7 steps to cannulate the most difficult veins! Live demonstration

[@humaira917]

Started a new job in NICU in a new country, nurses did canulation back where I worked. Struggling so much with canulation, get depressed everyday for not being able to canulate successfuly even once throughout the week. Gonna binge watch your videos amd cry at the same time..

[@Sandeeprudram]

@@humaira917 same here😔

[@jbtcrazy]

I'm a junior doctor in Perth, Australia and I just wanted to say thank you for doing such great teaching videos. I literally have not missed a cannula since adopting your technique and have even started helping my friends with difficult cannulations! Thanks so much, you have no idea how much these videos have helped!

[@ABCsofAnaesthesia]

Thank you so much for the message! If there’s any other videos you would like please let me know... in the future if you ever wanted to help with this education feel free to email me at [e-mail] My vision for this project is to create great material with others, and donate all earnings to an independent and effective charitable cause :)

[@rahulmalhar2254]

Great work sir

[@ikechukwuanthony8385]

Hello@Andrew..can I get your contact

[@vishnuparihar32]

Sir plz made a video for iv cannulation in obese patient , in emergency condition where we have no any tools , having only swab , cannula routine G

[@Karthika266]

@@vishnuparihar32 For obese patients, you really have to use anatomical landmarks and palpate those areas. But if it's truly emergent, you could get a central access or even an intraosseous line. Some tricks from me: 1) hang the arm below the bed to promote blood flow to the arm. Then place the tourniquet. 2) place 2 tourniquets 3) go for the antecubital. You can feel cephalic and basilic veins in almost any patient. 4) Put warm compress/hot packs to dilate the veins.

[@Lupcheong89]

You are a legend to all the EMT’s out there. Thank you 🙏🏼

[@seoyunkim8388]

you make this look so easy, man, you are so good at this. 😮

[@marciaclark3408]

Great technique. As a blood bank phlebotomist I remember times where I had to get the vein. Those needles are bigger than some of the veins I got into. It's satisfying to do so. As a person with non existent veins I am always grateful when I get someone like you. After doing it for years one really gets good at it.When in the ED after losing a great deal of blood they used a 18 or 16 gauge to get access into my thumbs bilaterally to flood me with fluids. I'm always indebted to those skilled folks who got in on the first try. I look forward to more videos.

[@ABCsofAnaesthesia]

Thanks for sharing your experience marcia :)

[@solslastcannula5665]

Why didn’t they try intraosseus for you?

[@Dexters.LaBOREatory]

@solslastcannula5665 I thought that was used in mostly emergency situations where patients are in v-fib etc needing to be defibrillated?? I don't want a drill in my bone unless I'm dying, but that's just my deal

[@drPokkuri]

Overall good technique. Many forget to "level out" and advancing the needle with catheter a few millimeters before advancing the catheter over the needle. Make sure your skin disinfection also covers the skin that gets in contact with the needle when "leveling out". That was not covered in this video, but is sometimes forgotten. Also, be careful when advancing the catheter with the tip of your finger. You're pushing the part that is supposed to be sterile (the end where you connect the intravenous fluids to) with a non-sterile finger tip. Your patients may get a catheter-related infection this way.

[@ABCsofAnaesthesia]

thanks for the comments! great to have critical feedback to improve technique :)

[@aleksap5459]

I think that last point is partly why my hospital introduced a policy that requires donning sterile gloves right before cannula insertion

[@aircavmedic]

Perfect. A difficult spot. RN-Prior to OR, had went to school for IV nurse, 1000+ bed hospital. It is a nice skill set to have. Everything from 16ga to 30ga. Every place on body accessed. Direct, indirect, mostly for delivery of just about any med/chemo agent. Rare when you great anesthesiologist & Nurse anesthetist do, if missed, when switched to OR, many would ask me to do the difficult ones. On hard vein team at major hospital. Keep posting wonderful videos. You are highly skilled.

[@melanieborthwick3651]

I really appreciate and enjoy watching your videos. Please consider an IV compilation video of at least 10 min. Doesn't even need to have commentary, but show different types of veins. I could only find something like this on one other "IV compilations" video. It's great for us to watch technique over and over again so these compilations could really help. Thank you for considering as that would take a lot of work and editing. Thanks!

