Super detailed IV cannulation talk covering everything I know

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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.
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The medical information is provided “as is” without any representations or warranties, express or implied.
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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.
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[@yonicoleeeo]

After leaving a weekend wardcover shift dejected because I missed almost every cannula I tried, I binged your videos before my next shift and my success rate has gone up! Thank you 🤗

[@ABCsofAnaesthesia]

Amazing!

[@AhmedMus-ih8di]

Can I ask if you held it the way he does in the video? I.e. thumb and middle finger?

[@BamSandle]

@@AhmedMus-ih8diin my opinion that’s the best way to really hold it because you need to have your index finger ready to advance the cannula.

[@joygernautm6641]

My tip for getting the van large is actually one I saw here on KZbin, I take a tensor bandage start at the upper arm and with medium tension, gradually wrap it down to just below the elbow. Works almost every time even on those little old ladies with veins, the size of a hair.🙂

[@azed5764]

As a brand new nurse who learned absolutely nothing about starting IVs in school or even during my training period on the floor, this info is invaluable. Thank you so much for this.

[@danielgant6200]

Your videos on IV access along with others are brilliant. When I first qualified as a Paramedic I have very little feedback on how to improve my IV technique but it improved a lot after watching your videos. Now as a mentoring Paramedic in the UK I always refer my students to your channel to improve their techniques.

[@angelavanhorn7335]

I've been successful almost everytime after learning your "aiming up" after blood return. Best advice ever!!! Thank you

[@ABCsofAnaesthesia]

Amazing! Love to read comments like these!

[@joygernautm6641]

Which video is that in? I totally would like to see this and learn it.🙂

[@angelidez13]

​​​@@joygernautm6641 its in this one as well, when he was teaching the IV insertion 33:39 and onward. The "Aim up" is him leveling out the needle before advancing, lowering the chances of you blowing the vein with the tip of the bevel. Edit: He explains it well at 39:46

[@yamomma7891]

You do NOT have enough subscribers my guy. This needs to get out there. Watching all of your videos on cannulation and applying your techniques while learning has increased my learning curve exponentially.

[@ABCsofAnaesthesia]

Haha you’re too kind :) and so glad for your success!

[@shilpisethi6150]

Please could you add a video on paediatric and neonates iv cannulation

[@titusdaniel]

I feel privileged to be included in an actual lecture session. Thank you for sharing, Dr.

[@kowachiaki3265]

Hi. I went to nursing school for 5 years and it's finally my 2nd month working in the hospital. I want to say thank you so much for making these videos relating to iv cannulation. I learn a lot watching your videos in a week than my 5 years in college (prolly also my lack of field experience too). 🥺✊️

[@kimmisc01]

[@darshanaadatiya3374]

Being a new RN grad on the floor and don’t have experience about IV insertion, your video is a great help. Thanks for sharing your knowledge, Dr!

[@richarddebono7092]

It's always a pleasure to watch a highly skilled person at their craft.

[@alihusnain3218]

Your videos are very comprehensive to understand 👍🏻

[@karenleavens7656]

That rapid infusion 12 over the 20 gauge was amazing! Wowser. I've been a nurse for 13 years, granted I'm rural. That was fire!

[@belubelRC]

As a nurse you have taught me so much! I'm so grateful!

[@ABCsofAnaesthesia]

You’re welcome!

[@aleksap5459]

As a RN, this was a great presentation. A lot of pointers I realised was missing from the cannulation practical I had to do at work - in fact, many corrections; so this was very helpful. Also loved the scenarios!

[@ABCsofAnaesthesia]

Excellent!

[@london_liv5539]

Me too! That was amazing. Thank you sincerely. 🙏🏽

[@bukkyoloyede6740]

Very details,thanks

[@vianb7161]

thanks to you..you help me alot..

[@johnjefar5579]

Awesome video mate!!

[@naomilaboo]

This nurse is really happy I found you

[@joygernautm6641]

Once had an anesthesiologist, put an IV directly into my cephalic nerve, thinking it was a pain. It is extremely painful and six years later I still have some numbness in two of my fingers. If you are going to go for the wrist vein like that, get a vein finder machine if you have it and confirm that what you are poking is indeed a vein.

