Cite this article as:

Henry Goldstein. Twelve Tips to placing a well secured Peripheral IV Cannula, Don't Forget the Bubbles, 2016. Available at:

https://doi.org/10.31440/DFTB.7939

Placing peripheral IV cannulas (PIVC) is THE paediatric procedure. Rather than including every single step towards being a 100% sharpshooting cannula guru (I’m not!), the emphasis for this post is securing a cannula. That is, making it last long enough to investigate & treat the child, and hopefully for several days of an admission if required. The need for repeated cannula placement isn’t just “annoying” for ward staff – they’re genuinely traumatising experiences for children and their families. A good reason to aspire to keep that first PIVC as secure as possible. Bear in mind, this is not a post about access in a resus situation; there are IOs for that. This post emphasises some key tips for securing a PIVC that will last the distance.

You are caring for Roman, a severe pre-school wheezer who is vomiting and moderately dry. He needs IV hydration in addition to IV steroids & you’d like a venous blood gas for your troubles, too, as you think he’s getting worse. But, he’s not so sick that he won’t fight you off; his hypoxic agitation mandates that rather than a gentle cuddle and songs, he’s a raging ball of fear. So, with the help of four others, you have him suitably positioned and calm for a few minutes. You find a vein in his plump wee hand, and… Zip, your 24g IV goes in first attempt. Boom! Flashback, gas taken, bloods off. Okay. Flush please. Now he’s getting cranky. And squirming. And screaming. You’re holding his sweaty hand firmly, plus the cannula as the extension set is attached. The assistant hurriedly puts on the first layer of tapes. Within seconds the ends are curling. The tension rises. The assistant whacks on the next layer of dressing. And the next. You ask them to try to flush the line; it’s ‘stiff’. You know it’s in the vein; now it’s kinked!? The dressing is beginning to lift. Roman is losing it, crying, trying to escape. Mum says “It’s almost done, honey.” nervously. (She’s squished up against the railing on the far side of the bed, holding Roman still and looking a bit pale herself.) Someone says “No more needles!” Roman doesn’t care, he wants it all to stop and is getting sweatier and more upset. Your team tries to retape, but Roman wriggles. You can see the entire cannula just sitting on the skin in a mess of sweaty, blood-stained tape. Roman’s Dad groans loudly.

It’s fair to say this is going badly. How did we get here? How can we avoid it? Just like all the simulation training we talk about, this is one you need to go over a few times, both in your head and in practice (with ‘smoother’ cannulations). Here’s one framework: