8-28 CV Procedures - King Flashcards
What are the indications for venipuncture?
–Health screening
–Pre-operative evaluation
–Diagnostic aid
What are the relative contraindications for venipuncture?
–Patient inability to sit still (young child)
–Skin conditions interfering with access (scleroderma, cellulitis)
What are the complications with venipuncture?
–Bleeding (bruising, hematoma)
–Infection
–Arterial/nerve injury
What are the supplies needed for venipuncture?
- Tourniquet
- Gloves
- Alcohol swabs
- Appropriate needle device
–Vacutainer, Butterfly, Syringe
• Blood specimen tubes
–Specific to the tests you want
- Gauze pads or cotton balls
- Bandage
- ID Labels
What is the most common method for venipuncture?
•Vacutainer and needle holder
–Most common method
–allows for draw of multiple tubes
What kinds of needles are frequently used for venipuncture? Why?
•10cc Syringe & 21-22 gauge 1” needle
–Easier to see flashback of blood
–Smaller bores needles cause RBC hemolysis which may be mistaken for anemia or hyperkalemia
•Butterfly needles
–Smaller and less painful
–Easy to hold
–Tubing is attached to vacutainer or syringe
What should you do to prepare to do a venipuncture?
- Assemble all supplies first
- Position patient
–Straighten patient’s arm with their elbow resting on a flat surface
•Apply tourniquet
–Above the antecubital fossa
–In a snug slip knot
•Distend veins by having patient open and close fist several times
How do you select a site for venipuncture?
- Choose a vein that is distended most commonly the median cubital
- Glove up
- Clean with the alcohol swab in concentric circles starting from the center and working out
- Don’t repalpate the clean area; you will contaminate it
What is the venipuncture procedure?
- Use non-dominant hand to apply traction below the vessel to anchor it, keep it from moving and tense the skin making needle insertion easier
- Use dominant hand to insert the needle at a 15-30 degree angle until you see a flashback of blood into the needle hub
–Flashback not visible with evacuated tubes until they are inserted into the tube holder
•If no flashback, partially withdraw the needle and reposition and advance again.
–If you accidentally withdraw the needle from the skin you must start over with a clean needle
- Release the tourniquet before removing needle
- Apply pressure with cotton ball after removing needle
What are the indications for IV catheterization?
–Administration of fluids and medications
What are the relative contraindications for IV catheters?
•Relative contraindications
–Patient inability to sit still
–Skin conditions interfering with access
What are the complications associated with IV catheters?
•Complications
–Bleeding (bruising, hematoma)
–Infiltration of fluid into subcutaneous tissue
–Infection
–Thrombosis
What supplies do you need for an IV?
- Gloves – non-sterile
- Alcohol or Betadine
- Tourniquet
- IV catheter
- IV tubing
- Extension or saline lock
- Skin tape or OpSite
- Gauze pads
- IV solution
How do you prep for an IV catheter?
- Assemble all supplies first
- Connect the IV tubing to the solution bag and allow the fluid to run through the tubing eliminating all the air (priming the tubing), then clamp the line closed.
- Tear several pieces of tape, 4-6 inches in length and place them nearby.
How do you select an IV site?
•Select a vein on the non-dominant forearm that is fixed
–Basilic or cephalic veins on the dorsal forearm are preferred
–Metacarpal veins on the dorsum of the hand are the easiest to visualize, but are more likely to occlude and are prone to infiltration
What should you avoid when selecting an IV site?
•Avoid
–Areas of flexion and bony prominences
•The antecubital fossa veins should be reserved for emergency use only
–Near multiple valves/branches
–Pre-existing catheter sites
–Ipsilateral mastectomy and/or lymph-node dissection
–Ipsilateral arteriovenous (AV) fistula or graft
How can you use topical anesthetic to start an IV?
- Use if necessary but remember it often causes more pain to administer than starting the iv.
- Topical
–Lidocaine based cream or ointment applied to the insertion site 30-60 minutes prior
•Injectable
–Lidocaine solution (1% or 2%) injected locally 5-10 minutes prior to form a small wheal
What is the procedure for an IV catheterization?
- Put on gloves.
- Tie a tourniquet using a “slip-knot” proximal to the venipuncture site.
- Clean the site with an alcohol or Betadine in a circular motion and allow to dry.
- Hold the catheter between your thumb and middle finger with your index finger on the top.
- Hold the catheter at a 30o angle with needle bevel facing upward and enter the skin .
- Continue to advance the needle until you feel a “pop” into the vein and see the “flashback of blood” within the needle’s transparent hub.
- Lower the angle of the needle and advance it about 3-5mm
- Slowly slide the catheter sheath of the needle into the vein by gentle twisting back and forth, while continuing to hold the needle hub at it’s present position. Do not advance the needle, just the IV catheter, until there is only 1- 3mm of the catheter remaining visible.
- Withdraw the needle completely from the catheter and occlude the blood flow from the catheter by pressing on the vein proximal to the catheter tip within the vein. Gauze placed under the catheter hub catches any leaks.
- Remove the tourniquet.
- While still holding the catheter still attach the free end of the primed IV tubing to the catheter hub.
- Open the clamps of the IV tubing to start the flow from the IV bag to ensure patency
- Use a small gauze pad or alcohol pad to wipe away the excess blood from the surface of the skin.
- Use the pre-torn pieces of tape or an OpSite to secure the catheter hub and tubing to the patient’s skin.
If:
- The patient complains of pain or burning
- The skin appears to be swelling
- There is not good flow in the drip chamber
What’s happening?
•The IV fluid may be flowing into the surrounding tissue instead of the vein. Remove the catheter and start over at a different site.
What are the indications for a central venous catheter?
–Inability to maintain peripheral venous access
–Need for access to central circulation, i.e. pacemaker or pulmonary artery catheter
–Infusion of hypertonic or substances that cause sclerosis of peripheral veins, i.e. TPN or chemotherapeutic drugs
–Hemodialysis
What are the contraindications for a central venous catheter?
–Contralateral pneumonectomy
–Bleeding diathesis
–Operator inexperience
–Infection at insertion site
–Recent placement of pacemaker
What are the possible contraindications with a central venous catheter?
–Arterial puncture
–Pneumothorax
–Thrombosis
–Infection
-Cardiac dysrhythmia
What is the EKG a representation of?
- The electrocardiogram (EKG) is a representation of the electrical events of the cardiac cycle.
- Each event has a distinctive waveform, the study of which can lead to greater insight into a patient’s cardiac physiology and/or pathology
What are the indications for an EKG?
•Indications
–Chest pain of suspected cardiac origin
–Suspected arrhythmia
–Screening for cardiac conditions (high risk)
–Pre-operative evaluation
