VENIPUNCTUREVENIPUNCTURE

Kyle ThorntonKyle Thornton

DMI 63DMI 63

Senate Bill 571Senate Bill 571

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

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

accredited education on venipunctureaccredited education on venipuncture Technologist must perform Technologist must perform 10 successful 10 successful

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

Before you stick, know:Before you stick, know:

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

Informed ConsentInformed Consent

Pt has right to know and participate in Pt has right to know and participate in his/her own health carehis/her own health care

Pt must be informed of following:Pt must be informed of following: Nature of treatment/procedureNature of treatment/procedure Any risk, complicationsAny risk, complications, expected benefits or , expected benefits or

effects of such treatmenteffects of such treatment Any alternativesAny alternatives to procedure and their risks to procedure and their risks

and benefitsand benefits

Types Of ConsentTypes Of Consent

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

ImpliedImplied consent consent By actionBy action

ExpressedExpressed consent consent VerbalVerbal

WrittenWritten consent consent• All are binding in courtAll are binding in court

WhoWho May Consent May Consent

Any person Any person over 18over 18 who is declared who is declared conscious and competentconscious and competent

Spouse’s consentSpouse’s consent Spouses have no authoritySpouses have no authority to consent for to consent for

each othereach other Minor’s consentMinor’s consent

Can only consent if emancipatedCan only consent if emancipated Only parents and legal guardians can consentOnly parents and legal guardians can consent State can consent State can consent if life threateningif life threatening or during regular or during regular

school hoursschool hours

TerminologyTerminology

Heparin lockHeparin lock An IV device plugged on the hub endAn IV device plugged on the hub end Used to maintain venous access w/out adding fluidsUsed to maintain venous access w/out adding fluids

ParenteralParenteral Not by mouthNot by mouth

Total parenteral nutritionTotal parenteral nutrition All nutrition needs met by parenteral routesAll nutrition needs met by parenteral routes

Terminology Terminology (cont’d)(cont’d)

CatheterCatheter A tubular, flexible, hollow instrument for A tubular, flexible, hollow instrument for

withdrawing or injecting fluidswithdrawing or injecting fluids

AngiocatheterAngiocatheter A catheter used specifically for blood vesselA catheter used specifically for blood vessel

Terminology Terminology (cont’d)(cont’d)

Butterfly needleButterfly needle An IV device with a An IV device with a

rigid metal needle and rigid metal needle and a short segment of a short segment of tubingtubing

Infection ControlInfection Control

Universal PrecautionsUniversal Precautions Hand washingHand washing Non-sterile glovesNon-sterile gloves GownsGowns Protective eyewearProtective eyewear Needles and syringesNeedles and syringes Sharp instrument containersSharp instrument containers All All bloodblood must be considered potentially must be considered potentially

infectiousinfectious

If Needle Stick OccursIf Needle Stick Occurs

ImmediatelyImmediately wash with soap and water wash with soap and water

Follow institution protocolsFollow institution protocols Report incident within 24 hoursReport incident within 24 hours Report incident immediately to supervisorReport incident immediately to supervisor Notify infection control officerNotify infection control officer

Site Selection And AnatomySite Selection And Anatomy

NeverNever use an arm with any of the following: use an arm with any of the following: FistulaFistula Shunt (Shunt (a hole or passage which moves, or allows movement of a hole or passage which moves, or allows movement of

fluidfluid from one part of the from one part of the bodybody to another) to another)

Decreased sensationDecreased sensation EdemaEdema On the side of a mastectomyOn the side of a mastectomy

Begin as Begin as distaldistal as you can as you can Anything distal to insertion site is Anything distal to insertion site is unusableunusable for for

24 hours24 hours

Site Selection And AnatomySite Selection And Anatomy

Best insertion site:Best insertion site:Hand for pts under 60Hand for pts under 60

Best insertion site:Best insertion site: Cephalic or basilic for patients over 60Cephalic or basilic for patients over 60

VeinsVeins should be pliant and resiliant should be pliant and resiliant

Venous AnatomyVenous Anatomy

Most common veins used are:Most common veins used are:

