IV access and Injections Flashcards
Hand washing
- Primary means of preventing spread of infection (especially nosocomial)
- Minimum 15 seconds, soap, friction
- Alcohol based antiseptic
- Wash hands before and after each blood draw
Blood Collection Tubes:
- Contain a vacuum
- Used with Vacutainer and Syringe system
- Stoppers universal color coded: indicates contents
- Have an order of draw
- Have an expiration date
ORDER OF DRAW
Blood collection tubes must be drawn in a specific order to avoid cross-contamination of additives between tubes.
The recommended order of draw for tubes is:
1. Blood culture bottle
2. Coagulation tube (light blue top).
3. Non-additive tube (red top)
4. Additive tubes
Contains a gel separator and clot activator
Needles: never do what and size of needle
- NEVER reuse a needle
- NEVER use if shield is broken
- NEVER recap, cut, bend or break
- Drop into sharps container immediately after venipuncture
Size of needle is indicated by gauge:
* Larger gauge number indicates smaller needle diameter
* 20,21,22 gauge needles routinely used for phlebotomy
* Needle length depends on injection site
* Adults 5/8” vs. 1” vs. 1.5”
* Children 5/8” vs. 1”
* If less SQ fat, use shorter needle
16 gauge-18 gauge- Larger size, not often used for venipuncture-20 gauge-21 gauge -Used with evacuated tube systems-22 gauge-23 gauge -Used w/ butterfly system, or syringes 0-5 mL capacity-25 gauge -Smallest gauge needle, pediatric, often causes hemolysis of blood
- Bevel is slanted opening at end of needle.
Puncture skin at a 5-30-degree angle-bevel up QQ - Needle must be oriented so that bevel faces up prior to insertion
Vacutainer
* Most often used
* Most economical
* Quick
* Least risk of accidental needle stick
Syringe
* More control
* Reposition easily
* Will see ‘flash’ of blood in syringe hub when vein successfully entered
Selecting the Site:
- Antecubital area most often accessed
- May also use hand or wrist
- Use tip of index finger on non-dominant hand to palpate area to feel for the vein
The Veins Most Commonly Accessed
Venipuncture Procedure:
- Locate vein
- Release tourniquet
- Cleanse site in outward rotation
- Allow to air dry
- Reapply tourniquet
- Do not contaminate site
- Anchor vein
- Insert needle at a 5-30-degree angle-bevel up QQ
- Fill tubes
- Correct order of draw
- Release tourniquet
- Withdraw needle
- Apply dressing
- Dispose of needle
- Recheck site and patient
Withdraw Needle:
- First release tourniquet
- Disengage tube
- Place gauze directly over needle, without pressing down
- Withdraw needle in swift, smooth motion
- Immediately apply pressure to wound
- Do not bend arm
- Apply dressing or bandage
- recheck draw site
Label Tubes Immediately:
In sight of patient
- Patient name
- Identification number
- Date of draw
- Time of draw (military time)
- Your initials
Collection Site Problems: Veins & Sites to Avoid During Venipuncture
Veins that lack resiliency
Extensive scarring
Hematomas: Prevent hematomas by removing the tourniquet before needle removal, applying direct pressure
Edematous area
Side of mastectomy
Intravenous line
reasons for Failure to Obtain Blood and what to do
Check tube position and vacuum
Always have back up tubes near by
Needle position
Collapsed vein
what to do: You should try again
* Look at alternate site
* Other arm
* Hand
* Use clean needle
* Use fresh syringe if contaminated
Poor Collection Techniques:
- Venous stasis
- Hemodilution
- Hemolysis
- Clotted Sample
- Partially filled tubes
- Specimen Contamination
- Specimen handling
Accidental Needle Stick:
- Remain calm
- Cleanse wound with alcohol
- Wash wound thoroughly
- Notify supervisor, instructor
- Follow site protocol
- Complete incident report
*
Obtaining Blood Culture
Blood cultures should only be taken when there is a clinical reason to suspect septicemia. They should not be taken for routine assessment or for the investigation of a localized infection.
- Locate the vein
- Prep kit
- Alcohol 5 sec. Dry 30-60 sec
- Chlorhexidine or tincture of Iodine-center to periphery. Dry 45-60 sec
- Put on gloves
- Remove caps, clean with alcohol
- Without palpating, draw 20 ml and put 10 in anaerobic and 10 in aerobic bottle
- Dispose of syringe in sharps container
- Label bottles and send to lab
Complications of venipuncture
- Nerve and arterial injury
- Abscesses (sterile or septic)
- Bleeding ( controlled with pressure)
Vasovagal Syncope
- Be aware of patient behavior
- Have patient sit before administration
- Lay patient down if necessary
- Check airway, breathing and vital signs
Documentation IV access
Finding a vein can be challenging
– Go by “feel”, not by sight. Good veins are bouncy to the touch, but are not always visible.
– Use warm compresses and allow the arm to hang dependently to fill veins. QQ***
– Avoid areas of joint flexion
– Start distally to proximal
contraindications of injection
- Allergy to any components of the injectate
- Active infection or dermatitis at the injection site
- Coagulopathy (IM injections)
rights of medcation administion
1. Right patient.
2. Right vaccine and diluent (if applicable).
3. Right time (product expiration time/date).
4. Right dosage.
5. Right route (including needle gauge, length, and correct technique).
6. Right reason.
7. Right documentation.
documentation injection
