Avoid ventral (flexor) surface of forearm near the wrist if possible
It is difficult to distinguish arteries and veins in an infant’s scalp
Cannulating an artery can interfere with blood supply to an extremity or
surrounding tissue and can cause necrosis of the tissue. Should an artery be
inadvertently cannulated, remove the cannula immediately and apply direct
pressure for 5 minutes.
RBP - Inserting the IV Cannula
If the infantís parents are present inform them about the procedure, why it
is required and what is involved. Encourage them to help comfort infant if
Position infant appropriately. Use comfort measures as needed (See
Visually assess condition of veins to ascertain suitability (ensure good
Prepare cannula, tape prefilled syringe containing 0.9% normal
saline and other equipment required.
Twist cannula slightly around the stylet to loosen it. Do not pull straight
off as this can cause pieces from the tip to shear off.
Using an appropriate disinfectant,
clean the skin thoroughly in a circular motion. Swab for
at least 30 seconds. Allow to dry. Do not re-palpate.
Stabilize vein below the site of insertion and pull the skin
Hold cannula at the sides to allow view of flashback chamber.
Insert cannula smoothly through the skin at about a 10-degree
angle with point of introducer down and bevel up.
If cannula is completely removed through the skin, a new cannula MUST be
MAXIMUM three attempts allowed– then you must seek help. Use
discretion with very small infants or infants with difficult access.
cannula until blood flashback appears. Press forefinger or thumb against the
hub of the needle so it moves off the stylet. Observe for flash back. Remove
stylet and place it in a proper container to discard appropriately.
inject 0.9% normal saline to distend the walls of the vein as you advance
the cannula. Aim to insert the full length of catheter into the vein. Optional: Gently thread the cannula into the vein without fluid.
securely. (See below)
Attach extension with luer plug and pall filter
Dispose of sharps and other IV equipment in a safe, appropriate manner.
Document all insertions on observation chart. If IV is to be discontinued,
state reason for discontinuation and state of IV site.
Taping Peripheral IV Cannulae
It is expected that:
IVs are taped so the site directly over the tip of the cannula is visible
for observing signs of infiltration.
Tape is not to be placed over pre-existing tapes. If an IV require re-taping,
existing tape must be removed first.
Tape so that it will be easy to remove. Consider making tabs at the ends
of each tape to help with easier removal. DO NOT use scissors to remove tapes.
Nailbeds must be visible for assessing peripheral circulation. Do not
tape too tightly which could interfere with circulation of the extremity.
Tape in a way that is developmentally appropriate for that baby. If the
IV is in the hand, ensure fingers are flexed over armboard and thumb is
free. Feet are to be taped in an anatomical position with toes visible. Minimize
restrictive movement as much as possible. Make sure baby will be comfortable
Tape in a way that is appropriate for that particular gestation. ELBW babies
require Coban dressing (stretchy gauze) and minimal use of adhesive tape due
to the fragility of their skin. Extra small armboards (handmade from gauze
and cloth tape) are also useful.
Minimise the excessive amount of
tape used directly on the skin.