There are only 3 ways you can fail iv cannula insertion

So I've tried to simplify this to 3 main areas of immediate cannula failure.

I believe that If you know how to fail, you will know exactly what to do not to fail.

When supervising doctors just starting to learn cannulation, I understand that failure occurs. However, if failure occurs and the student knows why they failed, this allows them to improve next time with deliberate attention to detail on their next attempt!

1) miss the vein altogether (no flashback of blood is observed)

2) puncture the deep wall or side wall

3) The needle and cannula isn't advanced far enough prior to advancing the plastic cannula.

that's it!

Thanks for watching!!!

---------
Find us at
Podcast: ABCs of Anaesthesia
Primary Exam Podcast: Anaesthesia Coffee Break
---------
Check out all of our online courses and zoom teaching sessions here!
---------
#Anesthesiology #Anesthesia #Anaesthetics #Anaesthetists #Residency #MedicalSchool #FOAMed #Nurse #Medical #Meded
---------
Please support me at my patreon
---------
---------

Disclaimer:

The information contained in this video/audio/graphic is for medical practitioner education only. It is not and will not be relevant for the general public.

Where applicable patients have given written informed consent to the use of their images in video/photography and aware that it will be published online and visible by medical practitioners and the general public.

This contains general information about medical conditions and treatments. The information is not advice and should not be treated as such.
The medical information is provided “as is” without any representations or warranties, express or implied.
The presenter makes no representations or warranties in relation to the medical information on this video.
You must not rely on the information as an alternative to assessing and managing your patient with your treating team and consultant.
You should seek your own advice from your medical practitioner in relation to any of the topics discussed in this episode’

Medical information can change rapidly, and the author/s make all reasonable attempts to provide accurate information at the time of filming. There is no guarantee that the information will be accurate at the time of viewing

The information provided is within the scope of a specialist anaesthetist (FANZCA) working in Australia.

The information presented here does not represent the views of any hospital or ANZCA.

These videos are solely for training and education of medical practitioners, and are not an advertisement. They were not sponsored and offer no discounts, gifts or other inducements.

[bloodvenomthestrongestoldh]

Me: * inserts and blows vein *
Patient: “is it in yet?”
Me: “you’re quite dehydrated sir you should drink more water” lol

[iplayCoDandBF]

This video genuinely changed my life. 99% of the time I've failed an IV it's because I wasn't inserting the catheter and needle far enough. Havent failed a patient since. Thank you so much for this.

[pb]

I can think of some rare others to add to your list for example: Improperly using a tight tourniquet on an elderly frail vein (especially patients on long-term oral steroids) can actually cause it to “blow up” on piercing. Another is choosing a vein that’s been recently cannulated or where they arm is been recently traumatized. Since I’ve been using ultrasound I’ve been occasionally finding superficial clot in a vein’s that would have been selected for standard IVs. Another very rare cause for a miss is that the needle lumen cores some skin or fat and so while you’re actually in the vein, you don’t see flash and pull the entire needle out when in fact you were in. In this last scenario, when you’re reasonably sure that you’re “in” but you didn’t get a flash, pull the trocar out to see if you have blood return rather than pulling the whole catheter out.

[yamomma]

My man straight up has blood on his right hand at 2:27. Now that's someone who does this for a living.

[marabanara]

As a nurse working in Day Onc, not only do my pts often have terrible veins from super frequent cannulation & path venepuncture, I also don't have local anaesthetic prescription privileges nor easy access to US guided cannulation. I LOVE your tips however, even though you assume in some vids that it's doctors doing the cannulating ;-P
In all, seriousness, thank you very, very much for your content. Anaesthetists are amazing at everything they do. I particularly appreciate when you are able to demonstrate on a real person. The tip about vasospasm after getting flashback was definitely a lightbulb moment for me, and I still raise the cannula while advancing it, taking advantage of that blunt edge of the bevel.
Thanks again, from a chemotherapy RN.