[@yesyes2113]

Thankyou sir!💥

[@DiscoveryWonders]

Thank you Doctor.

[@AG-bc9ij]

Very informative video. Thank you so much. :)

[@pb5640]

i’ve been starting IVs since 1978 and I average 30 a week since then. that’s about 68,640 IV starts for me. Much of what you say is spot on and I love your enthusiasm to do a good job with this skill. I will tell you the most dramatic thing that has come along in the last 44 years for those tough starts is point of care ultrasound guided IVs. I now have an extremely low threshold to use it. I figure why not convert your success rate to 99.6%.

[@BamSandle]

Any tips for rolling veins? Seems like that’s my main problem. Feels like no matter how well I anchor it it can sometimes roll away

[@carolyn3746]

30K viewer. Super video and many points I use to inform staff on successful cannulation. I love your explanations and many take away for me here. Nightlife Nurse and IVC insertion nurse here.

[@ABCsofAnaesthesia]

Thanks so much :)

[@umyekg7896]

U are excellent

[@gregoryferray565]

Thank you, very usefull hello from France.

[@dummydumb707]

Please do video on abg too if possible 😊

[@Piindtube]

If he’s made a 1 hour video about IV cannulation, I’d expect ABG video to be at least 5 hours long, make sure you free out an evening for this one.

[@dorothydulcevictorialabado7103]

Please make a blog about secret techniques in iv cannulation please

[@bartbug1]

Thanks for the video. I'm just about to finish my EN course and am very keen to undertake IV and Venipuncture training.

[@ABCsofAnaesthesia]

Best of luck!

[@Piindtube]

How in Gods green earth did you make a 1 hour video about IV cannulation

[@ABCsofAnaesthesia]

haha, yeah i was surprised myself...

[@richarddebono7092]

It's funny how people like to comment on videos they haven't watched.

[@ruhiasna9978]

😂

[@ashleyfrugoli4995]

Great tips! Random thought... say you have a #20g that works well but you really wish it was a 14 or 16g....would you be able to thread a wire and exchange to a larger catheter without needing a dilator for a 12g?

[@tanujasharma6034]

Sir I worked as a mbbs intern in India .. during initial days I was briefed by one of the seniors on cannulation technique...and I used to do it accordingly...but apparently it was not right...because it would lead to failed cannulation and vein puncture...I was very disheartened and got scared when somebody told me to put a cannula...so I decided to see some yt video on cannulation...I came across your video by chance...and it changed my internship experience forever...sir there came a point when people would call from different units and wards for putting their difficult cannulas and seniors used to say that before sending anesthesia call ..i should try once...chemo patients , obese patients and chronic patients used to call for me for putting their cannula... it was not my lone effort ...it was all because of you ....thank you so much sir... forever indebted to you ...may god bless you 🙏🏾🙏🏾

[@ABCsofAnaesthesia]

that is such a lovely message, thank you so much. If you ever want to have use any of my online courses. i'll give you a free code. email me [e-mail]. the courses are here: anaesthesia.thinkific.com/collections

[@jonathansailsman]

Question. Why do hand veins in the elderly blow when I'm trying to cannulate. As soon as I puncture the vein 8n the hand with my needle it blows. Is the tourniquet to tight or the hand veins are to fragile?

[@urjeshutthasani3714]

Which book would you like to recommend to us as the Bible of procedures?

[@charlesdavis7461]

I wish you were doing my wife's IVIG for 5 days in a session.

[@bahatihunziker5984]

I always thought that you shouldn't flush a clogged infusion with pressure... My English is very bad, so I ask again to be sure: I can flush an infusion that is no longer running with pressure and don't have to worry about one have embolism?

[@yas4229]

Heyyy!! I find that I often get flashback, then I get resistance on the way in, sometimes it can be instantly and sometimes it’s a couple of millimetres in! And then I try to push through the resistance, and inevitably the cannula is gone. When I take the cannula out, it’s always kinked, usually towards the top on the cannula . What am I doing wrong?! It’s always usually in the anticubital fossa

[@jayaniatapattu7129]

I did canulation on the dorsun of the hand in a person who has good veins.the canula went very eaily in.blood flush came back and everything was fine.then flushed it with saline.later on i was going to draw bloos from the canula non came out.i flushed wirh saline.saline goes in easily.no surrounding swelling but when a try to draw blood even the saline that i had pushed wont come into the syringe

[@doey10]

Problem I have is locating the vein again after I’ve palpated and decided on where I’m going. The veins I can only feel, not see, there is no visual clue. I just always need to keep feeling, I need an X marks the spot as it’s hard to keep the area sterile.