[@ABCsofAnaesthesia]

That’s a great idea Melanie :) I’ll try to get a vids for this :)

[@johnbalao9582]

This is a highly informative and very effective method of peripheral intravenous cannulation.

[@pakizakhokhar9832]

Please share more skills because your method of demonstration are too much good and simple😊

[@ABCsofAnaesthesia]

Thank you ☺️

[@nealpickering7265]

Great technique! I would be interested in more cannulation videos, in particular large bore cannula placement, site selection (considering bifurcation and valves) and more difficult access :)

[@ABCsofAnaesthesia]

I’ll definitely do a few more videos for large bore cannulas, local anaesthesia injection, and site selection! Great suggestions!

[@Louise90GV]

Impressive! I definitely find the small veins the most challenging ones. Just gotta keep practicing

[@kyliestewart2001]

Can I say thank you. It helps to see others doing this, I’m hoping one day to be as confident at pivc as you. Amazing

[@ABCsofAnaesthesia]

Any time! Thanks so much for your comment :)

[@peacevkw]

Just sharing my experience, my most difficult branulla insertion was during my housemenship in NICU where every single day I have to do for neonates. First 4 weeks I struggled but after that I mastered the technique and become best intern for the procedure. It was a good memory 10 years ago.

[@ABCsofAnaesthesia]

Well done :)

[@dominiguya5716]

a video of someone great putting in difficult IV's, strong work

[@akshaydahiya9472]

You’re the best doctor for dealing with veins

[@dream-to6ym]

Your efforts are appreciated .Could you please upload an iv insertion in pediatric (neonates, toddlers)

[@ABCsofAnaesthesia]

I would love to, I just have trouble with the consent for live patient videos.... to be honest I use the same principles but will often use these extra things 1) ultrasound more often in the chubby 1-2year olds 2) saphenous vein at the medial ankle 3) if a go through the vein, Childrens veins are often salvageable (ie I can rescue the vein by withdrawing the cannula and reinserting it unlike adult veins that will be damaged and extravasate blood, most Childrens veins seem to seal very well even after puncture.... would love to video this at some stage but prob a few years off until I get around the proper consent processes.

[@KKno1]

Hello, I'm a new nurse thank you for sharing these videos! since you have this experience of cannulating "the most difficult veins" can you please post some videos with tips on how to cannulate veins on patients that are your skin color or darker. I think your video is very helpful and more videos will be helpful in showing execution when it is difficult to see the vein with your eyes.

[@dalandabaker2389]

Hello, I can see that your comment is a year old so you have definitely much more experience and expertise in cannulation. I just wanted to say that I don't really need to see the vein with my eyes, when I feel the vein using my finger it is easier for me. This is just me, my experience. I understand that for others it is better to see the vein(s). How are you getting on now with the cannulation?

[@doremifasolatido-ro7zs]

Very interesting to watch. I've been out of nursing practice for almost 3yrs now. Hoping to get back in the bedside soon. Good job👍🏼

[@ABCsofAnaesthesia]

good luck!

[@newsmansuper2925]

The best person I ever saw canulate was a African man called Joshua, a Registered Nurrse, he was I think superanatural at, I never saw or heard of him miss. It was just out of this world. Shout out to you Josh your the man.

[@leeriley8035]

I just thought that I would reply to your excellent vids on cannulation, have really helped to reduce my anxiety and boosted my confidence + technique when inserting midlines into difficult veins. Thank you!

[@ABCsofAnaesthesia]

awesome to hear! thanks Lee

[@w.p1529]

This video is my go to recommendation for all Foundation Drs and med students. Taught >30/40 who have said all their issues went after following this technique. Bravo!

[@ifeyinwamadu7831]

Very educative. I enjoyed watching it. Thanks

[@ABCsofAnaesthesia]

Thank u!

[@frankfromupstateny3796]

beginning to like this guy alot. good explanations....good logic....all around good stuff.

[@precisionmedicine9091]

Wow, you could get blood from a stone.

