iv placement iv placement author: paula rozov course contributors: karen johnson, marc wilson...

IV PlacementIV Placement

Author: Paula RozovCourse Contributors: Karen Johnson, Marc Wilson

Greenville HealthCare simulation CenterGreenville, SC(864)455-2201

Starting an IV is a general CEPSC course meant for a wide audience.Although it is written in accordance with Greenville Hospital System

policies, minor changes make it applicable for any institution.

Starting Perpheral Intravenous LinesAt the completion of this course the participant will be able to

A. Discuss the following topics related to peripheral intravenous therapy:

1. Indications and contraindications for starting a peripheral IV 2. Options for delivery 3. Methods of intravenous delivery 4. Sites of intravenous treatments 5. Materials needed for placement 6. Associated complications and problems 7. Alternatives for control of pain and discomfort 8. Effective/appropriate approaches to dealing with fear and apprehension 9. Standard practices for infection prevention and self protection

Starting an IV

Starting an IV

B. Demonstrate the ability to:

1. Assess patient for indications and contraindications involving the procedure itself or the sites being considered for puncture 2. Determine and gather the setup appropriate to the intravenous application being applied 3. Determine appropriate sites for peripheral IV placement 4. Communicate appropriately and effectively with the patient prior to and during the procedure (that is – the patient is briefly interviewed for relevant history and understands what is being done and why) 5. Effectively determine patient’s level of fear and anxiety and deal with it appropriately 6. Effectively determine whether measures should be taken to reduce the pain of the procedure and carry out such measures 5. Perform the procedure and maintain proper technique during the IV placement 6. Demonstrate knowledge of infection control and self protection 7. Find alternative vessels in the event of unsuccessful initial placement or discontinued site 8. Perform ancillary functions related to the IV including Identity check, recording, reporting and disposal 9. Recognize complications arising from continuous IV therapy

• Access the Web-based Curriculum• At the work station, review the Power Point. Review

palpation and insertion on the Virtual IV Trainer. Practice IV insertion on the IV training arm.

• Schedule Simulation Activity and a Performance Evaluation by a Hospital Preceptor

Module Instructions

Module Instructions

Starting An IV

As a medical procedure, with its related treatments,

IV placement may be one of the most familiar to the

public at large. Most hospital stays, however brief,

include some form of intravenous administration.

Introduction Introduction

Starting an IV affords access to peripheral

circulation providing the ability to infuse fluids,

administer medication or withdraw blood. It is

still the method of choice because it is safe

and because of the relative ease and speed

with which the procedure may be performed.

Starting an IV

Starting an IV

Such access is essential in

the care and treatment of

surgical patients, patients who

are critically ill, patients whose

fluid volume is compromised

due to trauma, and patients who

suffer organ failure due to chronic

diseases. Peripheral venous access

provides both a way to avoid possible

complications and a quick method to

deal with them should they arise.

Anatomy and Physiology Related to Placement

Both veins and arteries are made up of three layers. The inner endothelial layer is surrounded by a muscular layer. The third, outside layer is connective tissue which serves to hold the vessel in place. The middle, muscular layer of veins is much thinner and weaker than in arteries which accounts for the ease with which veins collapse. Veins do dilate and constrict, but do so more effectively when the inside of the vessel is stimulated by blood flow and engorgement. Tourniquets, positioning and muscle contraction are all employed to help facilitate increased pressure inside vessels to make them both visible and accessible.

Check to make sure of the use of tourniquets

CognitiveBackground 1


Valves in peripheral veins are flaps of folded endothelium or inner layer which prohibit the blood moving through them from flowing backwards. They are more numerous where smaller veins join larger ones and in the extremities. They are almost nonexistent in the large central veins and those of the head and neck.






Peripheral veins are easiest to access at the apex of the “ ” formed when two tributaries merge into a larger vein or where the vein is straight and free of branches (and hence valves) for 2 cm or so proximal to the site of puncture. These sites tend to be anchored and hence “roll” less than other sites.

1


Y

2. The basilic vein supplies the posterior wrist and forearm on the ulnar side.



1. The distal veins of the upper extremities are the metacarpal and dorsal veins which connect at the dorsal venous arch and drain the veins of the hand. (22 – 20g catheter)

Excellent sites for IV therapy

3. On the radial side of the arm are the cephalic and the accessory cephalic veins. (22 – 16g catheter)

Superficial venous and lymphatic drainage of the upper limb (Moore KL, Agur AMR.

