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AN EASY TECHNIQUE FOR INTRAVENOUS CANNULISATION
830 Of 11 cases treated by this method 10 completely recovered.. I wish to thank Dr. L. Laub, late chief of the department of
laryngology, St. Roch’s Hospital, applying the local treatment.
for his skilled
is important, since it prevents difficulty at a later stage. If the cannula tip is left outside the incision it tends to become caught on the edge of the skin in passing through the incision at an acute angle. Enter the vein in the usual way about 1/2 in. proximal to the incision and slide the needle into the vein slightly further after ensuring, by withdrawing blood, that the vein has been entered. Then slide the cannula along the needle into the vein with the right hand, steadying the syringe with the left as this is done. There will be a definite feeling of resistance as the cannula enters the vein; it is then slid right in up to its base, and the syringe and needle are withdrawn after compression has been released.
cooperation in
_________________
ADDENDUM
Mr. C. Price Thomas, of the Brompton Hospital, was good enough to draw my attention to the fact that, about the same time, similar experiments were carried out, with similarly good results, by Mattei et al.1 at
Marseilles.
AN EASY TECHNIQUE FOR INTRAVENOUS
CANNULISATION ALLAN CLAIN Cape Town
M.B. ROUSE-SURGEON,
.
ROYAL NORTHERN
HOSPITAL,
LONDON
THE technique described here has been used on twentyfive patients at the Royal Northern Hospital, Holloway. It is a simple, speedy, and effective method for introducing rsiooa win men tncKie out 01 me canmua, ana tne a blunt cannula into a vein. It has advantages over the West Middlesex needle adapter is attached and the transfusion started. The cannula and tubing are strapped to the part in the method in that it is much easier and does not need a usual way, but it is unnecessary to splint the limb unless vein junction for its performance. Experience shows the patient is restless or a vein at the bend of the elbow that the West Middlesex needle tends to pierce veins When the time comes, the cannula is or slip past them unless one enters a fork where twois being used. veins join-e.g., at the origin of the cephalic vein at the simply pulled out and a small dressing applied. back of the wrist. The method described here can be My thanks are due to Mr. Hamilton Bailey, F.R.C.S., for advice and encouragement, and the nurses of the Royal used at this point, the bend of the elbow, the long saphenous vein in front of or above the medial malleolus, Northern Hospital for patient assistance. or any vein which can be distended sufficiently for It does not destroy an intravenous needle to enter. GLANDULAR ENLARGEMENT IN ADULTS the vein used and is successful in all but extremely REVIEW OF NINE CASES collapsed or very small veins and thus has definite advantages over a tied-in cannula. It is also much H. M. ROYDS JONES quicker to perform and the whole transfusion can be M.D. Lond. set up in five minutes. ORIENT STEAM NAVIGATION CO. SURGEON, Requirements.—These are simple and will be found in DURING the late war I saw occasional cases of enlarged most wards : lymphatic glands, with or without a rash and pyrexia, (1) a medium-sized (about S.W.G. 18) straight blunt where the blood changes did not correspond to those of cannula of the West Middlesex or Jube type ; or fever. alternatively a sharp-ended intravenous transfusion glandular These cases presented some difficulty in diagnosis, and needle which has had its tip filed off ; there was always doubt whether they were isolated (2) a fine lumbar-puncture needle which will go through atypical cases or a separate syndrome.For this reason the cannula easily and protrude from its tip for 3/4-1 in. ; this small group of cases, occurring on board ship, is (3) a small syringe ; and because the pathological investigations reported, (4) a fine hypodermic needle; did not seem to confirm the clinical diagnosis. (5) a small scalpel; The cases were distributed over two voyages in the (6) an adapter. same ship : 7 on the first voyage and 2 on the second. Procedure.-Choose any suitable vein and inject The group of 7 patients were seen within a period local anaesthetic intradermally about 1/2 in. distal to the of 16 days, 5 of them being members of the crew and point where it is proposed to enter the vein. All that 2 passengers. All 5 of the crew were about 21 years is necessary is to raise a small weal. While the local old. The histories of all the cases were similar, except anaesthetic is taking effect, set up the intravenous where stated. The patients first complained of a " lump behind the apparatus in the usual way and attach the adapter, which is going to fit into the cannula, to the end of the - ear," which proved to be a painful enlarged lymph-gland. rubber tubing. Next make a short skin incision (less Further search showed that glands were enlarged on than 1/4 in. is sufficient) and push the cannula through both sides of the neck, in the axillæ, and to a lesser extent in the groins. The spleen was impalpable this to ensure its going through easily when the time The lumbar-puncture needle is attached to the comes. throughout the illness, and the patients were apyrexial. local which has been used for the In 5 cases there was a macular rash on the chest (unnoticed anaesthesia, syringe and the cannula is slid over the needle so that its base by the patients), which faded in a few hours. A sixth lies next to the base of the lumbar-puncture needle. patient had a macular rash on the face only, and the The vein to be used is then distended. If the long remaining patient had no rash at all. Blood films done saphenous vein is being used, it is useful to have a on board showed a moderate leucocytosis (11,000sphygmomanometer cuff round the calf. Next, insert 14,000 per c.mm.) and an increase in mononuclears the lumbar-puncture needle and the tip of the cannula (14-25%). These cases were diagnosed as glandular fever through the skin incision (see figure). This latter point (infective mononucleosis). Cases 1, 2, and 3, in which the disease began on 1. Mattei, C., Recordier, M., Métras, H., Barbe, A. Pr. méd. March 19, 21, and 24, 1947, respectively, were further March 23, 1946, p. 185. _
..