[@ABCsofAnaesthesia]

haha, thanks, that's a great compliment :)

[@ankumir8955]

@@ABCsofAnaesthesia I love your videos. Thanks a lot

[@ayokcomfort]

🤣🤣🤣🤣

[@beverleylumb8048]

I know he is really good

[@irisafuadouse3538]

😂😂😂😂

[@amyyoung2804]

Bravo! This will help me in getting those veins the first time. I've been approaching at too great an angle. Insertion being almost parallel to the vein and slowing down the insertion. Thanks much :)

[@ABCsofAnaesthesia]

Glad it was helpful!

[@fisherhatakeyama]

Your video instructions helped me so much! Thank you!

[@ABCsofAnaesthesia]

So glad it helped!

[@aleksap5459]

Your videos are so good, you are actually helping out so many doctors and nurses, which in turn helps so many patients!

[@ABCsofAnaesthesia]

yeah, I'm so glad KZbin provides the opportunity to share this knowledge that was so generously shared with me

[@joetan2653]

That area is very painful specially when given meds - the 1st cannulation

[@kkm227]

It's all about the experience. By the way, I like this cannula as it was safe and has a valve.

[@Laurslifejourney]

Experience helps of course but I’ve been virtually impossible for years to cannulate. I’ve had top consulatant/anethetist with vein scanners fail on me, then a newly qualified nurse get one in instead 🤷🏻‍♀️🤷🏻‍♀️ rare but has happened

[@jaycobcagasan7922]

Meanwhile pilipinss. U could get prick by ur own needle hahaha

[@carolweaver3269]

you truly did this like one who has practice alot. Am sure many have been done, TY

[@ABCsofAnaesthesia]

thanks :)

[@cyd282]

You really do have a great technique and are able to teach it. My skills have increased watching your videos. Thanks!

[@ABCsofAnaesthesia]

Great to hear!!

[@JPRVoyager]

Saw the video, went through description, found that u shared profound knowledge. I am a nursing officer and request you to upload cannulation of dehydrated patients and geriatrics (i.e collapsed vein )

[@ABCsofAnaesthesia]

will try!

[@cessgarcia6860]

Wooow this is a great demo. Thanks for posting!!! I hope you could also do a video cannulation on pediatric patients.

[@Vivaz79]

Great work, Gj! I have failed multiple times going back of the wrist where previous failed attempts on other sites. Thx, for proving it's possible to get it done, if u 're confident enuf. Bravo!!!!

[@ABCsofAnaesthesia]

Haha, yeah it definitely took years of experience before I tried... And only because I had limited choice 😂

[@iubiricapufulica3609]

Great work ! Complimenti!

[@18arnabghosh53]

Very good technique. I would appreciate much if you post some cannulation videos in neonates like 2-3 days old and thalassemic babies

[@BLLINATIKTOK-yv4bn]

Woooooow. I have difficulty even locating a good vein. You are amazing at this

[@MananZiafat]

So professional, I mostly struggle at angles like this 🔥

[@mzdino8785]

You make it look so easy! ❤

[@ABCsofAnaesthesia]

haha, years of practice and great teachers :)

[@sciencescience9102]

Gosh! You are amazing! I didn’t see the first vein at all!!

[@ABCsofAnaesthesia]

Oh thank you!

[@lezelladroma9203]

Wow great video and instructions!!👍

[@ABCsofAnaesthesia]

Glad you liked it!

[@stephenjohnlim8529]

You know when youre watching these videos when your success rate is 1 out of five insertions, as a nurse im soul searching right now

[@ABCsofAnaesthesia]

hey I hope it keeps getting better! :)

[@malligrub]

It's just a numbers game bro, keep going!

[@docsantander]

Practice makes the master.. 💪🏻

[@teresamcgonagle5191]

Sometimes I can go weeks without missing & others I couldn’t get an IV with a person who has the plumpest & healthiest veins.

[@delorabecker]

I can relate ☝🏼

[@luminousyou5349]

Nice technique! I see here that it is important to use a catheter with "no blood return" to avoid extra movement, as you said. You have a great one. Which brand did you use in this video?

[@Anthony_Cybertruck]

On my bad days, I get 8-9 out of 10 IV insertions, but to be honest I don’t think I be able to do what you just did right here! 👏🏻👏🏻

[@anastasia-gj4gm]

Just got back from a really difficult diabetic patient who was really offensive to everyone, tried 6 times, although he had some visible veins and some not so much, I lost all of them. Will go try again in an hour wish me luck!

