Standard Operating Procedure for cannulation Effective date: 26.07.2017 Review due date: 31.03.2019 Original Author Name: Richard Metcalfe Position: PhD Student Date: 05.12.2012 Reviewer Name: Pippa Heath Signature: Position: Physiology Technician Date: 01.04.2017 Approved by Name: Dr Lisa Austin Position: DfH Research Manager Date: 26.07.2017 Signature: Amendment Chronology Version Effective Reason for amendment Reviewed/Amended by number date 1 05.12.2012 First issue Richard Metcalfe 2 27.07.2016 No amends, review only Ben Lee 3 26.07.2017 Reviewed, minor amendments, Pippa Heath updated cannulation RA link 4 27.11.2017 Minor changes to Risk Assessments. Minor changes to equipment. Addition of taking blood from a different type of connector. Mark Thomas Pippa Heath
Cannulation This Standard Operating Procedure is split into two sections. Section 1 contains the procedure for performing a cannulation of a vein. Section 2 details how to safely extract blood from an inserted cannula. Section 1: Performing the Cannulation IMPORTANT: Only those who have completed the required training and who have read and understood the following risk assessment may perform this procedure : cannulation If necessary (unable to prove prior training) people new to the lab need to do an external venepuncture course, then can be trained in cannulation in house. This requires 10 observed cannulations, which need to be signed off on (Appendix A). You will need: Lab Coat & Gloves Bedroll Blood trolley Sharps box Tourniquet (re-usable or disposable) Alcohol swabs A Cannula (blue for small veins, pink for large veins) Extension Tubing (Octopus) Tissues Plasters Anaesthetic (optional) Biohazard Bag Procedure: 1. Patient Position: Supine (laying down) position is preferred, flat on the back with both ventral (front) surfaces of the arm up. 2. Attach the Tourniquet: Attach a tourniquet on the arm, a few inches above a potential venepuncture site. It should be attached tightly but not so tight that it is uncomfortable for the patient. Try to prevent
pinching the subject s arm by placing a finger between the arm and the tourniquet whilst tightening. 3. Select a Site Although sometimes it is possible to directly see the most suitable site for venepuncture, site selection usually requires a technique known as palpation or feeling the vein. The most common site selected is the antecubital area of the arm. Once a site is located unclip/untie the tourniquet. 4. Site Preparation Wipe the site with an alcohol swab. Whilst the alcohol is drying, prepare the cannula by removing the packaging. The cannula should then be placed back within the open packaging on the blood trolley. Remove the cannula extension from its protective packaging and remove the white lid from the tubing. Place the cannula extension back in its packaging on the blood trolley. 5. The Puncture Retighten the tourniquet and re-locate location and direction of vein. Remove the plastic covering on the needle. Pull down on the skin with free hand and insert the needle in a smooth and quick manner at an angle of approximately 30. Once you see a flashback of blood release the tourniquet and stabilise the needle by pushing it down so it is lying against the skin. Push the cannula whilst holding the needle in place to prevent it moving further in. Once the cannula is fully in position clamp the vein above the insertion site using your free hand and remove the needle. The needle must be immediately disposed of in the sharps container. Attach the white end of the extension tubing and wipe away any blood. Tape down the cannula using appropriate tape allowing the point at which the cannula enters the skin to remain visible. Check flow in the tube by removing the cap on the extension tube. 6. Removing the Cannula Fold up tissue and apply over insertion site. Pull out the cannula (quickly to cause least discomfort) and immediately dispose of into a clinical waste bag. Ask the subject to apply pressure to the insertion site with the folded up tissue with the arm kept straight, and preferably raised for a few minutes to minimize blood flow. Plaster if necessary. Section 2: Extracting Blood from a Cannula IMPORTANT: Individuals performing this procedure must have first undergone training in this Standard Operating Procedure and then been supervised during the first 10 blood extractions. In addition, individuals performing this procedure must have read and understood the risk assessment : Cannulation You will need: 3 x Syringes (range of choices) Tissue Saline (0.9% w/v Sodium Chloride solution Braun )
Gloves Procedure: 1) Prior to making an extraction from the cannula a syringe of saline solution needs to be prepared. To do this, insert the syringe into the ampoule of saline and draw back the plunger until sufficient saline has been drawn (5-10 ml is optimal). You must then remove any air bubbles inside the syringe by gently tapping the side of it. Push the plunger in until all air is removed from the tip of the syringe and place back inside the protective packaging (from the syringe). 2) Ensure all equipment required for the extraction from the cannula is within easy reach. 3) Place a folded tissue underneath the tap on the cannula extension (in case of any dripping) and remove the white cap if present. 4) Insert a syringe into the tap on the cannula extension, open up the tap, and draw back the plunger to extract blood into the syringe. When sufficient blood has been drawn, close the tap and remove the syringe. If using a cannula with a one way valve instead of a tap, push syringe in firmly or if Luer-Lock twist syringe in until completely sealed and then draw back the plunger on the syringe. 5) IMPORTANT: for the first syringe, extract ~5 ml (the amount of waste to be taken depends on the metabolite to be analysed) of blood, put a tip cap on the syringe and dispose of in a biohazard bag (this is a waste sample which contains saline from the cannula extension). 6) Repeat step 4 to collect the blood sample to be used for analysis. Split this into appropriate tubes for centrifugation. If using more than one tube, eject the blood into the untreated tube first to avoid contaminating the end of the syringe. (IMPORTANT: Do this slowly to avoid blood splashing back.) 7) Lastly, the cannula extension must be cleaned with saline solution. To do this: Take the syringe containing the saline solution (prepared prior), check again for any air bubbles in the syringe, and then connect to the cannula extension (IMPORTANT if using a connector with a tap then air bubbles will still be present between the cannula tap and the syringe tip. There are two methods of connecting the syringe to the cannula extension to remove these bubbles prior to infusion of the saline see below). Draw Back Method: Connect the syringe to the tap on the cannula extension, open the tap, and then draw back the plunger on the syringe slowly to withdraw the air bubbles into the syringe. Flushing Method: Place the tip of the saline syringe on the edge of the tap (tap is closed!) on end of the cannula extension, with the tip of syringe angled upwards (~45 ). Push the plunger forward to eject saline into the tap, and when you have a fluid-to-fluid contact, fully insert the tip of the syringe to the cannula extension. Please note that it is important to have tissue underneath the tap if using this method as there will be some spillage of the saline solution. If using a one way valve, push the syringe firmly in and anchor with one hand.
Once the syringe is connected to the cannula extension (with air bubbles safely removed), open up the tap, and push the plunger of the syringe in to infuse saline through the cannula. This should be done very slowly at first in case any air bubbles remain (watch the tubing carefully to check). Once the desired amount of saline has been infused close the tap, remove the syringe and dispose of in a biohazard bag. It is important that the tap is closed whilst firm pressure is still being applied to the plunger on the syringe (otherwise blood may flow back through into cannula causing it to block). Never fully evacuate the contents of the saline syringe, always leave 1-2 ml of saline in the syringe. 8) Replace the cap onto the tap on the end of the cannula extension and wipe the participants arm with a clean tissue (or alcohol swab in the case of any blood spillage).
Appendix A: Cannulation Observation form Note: to be defined as a successful cannulation blood does not necessarily need to be obtained, but procedure should be in line with best practice. Number Site (Hand/Arm) Observed by Signed 1 2 3 4 5 6 7 8 9 10 When complete please scan this form and save a copy to: X:\Health\Groups\Sport & Exercise Science\Staff_Area\Physiology\Cannulation observation records End of Document