Venipuncture, IV, ABGs

Question 1

Indications for Venipuncture

Answer 1

Diagnostic- analyze blood sample
Monitor status of condition
Therapeutic- conditions associated w/excessive components
    polycythemia vera & hemachormatosis
Med admin
Donor for future transfusion

Question 2

Contraindications for venipuncture

Answer 2

Avoid puncturing skin with rash, scarring, tattoos, infection/cellulitis/phlebitis
History of surgery disrupting lymphatics of extremity, such as mastectomy with lymph node dissection
Recent venipuncture / IV at same location
likely thrombosed
Avoid collecting sample proximal to infusing IV
Extremity with dialysis shunt/ fistula
Poorly perfused extremity
Severe injury to extremity
Bleeding diathesis

Question 3

Veins feel

Answer 3

bouncy, compressible, tubular, thick-walled

Question 4

What vein is most often used in the outpatient setting

Answer 4

Median cubital

Question 5

What should you consider when using “houseman’s friend” or “interns vein”?

Answer 5

Radial nerve

Question 6

Femoral vein for venipuncture is used

Answer 6

as last resort
may need US guidance
need longer needle

Question 7

Tourniquet should not remain tight for more than

Answer 7

2 minutes

Question 8

Give up venipuncture after

Answer 8

3 failed attempts

Question 9

What draw is always done first

Answer 9

Blood cultures (aerobic/anaerobic)
note: prep skin and bottle with betadine

Question 10

complications of venipuncture

Answer 10

Hemorrhage/hematoma
skin infection (cellulitis)
Vein infection (phlebitis)
Thrombosis
Vasovagal event
hemolysis
Falsely elevated potassium

Question 11

Worst veins for Cath insertion

Answer 11

External Jugular
Digital Veins
Lower Extremities

Question 12

Best areas for catheter insertion

Answer 12

forearm veins

Question 13

After how many unsuccessful attempts should you give up when trying to place an IV

Answer 13

2

Question 14

IV should be changed to a new one after

Answer 14

~72hrs

Question 15

What test should be down before drawing an ABG

Answer 15

Allen test

Question 16

Indications for Arterial Puncture

Answer 16

need to accurately assess patient ventilation/oxygenation
determination of blood pH, partial pressure of O2 & CO2 as well as HCO3 level
Concentrations of hemoglobin, electrolytes

quantify patients response to interventions and if there is a need for further intervention
Example: monitor response to BIPAP, mechanical ventilation, etc.

Question 17

Arterial sample is preferable to venous when assessing

Answer 17

Ammonia level, CO2 level, Lactate level

Question 18

Contraindications to arterial puncture

Answer 18

Arterial pulse cannot be palpated (relative, use US)
Abnormal Allen Test
Arterial disease: atherosclerosis, arterial inflammatory disorders, aneurysm, AV malformation
High Risk bleed:
Coagulopathy, severe thrombocytopenia
Avoid using extremity with an AV shunt
Avoid puncturing non-intact or infected/cellulitic skin
Uncooperative patient

Question 19

MC artery used is

Answer 19

Radial artery

Question 20

If you cannot access radial artery, next artery to evaluate is

Answer 20

Brachial

Femoral as last option

Question 21

What should be done to ABG sample after label placed

Answer 21

Put on ice, get to lab ASAP

Question 22

Femoral artery is entered at what angle

Answer 22

90

Question 23

Brachial and radial artery is entered at what angle

Answer 23

40-60

Question 24

For venipuncture, what angle is recommended on insertion

Answer 24

15-30 degrees