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Med Procedures Quiz 2 > Venipuncture, ABG's, IV's & Injections > Flashcards

Venipuncture, ABG's, IV's & Injections Flashcards

1
Q

Purpose of Venipuncture

A

To obtain a blood sample for diagnostic testing (also starting IV’s)

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2
Q

Venipuncture Indications

A

If venous samples are needed in larger quantities than the finger-stick method can provide

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3
Q

Venipuncture Contraindications

A
  • Skin infections
  • Venous fibrosis on palpation
  • Presence of vascular shunt/graft
  • Presence of vascular access device on that extremity
  • In UE on the same side as a mastectomy
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4
Q

Venipuncture Complications

A
  • Infection (cellulitis)
  • Infection of the vein (Phlebitis)
  • Thrombosis
  • Laceration of the vein
  • Hemorrhage or hematoma @ puncture site
  • Vasovagal syncope
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5
Q

What veins are MC used for venipuncture?

A

Superficial veins in the antecubital fossa (median cubital vein)

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6
Q

Why are the superficial veins in the antecubital fossa MC used for venipuncture?

A
  • Less likely to roll
  • Lies more superficially
  • Skin is less sensitive here
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7
Q

Metacarpal Vein Considerations

A
  • More painful & likely to roll/collapse

- Use butterfly needle

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8
Q

MC needle sizes for venipuncture in adults

A
  • 21 gauge (green)

- 22 gauge (black)

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9
Q

Needle size for children or pts with small veins

A

23 gauge (light blue) butterfly

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10
Q

Light Blue Venipuncture Tube

A
  • 3.2% Sodium citrate
  • Prevents blood from clotting by binding Calcium
  • Coagulation
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11
Q

Red or Gold Venipuncture Tube

A
  • Serum tube with or without clot activator or gel

- Chemistry, serology, immunology

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12
Q

What does clot activator do?

A
  • Promotes blood clotting w/glass or silica particles

- Gell separates serum from cells

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13
Q

Green Venipuncture Tube

A
  • Sodium or lithium heparin with or without gel
  • Prevents clotting by inhibiting thrombin & thromboplastin
  • STAT & routine chemistry
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14
Q

Lavender or Pink Venipuncture Tube

A
  • Potassium EDTA
  • Prevents clotting by binding Calcium
  • Hematology & blood bank
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15
Q

Gray Venipuncture Tube

A
  • Sodium fluoride, & sodium or potassium oxalate
  • Fluoride inhibits glycolysis, and oxalate prevents clotting by precipitating calcium
  • Glucose, BAC, lactic acid
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16
Q

Indications for Blood Cultures

A
  • Infection of the blood suspected (bacteremia or septicemia)
  • Monitoring efficacy of pharm tx of blood borne infections
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17
Q

Blood Culture Contraindications

A
  • Site of active skin infection
  • Failure of multiple previous blood cx
  • Relative CI in pts on Coumadin
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18
Q

Suspect Contaminated Blood Culture in:

A
  • Samples with common skin flora (Staph epi)
  • Mixture of several kinds of bacteria in a sample
  • Growth is found in only one of several specimens from separate venipunctures
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19
Q

Blood Culture Equipment

A

Two bottles:

  • one containing aerobic media
  • one containing anaerobic culture media
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20
Q

Purpose of ABG’s

A

To determine gas exchange levels in the blood related to respiratory, metabolic & renal function (acid-base balance)
-ONLY reliable determination of ventilation & alveolar-arterial oxygen gradient (A-a Gradient)

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21
Q

What artery is used for ABG’s?

A

Radial

femoral 2nd choice

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22
Q

**What should be done prior to ABG’s?

A

Allen’s sign - to show that there is adequate collateral circulation

23
Q

ABG Indications

A
  • Identify respiratory, metabolic, and mixed acid-base disorders
  • Measurement of the partial pressures of respiratory gases
  • Monitoring of acid-base status
  • Assessment of the response to therapeutic interventions (ventilator pt in respiratory failure)
  • Quantification of oxyhemoglobin
  • Quantification of the levels of dyshemoglobins
24
Q

ABG Absolute Contraindications

A
  • Abnormal Allen’s test (consider different site)
  • Local infection of site
  • Presence of A-V fistula or vascular grafts
  • Known or suspected severe PVD of the limb involved
25
ABG Complications
- MC is hemorrhage or hematoma formation at the puncture site (more common in femoral & brachial arteries) - Thrombosis - Transient arterial spasm
26
Errors in ABG analysis can occur with
- Excess air bubbles (falsely elevated pO2) - Excess heparin in syringe (falsely low pCO2) - Delays in placing the sample on ice
27
What is the relationship of H+ to pH?
H+ concentration is inversely proportional to pH
28
Acidosis blood pH
29
Alkalosis blood pH
>7.45
30
Two types of respiratory failure
- Type I: pt has hypoxemia in the ABSENCE of hypercapnia | - Type II: pt has both hypoxemia and hypercapnia, indicating hypoventilation
31
Normal adult ABG values
- paO2: >10.7 | - saO2(%): 95-100
32
Hypoxemia values
-paO2:
33
Mild hypoxemia values
- paO2: 8-10.5 | - saO2(%): 90-94
34
Moderate hypoxemia values
- paO2: 5.3-7.9 | - saO2(%): 75-89
35
Severe hypoxemia values
-paO2:
36
Intradermal Injection Indications
- TB PPD testing - Intradermal anesthesia - Cosmetic procedures - Allergy testing - Vaccines - Sentinel node biopsies
37
Intradermal needle/syringe size
- 24-30g - 1/2 inch - 1cc
38
Subcutaneous Injection Indications
Drugs requiring slow absorption and long duration of action - Insulin - Hormones - Vaccines - Heparin/LMWH
39
Subcutaneous needle/syringe size
- 23-25 gauge in adults/older kids -25 or 27g in infants | - 5/8 to 3/4 inch
40
Subcutaneous Sites
-Thigh of infants (immunizations) Older kids/Adults: - Deltoid - Upper outer thighs - Abdomen
41
What is important to do with SC injections?
Aspirate (if blood, remove & pick new site)
42
IM Indications
- Drugs not easily absorbed orally - Intermediate rate of onset and duration of action preferred - When parenteral delivery necessary - Abx - Narcotics/pain meds - Hormones - Vaccines
43
IM Adult Sites
- Thighs Anterior - UOQ of Buttocks (avoidance of sciatic nerve) - Deltoid (
44
IM Children Sites
- UOQ of Buttocks | - Deltoid (avoidance of radial nerve)
45
IM needle/syringe size
- 19-22g - 1.5 inch - Size dependent on depth & drug viscosity
46
Venous Catheterization Indications
- Fluid replacement - Delivery of medications - Blood sampling
47
Venous Catheter Size
- Small veins: 18-20g | - Large veins/need for large volumes of fluids: 12-18g
48
Venous Catheter Site Considerations
- Largest vein in area where movement around joint will not be hampered - If drug to be infused don’t use small vein in hand = phlebitis - Consider length of time catheter to be in place
49
Intraosseus (IO) Lines
Process of injecting directly into the marrow of a bone to provide a non-collapsible entry point
50
IO Line Indications
Used to provide fluids and medication when IV access is not available or not feasible
51
First choice for IO placement
Antero-medial aspect of the upper tibia
52
Other sites for IO placement
- Anterior aspect of the femur & superior iliac crest | - Head of the humerus
53
MC complication of IO lines
Extravasation of fluid with a misplaced needle
54
How long can IO lines be left in place?
72-96 hours (goal is 2-4 hours)

Med Procedures Quiz 2 (2 decks)

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