NORTH COAST EMERGENCY MEDICAL SERVICES Policy # 5315

POLICIES AND PROCEDURES

Subject: Medical Direction

Associated Policies: 01/14/98

1. Purpose:

1. Intravenous cannulation is a means to gain direct access to the venous circulation.

2. Indications:

1. To administer drugs and fluids.
2. To obtain venous blood sample(s) for laboratory determinations.

3. Therapeutic Effects:

1. Provides direct access to the venous circulation.
2. IV lifeline is essential for administering drugs and fluids and ensuring their immediate uptake and distribution.

4. Contraindications:

1. Absolute:

1. None.

1. Relative:

1. None.

5. Adverse Effects:

1. Local complications:

1. Hematoma formation.
2. Cellulitis.
3. Thrombosis.
4. Phlebitis.

1. Systemic complications:

1. Sepsis.
2. Pulmonary embolism.
3. Air embolism.
4. Catheter-fragment embolism.

6. Equipment

1. Typical catheter sizes and indications:

1. 24-gauge and 22-gauge: Used for fragile and/ or small veins as in the pediatric patient.
2. 20-gauge: Used for the average-sized adult medical patient.
3. 18-gauge, 16-gauge, and 14-gauge: Used for volume replacement or the administration of viscous medications such as glucose.

1. Commonly used percutaneous IV sites in the adult patient:

1. Dorsum of the hand.
2. Wrists and forearms.
3. Antecubital Fossae.
4. External jugular vein.

1. Commonly used percutanous IV sites in the pediatric patient:

1. Dorsum of the hand.
2. Wrists.
3. Antecubutal Fossae.
4. External jugular vein.
5. Scalp veins.

7. Procedure

1. Vascular Access:

1. Apply tourniquet proximal to IV site or, for infant cannulation of scalp vein, apply a large rubber band tourniquet around head.
2. Immobilize extremity, especially small child or infant.
3. Locate vein and cleanse the overlying skin with alcohol or betadine, shave area if necessary.
4. Hold vein in place by applying traction on vein distal to the point of entry.
5. Puncture the skin and vein with bevel of needle upward.
6. Note blood return and advance the catheter and needle slightly.
7. Slide catheter off needle and into the vein.
8. Remove tourniquet.
9. Withdraw and remove needle and attach IV cap or infusion tubing.
10. Flush catheter and ensure patency. Adjust drip rate.
11. Tape securely in place.

1. External Jugular Vein Cannulation:

1. Place the patient in a supine, head-down position to fill the external jugular vein; turn the patient’s head toward the opposite side.
2. Cleanse thoroughly with alcohol and/ or Betadine.
3. Align the cannula in the direction of the vein with the point aimed toward the opposite shoulder.
4. Make venipunture midway between the angle of the jaw and the mid-clavicular line, "tourniqueting" the vein lightly with one finger above the clavicle.
5. Upon cannulation, connect IV tubing and tape securely.

8. Special Information:

1. If external jugular site infiltrates, do not attempt venipunture of the other external jugular vein.
2. Restrain pediatric patients prior to venipunture.
3. Do not delay transport for IV access in critical patients.