UNCONTROLLED WHEN PRINTED
Indications
  • Intravenous access for fluid or drug administration.
Contraindications
  • Directly over or distal to:
    • Burns
    • Cellulitis
    • Infection
    • Injury
  • Patients with chlorhexidine sensitivity/allergy, use 10% povidone-iodine swab
Patient Factors & Considerations
  • MAXIMUM of 2 attempts prior to transport (only 1 vascular (IV/IO) attempt in traumatic cardiac arrests)
Procedure
  • All relevant infection control methods to be utilised.
  • Prepare equipment required:
    • Cannula
    • 10ml syringe
    • 10ml normal saline for injection
    • 2% CHG 70% Alcohol swab OR 10% povidone-iodine swab
    • Needle-free valve (“bung”)
    • Giving set
    • Single patient use tourniquet
      (peripheral vein only)
    • Transparent IV dressing
    • “Ambulance Inserted” sticker

     


Peripheral IV access

  • Select site:
    • Hand, forearm or antecubital fossa (ACF)
    • Fistulas and site used distal to, should only be used as a last resort.
  • Select appropriate cannula size
  • Apply tourniquet
  • Clean insertion site with 2% CHG 70% alcohol swab OR 10% povidone-iodine swab
  • Consider local anaesthesia
  • Stabilise vein and insert cannula at 30°, bevel up[1].
    • Maximum of 2 attempts prior to transport.
    • Only 1x IV/IO attempt in cardiac arrest.
  • Observe for flash back of blood.
  • Reduce angle and advance needle.
  • Advance the catheter into the vein until a ‘click’ is heard[2].
  • If obtaining blood sampling, refer to Pre-hospital Blood Sample Collection clinical skill
  • Release the tourniquet.
  • Dispose of sharp immediately.
  • Attach needle-free valve (“bung”).
  • Flush the catheter with 5-10ml saline[3].
  • Remove the catheter if pain, haematoma, oedema or extravasation occurs
  • Secure catheter using transparent "Emergency" IV dressing; complete time and date label[4]
  • If not using an "Emergency" pre-printed IV dressing, apply “ambulance inserted” sticker, ensuring insertion site is visible[5]
  1. Vasc - Anchor
  2.  

  3. Vasc - Insertion
  4.  

  5. Vasc - Flush
  6.  

  7. Transparent IV Emergency Dressing
  8.  

  9. Vasc - AI
Success
  • Ability to administer medications as per specific guidelines.
Discontinue
  • If multiple failed attempts, consider whether vascular access is necessary to manage current patient presentation.
Additional Information

Potential complications of attempting intravenous access:

  • Air embolus
  • Arterial puncture
  • Cannula shear
  • Extravasation
  • Haematoma or haemorrhage
  • Infection
  • Nerve damage
  • Phlebitis
  • Vasovagal syncope

References
References

Document Control


Directorate
Clinical Services

Responsible Manager
Head of Clinical Services

Published Date

Review Date

St John Ambulance Western Australia Ltd © Copyright 2020, All Rights Reserved

Privacy Policy | Copyright Statement & Disclaimer