[@ABCsofAnaesthesia]

yeah its so tricky! i sometimes try and use a skin spot or something as a landmark.. but yeah, sterile mark is a great way!

[@dusanlukic6647]

Hello, please help. I had an operation and the medical worker put a green cannula (and a longer one) in the vein on my hand, which is closer to the index finger. during the infusion, the flow of fluid was constantly stopped. I guess that was the first sign of thrombophlebitis. they did not introduce the cannula into the second vein. due to its length, the cannula went over the joint surface and they let the infusion flow at high speed. the vein on my forearm hardened, I had slight bruises in its place. I don't know if it is a basilica or a cephalic. when the arm is in the anatomical supination position, that hardened vein is closer to the body. on the hand where the cannula was, the vein is completely thin, barely visible. hardened vein on the forearm after months of not being there. on the lower side of the wrist on the hand, the veins are more swollen, as if they have taken over their function. does all this mean that the vein in which the cannula was located and upstream on the forearm was totally destroyed? will he ever recover? and have a function? I am in great disbelief and very frustrated because I had the opportunity to read on the Internet that the vein collapses and collapses with multiple needle punctures and in drug addicts. this is not the case with me. is it possible that from one infusion and one poorly introduced cannula, I assume larger cannula for that vein and too much flow, my vein will be irretrievably destroyed?

[@aliciahart83]

What are your tips for getting in 18G and up successfully without ultrasound? Thanks I love your videos

[@ABCsofAnaesthesia]

Hey! I have a 14G cannula video.. check my iv cannulation playlist :)

[@angelidez13]

With the RIC, is it possible to cut the wire when your putting the incision in the skin and lose it in the vein? With how close the scalpel is to the wire i would think that thats a big risk. Btw, the RIC is, by far, the coolest thing Ive ever seen lol

[@ABCsofAnaesthesia]

Good point, i make sure i am not using force angled against the wire to avoid shearing, but also make sure it lightly contacts the wire to ensure theres no skin bridge.

[@angelidez13]

@@ABCsofAnaesthesiaThank you😁 Man, thank God I don't have to do that, I shake like a leaf!

[@silviazolam]

I always break the veins while advancing the cannula. I get the first flashback, advance a couple millimeters, partially retract the needle and get the second flashback. At that point, I try to advance the cannula and I break the vein. No nurse or anesthetist has been able to tell me what I do wrong, it's been 6 months now and I'm getting so frustrated I have a lot fo anxiety every time someone asks me to give it a try...

[@ABCsofAnaesthesia]

Maybe i can help, Would you like to Send a video of you doing a cannulation to me? I can then make a video giving my feedback. Interested?

[@titusdaniel]

He's like "basic things you learn as junior doctors, junior nurses, junior paramedics, junior health care professionals..." I'm a little basic EMT here saying thank you!!

[@Jkris68]

What happened when the nurse goes through the nerve? A nurse who put in Kyiv went through the nerve ? It hurt so. Bad?

[@chasefitz]

Love your videos~ Recent consensus statements (American Society of Breast Surgeons, the Society for Ambulatory Anesthesia) as well as expert advice from UpToDate have changed course on the avoidance of IVs on arms where there had previously been lymph node dissections (with shared decision making periop), unless the patient has a history of lymphadema of that limb. Society for Ambulatory Anesthesia (SAMBA) Statement on Intravenous Catheter Placement, Venipuncture and Blood Pressure Measurements in the Ipsilateral Upper Extremity after Breast Cancer Surgery with and without Axillary Lymph Node Dissection.

[@BloodyMaSSacR3]

Can you share a source link for that? Thanks a lot!

[@ABCsofAnaesthesia]

Amazing, thanks for the info! Yes a link would be great!