[ninakilbridesheehan]

Vasospasm IS a thing, but very uncommon. I had a 14 year-old girl who had POTS and weekly infusions (she refused any other vein but the same one). After 6 months, she had an issue for a few weeks where the IV would run fast and then slow (one liter over 45-60 minutes on gravity) even though she was diligent about keeping her arm still. My last cannulation to that vein was easily successful with flashback and advanced cannula easily, but absolutely no blood return when the needle was removed. No swelling, no bruising and connected fluids to flush line and it would not flow at all. No infiltration. Scarring of the vein would have been at the insertion site, so not that. Her mom allowed her to refuse the IVs and after 2 weeks her migraines came back and she agreed to using the other arm.

[JaneDoeowo]

I have a connective tissue disorder and have had many ivs and blood draws and central lines. Even with ultrasound they struggle to get lines in me. Central lines included. Peripheral lines that are in infiltrate within a few hrs/a day or less usually. As a nurse, I try to help out anyone trying to treat me but it's hard. Haha good video! Helps a lot with what the basic issues are! We should all know these things to help our patients

[pennychurchward]

My main issue is advancing the cannula....I get a good flash back but the cannula doesn’t move forward

[Feathers]

I get flashback, lower the angle, advance what I think is a few mm then try advance it completely and it either blows or I can see the plastic cannula flexing/bending as I try advance it in which then eventually blows. So frustrating as I need to cannulate multiple times a day for my infusion clinic job. I wish there was a practical course I could attend 😅

[keshavarsa]

I don't know why but when I am pushing cannula, back flow of blood is coming but the cannula is not moving forward

[sugerless]

As a person who has been to the hospital thousands of times & had so many blood draws throughout my life I wish nurses & phlebotomists would watch this. So many times people tell my oh my veins are tiny, it rolled or it blew. ER nurses are the best at IVs. Recently I started noticing when the blood doesn't come its not a good sign. Then I get stressed but I'm not afraid of needles. I wish there was a new technology for blood draws. I do have a lot of scar tissue from years in the medical system.

[caffeinefix]

Dr Lahiru, really enjoyed your pain management lecture at Sunshine yesterday, thank you for having an awesome energy and being so very approachable. Keep up the good work!

[angelavanhorn]

You give some of the best most detailed advice!! ☺ thank you!

[rishabgill]

Mate you got the best explanation out there

[duck-zqzo]

Although this is not for the general public, it is still interesting.

[janeannelson]

What happens when they hit a nerve or go through a vein on keep pushing and not taking it out and trying again! That is what happens to me

[ravenchua]

Awesome video! Im really new to this and some questions i have are:
1) how many cm of (straight) vein do i need to palpate in order to use it as a site for cannulation? Most of the time i can only feel up to 0.5cm to 1cm of vein, and then im not sure whether the vein travels left or right thereafter.
2) Is that 1cm "runway" enough for me to insert the cannula in and then just push the sheath hoping that the sheath will just follow whatever course the vein takes? I.e even if the vein courses left thereafter, as long as my sheath is inside the 1cm "runway", the sheath would just follow the vein and turn left.
3) Should my point of skin penetration be say, 1cm distal to the most distal part of the vein im able to palpate? Or should i just penetrate the skin right above where i can feel the vein?
4) Do you have any tips for antecubital cannulation? Regarding how the arm should be positioned, where the most common vein spots are and the typical course of the vein, as well as any other tips one should know if attempting to cannulate the AC region etc...


Im sorry for the numerous questions but I would be very appreciative and thankful if you could answer them! Thanks!

[ninaakerstrom]

Any tips as for stretching the skin before attempting an IV cannulation? Is it better to pull the skin down or to the sides from the chosen vein?

[PaulBakertx]

Been preaching this for years. It's either too shallow, too deep, or you missed. "blowing" and "valves" are so rare I can probably count on 1 hand how many times that's been an issue in 10 years.

[newsmansuper]

put in cannula - to large vien, no flashback - withdraw - exactly on target can see the dot - no roll - ????