[@inmymindalways8972]

He make it seem so easy. Thank you sir. Neuro ICU nurse here

[@joeswife]

Impressive! I don't place IV's but I do a lot of phlebotomy in my job as a medical assistant. Your technique is fabulous.

[@ABCsofAnaesthesia]

Thank you :)

[@voiceonfire-interviews]

Wow... The one thing that I'm still challenged by is the sighting of the vein for the flattening out and the 2-3 mm follow through... I was sure the needle was going in the wrong direction!!! Of course, excellent knowledge of venous anatomy helps. You made it look super easy.

[@ABCsofAnaesthesia]

Thank you :)

[@nadaqawasmi9140]

Could you please do paediatrics videos? Thank you

[@someoneelseright4671]

Thanks for the demo! Awesome skills🤓

[@juliet3267]

These editing skills are the greatest! Keep them coming!

[@jasminaparveen1690]

Really awesome ❤️

[@LoveeZahraaa]

Thanks! This video pushes me to try harder in iv cannulation, I really have difficulty in doing this procedure. I always fail.

[@ABCsofAnaesthesia]

Glad it was helpful! thanks so much for the comment Zah :)

[@dolmalaistibetan]

The best I have seen

[@ABCsofAnaesthesia]

that's too kind, thank you Tenzing :)

[@tamizhselvitamizhselvi7741]

Nice explanation teach about ng tube feeding also

[@ABCsofAnaesthesia]

So nice of you! I'm sorry but NG tubes aren't common in my practice.... hopefully someone else can make this video!

[@vishnuparihar32]

Very useful video , sir

[@ABCsofAnaesthesia]

thanks!

[@sudeshjacobschwartz7703]

Hello sir...I am Jacob from Africa.. Basically I am from India. I am a staff nurse. I completed My bsc nursing course on 2016. But I till I did not any cannulation successfully. I don't have confidence.....I am watching your KZbin videos. It's helpful me. I need train cannulation...

[@elizabethosasumwen6377]

Thanks for the video. But pls what are the terms: Flashback, Give, level out?

[@azlanfa8286]

brother u are great thanks for the guidance

[@ABCsofAnaesthesia]

thank you :)

[@mekdesdemeke4697]

You are good teacher.!!!

[@thooyavan4394]

Hello could you please suggest us on how to practice on finding the veins before approaching the patients

[@Babalutu573]

I can insert IVs when I see or by feeling the veins but I’m having trouble when I have to insert on a person of size or someone who’s just very swollen, sometimes, I can see the color of the veins but not sure how deep I’d have to go cuz they seem so deep, Any tips on improving my practice?

[@nantezaasha5945]

Exactly.i also like to know 😊

[@joannaluca8495]

That’s fantastic technique 👏👏👏

[@ABCsofAnaesthesia]

Thanks so much 😊

[@charliwilson1983]

Excellent video. Thanks for sharing

[@ABCsofAnaesthesia]

Glad you enjoyed it Charli!

[@haifa2207]

Thank you so much. You have experience a lot about nerves . I hope someday will be able to by nurse like you 👍

[@ABCsofAnaesthesia]

Good luck!

[@jaimeguadian5558]

Really great clip. How about one with a larger gauge catheter? 20”.

[@anbay3213]

Thank you for the great video! I really would love a video showing how to find the veins in the inner elbow area, if you are up for it!

[@mrcx6142]

Impressive! What do you do when the patient has lymphedema or significant amounts of subcutaneous fat, maybe even combined with the skin of an old patient (wrinkly, "loose") and when you're having trouble feeling or even seeing veins? This also applies to patients with darker skin when you can't feel a vein. Thank you in advance!

[@kelvinwong829]

I want to know as well!!!!

[@nickpicard1986]

look where the shoulder meets the chest, theress a branch of 2-3 veins there. bend the arm up and out laterally and they will show easier. i just bring those up with heat and friction from chlorahexadine , works well for me in ER

[@mrcx6142]

@@nickpicard1986 Grest tip, thank you! I'll remember that is one of my last ressorts for a peripheral i.v. it nothing Else works/feels doable

[@joebeta1837]

Having experienced what you described hundreds of times throughout my career (well, maybe hundreds, but many many times) you either have to become familiar with the veins in the antecubital fossa area and make that your favorite spot, or better yet, become familiar with the use of the ultrasound machine. You'd need to watch hours of KZbin videos, maybe watch the videos over and over to start getting comfortable with it's use. Be forewarned: once you get really good at using the ultrasound machine, people will coming to you for difficult IV starts. That's what is happening with me.