Essential Clinical Anatomy (1995). London: Williams and Wilkins. p291)5

Cognitive Background 5


4. In the middle of the forearm is the Median Antebrachial vein.

Excellent sites for IV therapy, cont.

5. The antecubital veins are the Medial Cubital vein the Basilic vein and Cephalic vein.

6. The larger Cephalic vein and Basilic vein above the antecubital space are accessible but more difficult to visualize.

Superficial venous and lymphatic drainage of the upper limb (Moore KL, Agur AMR.

Essential Clinical Anatomy (1995). London: Williams and Wilkins. p291)5

Choosing Placement

Generally, the preferred sites for peripheral IV’s are in the veins of the forearm and hand. Lower extremities are avoided due the risk of dislodging DVT’s, infection and impairment of patient mobility. Many factors should be taken into consideration. Use the non-dominant hand or arm and good distal sites when possible.



Factors to consider:

1. What is the patient’s medical history? Is it likely that there is tissue or vessel damage from previous infiltration or complication?

2. Assess the overall condition of the patient; age, weight, level of alertness and physical movement.

3. What is the purpose for venipuncture?

4. Are expected IV therapies short or long term?



Indications for IV Placement or Venipuncture

1. Blood sampling, venous2. Administration of the following: Fluid solutions Intravenous medication Blood products Short-term partial nutrition3. Cardiac arrest 4. Major trauma5. Cardiopulmonary resuscitation



Contraindications for IV Placement or Venipuncture

1. IV placement in feet and ankles is not optimal and should be reserved for the ER or OR.

2. Avoid IV placement in an injured extremity.

3. Veins that fill from an area of neck trauma or on the side of chest or abdominal trauma should not be used. Proper care of the injury or venous drainage could be impeded. General circulation in the area could be impaired and therefore affect fluid and medication delivery.



3. Upper extremities on the side of radical mastectomies or dialysis grafts should not be used unless they need to be considered during an emergency.

4. Venipuncture should be avoided in tissue which is infected or burned and areas of edema, sclerosis, phlebitis or thrombosis.




5. Avoid veins blow a previous IV infiltration.

6. Puncturing sites of cellulitis could contribute to bacteremia.

7. Using extremities with arteriovenous shunts or fistulas could contribute to infection or thrombosis in those areas.




Algorithm for Peripheral Venous Access in Adults

Postgrad Med J 1999;75:459–462 © The Fellowship of Postgraduate Medicine, 19994

─ Peripheral IV therapy is short term ─

Long term therapies not covered in this course are:

Peripheral Intravenous Central Catheters (PICC)

And

Central Lines



Peripheral intravenous catheters(PICC) are composed of a thin layer of biocompatible material and an attachment hub that is inserted percutaneously into peripheral veins and advanced into a large central vein with radiographic confirmation of placemet. PICC lines are suitable for long-term vascular access for blood sampling and infusion of hyperosmolar solutions such as those used for total parenteral nutrition. These lines should be inserted as soon as intermediate-term access is anticipated.

2



Long Term Therapy

Long Term Therapy

Central venous catheters (CVC) are placed to facilitate fluid infusion when peripheral access is poor, especially with critical care patients. There are five techniques, Basilic (peripheral) puncture, Internal jugular puncture, Femoral

puncture, Infraclavicular subclavian approach and Supraclavicular subclavian approach. The following are

indications for central venous insertion: CVP measurements, SG insertion, need for multiple lines for critical care meds,

infusion of irritating or hypertonic solutions, trauma patients in shock with collapsed peripheral veins.



Long Term Therapy

Long Term Therapy

Equipment Equipment

Equipment Needed to Start IV

IV Start Pak Includes the following:

1. Antiseptic Solution approved by the Institution GHS - ChloraPrep® One-Step Frepp® Applicator (Chlorhexidine Gluconate 2%; Isopropyl Alcohol 70%)2. Non-latex tourniquet3. Sterile 2 x 2 gauze4. Tegaderm®5. Tape6. Identification Label

Equipment Equipment

1. IV Start Kit 2. Saline syringe 3. Saline Well or Lock and an end cap or Extension Set 4. Local anesthetic solution or spray 5. Non-latex gloves 6. 25 gauge needle 7. IV Catheter of appropriate size 8. 1 ml syringe 9. Stabilization device 10. Sharps container

1. IV Start Kit 2. Saline syringe 3. Saline Well or Lock and an end cap or Extension Set 4. Local anesthetic solution or spray 5. Non-latex gloves 6. 25 gauge needle 7. IV Catheter of appropriate size 8. 1 ml syringe 9. Stabilization device 10. Sharps container

Start an IVEquipment Needed

Stabilization Device

Extension SetsAlong with knowing the items being used to perform the insertion,it will be important to determine and gather the setup appropriateto the intravenous application being applied and have them withyou. Pictured below are five common examples of ExtensionSets,any one of which may be attached to the catheter hub afterinsertion into the chosen site.

