lab procedures Flashcards
venipuncture indications
health screening
pre-op eval
diagnostic aid
venipuncture relative contraindications
patient inability to sit still
skin conditions
venipuncture complications
bleeding
infection
arterial/nn injury
vacutainer
most common
allows for draw of multiple tubues
needle info for venipuncture
10cc syringe
21-22 gauge 1” needle
butterfly needles
smaller and less painful
easy to hold
venipuncture site and prep
choose v that is distended, usually medial cubital
glove up
clean w/alcohol swab concentric circles from inside out
don’t repalpate
venipuncture procedure
non-dominant hand to apply traction below vessel to ancor it
dominant hand to insert needle at 15-30 degrees until flashback is visible
if no flashback partially withdraw and advance again
release tourniquet BEFORE removing needle
IV cath indications
administration of fluids and meds
IV cath relative contraindications
patient inability to sit still
skin conditions interfering w/access
IV cath complications
bleeding
infiltration of fluid into subQ
infection thrombosis
selecting IV site
v on non-donminant forearm that is fixed
basilic or cephalic vv on dorsal forearm
metacarpal vv on dorsum of hand are easiest to visualize, but more likely to occlude
avoid sites for IV
areas of flexion and boney prominences near mutliple valves/brr pre-existing catherter sites anatomic deformities ipsilateral mesectomy and/or lymph dissection ipsilateral AV fistula or graft
local anestetic
lidocaine based cream or ointment 30-60min prior injectable lidocaine (1-2%) 5-10min prior
IV cath procedure
-gloves
-tourniquet
-clean w/alcohol or betadine
-hold catheter between thumb and middle finger w/index on top
hold catheter at 30 degree angle w/needle bevel facing upward
-enter the skin
-advance needle until flashback visible
-lower angle of needle advance 3-5mm
-slide catheter sheath of needle into vv, DO NOT ADVANCE NEEDLE
-withdraw needle completely from cateter and occlude blood
-remove tourniquet
-make sure fluid will flow
-tape
central venous catheter indications
inability to maintain peripheral vv access
need to access central circulation
infusion of hypertonic or substances that cause sclerosis or peripheral vv (chemo)
hemodialysis
central venous catheter contraindications
contralateral pneumonectomy bleeding diathesis operator inexperience infection at insertion site recent placement of pacemaker
complications
arterial puncture pneumothorax thrombosis infection cardiac dysarthmia
limb leads
white= right and smoke over fire
RA- white
LA- black
LL- red
V1
red
4th ICS at RSB
V2
yellow
4th ICS at LSB
V3
green halfway btwn V2 and V4
V4
blue
5th ICS MCL
V5
tan
5th ICS AAL
V6
violet
5th ICS MAL
