IV initiation Flashcards
Short peripheral catheter
what we seen most in practice
midline peripheral catheter
in between of PIV and PICC
- allows for better flow rate and more hemodilution
- usually inserted in median cubital vein and resides at level of armpit
vein condition for IV insertion
should be straight, bouncy, and nicely palpable
vein collapse
will occur if patient is hypotensive or hypovolemic
Infant vein selection
if under 18 months then go for scalp veins due to the increased body fat
Elder patient vein selection
use BP cuff for vein dilation
- avoid metacarpal veins due to fragility
considerations for patients on anticoagulants
- will bleed more so hold gauze for longer
- will bruise more
stroke considerations
will have decreased circulation and increased chance of phlebitis
first choice for IV insertion
cephalic vein
- at wrist, on thumb side
go 8-10 cm above wrist
cephalic vein
- close to radial nerve
- first choice
- on thumb side
antecubital fossa vein
close to tendons of bicep, brachial artery, and median nerve
- inner elbow
palm side of wrist vein
close to median nerve
- on inside of thumb
metacarpal veins
easily visualized but small and fragile
- mostly avoid
feet veins
MUST require doctor order if inserting IV in foot
basilic vein
on pinky side
- large vein but difficult to start
median cubital and basilic vein
second option if cephalic not useable
median antebrachial
not ideal because lots of nerves nearby
- pinky side close to wrist; between cephalic and basilic
- commonly used in bloodwork
strategies for vein distention
- position extremity lower than heart
- tourniquet
- clench fist
- warm compress
gauge
the SMALLER the number the BIGGER the needle
most common gauge
20-24
irritants gauge
22-24
16 gauge
gray
18 gauge
green
20 gauge
pink
22 gauge
blue
24 gauge
yellow
26 gauge
violet
lab typically draws from … and use a gauge size of…
16 (grey) or 22 (blue) gauge at median cubital vein
once site is prepped you cannot..
re-palpate vein
drying the site
must not touch, let dry on own
for hairy patients site prep
use clippers, do not shave
direct venipuncture
appropriate for small gauge needles; most commonly done
- approach directly over vein
indirect venipuncture
can be used for all vein sites
- enter skin slightly adjacent to vein and insert into side of vein
PLAT
pause
lower
advance
thread
adult patient monitoring post insertion
every 4 hours
critically ill patient monitoring post insertion
every 1-2 hours
pediatric patient monitoring post insertion
every hour
mechanoreceptors
feel palpation of vein
thermoreceptors
sense temperature
chemoreceptors
process osmotic changes in blood
venipuncture for phlebotomy
similar to IV
- insert needle and attach tube to other end of needle
purpose of phlebotomy
-diagnostic testing
- blood donation
- therapeutic reasons
tunica adventitia
outter most layer
- connective tissue
tunica media
middle layer
- muscular and elastic tissue
tunica intima
inner layer
- endothelium layer
Evacuated tube system
most direct and efficient method
- closed system
Syringe system for blood collection
not preferred but useful for patients with small or difficult veins
butterfly system
used for small or difficult veins
- 23 gauge usually used
tube size selection criteria
age, amount of blood required, vein condition
tubes for blood collection
color coded and help determine order drawn in
- made of unbreakable plastic
additives in tubes for blood collection
anticoagulants, oxalates, citrates, EDTA, heparin
purpose of anticoagulants in blood collection tubes
extend metabolism and life span of RBCs
Oxalates, citrates, EDTA function
anticoagulants
- remove calcium and form calcium salts
oxalate
decreases calcium and regulates it
EDTA
decreases calcium and decreases platelet aggregation
-used for CBC
citrate
prevents high acid levels
- for coagulation study
heparin
prevents clotting by inhibiting conversion of prothrombin to thrombin and fibrinogen to fibrin
assessment data impacting blood collection
diet, stress, age, weight
first vein choice for phlebotomy
median cubital vein
second vein choice for phlebotomy
cephalic vein
order of collection when collecting multiple tubes of blood
blood culture –> coagulation tubes –> serum tube –> heparin tube –> EDTA tube –> oxalate tube
yellow tube
blood culture
- invert 8 to 10 times
blue tube
coagulation citrate
- invert 3 to 4 times
red tube
serum
- do not invert
red/gray tube
clot activator
- invert 5 times
green/gray tube
plasma separator
- invert 8 to 10 times
green tube
heparin
- invert 8 to 10 times
pink/purple tube
EDTA
- invert 8 to 10 times
gray tube
oxalate
- invert 8 to 10 times
discard method for drawing blood from CVAD
discarding first aspiration of blood to ensure no meds interfere with results
hematoma complication of phlebotomy and treatment
most common complication
- rapid swelling
- hold pressure over site for 2 min
- cold compress
Iatrogenic anemia complication of phlebotomy
will cause decreased Hct and Hgb due to large and frequent blood sampling
cephalic and basilic blood flow
45-95ml/min
subclavian vein blood flow
150-300ml/min
gauge size for blood
18-20
