Venipuncture, IV, ABGs Flashcards
Indications for Venipuncture
Diagnostic- analyze blood sample
Monitor status of condition
Therapeutic- conditions associated w/excessive components
polycythemia vera & hemachormatosis
Med admin
Donor for future transfusionContraindications for venipuncture
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
Veins feel
bouncy, compressible, tubular, thick-walled
What vein is most often used in the outpatient setting
Median cubital
What should you consider when using “houseman’s friend” or “interns vein”?
Radial nerve
Femoral vein for venipuncture is used
as last resort
may need US guidance
need longer needle
Tourniquet should not remain tight for more than
2 minutes
Give up venipuncture after
3 failed attempts
What draw is always done first
Blood cultures (aerobic/anaerobic) note: prep skin and bottle with betadine
complications of venipuncture
Hemorrhage/hematoma skin infection (cellulitis) Vein infection (phlebitis) Thrombosis Vasovagal event hemolysis Falsely elevated potassium
Worst veins for Cath insertion
External Jugular
Digital Veins
Lower Extremities
Best areas for catheter insertion
forearm veins
After how many unsuccessful attempts should you give up when trying to place an IV
2
IV should be changed to a new one after
~72hrs
What test should be down before drawing an ABG
Allen test
Indications for Arterial Puncture
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.
Arterial sample is preferable to venous when assessing
Ammonia level, CO2 level, Lactate level
Contraindications to arterial puncture
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
MC artery used is
Radial artery
If you cannot access radial artery, next artery to evaluate is
Brachial
Femoral as last option
What should be done to ABG sample after label placed
Put on ice, get to lab ASAP
Femoral artery is entered at what angle
90
Brachial and radial artery is entered at what angle
40-60
For venipuncture, what angle is recommended on insertion
15-30 degrees
