Where intravenous (IV) access has been established prior to cardiac arrest, the in situ cannula should be used. Where a patient has developed chest pain or has become acutely unwell, inserting a cannula should be performed at the earliest opportunity, not least because it will be needed to administer adequate analgesia.
Peripheral cannulation is a skill that is currently performed by nurses and other healthcare professionals. However, inserting a peripheral cannula during a resuscitation attempt is not easy, because the patient's arms move with the motion of chest compressions and peripheral veins collapse because of poor cardiac output. The usual advice to cannulate as peripherally as possible should be reversed; the largest available veins should be cannulated, most commonly in the antecubital fossa. If possible, a sample of blood should be withdrawn while cannulat-ing and care should be taken with the disposal of sharps.
If the cannula is patent, drugs can be given through it at any time other than during defibrillation. All drugs should be flushed with 20 ml of normal saline and if possible, the arm should be raised. Without these manoeuvres, the drug will remain in the peripheral circulation. It has been suggested that it takes up to five minutes for a drug administered by a peripheral cannula during cardiopulmonary resuscitation (CPR) to reach the heart and the central circulation (Resuscitation Council UK 2000).
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