Peripheral Venous Cannulation

Source: Sharon Bord, MD, Department of Emergency Medicine, The Johns Hopkins University School of Medicine, Maryland, USA

Placement of an intravenous (IV) catheter is one of the key procedures in medicine. The IV catheter allows patients to receive critical medications, including pain medicine, insulin, antibiotics, blood products, and fluids for rehydration. Additionally, placing an IV catheter allows for blood samples to be obtained, which can be sent to the laboratory for testing and evaluation. A majority of peripheral IV lines are placed in the superficially located veins of the upper extremities. IV catheters can be placed in any superficial vein from the upper arm to the hand (though the veins in the antecubital fossa are larger than those in the hand). IV catheters can be placed in the lower extremities as well; however, this procedure should be performed with caution in patients with a history of diabetes or poor peripheral circulation.

1. Have the equipment ready.

The equipment needed for peripheral venous cannulation includes:

Gloves
Rubber tourniquet
Chlorhexidine or alcohol swabs
Combined catheter and needle mechanism
IV set of tubing and bags
Adhesive tape only or tape and clear adhesive dressing
2x2 or 4x4 inch gauze
Normal saline 5 cc syringe for flush
10 cc syringes for blood samples for lab examinations if needed

Effectively placing an IV in a patient is imperative to treat many common medical problems. Common learner errors include not being prepared with all the supplies prior to starting the procedure and poor vein selection. Anecdotally, being able to "feel" the vein is more important than visualizing a vein. However, many learners will try and place an IV based on what they can see. In some groups of patients, peripheral IV placement might be challenging. These include current or prior intravenous drug users, patients with s

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