How to perform intravenous (IV) cannulation – OSCE Guide
Introduction
Introduce yourself
Wash hands
Check patient details (name / DOB)
Explain procedure:
Check understanding & gain consent
Gather equipment
Non sterile gloves
Apron
Cannula – the standard size is 20g (pink)
Cannula dressing
Tourniquet
Gauze
Saline – 10ml
Syringe – 10ml
Alcohol swab
Palpate a vein
1. Apply a tourniquet – avoid nipping the patient’s skin
2. Palpate a vein:
Go for a vein you can feel – it’s best if they feel “springy”
It should ideally be straight
Tapping the vein & asking the patient to pump their fist can make it easier to see & feel veins
Avoid areas where two veins are joining (valves present)
3. Prepare cannula:
Open wings
Check top cap is working
Slightly withdraw & replace needle – this will make it glide easier
Unscrew the cap at the back of the cannula & place upright in tray
Inserting the cannula
1. Put gloves on
2. Clean the area with an alcohol swab for 30 seconds – outward circular motion
3. Check with the patient that it’s ok to proceed
4. Remove the cannula sheath
5. Ensure needle’s bevel is pointing upwards
6. Secure the vein with your non-dominant hand from below
7. Warn the patient of a sharp scratch
8. Insert cannula at 20-40º – do it in a smooth firm motion & don’t hesitate
9. Observe flashback
10. Advance the needle a further 1-2mm after flashback to ensure it’s in the veins lumen
11. Withdraw the needle slightly so that it’s sharp point is inside of the plastic tubing
12. Advance cannula fully into vein – the needle still inside the tubing will stop the plastic from kinking
13. Release the tourniquet – this will reduce bleeding
14. Place some gauze directly underneath the cannula – this will prevent blood dripping
15. Apply pressure over the vein from above – this should occlude the vein & reduce bleeding
16. Remove the needle
17. Replace cap onto the cannula
18. Dispose of the needle into a sharps bin
Securing the cannula
Put some sticky strips on the cannula wings to secure it before flushing
Flushing the cannula
1. Set up flush:
Open 5-10ml syringe
Get 10ml bottle of saline 0.9%
Confirm type of fluid & date of expiry
Withdraw fluid from saline bottle into syringe
Remove any air bubbles within syringe
2. Remove the top cap from the cannula port & insert syringe
3. Inject the saline into the cannula:
It should go in smoothly with little resistance
Watch for signs of swelling around the site – stop immediately if you see this!
If the patient complains of pain you should also stop immediately!
4. Close the cannula port
5. Apply dressing to the cannula site
To complete the procedure…
Thank the patient
Document the following;
Patient details (name / DOB / hospital number)
Date & time of cannulation
Reason for cannulation
Type of cannula used – (e.g. 20 gauge)
Date the cannula should be removed/replaced
Your name and grade
What if I fail my first attempt?
Don’t panic! – This is common and not the big deal you’ll feel it is
Try again:
Get some new equipment
Try to cannulate another vein
If you fail again, ask someone else to try – don’t let it get you down, it’s not a big deal
DO NOT
Relentlessly continue trying to cannulate a patient – ask for help
Re-use the same equipment