Iv

Question 1

What is the purpose of IV cannulation?

Answer 1

To take a blood sample

To administer medicine, IV fluids (therapeutic intervention)

To administer medicine (diagnostic purposes)

Follow up procedures

Question 2

What are your responsibilities as an injector?

Answer 2

You must be a competent practitioner – do you have responsibility and accountability

You owe a duty of care to your patience

You must work with the protocols and schemes of work that are set out by your employer

It is your responsibility to check the contrast before is administered

You must document what is being injected

Question 3

Where can you get training for a cannulation?

Answer 3

In the hospital

At a higher institution

Can also be accredited by the college of radiographers

Question 4

What are the different types of cannulae?

Answer 4

22G cannula (blue venflon)

20G cannula (pink venflon)

18G cannula (green venflon)

(As a number gets lower the cannula is bigger)

Question 5

List the different components of a catheter:

Answer 5

Flashback chamber

Luer lock plug

Needle grip

Luer connection

Injection port cap

Valve

Blushing

Catheter

Needle

Question 6

What safety mechanism does a cannula have?

Answer 6

It has a Mechanism which prevents the use of the cannula twice

After the needle is used once it is blunted

The mechanism take back the needle on injection

Question 7

Are the preprocedure considerations for cannulating?

Answer 7

Previous moderate/severe reaction to IV contrast

Filtration function (EGFR)

Diabetes (Metaformin/glucophage) - lactic acidosis

Problems – risk of hypertensive crisis

Asthma

Hayfever

Question 8

what is the procedure for cannulation?
(prep)

Answer 8

Preparation – equipment ready
Gloves
Injection material (syringes, pump)
Injection devices (cannulas etc)
Injection tray/trolley
Alcohol/antiseptic swaps, gauze swabs, tape, tape/sterile cannula dressing
Tourniquet
5/10 ml syringe sodium chloride 0.9% only to flush device after insertion
Disposal – soiled materials, sharps bin
Know who and how to call for help
Includes emergency equipment (emergency drugs, trolley etc)

Question 9

what is the procedure for cannulation?
(patient - communication)

Answer 9

Ensure equipment (and emergency) is ready
Introduce yourself
ID check (unless you were there when it was done)
Ensure patient is warm – why?
Confirm examination to be done
State the need for IV contrast
Ask if they have had IV contrast before and if they had any problems with it
Check for any potential contraindications
Ask if they have any questions!!
Gain informed consent…..

Question 10

what is the procedure for cannulation?
(infection control + injection prep)

Answer 10

Wash hands (wear gloves – following departmental protocol)
Use aseptic technique – why?
Need to know injection rate and volume
Ask if they know about their venous access
Apply tourniquet
Patient to pump hand

Question 11

what is the procedure for cannulation?
(injection)

Answer 11

Palpate for veins – ideally, antecubital fossa
Cleanse area with alcohol/antiseptic wipe (and allow to dry)
Stabilise the vein by pulling the skin taut in the longitudinal direction of the vein. Do this with the hand you are not going to use for inserting the needle.
(Avoid valves, clear stretch of vein. Palpate finger pads.)

Question 12

what is the procedure for cannulation?
(cannulation)

Answer 12

Once the tip of the needle is in the vein there will be a flashback of blood in the flash back chamber
Hold the needle steady and do not advance it any further into the vein
Slide the plastic cannula forward over the needle as far as it can go
Release tourniquet
Apply pressure over vein (at needle tip)
Remove the needle and cap the end
Fix cannula in position
(Avoid touching needle. If doesn’t slide, then need to remove and site another device. 2 attempts (as per local protocols) at 2 sites.
Flushed extension tube MRI)

Question 13

what is the procedure for cannulation?
(post cannulation)

Answer 13

Flush hard with saline/water for injection (5ml) and ensure good flow
If in doubt, DO NOT proceed with contrast injection
Confirm good seal/lock at connectors
Warn patient of hot/wet sensations during contrast injection!
Monitor flow during injection (manual/pump)
Instruct patient to call out if arm feels painful, tight or swollen (what could this indicate?)

Question 14

how to dispose of a cannula?

Answer 14

Dispose of needle and used equipment safely

Needle only in sharps bin

Question 15

what can go wrong with cannulas?

Answer 15

Extravasation
Unable to find vein?
How many goes is acceptable?
Hit an artery?

Question 16

IV - what would you do if Patient says they are diabetic?

Answer 16

• what type of diabetes do they have and how do they manage it - metformin

Question 17

what would you do if Patient says they are needle phobic and is anxious about the CT scan?

Answer 17

• site the cannula before going into the ct environment
• show them around the ct and the room all the equipment

Question 18

what would you do if Patient says they take aspirin/warfarin?

Answer 18

• blood thinning products
• means they are going to bleed for much longer after taking the cannula out
• make them hold the site + raise their hand for much longer
• monitor to ensure that it has actually stopped

Question 19

what would you do if Patients says they are asthmatic?

Answer 19

• more info about their asthma - how long have they had it (child hood -enviromental)
• have they been hospilitised because of it
• what kind of inhalers
• consult with radiologist + local rules