Venipuncture PPT Flashcards
In order to access an extremity for venipuncture on a patient with a prior mastectomy, what must one have to access the extremity involved in the lymph node removal?
Physician’s order
What happens to the veins when a patient is apprehensive or is cold and fearful of the procedure?
The veins constrict and disappear making venipuncture more difficult
Vasovagal response
Reaction based on fear
What type of information must one obtain from a patient prior the venipuncture procedure?
- Possible allergies
- Current medications
- Prior surgeries to include mastectomy with lymph node involvement
Types of Syringe
Plastic disposable syringes: glass syringe
3 components of Syringe
-Tip: where needle attaches to syringe
(Contains a locking device to hold needle securely)
-Barrel
-Plunger: fits inside the barrel
Needles
Disposable; one use only
Needle length Measured
in inches
Varies from ½ inch to 4½ inches
Generally 1 to 1½” is used for IV injections
Types of needles
- Hypodermic needle
- Butterfly set
- Over-the-cannula needle
Butterfly sets
- Stainless steel needle with plastic appendages on both sides (wings)
- Aids in insertion and stabilization of needle 6” of tubing with a connector at the end
Over-the-needle cannula
- Once venipuncture is established, the catheter slips off the needle into the vein – steel needle is removed
- Recommended for long-term therapy or for rapid infusions
What are the components to a needle?
- Hub – part that attaches to syringe
- Cannula/shaft – length of needle
- Bevel – slanted portion of needle tip
What is the average range for the GFR, BUN and creatinine levels?
- GFR = 90 to 130
- BUN = 10 to 20 mg/dL
- Creatinine = 0.05 to 1.2 mg/dL
As the gauge of the needle increases, the diameter of the bore
decreases
Which is larger an 18 gauge or a 22 gauge needle?
18 gauge
Where are the veins typically located for IV access for use in radiologic examinations?
- Anterior forearm
- Posterior hand
- Antecubital space
Are you allowed to use the anterior wrist for starting an IV?
No
Could damage radial nerve
Feet and legs for IV access require an order on all patients
3 years and older
What equipment is needed for starting an IV?
Gloves Tourniquet Alcohol or betadine Tape/tegaderm Needle (22 gauge) Syringes (3cc saline/60cc contrast) Contrast Extension tubing Cotton ball/gauze Band-aid
When applying the tourniquet, how far above the intended site of puncture must it be positioned?
6” to 8”
How much should the BP cuff be inflated if using it to secure a site for venipuncture?
60 to 80 mm/Hg
What is the difference between an artery and vein
- Arteries contain more pressure (If you feel a pulse you have an artery and not a vein)
- Veins lie closer to the surface
What is the procedure for starting an IV?
Apply tourniquet
Tight enough to distend vessels but not occlude them
One hand release technique
Locate desired vein
Open and close fist to promote venous distention
Clean surface of the skin with an antiseptic
Circular motion/NSEW direction
Don gloves
Hold the patient’s arm with the nondominant hand and use the thumb to anchor the selected vein
Anchor vein distally with finger by stretching skin against direction of insertion – taunt surface (less pain)
Place needle bevel up at a 20-30° angle to the skin’s surface
Enter just distal to site of insertion and parallel to vein – top entry not a side entry into vein
Use a quick controlled entry to enter skin and vein decreasing angle; look for return of blood in the flashback chamber
Advance needle or catheter into vein and release tourniquet
Do not touch needle or catheter – allows bacteria to enter skin
Anchor needle with tape or tegaderm
If both walls of the vein are punctured with the needle a hematoma will develop
Needle should immediately be removed and direct pressure is applied to the puncture site
If the venipuncture attempt is unsuccessful
Do not reinsert same needle; a new needle is required
Do not reinsert a stylet into the catheter once it has been removed – a new catheter is required
ONLY ONE DEVICE PER ATTEMPT
NO MORE THAN 2 ATTEMPTS – NOTIFY IV NURSE!
At what angle should the needle be placed when it is about to enter the skin’s surface?
20 to 30 degrees
How many attempts should be made before the IV team needs to be called?
No more than 3 attempts
What is infiltration?
A process where fluid has passed into the tissue instead of the vein
What is extravasation?
The most common cause is needle displacement
What are some symptoms associated with a mild anaphylactic reaction?
Dizziness Shaking Altered taste Itching Pallor Flushing Chills Sweats Rash/hives Nasal stuffiness swelling eyes/face anxiety
Moderate Reactions to Contrast Media
Tachycardia Bradycardia Hypertension Generalized or diffuse erythema Dyspnea Bronchospasm wheezing Laryngeal edema Mild hypotension
Severe Reactions to Contrast Media
Laryngeal edema Profound hypotension Unresponsiveness Cardiopulmonary arrest Clinical manifested arrhythmias Convulsions
Document
Size, type and location of needle
Number of venipuncture attempts
Name of technologist who performed procedure
Indicate how patient handled contrast
5 rights of medication administration
Right patient Right medication Right route Right amount Right time
