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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
Q

ABG Complications

A
  • MC is hemorrhage or hematoma formation at the puncture site (more common in femoral & brachial arteries)
  • Thrombosis
  • Transient arterial spasm
26
Q

Errors in ABG analysis can occur with

A
  • Excess air bubbles (falsely elevated pO2)
  • Excess heparin in syringe (falsely low pCO2)
  • Delays in placing the sample on ice
27
Q

What is the relationship of H+ to pH?

A

H+ concentration is inversely proportional to pH

28
Q

Acidosis blood pH

A
29
Q

Alkalosis blood pH

A

> 7.45

30
Q

Two types of respiratory failure

A
  • Type I: pt has hypoxemia in the ABSENCE of hypercapnia

- Type II: pt has both hypoxemia and hypercapnia, indicating hypoventilation

31
Q

Normal adult ABG values

A
  • paO2: >10.7

- saO2(%): 95-100

32
Q

Hypoxemia values

A

-paO2:

33
Q

Mild hypoxemia values

A
  • paO2: 8-10.5

- saO2(%): 90-94

34
Q

Moderate hypoxemia values

A
  • paO2: 5.3-7.9

- saO2(%): 75-89

35
Q

Severe hypoxemia values

A

-paO2:

36
Q

Intradermal Injection Indications

A
  • TB PPD testing
  • Intradermal anesthesia
  • Cosmetic procedures
  • Allergy testing
  • Vaccines
  • Sentinel node biopsies
37
Q

Intradermal needle/syringe size

A
  • 24-30g
  • 1/2 inch
  • 1cc
38
Q

Subcutaneous Injection Indications

A

Drugs requiring
slow absorption and
long duration of action

  • Insulin
  • Hormones
  • Vaccines
  • Heparin/LMWH
39
Q

Subcutaneous needle/syringe size

A
  • 23-25 gauge in adults/older kids -25 or 27g in infants

- 5/8 to 3/4 inch

40
Q

Subcutaneous Sites

A

-Thigh of infants (immunizations)

Older kids/Adults:

  • Deltoid
  • Upper outer thighs
  • Abdomen
41
Q

What is important to do with SC injections?

A

Aspirate (if blood, remove & pick new site)

42
Q

IM Indications

A
  • 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
Q

IM Adult Sites

A
  • Thighs Anterior
  • UOQ of Buttocks (avoidance of sciatic nerve)
  • Deltoid (
44
Q

IM Children Sites

A
  • UOQ of Buttocks

- Deltoid (avoidance of radial nerve)

45
Q

IM needle/syringe size

A
  • 19-22g
  • 1.5 inch
  • Size dependent on depth & drug viscosity
46
Q

Venous Catheterization Indications

A
  • Fluid replacement
  • Delivery of medications
  • Blood sampling
47
Q

Venous Catheter Size

A
  • Small veins: 18-20g

- Large veins/need for large volumes of fluids: 12-18g

48
Q

Venous Catheter Site Considerations

A
  • 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
Q

Intraosseus (IO) Lines

A

Process of injecting directly into the marrow of a bone to provide a non-collapsible entry point

50
Q

IO Line Indications

A

Used to provide fluids and medication when IV access is not available or not feasible

51
Q

First choice for IO placement

A

Antero-medial aspect of the upper tibia

52
Q

Other sites for IO placement

A
  • Anterior aspect of the femur & superior iliac crest

- Head of the humerus

53
Q

MC complication of IO lines

A

Extravasation of fluid with a misplaced needle

54
Q

How long can IO lines be left in place?

A

72-96 hours (goal is 2-4 hours)

Med Procedures Quiz 2 (2 decks)

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