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Peripheral intravenous cannulation: over-the-needle catheter, 20 or 22 gauge;
povidone-iodine or chlorhexidine antiseptic solution, tape or other securement
device.
Ultrasound can be used to guide the procedure (see Chapter 131 Ultrasound ).

Procedure
If time allows, apply topical or local anesthetic over the expected puncture site to
achieve local anesthesia of the superficial skin. Place the patient on the examining
table in the supine position with the patient’s shoulders 7 to 10 cm from the end
of the table. Have the assistant lean over the patient to stabilize the trunk. The
assistant then holds the shoulder ipsilateral to the external jugular vein to be
punctured with one hand and places the other hand over the ipsilateral zygoma
and forehead, turning the head toward the contralateral shoulder and dropping the
head 15 to 20 degrees over the table top. Alternatively, the bed can be placed in
the Trendelenburg position with the head down 15 to 20 degrees.
Attach the butterfly to the syringe and check for patency if venipuncture for
blood draw is to be performed. Cleanse the skin over the vein circumferentially
with the antiseptic solution. Allow the antiseptic solution to dry. If the vein is not
easily visualized in this position, it may be necessary to stimulate an infant to cry
or a cooperative patient to perform a Valsalva maneuver to improve filling and
visualization of the vein. Slight manual pressure may also be applied parallel to
the superior margin of the clavicle by placing a finger along the clavicular border
to promote venous filling and improved visualization. Align the butterfly needle
(for venipuncture) or the over-the-needle catheter (for venous cannulation)
parallel to the vessel as shown in Figure 130.2 , and pierce the skin near the
white circle shown overlying or just next to the vein approximately one-half to
two-thirds of the distance between the angle of the jaw and the clavicle. Then
with gentle suction applied if using the syringe, advance the needle ( Fig. 130.2 ,
dotted line ) or over-the-needle catheter until the external jugular vein is entered.
If performing venipuncture, relieve the suction on the syringe and withdraw the
needle after withdrawing an adequate blood sample, and apply a sterile gauze

dressing. The assistant should bring the infant to the upright position and
compress the venipuncture site for 5 minutes. If performing venous cannulation,
advance the catheter into the vein, and remove the needle. Secure the catheter
with tape or other securement device.

RADIAL ARTERY PUNCTURE OR CANNULATION
Indications