What immediate actions should be taken after inserting an IV cannula in the left hand, including neurovascular assessment, securing the line, documentation, and patient education?

Immediate Post-Insertion Management of IV Cannula in Left Hand

After placing an IV cannula in the left hand, immediately secure the line with transparent dressing, confirm patency by aspirating and flushing with normal saline, assess for signs of infiltration (pain, swelling, discoloration), document the insertion date and site, and educate the patient on warning signs. 1, 2, 3

Immediate Post-Insertion Steps

Confirm Proper Placement and Function

• Aspirate back 1-5 mL with a syringe to confirm blood return, then flush with normal saline 1, 2
• The syringe must aspirate and flush with ease—resistance indicates malposition 1
• Monitor immediately for signs of infiltration: patients typically experience sharp pain if saline infiltrates into tissues 1, 2

Secure the Cannula

• Tape the cannula securely at the same angle or similar to the angle of insertion 2
• Use transparent dressing to allow visualization of the insertion site 3
• Critical pitfall: Avoid pressing the needle shaft flat against the skin, as this can move the catheter tip from its desired position within the vessel lumen 2

Neurovascular Assessment

• Assess carefully for signs of infiltration: pain, swelling, or discoloration 1, 2
• If the patient complains of paresthesias or numbness near the IV site, remove the catheter immediately—this may indicate nerve injury 4
• Monitor for adequate blood flow and vessel patency 1

Documentation Requirements

• Document the date of cannula insertion 3
• Document the site of cannula insertion (left hand) 3
• Document the indication for cannula insertion 3
• Complete the cannula care bundle if your institution uses one 3

Flushing Protocol

• Only use heparinized saline or normal saline to flush the cannula 5
• Never use glucose-containing solutions—these are contraindicated as they have caused severe hypoglycemia when mis-administered 5

Ongoing Monitoring

• Assess the cannula site at least every 24 hours 3
• Monitor for cannula-related complications including thrombophlebitis, infiltration, and infection 3, 6
• The hand site has been associated with higher rates of thrombophlebitis compared to cubital fossa sites, so vigilance is particularly important 7, 6

Patient Education

• Instruct the patient to report immediately if they experience:
  • Sharp pain at the insertion site 1
  • Swelling or discoloration around the cannula 1
  • Numbness or tingling near the IV site 4
  • Any sensation that the IV "doesn't feel right" 1

Common Pitfalls to Avoid

• Do not apply pressure or manipulate the cannula after insertion, as this can dislodge it from the vessel 2
• Do not ignore patient complaints of paresthesias—remove the cannula immediately if nerve symptoms occur 4
• Do not use glucose solutions for flushing 5
• Do not skip documentation of insertion date and site, as this is essential for monitoring cannula dwell time and preventing complications 3
• Limit probing if the cannula needs repositioning to minimize nerve injury risk 4

When to Remove the Cannula

• Remove immediately if signs of infiltration, infection, or nerve injury develop 1, 4, 3
• Remove if the cannula is no longer patent or functional 3
• Do not routinely rotate IV sites—change only for clinical indications 5