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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