Equipment Equipment

Macro Extension Set Micro Extension Set Macro Dual Extension SetMicro dual Extension Set T Set

Skill Step 1 Skill Step 1

Proper Procedure for Starting an IV

1. Before approaching the patient, know the purpose for the introduction of the IV you are about to perform. Know the patient’s contraindications.

2. Know which supplies and equipment are appropriate and necessary and have them with you.


4. Before positioning the patient inquire about her/his

dominant side.

5. Wash your hands.

3. Introduce yourself to the

patient. Tell the patient the

procedure you are going to

perform and give a clear

explanation in lay terms, what

you are going to do and why. Try to quickly establish

rapport and obtain useful and pertinent information.

Check the patient’s arm bracelet.


6. Prepare the saline lock or extension set by flushing

it with saline. Place it within reach.

7. After inspection of potential sites, tie the tourniquet

above the site, tightly enough to cause vein distention

but not so tight as to affect arterial flow.


8. Palpate the site with the index and middle fingers. Veins feel soft and elastic. There is no pulse.

10. Put on your gloves.

11. Allow the skin surface to dry.

9. Clean the site for 30 seconds.


12. With your non-dominant hand, stabilize the vein by placing your thumb beside the vein and pull down. Being careful not to contaminate the site, place the index finger on the same side of the same vessel and push up.


13. With your dominant hand, grasp the catheter and with the

bevel up, insert it into the vein at 10 – 30° angle.

14. Once you achieve flash back, advance the catheter to make sure it is in the vein, but not so far as to puncture the posterior wall. Loosen the stylet and finish advancing the catheter.


15. Move the fingers stabilizing the

vein to the tip of the catheter and

apply enough pressure to the vein

to occlude it. Remove the needle,

make the appropriate connection

to complete the procedure and

remove the tourniquet.

16. Apply the Tegaderm® dressing


16. Secure the catheter in place using a Statlok® stabilization device.

17. Date the dressing.

• Factors which may contribute to slow dilation of the vessel are hypotension, colder environments, or any condition or circumstance impairing peripheral circulation.

• Patient positioning is important. The optimal position would be supine, head slightly elevated with arm supported.• Try to use the non-dominant arm.• Vasovagal reactions are more likely if the patient is seated upright.• If veins fill poorly or slowly after placing the tourniquet, gently stimulate the vessel at the site of puncture, have the

patient open and close her hand, and make sure the arm is below the level of the heart. This may particularly be the case with elderly patients or patients with compromised fluid volumes. It may be necessary to remove and replace the tourniquet to allow the vessel to refill.

• Place the tourniquet 5-6 inches above the prospective puncture site. It should not be painful to the patient. Pulse should still be palpable while occluding the veins enough to prevent full return so they become distended.

Points to Remember

Several factors may determine catheter size:• 16 gauge when large volumes of fluid must be delivered rapidly• 18 gauge for surgical patients and rapid blood delivery• 20 – 24 gauge for both postoperative and medical patients• 22 – 24 gauge for elderly and pediatric patients

Points to Remember

Points to Remember

Catheter Size Length (inches) Flow rate (ml/min)

8.5 french 3.50 160

14 gauge 2.00 93

16 gauge 2.00 75

16 gauge 5.25 64

18 gauge 2.00 62

18 gauge 8.00 13

20 gauge 2.00 42

24 gauge 0.75 14



Complications

Pain can result from any of the complications in the following list. Pain may also result from multiple sticks and from using large bore needles and cannulas.



Infiltration or the leaking of infusion fluids into surrounding tissuecan result in varying degrees of pain, swelling, skin discoloration andin worse cases necrosis. Preventionary measures should alwaysinclude careful stabilization of the cannulation device, frequent Checks of parenteral infusion sites and catheter removal before 72hours have passed.



Hematomas resulting from extravasation resolve on theirown however tourniquet removal prior to needle withdrawalAnd direct pressure applied to the site after needle or catheterremoval help prevent formation. Ice packs and analgesics maybe used to treat discomfort.



