Interventional procedures for neonates

To administer intravenous medications and fluids and remove the cannula when it is no longer needed or if swelling occurs.

Procedure:

First: Insertion of Intravenous Cannula

Equipment:

• Sterile gloves
• Two cannulas (sizes 24, 22)
• Three syringes (1 ml)
• Saline solution or sterile water for injection
• Sterile gauze and cotton
• 70% ethyl alcohol
• Sterile towel
• Sterile scalpel
• Adhesive tape
• Tourniquet
• Sharps disposal container

Steps:

• Wash hands using routine handwashing and prepare the required equipment.
• Examine the veins to determine the best site for cannula insertion based on priority.
• Prepare pieces of adhesive tape for securing the cannula.
• Disinfect the area with alcohol using a unidirectional motion from top to bottom or a circular motion from the center outward.
• Fill the syringe with saline or sterile water.
• Open the cannula package.
• Inject saline into the cannula to confirm its patency.
• Keep the cannula in its plastic cover.
• Lightly tie the arm or leg above the vein with a tourniquet to make the vein visible or instruct the assisting nurse to apply pressure using their index finger.
• Insert the needle gently without pushing it too far into the vein until blood appears.
• Release the tourniquet.
• Withdraw the stylet (needle) while applying pressure on the skin above the vein to prevent blood flow.
• Place the stylet in its plastic cover in case it is needed again if blood does not flow properly.
• Inject 1 ml of saline to ensure the blood flow is unobstructed.
• Cover the cannula entry point with the white cap.
• Place a piece of sterile gauze under the cannula hub (especially if it has no wings) and another over the insertion site.
• Remove gloves to secure the cannula with adhesive tape.
• Record the date and time of insertion, as well as the name of the person performing the procedure, on the tape and in the documentation.
• Dispose of the used equipment properly and place the stylet in the sharps container.
• Remove gloves and wash hands using routine handwashing.

Precautions When Inserting a Cannula:

• Use a new sterile cannula for each new attempt.
• Perform routine handwashing and wear gloves before handling the cannula.
• Whenever possible, use upper limbs for cannula insertion.
• If inserting the cannula in the scalp, carefully remove excess hair using a scalpel and wash hands again.
• Attempt insertion in the lower part of the arm first, moving upward if necessary.
• Avoid inserting the cannula in areas with wounds, infections, or near joints.
• Avoid touching critical areas of the cannula, including:
• Cannula opening
• Inner surface of the cap
• Upper port opening and its inner surface
• Area in front of the wings

Second: Removal of Intravenous Cannula

Indications for Removal:

• If the area around the needle swells or shows signs of infection.
• Immediately after administering blood, blood products, or lipids.
• After 72 hours of insertion (ensuring a new cannula is placed in another site before removal and verifying fluid flow in the new vein).

Equipment:

• Sterile gloves
• Sterile gauze
• 70% ethyl alcohol
• Surgical betadine
• Adhesive tape
• Sterile towel
• Medical waste bin with a red bag
• Sharps disposal container

Steps:

• Perform routine handwashing and prepare the equipment.
• Moisten the adhesive tape with alcohol to ease removal and reduce pain.
• Disinfect the cannula site with betadine and apply sterile gauze over the site to prevent bleeding.
• Dispose of the removed cannula in the sharps container.
• Remove gloves and wash hands using routine handwashing.

Responsible Personnel:

• Nursing staff.