Checklist
| Preparation | Wash – Name – Explain | |
| Check for allergies | ||
| Position patient appropriately for procedure | ||
| Clean preparation surface | ||
| Gather equipment
(See explanation if pre-filled flush unavailable) |
Clean equipment tray | |
| Wash hands | ||
| Tourniquet | ||
| Skin cleaning equipment | ||
| Cannula (+ spare) | ||
| 0.9% NaCl flush | ||
| Cannula dressing | ||
| Separate tape & date strips from cannula dressing | ||
| Gauze | ||
| Safe sharps disposal | ||
| Blood bottle(s) if required | ||
| Site identification & cleaning | Return to patient | |
| Wash hands | ||
| Select appropriate site | ||
| Place tourniquet | ||
| Identify appropriate vein | ||
| Clean skin | ||
| Allow skin to dry | ||
| Cannulation | Wash hands and put on gloves | |
| Remove cannula bung and keep with equipment | ||
| Insert needle into vein | ||
| Observe primary flashback | ||
| Place gauze under port site to catch any spills | ||
| Advance cannula and withdraw needle | ||
| Observe secondary flashback | ||
| Release tourniquet | ||
| Remove needle and push cannula proximal to skin | ||
| Dispose of sharp safely | ||
| Replace bung | ||
| Secure cannula with tape strips | ||
| Apply dressing to cannula site | ||
| Take blood samples if required | ||
| Flush cannula with 0.9% NaCl | ||
| Finishing | Label date strip and attach to cannula dressing | |
| Dispose of all waste appropriately | ||
| Wash hands |
Explanation
Preparation
Wash, name, explain:
- Wash your hands
- Introduce yourself by name and role
- Check the patient’s name and date of birth
- Explain the task and get consent
- Check whether the patient has any known allergies, e.g., to plasters
“Hello, I’m one of the doctors. I’ve been asked to insert a cannula. This will involve placing a small plastic tube into a vein in your arm using a needle, which will then be used to give you medication or fluid. It may be slightly uncomfortable but should not be painful. You can ask me to stop at any time. Would that be okay?”
Position the patient appropriately for the procedure. For cannulation, ensure the patient is sitting in a comfortable position and you are able to comfortably access the procedure site. You may wish to place a pillow under the patient’s arm for support.
Clean your preparation space, typically a clinical trolley, using appropriate surface cleaning agents.
Gather Equipment
Clean an equipment tray and place it on your preparation surface. Wash your hands again after cleaning surfaces.
Gather the following equipment and place it in your clean tray, ensuring that key parts remain protected:
- Tourniquet
- Skin cleaning apparatus – usually alcohol-based
- Cannula – the type used will depend on your local equipment. The colour (and gauge) of the cannula will depend on the clinical scenario, however a pink (20G) cannula is usually a good choice for most non-emergency scenarios.
- 0.9% NaCl flush – may come pre-prepared. If no pre-prepared flush is available, see further information below. Check the expiry date of your flush. Expel any air bubbles from the flush.
- Gauze
- Cannula dressing
- Safe sharps disposal e.g., sharps bin
- Blood bottle(s) if required – sometimes a blood sample is taken at the time time as inserting a cannula. The cannula may require an adaptor to attach blood bottles depending on your local equipment.
Follow the below steps if you are required to draw up your own 0.9% NaCl flush:
- Gather equipment: 10ml syringe, drawing-up needle, 21 or 23G needle, 0.9% NaCl ampoule
- Check the expiry date of the NaCl
- Attach drawing up needle to syringe, ensuring that you do not touch the key-parts
- Draw up 10ml of NaCl into syringe
- Attach 21 or 23G needle to protect key part of syringe
- Expel any air bubbles
Site Identification & Cleaning
Return to the patient, wash your hands, and confirm that they are still happy to proceed. Ask the patient if they have a preference which arm you insert the cannula into. Ensure that there are no contraindications to using an arm e.g., active or recent infusion, fistula, lymphoedema. Identify the best site on the chosen arm, usually this is the dorsum of the hand.
Attach the tourniquet proximal to the preferred site. Ask the patient to make their hand into a fist. Look and feel for an appropriate vein. The best veins will be palpable, bouncy feeling, straight, and not too close to a venous junction.
Clean the skin using the appropriate equipment for at least 30 seconds and then allow the site to air dry for a further 30 seconds.
Cannulation
Wash your hands and put on your gloves. Do not touch the site you have cleaned.
Unsheathe the cannula. Confirm that the needle can move freely within the cannula tubing, and unfold the cannula wings. Remove the bung from the cannula port and place in your equipment tray to accidental disposal with the needle. Using your non–dominant hand, anchor the skin just distal to the venepuncture site to stabilise the vein and minimise movement. Insert the cannula into the vein at an angle of approximately 15-30° to the skin.
At this point you should observe primary flashback of blood in the chamber at the base of the cannula, indicating correct needle placement. Place a piece of gauze under the port site to catch any spills.
Slowly advance the cannula into the vein, while simultaneously withdrawing the needle gradually from the cannula tubing. You should then observe secondary flashback of blood in the cannula tubing.
Release the tourniquet as the cannula is now in the correct place and just needs securing. Advance the cannula gently upwards until it sits flush against the patient’s skin, while slowly withdrawing the needle entirely from the cannula tubing. Dispose of the sharp needle immediately and safely. Occlude the cannula port with the bung to prevent any blood leakage.
Secure the cannula by placing one strip of tape from the dressing over each cannula wing, then apply the dressing.
Take blood samples if required. Flush the cannula with the 0.9% NaCl, ensuring that the patient experiences no significant pain or swelling at the cannula site as you do so which might indicate the cannula is not sited correctly.
Finishing
Fill out the date sticker to record the date of insertion and place in a visible location on the cannula dressing.
Confirm that the patient is feeling well.
Dispose of all waste appropriately and clean your tray and trolley. Wash your hands.
Last updated Mar 2025
Head to members.zerotofinals.com for practice OSCE stations, including an interactive checklist, specific cases and clinical findings.
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