Phlebitis resulting from IV cannulation and damage done tothe venous wall may produce redness, swelling, pain, heat andpalpable cords or lumps and red tracing above the IV site.Phlebitis may present while catheters are still in place orshortly after IV treatment is discontinued. In either case noaction is called for or helps. It will clear, sometimes slowly, onits own.

Factors contributing to the development of phlebitis are: (a) IV placement over movable joints or in lower extremities(b) medications such as vancomycin, potassium or pressors like dopamine(c) hyperosmolar solutions(d) cytotoxic agents.



Cellulitis is the most common infectious complication. Skinbecomes red and swollen and is both warm and painful to thetouch due to inflammation of connective tissue. Properasceptic technique and avoidance of contraindicated sites areessential in avoiding this complication. Bacteremia and sepsisresulting from IV placement are rare.



Complications

Pain More than likely all patients will experience some degree of pain with sticks. Talk to your patients and try to determine their perceptions of pain. Remember, measures can be taken to make IV placement more comfortable.



Skin becomes red and swollen and is both warm and painful to thetouch due to inflammation or redness, swelling, pain, heat andpalpable cords or lumps and red tracing above the IV site –

WHAT DO YOU DO?

1. Take a wait an see approach2. Try to reposition cannula and redress the site3. Discontinue the IV immediately√



With the onset of symptoms at the IV site be aware that it has been compromised. The IV must be discontinued immediately.

─ Remember, IV placement is the delivery mode for therapy not ─simply a procedure and some patients lives may depend on it.

To discontinue the IV: 1. Gather tape and sterile 4 x 4’s. Prepare them for use. 2. Inform the patient of what you are about to do and why in terms he/she and understand. 3. Carefully remove all dressing and expose the site. 4. Place digital pressure at the insertion site while pulling the cannula and remove it. 5. Continue to apply digital pressure, fold a 4 x 4, place it directly over the puncture site and tape it firmly in place. 6. Document and report all findings and actions.

Occupational Safety

Standards and Final Rule are determined by the Department of Labor Occupational Safety andHealth Administration (OSHA) and are set forth in 29 CFR Part 1910 of the Federal Register,Occupational Exposure to Bloodborne Pathogens; Needlesticks and Other Sharps Inguries.

Greenville Hospital System uses the following tool to monitor compliance:1. Gloves are worn when touching blood, body fluids, mucous membranes or non-intact skin.2. Gloves are worn for handling of items or surfaces soiled with blood or body fluids.3. Gloves are worn when contact with blood is possible, i.e., IV initiation,

fingersticks, etc.4. Gloves are worn when policy or procedure requires them.5. Hands are washed immediately after gloves are removed.6. Gowns are worn when there is potential for blood and/or body fluids to splash

onto the caregiver.7. Masks, eyewear and/or face shields are worn when isolation procedure requires them.8. Facial protection is worn when care is likely to generate droplets or splashing that could expose the mucous membranes of the caregiver.9. Personal protective equipment is available for use.

Greenville Hospital System PROTOCOL FOR PERCUTANEOUS AND /OR MUCOUS MEMBRANE EXPOSURE TO BLOOD AND BODY FLUID

I. Definition of A. Healthcare Worker (HCW) Exposure is defined as contact with blood or Exposure body fluids of a patient.

B. Reverse Exposure is defined as the patient being exposed to the blood of body fluids of the Healthcare Worker. C. Method of exposure:

1. Needle stick or other contaminated sharp object injury

2. Splash to eye, mouth, or other mucous membrane

3. Ingestion

4. Open wound or other non-intact skin (i.e. hangnails, rashes, eczema, etc.)

5. Intact Skin: If the exposure was to blood and an extensive area of skin was exposed or there was prolonged contact.

Greenville Hospital System

Body fluids include:

cerebral spinal fluid

synovial fluid

pericardial fluid

amniotic fluid

Semen

vaginal secretions

peritoneal fluid

pleural fluid

saliva in dental procedures

any other body excretion/secretion (e.g., urine, stool, sputum, saliva) that contains visible blood

Greenville Hospital System PROTOCOL FOR PERCUTANEOUS AND /OR MUCOUS MEMBRANE EXPOSURE TO BLOOD AND BODY FLUID, contd.