[@moonflower32]

@@joebeta1837Hello, I was recently hospitalised for a procedure requiring a cannulation, 2 phlebotomists, a fully qualified doctor (he did the worst job of all) and then another phlebotomist failed to cannulate. Then a junior medical doctor decided to give it a shot by using ultrasound first, she got it first time! The doctor stuck the needle containing the cannula into my pinky joint, then he proceeded to flush with saline to make sure he "had it", which stung like hell bringing me to tears. I have had pain, numbness and tingling ever since, I think he hit a nerve. There is still bruising there as well as pain. So to all you operators out there, if in doubt, don't try it, you should do no harm to a patient. EVER.

[@mihaelaionescu2443]

Amazing! Your video is very useful for me. Thank you!

[@ABCsofAnaesthesia]

Glad it was helpful!

[@ingothitrust5248]

I wish I could possess even a mere fraction of the skill you display while cannulating difficult patients. I used to be reasonably good at them, until I taught myself how to use the sonosite, and so my MO has always been 1 attempt at a dry stick and then the 2nd with the sonosite but I know as an anesthesiologist, you won't always have the luxury of having an ultrasound readily available....even for a-lines and such.....

[@humma91]

You just taught me something about the cannulas structure that despite having hands on experience I didn’t know. Now I know how prevent double pricks.

[@kalaiselvi.kkalaiselvi.k7768]

Thank you for amazing tips sir

[@ABCsofAnaesthesia]

So nice of you

[@marciliamussy439]

Excelente técnica!🇧🇷

[@GlobbitsGaming]

Fledgling Paramedic here, intend to watch this on repeat for hours and have go on the next shift :)

[@ABCsofAnaesthesia]

haha, hope my voice doesn't grate too much! and thanks for the comment!

[@newsmansuper2925]

Very good, I have never canulated some in that first location. Do the small caliber veins tissues easily, rather than more proximal viens. Eg lots of Pt on ABX for several days - and often tissue?

[@bhuvana612]

Good explanation 🎉🎉🎉

[@mirmahmud1438]

Awesome. Want more like this.

[@ABCsofAnaesthesia]

You got it!

[@ponnusvlogs2808]

Am a nurse... Would like to know more... So keep going...

[@DeepMysterio]

I could have put a 20G cannula in the 2nd one...please show technique for cannulation of small, spidery veins seen generally in diabetics and chemotherapy recipients. Thanks.

[@ABCsofAnaesthesia]

I will do... hopefully soon in an upcoming video :)

[@whynotjustmyusername]

To get into those veins in the first place can be achieved just by what is shown in the video. The difficult part is maneuvering in far enough. To do that you don't retract the mandrin entirely, but such that only the farthest third of the catheter moves freely. Then you carefully wiggle the catheter from side to side such that it finds its way through all the curves, sliding them on it like a curtain on a curtain pole. Once you're in far enough, retract the mandrin entirely and secure the catheter.

[@birkineshtereda2896]

wow! Great skill. Thanks for sharing

[@ABCsofAnaesthesia]

Thank you! Cheers!

[@yehuditplants6172]

If you miss and you do another attempt, can you reuse the same needle in butterfly needle for blood test

[@vrdINOFFICIAL]

so amazing,great technique👍

[@rodrigoprado9710]

Great job

[@LeaDiary]

A very helpful video thank you for sharing

[@ABCsofAnaesthesia]

Thank you!

[@CatherineAlexander-b6n]

He makes it look so easy

[@ashwinwadwani]

Would love to get some advice on how junior doctors/nurses should manage a scenario where the vein has rolled and I have been unable to get flash back. Tips on managing these scnarios. I have seen times where the cannula is brought back and then pushed forward at a different angle. Would love to hear your thoughts

[@ABCsofAnaesthesia]

Great question! Thats such a common scenario and there's a few options... 1) If it hasn't rolled too much, I re-angle the cannula and again attempt to get flashback. often this can be too difficult and I'm having to travel through more tissue, and causing a bit more pain. so I often go straight to: 2) take cannula out of skin. and start again slightly changing my insertion point. (do all standard precautions as per hospital policy, eg, change cannula, swab skin). I like doing this as hopefully the new insertion point is better placed to avoid the vein rolling away. hope that helps!

