9.9.24 - Cannulation

Question 1

What is cannulation?

Answer 1

a process by which which a small plastic tube is inserted into a peripheral vessel through a needle puncture, for the safe administration of medication.

Question 2

what percentage of patients will receive medication through a cannula during a hospital stay?

Answer 2

70%

Question 3

what are the 4 main points surrounding consent?

Answer 3

1. Does the patient have capacity?
2. Is the consent informed?
3. Has the consent been freely obtained?
4. Is the consent obtained appropriate for the procedure?

Question 4

what are the 3 types of consent?

Answer 4

written, implied, informed/verbal

Question 5

which procedure could implied consent be used for?

Answer 5

Pelvis x-ray

Question 6

which procedure could written consent be used for?

Answer 6

Invasive cardiac angioplasty

Question 7

which procedure could informed/verbal consent be used for?

Answer 7

peripheral cannulation insertion

Question 8

what gauge is a violet canula and what may it be used for?

Answer 8

26
Elderly and neonates

Question 9

What gauge is a yellow canula and what may it be used for?

Answer 9

24
Very fragile veins, Elderly and pediatric patients

Question 10

what Gauge is a blue canula and what may it be used for?

Answer 10

22
Chemo infusions, contrast,

Question 11

what gauge is a pink canula and what may it be used for?

Answer 11

20
Multi-purpose IV for medications and hydration

Question 12

What gauge is a green canula, and what may it be used for?

Answer 12

18
blood transfusions, large volume infusions (eg high pressure contrast injection)

Question 13

What gauge is a grey canula and what may it be used for?

Answer 13

16
Trauma, surgery, large volume infusion

Question 14

what gauge is an orange canula and what may it be used for?

Answer 14

14
massive trauma

Question 15

what are the layers of a vein?

Answer 15

Tunica Adventia
Tunica media
- outer longitudinal muscle
- external elastic layer
- Inner longitudinal muscle
Internal elastic layer
Tunica Intima
- epithelial linings
- valves

Question 16

what are the layers of the skin?

Answer 16

Epidermis
Dermis
subcutaneous tissues - veins within

Question 17

What makes a good vein?

Answer 17

• soft
• No pulse
• Bouncy
• Well supported
• Not lumpy
• Straight

Question 18

What makes a bad vein?

Answer 18

• Hard vessel
• Has a pulse (means its an artery or too close to an artery)
• solid
• Wobbly
• Lumpy
• Meandering/wiggly

Question 19

What is ANTT?

Answer 19

Aseptic Non-Touch Technique (ANTT)
This framework provides a standard for safe and effective aseptic practice, which can be applied to all clinical procedures.

Question 20

What is the definition of a sharp?

Answer 20

Sharps are defined as Objects or instruments necessary for the exercise of specific healthcare activities, which are able to cut, prick or cause injury/infection

Question 21

what would you do if you had a needle stick injury?

Answer 21

+ Let the wound bleed
+ Run it underwater for at least 5 minutes
+ Dress the wound appropriately
+ Report to line manager immediately
+ Datix then self-refer to OH
+ carry out blood tests on the patient

Question 22

How to avoid and manage an extravasation?

Answer 22

• Always flush the cannula after the patient’s arm is in the required position.
• Record details of the extravasation incident with a clear management plan.
• Elevate the affected limb and applycold packs to the affected area
• If symptoms resolve the patient can be allowed home, with advice and advice leaflet.
• If symptoms don’t resolve quickly, admit and observe.
• Skin blistering, paraesthesia, altered tissue perfusion or persistent pain for more than four hours suggests severe injury. In this case seek urgent plastic surgical review

Question 23

What to do with a mild reaction?

Answer 23

Reassure the patient
Symptoms usually pass within minutes

Question 24

What to do with a moderate reaction?

Answer 24

If you observe hives on the patient, giving the patient an oral antihistamine may be necessary. Call the radiology registrar to review the patient. Keep in the department for observation until the hives settle.

Question 25

What would you do for a severe reaction?

Answer 25

Call for help, assess patient using an ABCDE approach.
If necessary, administer 0.5mg of 1 in 1000 Adrenaline IM and attach patient monitoring.

Question 26

What is the dose for adrenaline?

Answer 26

0.5mg of 1 in 1000
Given IM

Question 27

What is a POM?

Answer 27

Prescription only medicine

Question 28

How are POMs administered?

Answer 28

Prescribed by radiologist when vetting
Patient Group Directive and procedure for safe administration
Administered by registered operator through PGD

Question 29

What is the definition of a Breach in duty of care?

Answer 29

Radiographers have a legal obligation to ensure the safety and well-being of their patients – failure to meet this standard is a breach.

Question 30

what is the definition of Caused harm?

Answer 30

Harm is a moral and legal concept and can be as any of the following: pain, death, disability, or loss of ability.

Question 31

what is the legal justification of harm?

Answer 31

Harm is of a type that was foreseeable
Sometimes harm is caused e.g. IV cannulation is a deliberate act that causes pain. However, if correct procedures were not followed and the patient subsequently hadinfective phlebitis at the cannulation site, this is foreseeable and an act of negligence.

Question 32

How to avoid issues with cannulations?

Answer 32

Reduce the number of device insertions
Right device for the procedure
Right treatment at the
Right time for the treatment duration
Is the cannula needed? Assess your checklist and protocol
Cost implications on unnecessary cannulations