauge, and other pertinent details about the insertion.

Maintaining IV Cannulas

Securing and Dressing the Cannula Site.

• To secure the cannula in place to prevent accidental removal, use a clear dressing or other fastening mechanism.
• Make that the dressing is sterile, undamaged, and adheres to the skin appropriately.
• Check the dressing regularly for indications of contamination, moisture, or loosening.
• If the dressing becomes soiled, loosened, or undermined, replace it.

 Flushing and Monitoring the Cannula Regularly

• In accordance with institutional norms, flush the cannula before and after each time medicine or fluid is administered.
• To preserve patency and prevent blockage, use a sterile syringe and the appropriate flushing solution (usually normal saline).
• When flushing, observe any resistance or difficulty that might mean the catheter is obstructed and take immediate action to fix it.
• Take the necessary action if you notice any indications of infiltration, such as swelling, discomfort, or leaking, at the cannula site.

 Troubleshooting Common Issues

• Any indications of problems, such as redness, swelling, discomfort, or infection, should be treated very away.
• If flushing the cannula or getting blood to return is challenging, try using mild pressure or a positive pressure method (such as occluding the cannula and then releasing).
• Follow institutional procedures to remove and replace the cannula if it is broken or showing indications of infection.
• Assess the insertion site and consult with a healthcare expert to decide what to do if the cannula is accidently withdrawn or becomes dislodged.
• Inform the patient and any carers of problems to watch out for and when to call for help.

Potential Complications and Troubleshooting

Infiltration and Extravasation

Definition

     Extravasation refers to the infiltration of vesicant chemicals that may cause tissue harm, whereas infiltration happens when fluid or medicine escapes into the surrounding tissue.

Troubleshooting 

• Infusions should be stopped immediately if extravasation or infiltration is suspected.
• Assess the area for symptoms like pain, swelling, pallor, or coldness.
• If necessary, elevate the injured limb to lessen swelling.
• Apply warm or cold compresses as appropriate, depending on the infiltrating substance.
• Notify a healthcare professional for additional evaluation and proper therapy, which may include stopping the infusion, treating the wound, and maybe providing an antidote.

Phlebitis and Thrombophlebitis

Definition

     An inflamed vein is known as phlebitis, but an inflamed vein that has a blood clot inside of it is known as thrombophlebitis.

Troubleshooting

• Assess the insertion site for signs such as redness, warmth, swelling, and pain.
• Discontinue the infusion and remove the cannula if phlebitis or thrombophlebitis is suspected.
• Apply warm compresses to promote vasodilation and relieve discomfort.
• Notify a healthcare professional for further assessment and management, which may involve initiating the proper course of action, such as giving anti-inflammatory medicine or anticoagulant therapy.

Catheter-Related Bloodstream Infections (CRBSIs)

Definition

    When bacteria or other pathogens get into the bloodstream through the IV cannula and cause an infection, CRBSIs happen.

Troubleshooting

• Keep monitoring out for infection-related signs and symptoms, such as fever, chills, redness, swelling, or purulent drainage at the insertion site.
• During cannula insertion, dressing changes, and any other cannula-related procedures, strictly follow hand hygiene and aseptic techniques.
• Follow institutional guidelines for changing dressings and caring for catheters, which include using sterile techniques and the proper antimicrobial or antiseptic solutions.
• For further evaluation and management, which may involve removing the cannula and starting the proper antimicrobial medication, routinely check the cannula site for infection. Immediately report any signs of infection to a healthcare professional.

Safety Measures and Patient Care

Ensuring Accurate Documentation

• Include in the patient's medical file any pertinent details about the insertion, maintenance, and removal of an IV cannula.
• Include the insertion date and time, catheter size, insertion site, and any other relevant details.
• Keep record of any negative outcomes, issues, or IV cannula-related interventions.
• Make sure that all documentation is timely, accurate, and complete.

Proper Hand Hygiene and Personal Protective Equipment

• Before and after handling IV cannulas, wash your hands properly.
• When caring for patients with IV cannulas, put on the proper personal protective equipment (PPE), such as gloves, a mask, and a gown.
• After use, dispose of PPE properly.

Strategies for Preventing Catheter-Related Complications

• Adhere to institutional guidelines and recommended practices for installing, maintaining, and removing IV cannulas.
• Make sure that the proper catheter site is selected, taking into consideration the patient's health, amount of activity, and accessibility of the vein.
• For the insertion, upkeep, and removal of cannulas, use aseptic technique to avoid infections.
• Regularly check the cannula site for symptoms of problems like infection, infiltration, or phlebitis.
• To avoid catheter-related bloodstream infections, think about putting evidence-based practices such daily catheter site inspection, early removal of superfluous catheters, and usage of catheter bundles into practice.

Conclusion

IV cannulas are essential in modern healthcare because they make it easier to provide medications, fluids, and blood products. Healthcare practitioners can improve patient care and safety by being aware of the many varieties, choosing an appropriate cannula, and following best practices. This thorough guide aims to provide insightful information and knowledge, helping medical professionals choose IV cannulas wisely and improve patient outcomes.