[@darshanadias9]

Happy to see you dr lahiru Are you sri lankan

[@susangeorge4146]

You are amazing

[@ABCsofAnaesthesia]

haha thanks, just some really good teachers :)

[@sunnybinoy2345]

Great sir

[@youngneil8865]

can u please demonstrating IV access in an edematous patient

[@ABCsofAnaesthesia]

hopefully soon I'll be able to do more videos of different patients :)

[@proudsanatani461]

Can u show how to insert it on edmateous hands? Plz 🙏 Or puffy hands

[@ABCsofAnaesthesia]

I'll try to find the right patient :)

[@nazirahidris]

I listen to ur podcast and found the youtube channel. Ur doing the lord's work.

[@arjunramar432]

podcast name pls ?

[@ABCsofAnaesthesia]

Anaesthesia coffee break :) it's a podcast going through our part 1 exam which is pharmacology and physiology. we try to have conversations about these concepts and relate it back to clinical practice.. and provide performance tips that helped us during our training to increase our learning curve, memory and ability ....

[@lynclashaccount4296]

Wow thank you for showing this,

[@timschricker5711]

Great Video! Best one I have seen so far from my stand point! I have one question regarding IV insertion under difficult conditions: As you mentioned any slight dynamic movement can alter the IV position. In that regard, is a pull back of the bevel once the bevel and the canula have entered the vein even necessary ? In Germany we use vasofix IVs from Braun that are constructed differently. It is always taught that once you have entered the vein and pushed further to ensure the canula is also inside, you should pull back the bevel to not damage any vessel walls before pushing through the canula, but it seems that this slight pull back may also alter the position of the IV. In your professional opinion, does the only over the needle push technique without pull back also ensure secure IV access ? That would be fantastic to know ! Thanks for your sharing of Knowledge , with kind regards from Germany from a colleague

[@ABCsofAnaesthesia]

Thanks so much for the comment! That’s a really good question. I had a look at the vasofix iv and it looks like the same principles will apply to it as well. In my opinion as long as the needle and cannula are both inside the vein, it is now safe to do either 1) advance cannula or 2) pull back needle then advance cannula. I suspect with more and more experience, #2 wont be necessary as you will have developed a very steady hand, and it’s an extra step for error to occur... Eg. As you pull back bevel, while you decrease risk of damage to vessel walls, you then increase risk of pulling cannula back as well.. so in effect replacing one risk with another ... that said once you get good at either method you will be completely safe and effective with either . Hope that helps :)

[@timschricker5711]

ABCs of Anaesthesia thanks for the rapid reply! Am going to try that out during my shift as early as of tomorow! Thanks for your videos theyve been a big help!

[@ABCsofAnaesthesia]

Good luck!!

[@besh3734]

@@timschricker5711 hello there, I know it’s a year later but I want to ask you which method you chosen, does it the advance one or to pull it back then advance? Because I’m currently having same thoughts and curious what did you preferred now a year later and what is the best way?

[@wisdomchitatu8400]

Good 👍 video

[@irynaYe]

THANK YOU SO MUCH!!! Please, could you advise regarding arterial line cannulation? Thank you!!! ❤

[@fatmatakargbo3169]

Thank you very much this is very superb I'm just a training nurse and I need more IV calculation cause this is really helpful

[@mariyamwaseem7885]

Thankyou so much! This video was great 👍😍

[@Peace-yu6yu]

Hi ABC of anesthesia , thank you so much for videos.They are excellent . what techniques can we apply in case of invisible veins? can you recommend us the best veins for blind Peripheral IV insertion attempt ?

[@manonamanona9594]

Thank you. When you say "flashback", do you mean blood? Because I didn't see blood when you said "flashback". Is it just the camera? I was taught that we should aim slightly down until we see blood and then go shallow.

[@chrismitchell5745]

The flashback was more towards the clear part of the IV. If you watch real close you will see it barely

[@steve1234596]

Great demonstration mate, 100% 🇦🇺