laryngology, St. Roch’s Hospital, applying the local treatment.
for his skilled
is important, since it prevents difficulty at a later stage. If the cannula tip is left outside the incision it tends to become caught on the edge of the skin in passing through the incision at an acute angle. Enter the vein in the usual way about 1/2 in. proximal to the incision and slide the needle into the vein slightly further after ensuring, by withdrawing blood, that the vein has been entered. Then slide the cannula along the needle into the vein with the right hand, steadying the syringe with the left as this is done. There will be a definite feeling of resistance as the cannula enters the vein; it is then slid right in up to its base, and the syringe and needle are withdrawn after compression has been released.
cooperation in
_________________
ADDENDUM
Mr. C. Price Thomas, of the Brompton Hospital, was good enough to draw my attention to the fact that, about the same time, similar experiments were carried out, with similarly good results, by Mattei et al.1 at
Marseilles.
AN EASY TECHNIQUE FOR INTRAVENOUS
CANNULISATION ALLAN CLAIN Cape Town
M.B. ROUSE-SURGEON,
.
ROYAL NORTHERN
HOSPITAL,
LONDON
THE technique described here has been used on twentyfive patients at the Royal Northern Hospital, Holloway. It is a simple, speedy, and effective method for introducing rsiooa win men tncKie out 01 me canmua, ana tne a blunt cannula into a vein. It has advantages over the West Middlesex needle adapter is attached and the transfusion started. The cannula and tubing are strapped to the part in the method in that it is much easier and does not need a usual way, but it is unnecessary to splint the limb unless vein junction for its performance. Experience shows the patient is restless or a vein at the bend of the elbow that the West Middlesex needle tends to pierce veins When the time comes, the cannula is or slip past them unless one enters a fork where twois being used. veins join-e.g., at the origin of the cephalic vein at the simply pulled out and a small dressing applied. back of the wrist. The method described here can be My thanks are due to Mr. Hamilton Bailey, F.R.C.S., for advice and encouragement, and the nurses of the Royal used at this point, the bend of the elbow, the long saphenous vein in front of or above the medial malleolus, Northern Hospital for patient assistance. or any vein which can be distended sufficiently for It does not destroy an intravenous needle to enter. GLANDULAR ENLARGEMENT IN ADULTS the vein used and is successful in all but extremely REVIEW OF NINE CASES collapsed or very small veins and thus has definite advantages over a tied-in cannula. It is also much H. M. ROYDS JONES quicker to perform and the whole transfusion can be M.D. Lond. set up in five minutes. ORIENT STEAM NAVIGATION CO. SURGEON, Requirements.—These are simple and will be found in DURING the late war I saw occasional cases of enlarged most wards : lymphatic glands, with or without a rash and pyrexia, (1) a medium-sized (about S.W.G. 18) straight blunt where the blood changes did not correspond to those of cannula of the West Middlesex or Jube type ; or fever. alternatively a sharp-ended intravenous transfusion glandular These cases presented some difficulty in diagnosis, and needle which has had its tip filed off ; there was always doubt whether they were isolated (2) a fine lumbar-puncture needle which will go through atypical cases or a separate syndrome.For this reason the cannula easily and protrude from its tip for 3/4-1 in. ; this small group of cases, occurring on board ship, is (3) a small syringe ; and because the pathological investigations reported, (4) a fine hypodermic needle; did not seem to confirm the clinical diagnosis. (5) a small scalpel; The cases were distributed over two voyages in the (6) an adapter. same ship : 7 on the first voyage and 2 on the second. Procedure.-Choose any suitable vein and inject The group of 7 patients were seen within a period local anaesthetic intradermally about 1/2 in. distal to the of 16 days, 5 of them being members of the crew and point where it is proposed to enter the vein. All that 2 passengers. All 5 of the crew were about 21 years is necessary is to raise a small weal. While the local old. The histories of all the cases were similar, except anaesthetic is taking effect, set up the intravenous where stated. The patients first complained of a " lump behind the apparatus in the usual way and attach the adapter, which is going to fit into the cannula, to the end of the - ear," which proved to be a painful enlarged lymph-gland. rubber tubing. Next make a short skin incision (less Further search showed that glands were enlarged on than 1/4 in. is sufficient) and push the cannula through both sides of the neck, in the axillæ, and to a lesser extent in the groins. The spleen was impalpable this to ensure its going through easily when the time The lumbar-puncture needle is attached to the comes. throughout the illness, and the patients were apyrexial. local which has been used for the In 5 cases there was a macular rash on the chest (unnoticed anaesthesia, syringe and the cannula is slid over the needle so that its base by the patients), which faded in a few hours. A sixth lies next to the base of the lumbar-puncture needle. patient had a macular rash on the face only, and the The vein to be used is then distended. If the long remaining patient had no rash at all. Blood films done saphenous vein is being used, it is useful to have a on board showed a moderate leucocytosis (11,000sphygmomanometer cuff round the calf. Next, insert 14,000 per c.mm.) and an increase in mononuclears the lumbar-puncture needle and the tip of the cannula (14-25%). These cases were diagnosed as glandular fever through the skin incision (see figure). This latter point (infective mononucleosis). Cases 1, 2, and 3, in which the disease began on 1. Mattei, C., Recordier, M., Métras, H., Barbe, A. Pr. méd. March 19, 21, and 24, 1947, respectively, were further March 23, 1946, p. 185. _
..