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 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 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