VENIPUNCTURE

DMI 63

Senate Bill 571

Filed on 8/26/97 Allows technologist’s to perform venipuncture

under general supervision of a physician Technologist must obtain 10 hours of accredited

education on venipuncture Technologist must perform 10 successful

injections under direct supervision of a physician, registered nurse, or CRT w/venipuncture certification

Before you stick, know:

Right patient? Right contrast (medication)? Right concentration? Right amount? Right site? Labs? Conflicting meds? Allergies?

Informed Consent

The patient has a right to know and participate in his/her own health care

Patient must be informed of the following:The nature of the treatment/procedureAny risk, complications, expected benefits or

effects of such treatmentAny alternatives to the procedure and their

risks and benefits

Types Of Consent

Consent is the affirmation to have one’s body touched by others

Implied consentBy action

Expressed consentVerbal

Written consent All are binding in court

Who May Consent

Any person over 18 who is declared conscious and competent

Spouse’s consentSpouses have no authority to consent for each

other Minor’s consent

Can only consent if emancipated Only parents and legal guardians can consent The state can consent if life threatening or during regular

school hours

Terminology

Heparin lock An IV device plugged on

the hub end Used to maintain venous

access w/out adding fluids

Parenteral Not by mouth

Total parenteral nutrition All nutrition needs met by

parenteral routes

Catheter A tubular, flexible, hollow

instrument for withdrawing or injecting fluids

Angiocatheter A catheter used specifically for

blood vessel Butterfly needle

An IV device with a rigid metal needle and a short segment of tubing

Infection Control

Universal PrecautionsHand washingNon-sterile glovesGownsProtective eyewearNeedles and syringesSharp instrument containersAll blood must be considered potentially infectious

If Needle Stick Occurs

Immediately wash with soap and water Follow institution protocols

These should include:Report incident within 24 hoursReport incident immediately to supervisorNotify infection control officer

Site Selection And Anatomy

Never use an arm with any of the following: Fistula Shunt Decreased sensation Edema On the side of a mastectomy

Begin as distal as you can Anything distal to insertion site is unusable for 24 hours

Site Selection And Anatomy

Best insertion site:Hand for patients under 60

Best insertion site:Cephalic or basilic for patients over 60

Veins should be pliant and resiliant Most common veins used are:

Basilic, cephalic, and metacarpal

Venous Anatomy

Differences Between Arteries And Veins

Vein Artery

Color ofblood

Dark red Bright red

Pulsation Absent Present

Valves Present Absent

Location Superficialand deep

Deep only,surroundedby muscle

Four Things To Do Before Venipuncture Verify:

Dr’s orderPatient identityAllergiesGlucophage

Selection Of Equipment

Gauge of needle Length of needle Type of needle Tourniquet Iodine, Phisohex,

or alcohol

Tape/Tegaderm 2X2 or 4X4 gauze Gloves Contrast Normal saline Bandaids

Venipuncture Equipment

Avoid contamination

Highest moments of risk of contamination:Opening the venipuncture devicePerforming the venipuncture Infusing medication or contrastChanging solutions

IV Set-Up Procedure

Safe Re-cap Methods

Venipuncture Procedure

Apply tourniquet 8 inches above site Cleanse site for one minute Stabilize vein and insert needle, bevel up Watch for backflow Connect syringe Secure needle

Pre-Injection Procedure

Hypodermic needles w/syringes

Assorted needles

Hypodermic needles

More hypodermic needles

Angio Catheter

Butterfly Needles

Angiocatheters

InjectionProcedure

Removing The IV

Remove tape (carefully) Pull needle out quickly Immediately apply pressure Elevate the arm Examine the site Apply dressing

Needle Removal and Discard Procedure

Special Considerations

There must be a physician’s order A radiologist must be within the immediate

area Emergency equipment must be available Allergies must be checked for prior to injection BUN and Creatinine must be checked within

72 hours

More Special Considerations

Normal BUN - 5 - 25 Normal Creatinine - 0.5 - 1.4 If values abnormal, notify radiologist Explain procedure to patient Check all medications for expiration dates Check to see that all emergency drugs are present Obtain a baseline blood pressure prior to injection

– rarely done, but a real good idea

Possible Side Effects

Infiltration/ExtravasationSwelling, tenderness, redness

Adverse reaction to contrastMild - hives, nausea, vomitingSevere - shortness of breath, shock

Typical Emergency Medications

AntihistamineBlocks histamine release

SteroidControls inflammation

EpinephrinePromotes vasoconstriction