Stage 1 Skills Flashcards
Venepuncture, IV cannula, infusion
Equipment for venepuncture
Butterfly device.
Vacutainer barrel.
blood sample tubes / blood culture bottles for collection of samples.
gloves and apron
A clean receptacle to put the equipment in.
A sharps disposal bin.
Antiseptic wipe x 3.
Single use tourniquet.
Cotton wool and tape.
Standard Intro for all procedures
- Full name and post.
- Identify the patient by asking them to state their name, date of birth and first line of address. Check against laboratory request forms, patient identification wrist band and patient’s notes.
- Explain and gain the patient’s consent. Inform them about potential complications (pain, bleeding, swelling/haematoma, infection).
- Ask the patient if they have any known allergies to surgical tape.
Performance of venepuncture
Handwash
PPE
equipment
palpate/ contraindications
set up equip
tourniquet
clean site
DO NOT REPALPATE
explain to patient
draw blood
release tourniquet
discard needle
Assess site
dress with cotton swab and tape
Contraindications for Venepuncture
- broken skin
- an arterio-venous fistula
- local infection
- hard or cord like veins on palpation
- or if the patient has had breast surgery / axillary lymph node removal or radiotherapy on that side.
Equipment for Cannula
Gloves and Apron
A clean receptacle to put the equipment in.
A sharps disposal bin.
Sterile Intravenous cannula
Sterile bung.
Clinell alcohol / chlorhexidine skin wipe
Single use tourniquet.
Transparent sterile dressing.
Appropriate sized syringe for the flush.
0.9% sodium chloride for injection for the flush.
Performance of IV cannula
Handwash
PPE
equipment
identify vein
Contraindications
Tourniquet
recheck vein
clean
ANTT - equipment set up
make sure patient ready - scratch
needle - 15-25 degrees until flashback
lower angle for secondary flahback advance cannula
fully insert
release tourniquet
apply pressure on vein near tip of cannula
anhor cannula remove needle
attach bung while maintaining hand
secure with dressing
Check name and expiry date on saline
flush nappy with solution (5ml)
While flushing ask if the patient can experience any pain
check for sweeling or leakage
write date and time attach to dressing
Sizes of cannulas - vol and common meds
20g - pink - 55ml/min
Purpose of tourniquet
To allow the vein to fill, ensuring it is as visible & ‘bouncy’ as possible
To occlude venous return
Infusion Equipment
Patient’s fluid prescription chart
500ml bag of Sodium chloride 0.9%
Intravenous infusion set “giving set”
Drip stand
Antiseptic wipe
Non sterile gloves and a disposable plastic apron.
0.9% sodium chloride ampoule for flush.
5 ml syringe.
Infusion rate calculation sheet.
Initiating infusion
- Introduce yourself
- Identify the patient
- Check that intravenous infusion is correctly prescribed on the patient’s fluid prescription chart and that the prescribed fluid has not already been administered. This is done to ensure that the patient does not receive any duplication of the treatment.
- Explain /gain the patient’s consent. Inform them about potential complications.
- Ask the patient if they have any known allergies or if they have had any adverse drug reactions in the past.
- If the patient has a cannula in place, check the area around the cannula including the insertion site for any signs of inflammation or infection.
- If you see any signs of infection and/or inflammation, then remove the cannula immediately and insert a new cannula at a different site.
Performance of Infusion
Check the fluid prescription chart for the fluid, volume and the rate, and the time and date of the prescription. Make sure that the prescription is signed and dated.
Collect the fluid and check it against the prescription chart and it is within the expiry date.
Check the fluid
Handwash
PPE
Remove infusion bag and check it
Check the packaging of the intravenous administration set (‘giving set’)
Open and Uncoil the set and check for any kinks in the tubing or damage.
Close the roller clamp fully on the giving set.
Remove the seal from the entry port on the infusion bag aseptically.
Remove the protective cover from the spike on the giving set.
Make sure that you do not touch the spike on the giving set.
remove the seal
Using a twisting action, insert the spike in the entry port on the infusion bag aseptically.
Place the infusion bag on a drip stand.
Gently squeeze the drip chamber until the fluid level reaches the half way mark.
Place the infusion bag on a drip stand
Leave the cap at the end of the giving set in place until ready to connect to the cannula. This ensures that you maintain an aseptic technique at all times.
Leave the cap at the end of the giving set
Open the roller clamp and observe as the fluid descends through the tube. This step will prime the line with fluid, expelling the large volume of air present in the infusion line.
Close the roller clamp once all air bubbles are expelled and fluid is dripping out. Close roller clamp.
Type of this Infusion?
The intravenous administration sets (giving sets) are ideal for giving fluids that are additive free or where no adverse effects are anticipated if the infusion rate varies. Theatres and A & E departments are two areas where ‘gravity’ infusions are often used.
Some groups of patients are at more risk of complications if the infusion rate varies unintentionally. These include children, elderly patients, patients with impaired cardiovascular status and those on complex medicine regimes. In such cases use of an infusion pump provides a greater degree of accuracy and control on the infusion rate.
Problems with Infusions:
- The infusion is running too slowly
- The infusion is running too quickly
- The infusion will not run
- Open the roller clamp and observe the flow rate
- Ensure that the infusion bag is at least 90cm above the patient and correctly placed on the drip stand
- Check the position of the patient’s arm
- Check the tubing, is it kinked?
- Gently flush with 5-10ml 0.9% saline - Check the roller clamp. Readjust the roller clamp
- Check the roller clamp
- Check the tubing, is it kinked?
- Gently flush the cannula with saline
- If the cannula is blocked then it may need to be replaced
What should you avoid on a cannula?
avoid antecubital fossa and wrist if possible
Things to check on an infusion
fluid -discolouration, cloudiness or presence of particulate matter. If any of these are observed then the fluid should not be used and be discarded.
Infusion bag - rom outer plastic covering and check for any signs of leakage or puncture. (moisture present on inner surface of the outer plastic - leaked)
for any damage. Ensure that it is not open and check the expiry date on the package.
Check the packaging