II. FIRST AID At the time of a suspected exposure, basic first aid measures should be taken to thoroughly irrigate and disinfect the affected body part to prevent infection/illness:

1. Skin exposure, puncture or laceration - Wash with bactericidal soap and water. 2. Eyes, mouth or other mucous membranes - Rinse with running water, normal saline, or other suitable sterile eyewash for at least ten (10) minutes. 3. Human bite: If visible breaking of the skin occurs, the patient may have been exposed to the Healthcare Worker (HCW); this is a Reverse Exposure. If the patient's blood has contact with the bite sight of the HCW, the HCW is also potentially exposed. (An example would be a patient who has trauma to the mouth and is bleeding at the time of the bite).


PROTOCOL FOR PERCUTANEOUS AND /OR MUCOUS MEMBRANE EXPOSURE

TO BLOOD AND BODY FLUID, contd.

III. REPORTING OF All blood and body fluid exposures should be

EXPOSURES reported immediately!!!

A. Immediately after first aid, reporting of an exposure (or possible

exposure) to blood or body fluids is the responsibility of the

individual who was exposed and is to be reported immediately to

the Exposure Control Nurse (ECN) at the appropriate facility. In the

case of a Reverse Exposure, the HCW involved is to do the

reporting.

B. The exposed Healthcare Worker (HCW) obtains a Supervisors‘

Report of Employee Occurrence (SREO) form from the

department manager and completes the written report. If

circumstances do not allow time for completing SREO

(e.g.performing surgery), or the manager is not available, the

exposure is still reported immediately to the appropriate ECN.




III. REPORTING OF C. The HCW will be instructed by the ECN regarding disposition

EXPOSURES, contd. of the SREO and scheduling of follow-up appointment with

the ECN.

D. Employees requiring medical attention, beyond basic first aid

should receive clearance from the Employee Health and

Wellness (EHW) office or, after hours, should contact the

Administrative Coordinator for injury assessment and

authorization for treatment prior to going to the Emergency

Department. The completed SREO will be taken to the

appropriate Emergency Department at the time of treatment.

At GMMC the SREO and a copy of the ETC record are to be

placed in the EHW basket for pick up by the ECN the next

working day.




III. REPORTING OF E. The department manager is responsible for counseling

EXPOSURES, contd. the employee regarding injury prevention and disciplinary

action that may be taken if employee injuries are

preventable and repetitive. After initial exposure

management has been competed by the ECN, the

department manager will complete the analysis of the

occurrence on the reverse side of the last page of the

SREO form and send it via interoffice mail to the

Director of Infection Control.

GREENVILLE HOSPITAL SYSTEM

Infection Control Precautions

INTRODUCTION The GREENVILLE HOSPITAL SYSTEM (GHS) practices Standard Precautions, airborne/droplet/contact precautions, and protective precautions to minimize the spread of infectious disease. More stringent precautions are used for Creutzfeldt-Jakob disease. A disease-specific table is used as a resource for identifying diseases.

STANDARD GHS considers all blood, body substances, and non-intact skin asPRECAUTIONS potentially infectious. Work practice controls, engineering/environmental controls, and the use of personal protective equipment (PPE) are in place to minimize exposure. These controls and barriers are called STANDARD PRECAUTIONS and are practiced at all times for all patients and situations Work Practice Controls.


Work Practice Controls*The following practice controls which are relevant to venipuncture have been excerpted from the full list.

HAND HYGIENE See GREENVILLE HOSPITAL SYSTEM (GHS) Infection

Control Manual, Section 7.

PERFORMING All procedures involving blood or other potentially infectious

PROCEDURES material shall be performed in such a manner as to minimize

INVOLVING splashing, spraying and splattering of the substance.

BLOOD OR

BODY FLUIDS

HANDLING All healthcare workers will take precautions to prevent injury

SHARPS caused by needles, scalpels, and other sharp instruments or

devices during procedures, when cleaning used instruments,

during the disposal of used needles, and when handling sharp

instruments after procedures.


Work Practice Controls, contd.*The following practice controls which are relevant to venipuncture have been excerpted from the full list.

DISPOSABLE To the extent possible, safety medical devices will be used toSHARPS prevent blood and body fluid exposure. Contaminated needles are NEVER hand-to-hand recapped, purposely bent or broken by hand, removed from disposable syringes, or otherwise manipulated by hand. All disposable sharps are immediately placed in puncture-resistant containers for disposal. Sharps collection units are replaced when ¾ full, closed, and routed or disposal. If recapping of a contaminated sharp is required, a hand-to surface resheathing device must be used.

