Types of Intravenous Cannulas The most common types of intravenous catheters are: Catheter over the Needle (Most

common in prehospital care); Butterfly needle (Only recommended for drawing blood samples); Through the needle catheters; and Indwelling plastic catheters inserted over a guidewire. Sites for Insertion Intravenous cannulas can be inserted in either central or peripheral veins. EMT-As are allowed to insert intravenous cannulas into peripheral veins. In Alberta, only EMT-Ps can insert IVs into the external jugular vein. Potential insertion sites will include: The veins of the hand; The veins of the arm (antecubital, radial, ulnar, cephalic,...); and The external jugular vein. Steps Involved for Insertion of the Intravenous Catheter To perform intravenous cannulation the EMT-A or EMT-P must do the following: Identify that the patient requires an intravenous line, the proposed purpose of obtaining venous access, and select the appropriately size I.V. cathalon; Gather the equipment to perform the entire procedure (penrose drain/tourniquet, alcohol swab, iodophore swab, tape, gauze, IV solution, IV tubing/saline lock, and a surgical dressing); Verify correct solution and prime intravenous tubing; Apply the tourniquet and cleanse the site appropriately (iodophore first, followed by alcohol) after 30 seconds;

Using sterile technique, insert the intravenous needle (bevel side up) until the vein is punctured, and advance the needle a few millimetres after "flashback" is obtained; Advance the intravenous catheter while leaving the needle in a stationary position; Release the tourniquet from the patients arm; Connect the intravenous tubing, or saline lock, to the intravenous catheter and set the flow rate; Secure the intravenous catheter with tape and or a surgical dressing; and Document the procedure completely.
Complication Hematoma Cellulitis Thrombosis Phlebitis Sepsis Pulmonary thromboembolism Air embolism Catheter fragment embolism Description bruising infection of the subcutaneous tissue creation of a blood clot infection of the vein generalized systemic infection creation of a clot that lodges in the lungs allowing an air bubble to enter the circulatory system breaking the continuity of the intravenous catheter and allowing the fragments to enter the circulatory system. infusion of intravenous fluid into the tissues of the skin. administration of an excessive amount of fluid into the circulatory system that may cause heart failure and pulmonary edema.

Local infiltration Circulatory overload

A Guide for Catheter Gauges (Adapted from Loeb, 1992)

GAUGE USES CONSIDERATIONS

 14 16 18

Large adolescents or adults Trauma Rapid infusion of fluids and/or blood and blood products Adolescents and adults Trauma Infusion of large volume of fluids Infusion of blood or blood products Older children, adolescents & adults Fluid resuscitation Infusion of blood, blood components & viscous solutions Obstetric patients Children, adolescents & adults Suitable for most infusions, TKVO lines Infusion of blood or blood components (Vollote,1989)
Infants, toddlers, children, adolescents & adults (especially the aged and emaciated) Suitable for most infusions Neonates, infants, toddlers

Very painful insertion Requires large vein

Painful insertion Requires large vein

Mildly painful insertion Requires decent sized vein

20

Commonly used Slower to infuse large amounts of fluid

22 24

Easier to insert in small, thin, fragile veins Use with slower flow rates Difficult to insert into tough skin Flow rate would be very slow

COMPARING PERIPHERAL IV SITES

(Loeb, 1992)
SITE METACARPAL VEINS Located on dorsum of hand; formed by union of digital veins Adapter lies flat on back of hand Insertion painful because of large number of nerve endings In adult or large child, bones of hand act as a splint Site becomes phlebitic more easily Usually first choice for cannulation May be contraindicated with an aged patient as thin skin & loss of connective tissue may predispose to extravasation of blood (Villote, 1989) Uncomfortable position for patient during insertion ADVANTAGES Easily accessible DISADVANTAGES Wrist mobility decreased unless a short cannula is used

BASILIC VEIN Runs along ulnar aspect of forearm & upper arm.