[@Tahsin_Hussain]

You cannulate very EASY ones with all YOUNG patient. Try to do Cannula in 97 years old with Atherosclerotic veins, thin skin, no muscles, vein moves when try to insert cannula

[@hingz9282]

Great video! I've seen nurses use saline on the peripheral venous catheter in this following scenario. Whilst inserting the catheter they get flashback but are unable to insert the whole catheter, they then use a syringe with saline as they withdraw the catheter (with the needle withdrawn already but with the tiny catheter still inside the patient) untill they see another flashback in the catheter. They then push in a 1-2 ml of saline at the same time at they advance the catheter only in order to expand the vein with the saline and put the plastic catheter in place. How you seen this? Is this a valid technique? Kind regards, Anaesthesia resident

[@BamSandle]

I’ve done this several times in the ER. Sometimes you run into a valve and can’t advance the cannula any further. Sometimes flushing it through with NSS is enough to “push” the valve open enough to advance the cannula in

[@filip3181]

What is the angle of insertion?

[@fhb1997]

HEY! I love your vids! Im a med student in Ireland and I was just wondering if you would know of any courses or anything like that I can do at undergrad level to bolster my CV for anaesthetics? Like any courses I could get certificates for etc haha cheers!

[@ABCsofAnaesthesia]

Thanks :) ill be creating some courses for anaesthesia online.. check out anaesthesiacollective.com

[@ABCsofAnaesthesia]

Otherwise look for ALS, anesthesia crisis, and airway courses. Also peripheral courses like ones about research, teaching, welfare are great skills you can show as well.. listen to abcs of anaesthesia podcast .. we have a few episodes on that stuff

[@ABCsofAnaesthesia]

Good luck!!

[@ABCsofAnaesthesia]

Hey! Just launched an iv cannulation course. Check my website :)

[@indiano4071]

If the second part of the vein becomes curved, will the catheter be able to enter?or does the vein have to be completely straight? Thank you

[@princessnjel2865]

After a month the needles scars of IV still visible blister in mine like a pimple..

[@remickbloss4423]

Is the patient awake when you do this technique? I would get anxiety if my skin were cut using that knife blade.

[@becky290597]

If your cannula ended up in the subcutaneous and you flush with saline and the skin swells up, what should you do?

[@SpudOfDoom]

Stop flushing it! Best you can do is remove it and compress the site. The subcut fluid will clear eventually. You can reduce the chance of this by ensuring there is good flashback before fully withdrawing the needle, and getting familiar with what a "normal" amount of resistance should feel like when threading the cannula off the needle

[@remickbloss4423]

maybe I missed it... what is a bung?

[@sudhan1995]

He using different cannula in our hospital we use different one.

[@Kh.Shafiq]

You are a doctor or nurse?!!

[@user-oi3lt7nu8g]

Good video, but the thing with diabetes is wrong. People with diabetic coma will have high blood glucose, not low. Therefore you won`t give them glucose, at least not glucose alone.

[@christopherlovell3130]

glass of warm water for patient

[@sierrahayes59]

I'd like to add the "worst thing that can happen" in reference to an IV. I had a student start an IV and they sheared off a large portion of the catheter into this patient's vein while moving the needle in and out. Please when teaching students emphasize the importance of proper technique so this does not happen to any of you reading this. Thank you for your expertise, I love your videos!

[@Holypikemanz]

Immediately starts babbling. GJ Apu

[@shortforsophie]

His name is Dr Lahiru Amaratunge, not Apu. I’m curious, are you this overtly racist in person, or do you save that stuff for when you are safely hidden behind a screen and a username?

[@Holypikemanz]

@@shortforsophie feel free to speak in your native tongue and stop pretending you are english. You can go back to chanting racist some more, pole smoker.

[@shortforsophie]

@@Holypikemanz does asking a single question count as chanting now? That doesn’t seem accurate…. are you sure English is your birth language? Also, are you implying I am somehow mistaken in accusing you of racism? That might be more convincing if you didn’t immediately precede that accusation by telling me to stop pretending to be English. Just a suggestion. For the record, English is my first language (second is French), as I was born and (mostly) raised here in Canada. But I gotta say, I am *pissed* that neither of my Immigrant parents taught me their native languages. To think, I could be fluent in Turkish and German… ugh, what terrible missed opportunities.