Intravenous Cannulation


Authorised by: Dale Garton, Luanne Massey, Nicola Svirskis

September 2010
Clinical Guidelines Back Newborn Services Home Page
Preparation Comfort Measures Catheter Selection Vein Selection
Differentiating between veins and arteries Inserting IV Cannula Taping IV Cannula Complications


Identify necessity for ongoing IV therapy:

Comfort Measures

IV cannulation can be a painful procedure for the infant. The procedure should be approached in a developmentally supportive manner.

Catheter Selection

  1. Butterfly. Only used for scalp veins, sometimes used for obtaining blood samples.
    NS-ANP /Dr. procedure only. Discouraged due to shorter dwell time.
  2. Surflow: Radiopaque Teflon. (current catheter used in newborn services is the Terumo Surflow in sizes 24 gauge, and 22 gauge).

Vein Selection

Select a site in where

If there is difficulty finding an appropriate site, notify the medical staff to assist.

Differentiating between Veins and Arteries (link to diagrams)

  1. When palpated, artery pulses (but not always)
  2. Artery blanches when flushed
  3. Artery has bright red blood
  4. Avoid ventral (flexor) surface of forearm near the wrist if possible
  5. It is difficult to distinguish arteries and veins in an infant’s scalp
  6. 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 feasible.
Position infant appropriately. Use comfort measures as needed (See preparation).
Visually assess condition of veins to ascertain suitability (ensure good lighting).
  • 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 taut.
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 used.
MAXIMUM three attempts allowed– then you must seek help. Use discretion with very small infants or infants with difficult access.
Advance 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.
Gently 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.
Tape IV 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:

Complications of IV Cannulation

  1. Local and systemic infections
  2. Phlebitis
  3. Thrombus
  4. Haematoma
  5. Embolism of clot by forceful flushing
  6. Air Embolism
  7. Accidental insertion into an artery
  8. Bleeding if disconnected
  9. Extravasation with blistering or tissue necrosis