Pulse Training Course

Inserting the cannula

1. Wash your hands again, removing gloves if these were worn for setting up the saline flush.

2. Don a new pair of non-sterile gloves.

3. Re-apply the tourniquet if removed previously.

4. Remove the cannula sheath.

5. Prepare the cannula:

Open the cannula wings if present.
Slightly withdraw and replace the needle (this will allow it to glide easier during cannulation).
Unscrew the cap at the back of the cannula and place upright in the tray (if the cannula is ported).

6. Anchor the vein with your non-dominant hand from below by gently pulling on the skin distal to the insertion site.

7. Warn the patient that they will experience a sharp scratch.

8. Insert the cannula directly above the vein, through the skin at an angle of 10-30º with the bevel facing upwards.

9. Observe for a flashback of blood into the cannula chamber, which confirms that the needle has punctured the vein.

10. Lower the cannula and then advance the needle a further 2mm after flashback is observed to ensure it’s within the vein’s lumen.

11. Partially withdraw the introducer needle, ensuring the needle end is within the plastic tubing of the cannula (you should observe blood entering the plastic tubing of the cannula as you do this).

12. Carefully advance the cannula into the vein as you simultaneously withdraw the introducer needle until the cannula is fully inserted and the needle is almost removed.

13. Release the tourniquet.

14. Place some sterile gauze directly underneath the cannula hub.

15. Apply pressure to the proximal vein close to the tip of the cannula to reduce bleeding.

16. Gently pull the introducer needle backwards whilst holding the cannula in position until it is completely removed.

17. Connect a Luer lock cap or primed extension set to the cannula hub.

18. Dispose of the introducer needle immediately into a sharps container.

19. Apply adhesive strips to secure the cannula wings to the skin. Do not obscure the insertion site with the strips, as this needs to remain visible to allow early identification of phlebitis.

There is significant variability in the recommended method of cannulation, therefore, you should always consult your local medical school or hospital guidelines.

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