Exult's top tips for cannulation success.

Tip 1

Failed an attempt? Don’t just try again – think why? Change something then try again.

Tip 2

Cannula over a vein

The chamfer of the needle is specially designed for a wide range of insertion angles.

So, if you find the vein moves to the left or right slightly, you can change the angle of the cannula laterally so that you are once again aiming towards the centre of the lumen. Only, now you might be entering through the side of the vein – no problem.

Cannula aiming towards a vein

Tip 3

It took a certain amount of force to break through with the tip of the needle. Now you have breached and you have needle flashback, relax that force to ensure the needle tip isn’t digging into the opposite wall of the vein.

Cross section of vein

Now lower the insertion angle.

The end of the needle may be in the lumen – hence the needle flashback, but you have one more tricky hurdle to get over before you are home free.

The end of the catheter is further back than the tip and chamfer of the needle so the catheter may not be through into the lumen yet. If this is the case, you are not going to be able to advance it where you want it to go.

Needle in vein

Relax the pressure and drop the angle. Now advance the needle one or two millimetres so that the end of the catheter clears the walls of the vein.

Needle advanced into vein

Now you can advance the catheter and you will get your catheter flash – happy days!

Tip 4

Advance the cannula a tiny amount once you have a flash (as above), then pull the sharp back and advance the cannula all in one movement.

Tip 5

It’s psychological - As a rule of thumb, a second attempt is half as likely to succeed as the first, and a third attempt is half as likely again… so do everything you can to make the first one count.

Tip 6

You’ve mastered it on a mannikin in a classroom – now head outside, practice when it’s dark, noisy, cold, raining. It’s no good laying out your kit on a sterile field when it will blow away or get wet.

Tip 7

Test yourself by cannulating with your non-dominant hand – makes you concentrate on the technique and makes you more aware of the feel. Many clinicians over-rely on visual cues. The over-use of visual cues is particularly troublesome when clinicians who predominantly work with light-skinned patients have to cannulate a patient who has very dark skin.

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