CV Procedures (Trawick) Flashcards
Venipuncture indications, contraindications, complications
Indications:
Health screening
Pre-operative evaluation
Diagnostic aid
Relative Contraindications:
Patient inability to sit still (young child)
Skin conditions interfering with access (scleroderma, cellulitis)
Complications:
Bleeding
Infection
Arterial /nerve injury
Venipuncture Supplies
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
Vacutainer and needle holder
Most common method
allows for draw of multiple tubes
Butterfly needles
Smaller and less painful
Easy to hold
Tubing is attached to vacutainer or syringe
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
Venipuncture Site Selection and Preparation
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
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
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
Intravenous Catheterization- indications, contraindications, complications
Indications
- Administration of fluids and medications
Relative contraindications
- Patient inability to sit still
- Skin conditions interfering with access
Complications
- Bleeding (bruising, hematoma)
- Infiltration of fluid into subcutaneous tissue
- Infection
- Thrombosis
IV Supplies
Gloves – non-sterile Alcohol or Betadine Tourniquet IV catheter IV tubing Extension or saline lock Skin tape or OpSite Gauze pads IV solution
Preparation for IV Procedure
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.
Selecting an IV Site
Select a vein on the non-dominant forearm or hand:
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
Local Anesthetic- 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
IV Catheterization Procedure
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 into the vein, 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.
Place gauze under the catheter hub to catch any blood leaks.
Remove the tourniquet
Withdraw the needle completely from the catheter while occluding the blood flow from the catheter by pressing on the vein proximal to the catheter tip.
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.
IV problems
If:
- The patient complains of pain or burning
- The skin appears to be swelling
- There is not good flow in the drip chamber
The IV fluid may be flowing into the surrounding tissue instead of the vein. Remove the catheter and start over at a different site.
Central Venous Catheter(Central Line) Indications, contraindications, complications
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
Contraindications Contralateral pneumonectomy Bleeding diathesis Operator inexperience Infection at insertion site Recent placement of pacemaker
Complications Arterial puncture Pneumothorax Thrombosis Infection Cardiac dysrhythmia
EKG indications, contraindications, complications
Indications
Chest pain of suspected cardiac origin
Suspected arrhythmia
Screening for cardiac conditions (high risk)
Pre-operative evaluation
Baseline data prior to exercise prescription
Baseline or longitudinal data for patients with HTN to screen for LVH
Contraindications
Patient inability to sit still
Skin conditions interfering with lead placement
Need for Basic Life Support
Complications
Skin reaction to adhesive
Incorrect interpretation of results
EKG Findings
Arrhythmias Myocardial ischemia and infarction Pericarditis Chamber hypertrophy Electrolyte disturbances Drug toxicity
EKG Lead Placement
Lie patient flat with arms to sides
If can’t lie flat make note on ECG what angle patient is resting at. (affects axis)
Legs should be flat and shoulder with apart
Wipe the areas for electrode placement with an alcohol pad to remove oil and dirt and shave any hair that may get in the way
Place the limb electrodes on the Right arm (white), Left arm (black) and the left leg (red) [and right leg if available (green)]
Way to remember: White = Right, and smoke over fire
These can be anywhere on the extremity but should be symmetrical
Place the chest electrodes in the following order
V1 (red)- 4th intercostal space at the right sternal border
V2 (yellow)- 4th intercostal space at the left sternal border (tricuspid)
V4 (blue)- 5th intercostal space at the midclavicular line (mitral)
V3 (green)- Halfway between V2 and V4
V5 (tan)- Anterior axillary line at the same level as V4
V6 (violet)- Midaxillary line at the same level as V4 and V5
