3. Venipuncture

8/4/2019 3. Venipuncture

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ANATOMY AND

PHYSIOLOGY



The Integumentary and

Vascular System



Integumentary System

• an anatomical barrier from pathogens anddamage between the internal and externalenvironment in bodily defense.



Two Main Layers:

1. Epidermis – outer layer composed of

squamous cells.2. Dermis – inner, thicker layer consisting

of blood vessels, hair follicles, sweat

glands, small muscles, and nerves.





Sensory Receptors

–Mechanoreceptors – skin tactileperceptions

–Thermoreceptors – process cold,warmth, and pain

–Nociceptors – process pain



The Vascular System



Vascular System

•

is concerned with thetransport of blood andlymph through the body.



Variations:

1. Arteries – carries blood from

the heart to the body.2. Veins – carries blood from

the capillaries towards the heart.3. Capillaries – resembles a hair

follicle.



1. Tunica Adventitia – outermost layer;which consist mainly of connective tissue

fibers; blends with the connective tissue

surrounding the vessel; supports andsurrounds a vessel.

Layers of the Blood Vessel:



2. Tunica Media – middle layer; is formed

by a layer of circumferential smoothmuscle and variable amounts of

connective tissue; collapses or distends as

pressure changes.



3. Tunica Intima – innermost layer;

delimits the vessel wall towards thelumen of the vessel and comprises of

endothelial lining and connective tissue.





Peripheral Vascular

Vascular system that runs across the

periphery.

MAJOR TYPES OF VEINS (ARM)

1.) Digital Veins

2.) Metacarpal Veins – best choice

3.) Cephalic Veins

4.) Basilic Veins



Major Types of Veins:

1. Digital – lateral and dorsal

portions of fingers

2. Metacarpal – dorsum of hand3. Cephalic – along radial bone of

forearm

4. Basilic – runs up to the ulnarbone





Peripheral Vascular

System



Key Points Prior to IV Initiation

1. Physician’s order

2. Patient assessment3. IV set and equipment

preparation4. Medications



Physician’s Order 1. Initiation is based upon the written order of a

licensed physician.

2. The order must indicate:

a. Patient’s name b. Type and amount of solution

b. Flow rate

c. Type, dose, and frequency of medications to

be incorporated/pushed.

d. Orders affecting the procedure



Patient Assessment1. Clinical status of the patient

2. Patient’s diagnosis

3. Patient’s age

4. Dominant arm

5. Condition of the vein/skin

6. Cannula size

7. Type of solution

8. Duration of therapy



Choosing the Right Vein

Prioritize the ideal veins for

venipuncture.Begin with distal veins.

Watch out for bifurcated orbranched veins.



Choosing the Right VeinDo not perform venipuncture at the

palm side of the wrist and cephalic

veins of the wrist.Palpate for arterial pulse in order to

avoid puncturing the arteries if thesite chosen is cephalic or the inneraspect of the arm.



Other sites to avoid include:

Veins below a previous IV infiltration.

Veins below a phlebitic area.Sclerosed or thrombosed veins.

Areas of skin inflammation, disease, bruising, or

breakdown.An arm affected by a radical mastectomy, edema,

blood clot, or infection.

An arm with an arteriovenous shunt or fistula.

Choosing the Right Vein



IV Set and Equipment Preparation

1. Check for expiration date.2. Check for clarity.

3. Check label against physician’s writtenprescription.

4. Label any medications added.

5. Functionality of infusion pumps, PCA.



Medications

1. Nurses should have a knowledge onall medications administered

including:a. Dosages

b. Drug interactionsc. Possible clinical effects



Venipuncture Techniques (do

not include)1. Vein dilatation

2. Sitepreparation

3. Catheter

insertion4. Securing thecatheter



Vein Dilatation

1. Tourniquet – place 6-8 inches abovethe venipuncture site.

2. Gravity – position the extremity below

the heart.3. Fist clenching – open and close his fist.

4. Warm compress – maximum of 10

minutes.5. Multiple tourniquet technique – use of 2-3 tourniquets.



Site Preparation

1. Do not shave site. Remove hair with clippersonly.

2. Depilatories are not recommended.

3. Cleanse with one of the following solutions:a. 2% Chlorhexidine gluconate

b. Povidone-iodine

c. 70% Isoprophyl alcohol

4. Work from the center outward in a circular

motion.



Catheter Insertion

1. Hold skin taut.2. Adjust angle of

insertion.

3. Puncture vein

and observe

flashback.4. Release

tourniquet.



5. Upon flashback

visualization, lower

catheter parallel to

skin.

6. Advance needle

and catheter

together 1/8 inch.

7. Thread catheter

into vein.



8. Place middle finger

over vein distal to

catheter tip9. Stabilize catheter hub

with index finger

10.Withdraw needlewith a swift,

continuous motion

parallel to the skin11.Dispose of needle

immediately into

sharps container



Securing the Catheter

Basic Methods:

1. Chevronmethod

2. U method3. H method



Chevron Method

•Cut a strip of tape

then place under

the cannula, parallelto the hub.

•Cross the end of

the tape over the

cannula.

U h d



U Method

•

Cut a strip of tapeand place it under the

hub of the cannula.

•Bring each side of the tape up, folding it

over the wings of the

cannula in a U shape.

H M th d



H Method

•

Cut three strips of tape and place one

strip over each wing

of the cannula.•Place the third strip

over the wings

perpendicular to thefirst two.



•Always apply a label after securing thecatheter.

•On the label, write the following:

Date of insertion

Time of insertion

Type of catheter usedGauge used

Your initials

Reminder for all methods:



Maintaining Peripheral IV

Therapy:

1. Changing the dressing

2. Changing the IV solution

3. Changing the administration set

4. Changing the IV site



•The insertion site should be inspectedand palpated for tenderness daily,through intact dressing.

•Gauze dressing should be changed

routinely every 48 hours.

•A semipermeable dressing should bechanged whenever its integrity is

compromised.

Changing the Dressing:



•Do not allow an IV container to hang formore than 24 hours.

•Before changing the IV container, check

the new one for cracks, leaks, and otherdamages.

•

Check the solution for discoloration,turbidity, and particulates.

•Note date and time the solution was mixed

and the expiration date.

Changing the IV solution:



•Change the administration setevery 72 hours and whenever you

note or suspect contamination.•As much as possible, change the

administration set when you start anew venous access device duringroutine site rotation.

Changing the Administration Set:



•

As a standard of care, rotate the siteevery 48-72 hours.

•If limited venous access will prevent

you from changing sites, notify thedoctor of the situation.

•

Be prepared to change the entiresystem when you detect signs ofthrombophlebitis, cellulitis, or IV

therapy related bacteremia.

Changing the IV Site:



•

Be careful to avoid manipulating thedevice in the skin to prevent skinorganisms from entering the

bloodstream.

•Never use an alcohol pad to clean the

site when discontinuing an infusion.•If the patient feels lingering tendernessat the IV site, apply warm, moist packs.

Discontinuing Peripheral IV:

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3. Venipuncture