Cannula - Essential Medical Devices for Safe Fluid Transfer

What is a Cannula?

A cannula is a thin tube that is inserted into the body, usually through the skin, to administer or remove fluids or to monitor certain conditions. Cannulas come in various sizes and designs depending on the intended use and area of insertion. The most common types of cannulas are used for intravenous therapy, dialysis, blood collection, and arterial access during surgery.

Intravenous Cannula Insertion and Use
One of the most common uses of cannulas is for intravenous (IV) therapy. An IV cannula is inserted into a vein, usually in the arm or hand, to deliver fluids, medications, blood products, nutrients, or other treatments directly into the circulatory system. The intravenous cannula allows healthcare providers to administer these substances quickly and efficiently without repeated needle sticks. Some key points about IV cannulas:

- They are made of thin, flexible plastic or silicon materials and range from 18-24 gauge in size depending on the vein size and intended use. Larger gauges are used for fluid replacement while smaller sizes are used for medications.

- Various parts of the cannula include the needle used for insertion, catheter portion that remains in the vein, tube attached for fluids/ medications, and stabilization device like tape or securement device.

- Proper insertion involves finding a suitable vein, cleaning the skin with antiseptic, and quickly inserting the needle attached to the catheter into the vein until flashback of blood is seen. The needle is then withdrawn leaving just the catheter portion in place.

- IV cannulas are generally left in place for hours, days or even weeks depending on the treatment needs and are secured to prevent dislodgment or movement in the vein. Dressings are changed periodically.

- Signs of complications include pain, redness, swelling or oozing at the insertion site, leaking infusions, or dislodgment of the cannula.

Central Venous Catheters for Long-term or Frequent Access

For patients requiring longer term IV access or frequent administration of substances like antibiotics, chemotherapy or total parenteral nutrition, a central venous catheter may be used instead of peripheral IV cannulas. These are inserted into a large vein in the neck, chest or groin and fed into a central vein leading to the heart. Some catheter types are:

- Peripherally inserted central catheter (PICC) - inserted at the inner elbow/arm and guided into a central vein through x-ray.

- Central venous catheter (CVC) - directly placed in a central neck or chest vein during a procedure.

- Hemodialysis catheters - used short term for dialysis through two lumens in a neck or chest vein.

- Port-a-cath - a port or reservoir placed under the skin in the chest area with a catheter extending to a central vein. It has a septum where fluids can be injected without piercing the skin each time.

Central lines remain in place longer but have higher risks of complications like bloodstream infections if not handled aseptically. Thus, sterile technique is imperative during any access, administration or dressings changes.

Arterial Cannulation
Arterial cannulas are essential during surgeries involving monitoring of blood pressure, gas analysis or blood draws from the arterial system. They are generally placed in the radial, femoral or brachial artery using sterile technique under local anesthesia. Arterial cannulas have stiffener Inside to prevent collapse and are connected to invasive monitoring systems. Due to associated risks of bleeding, infection, or damage to the artery, arterial lines are removed as soon as they are no longer needed.

Hemodialysis Cannulas
Patients with renal failure requiring long term dialysis treatment undergo cannulation of arteriovenous fistulas or grafts created between an artery and vein specifically for hemodialysis access and recirculation of blood. Two large bore cannulas are inserted - one for withdrawal of blood to the dialysis machine and other to return purified blood. Cannula needles range from 15-17.5 gauge and must be carefully inserted to avoid damage or clotting off of the fistula/graft. Proper cannula care, dressing and monitoring helps prevent infections and maximize patency of the access.

Other Specialty Cannula Uses

Some other less common applications of cannulas include peritoneal dialysis catheters placed into the abdominal cavity, epidural or intrathecal catheters for anesthesia/pain management inserted into the spine, chest tubes inserted after surgery to drain air/fluid from the pleural space, umbilical vein catheters in newborns, or peripheral nerve blocks for surgical procedures. In all cases, the cannula material, size, insertion site and technique are chosen carefully based on the intended use for optimal outcomes.

cannulas in various designs are utilized commonly across medical fields for short or long term vascular access and administration/monitoring of fluids, medication or blood components. When inserted and cared for properly by trained staff using aseptic technique, cannulas prove invaluable for patient care, treatment and management of conditions. However, vigilant monitoring helps minimize potential complications from misplacement, dislodgment, leakage, infection or nerve injury related to these short or long indwelling devices.

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