Straight strong vein suitable for large gauge cannula

Painful area to penetrate skin Vein tends to roll on insertion Decreases elbow joint mobility Vein tends to roll during insertion Does not impair mobility ACCESSORY CEPHALIC VEIN Runs along radius as a continuation of metacarpal veins of the thumb Does not impair mobility Large vein readily accepts large gauge cannula Sometimes difficult to position adapter flush with skin With adapter placed at bend of wrist, movement can cause discomfort or kinking of tubing

CEPHALIC VEIN Runs along radial aspect of forearm & upper arm

Large vein readily accepts large gauge cannula

ANTECUBITAL VEINS Located in antecubital fossa (median cephalic, located on radial side; median basilic, on ulnar side; median cubital, in front

Does not require an armboard in older child or adult Often palpable or visible in children when other veins will not dilate May be used for peripheral IV therapy in

Difficult to immobilize joint Median cephalic vein crosses in front of brachial artery, increasing the risk

of elbow joint)

an emergency or as a last resort

of arterial puncture and intra-arterial infusion of medication, resulting in permanent damage Veins may be small & scarred if blood has been drawn frequently Many nerve endings in area may cause painful venipuncture Infiltration occurs easily, increasing risk of nerve damage Finger is splinted with a tongue depressor, limiting mobility

MEDIAN ANTEBRACHIAL VEIN Arises from palm and runs along ulnar aspect of forearm

A last resort when no other sites available

DIGITAL VEINS Run along dorsal & lateral portions of fingers (digits)

Last resort for fluid administration or for non-irritating medications

Uncomfortable for patient Infiltration occurs very easily

Cannot be used if metacarpal veins have already been used

REDpoint's primary manufacturing goal was to eliminate PVC while still keeping the product cost-efficient, safe and patient-friendly. Genesis led REDpoint to lower-cost PE and PET materials well-suited for singleuse medical products such as the IV sleeve yet robust enough to provide the desired product strength. A PVC-free medical device was important to REDpoint because medical devices made of certain PVCs can leach DEHP, which has been found to cause organ damage in animals, according to the American Medical Association. The U.S. FDA has advised health care providers to reduce DEHP exposure for certain vulnerable populations, including infants and other patients receiving multiple medical treatments. "With our latest product, the StedLine IV sleeve, it was important that we find an RF plastics welding manufacturing partner within the United States who understood the importance and potential of our product within the medical device industry," said Chuck Nokes, REDpoint founder and president. "We found these qualities with Genesis, and we are thankful for their ability to help us find a non-PVC material that not only keeps patients safe but provides them with a durable, comfortable and long-lasting product."

Benefits of the StedLine Products System

Eliminates tapes and adhesives Diminishes catheter movement & dislodgement Decreases complications Maximizes patient comfort Simple to use Cost competitive Disposable and environmentally friendly Reduces the risk of infection

The StedLine Products utilize similar brand and patented technology. They qualify to hold product specific design patents and trademarks.

StedLine - IV Sleeve

REDpoints StedLine - IV Sleeves Advantages

It stabilizes the primary tubing without the use of tape or adhesives It is universal in use as it may be applied to either arm and will work with any IV line-set Stronger stabilization of the line-set (will NOT dislodge due to accidental movement, pulling or tugging on the line-set) Very easy to use, easy to teach and is easily repeatable for the staff. No fear of StedLine - IV Sleeve coming off due to poor adhesion No fear of skin tears when being removed, thus providing greater patient comfort and confidence.

Significant reduction in IV failures Significant cost savings

REDpoints StedLine - IV Sleeve has eliminated the cumbersome design used by the competition for skin prep, adhesives and the need for multiple devices to match each line-sets manufactures specifications with our universal, adhesive-free design.

Studies show that IVs fail as a result of pulls and line movement causing dislodgments, infiltration (photo), oscillation, migration, extravasations and phlebitis. These failures have far reaching effects on all involved.

The Challenge Patients:

NO caregiver wants to tell a patient they must restart their IV. Failures can increase exposure to blood stream infection 34% of patients experience skin tears and/or reaction to tapes and adhesives Stabilizing the catheter with tape is ineffective

Caregivers:

Clinicians have never been busier as patient loads and workloads increase Acute care nurses spend an average of 43 minutes each shift responding to IV failures Risk of accidental needle sticks to the caregiver increases by 45.8% each time a new catheter is inserted Frustration mounts as challenges increase as clinicians work to meet the needs of the patient

Institutions:

Everyone is worried about the rising cost of health care Inefficient utilization of staff time Increased risk of possible litigation Increased cost due to infections

Institutional value is not captured as the result of reinsertion of IVs

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