HANDLING Specimens of blood or other potentially infectious materials shall beSPECIMENS placed in containers which prevent leakage during collection, handling storage, transport or shipping. Double bagging is not required unless there is contamination of the first bag. Specimens are placed in ziplock bags with biohazard labels for transport to the Laboratory.

Specimens shall not be transported to the Lab with a sharp unless issue in the sharp is required for testing. In that case, hand-to-surface re-sheathing is necessary.


Work Practice Controls, contd.*The following practice controls which are relevant to venipuncture have been excerpted from the full list.

Specimens may be transported in the pneumatic tube system only if a foam-lined tube is used, the specimen is contained in a leak-proof container, and the specimen is bagged and labeled.

Items not approved for transport in the Central Tube System 1. Blood culture bottles – except in GMH ER using approved transportation method 2. 24-hour urine specimens 3. Cerebrospinal fluid (CSF) specimens 4. Frozen section specimens 5. Any specimen with a chain of custody form (example: alcohol or drug screens) 6. Blood bags for transfusion or any blood product for transfusion 7. Needles or any other sharps

Note: Weight limit on items put in the carrier is three (3) pounds. One liter of IV fluid is approximately two (2) pounds. Mouth pipetting/suctioning of blood or other potentially infectious materials is prohibited. Refer to the Laboratory procedure for removing rubber stoppers.

IV Placement Assessment Description Summative in nature, this assessment will consist of three successful peripheral intravenous placements performed in succession in accordance with the goals and objectives of this course, to be conducted by a competent facilitator. The instrument used will be the IV Performance Assessment which accompanies these curriculum materials. The simulation set up will consist of a full body manikin with the left IV arm accessible. All appropriate materials will be displayed in a cabinet with a full array of other unrelated treatment supplies. The student will be expected to elicit pertinent patient background and history, research and gather appropriate supplies, interact appropriately with the patient/manikin and perform correctly the three intravenous punctures to achieve a positive assessment by the facilitator.

Simualtion Set Up

Self guided training will include one IV training arm. The student will be guided by Power Point through the series of proper steps for identifying the complication of infiltration, terminating the site, finding a new site and placing a new IV. The Power Point will reiterate content covered in the Web curriculum.

Teaching points will accompany each step.1. Infiltration – pictures/video and description of this and other complications.

2. Terminate Site - pictures/video will guide the students they perform on the IV training arm.

3. Find New Site - pictures/video will guide the students they perform on the IV training arm.

4. Place IV - pictures/video will guide the students they perform on the IV training arm.

IV Performance AssessmentSkills• Demonstrated knowledge of supplies and equipment necessary for the procedure.• Properly positioned the patient.• Washed hands.• Applied tourniquet properly.• Put on gloves.• Demonstrated proper vein palpation.• Chose site and demonstrated knowledge of anatomy.• Cleaned the chosen puncture site properly.• Used proper technique for stabilizing the vessel.• Grasped the catheter properly.• Inserted the catheter into the skin at the correct angle.• Achieved venous blood return on puncture.• Advanced and seated catheter properly.• Completed procedure correctly.• Removed tourniquet at appropriate point.• Applied dressing properly.• Applied Statlok® stabilization device properly.• Dated dressing.• Recognized infiltration and found alternative vessel.• Performed ancillary functions related to the IV including Identity check, recording, reporting and disposal.• Demonstrated knowledge of complications arising from continuous IV therapyInterpersonal• Demonstrated appropriate interaction with the patient.• Was able engage in diversionary dialog while performing tasks.• Overall dialog with patient was appropriate.• Assessed patient for contraindications involving the procedure itself or the sites being considered for puncture.

Checklist for Performance Assessment

References

1. Feldman R; Venipuncture and peripheral intravenous access. Emergency Medicine Procedures, 2004.

2. Stovroff M, Teague WG: Intravenous access in infants and children. Pediatr Clin North Am 45:13773, 1998.

3. Hadaway, Lynn C.; Millam, Doria; Volume 35 Number 5 – Supplement: On the Road to Successful IV Starts, Supplement,pp1-14, May 2005.

4. Methods of obtaining peripheral venous access in difficult situationsDavid Mbamalu, Ashis BanerjeePostgraduate Medical Journal 1999;75:459Copyright © 2007 The Fellowship of Postgraduate Medicine – placement algorithms

5. Moore KL, Agur AMR; Essential Clinical Anatomy (1995). London: Williams and Wilkins. p291)

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