BasilicBasilicCephalicCephalic MetacarpalMetacarpal

Blood color Blood color Bright redBright red Dark redDark red PulsationPulsation PresentPresent AbsentAbsent Valves Valves AbsentAbsent PresentPresent Location Location Deep onlyDeep only Superficial &Superficial &

((surrounded by muscle)surrounded by muscle) deepdeep

Differences Between Differences Between ArteriesArteries And And VeinsVeins

44 Things To Do Things To Do BeforeBefore Venipuncture Venipuncture

Verify:Verify:

Dr’s orderDr’s order Pt identityPt identity AllergiesAllergies GlucophageGlucophage

Selection Of EquipmentSelection Of Equipment

Gauge of needleGauge of needle Length of needleLength of needle Type of needleType of needle TourniquetTourniquet Iodine, Phisohex, Iodine, Phisohex,

or alcoholor alcohol

Tape/TegadermTape/Tegaderm 2X2 or 4X4 gauze2X2 or 4X4 gauze GlovesGloves ContrastContrast Normal salineNormal saline BandaidsBandaids

Selection Of Equipment Selection Of Equipment (cont’d)(cont’d)

Venipuncture EquipmentVenipuncture Equipment

Avoid contamination!Avoid contamination!

Highest momentsHighest moments of risk of contamination: of risk of contamination:

Opening venipuncture deviceOpening venipuncture device Performing venipuncturePerforming venipuncture Infusing medication or contrastInfusing medication or contrast Changing solutionsChanging solutions

IV Set-Up ProcedureIV Set-Up Procedure

SafeSafe Re-cap Methods Re-cap Methods

Venipuncture ProcedureVenipuncture Procedure

Apply tourniquet 8 inches above siteApply tourniquet 8 inches above site Cleanse site for 1 minuteCleanse site for 1 minute Stabilize vein and insert needle, bevel upStabilize vein and insert needle, bevel up Watch for backflowWatch for backflow Connect syringeConnect syringe Secure needleSecure needle

Pre-Injection Pre-Injection ProcedureProcedure

Hypodermic needles w/syringesHypodermic needles w/syringes

Assorted needlesAssorted needles

Hypodermic needlesHypodermic needles

AngiocathetersAngiocatheters

Injection ProcedureInjection Procedure

Removing the IVRemoving the IV

Remove tape (carefully)Remove tape (carefully) Pull needle out quicklyPull needle out quickly Immediately apply pressureImmediately apply pressure Elevate the armElevate the arm Examine the siteExamine the site Apply dressingApply dressing

Needle Removal and Discard ProcedureNeedle Removal and Discard Procedure

Special ConsiderationsSpecial Considerations

Must be a physician’s orderMust be a physician’s order Radiologist must be within immediate areaRadiologist must be within immediate area EmergencyEmergency equipment must be available equipment must be available Allergies must be checked for prior to Allergies must be checked for prior to

injectioninjection BUN and Creatinine must be checked BUN and Creatinine must be checked

within 72 hourswithin 72 hours

Special ConsiderationsSpecial Considerations (cont’d)(cont’d)

Normal BUN - 5 - 25 Normal BUN - 5 - 25 (Blood Urea Nitrogen)(Blood Urea Nitrogen)

Normal Creatinine - 0.5 - 1.4Normal Creatinine - 0.5 - 1.4

If values abnormal, notify radiologistIf values abnormal, notify radiologist

Explain procedure to ptExplain procedure to pt

Special ConsiderationsSpecial Considerations (cont’d)(cont’d)

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 EffectsPossible Side Effects

Infiltration/ExtravasationInfiltration/Extravasation Swelling, tenderness, rednessSwelling, tenderness, redness

Adverse reactionAdverse reaction to contrast to contrast Mild - hives, nausea, vomitingMild - hives, nausea, vomiting Severe - shortness of breath, shockSevere - shortness of breath, shock

Typical Emergency MedicationsTypical Emergency Medications

AntihistamineAntihistamine Blocks histamine releaseBlocks histamine release

SteroidSteroid Controls inflammationControls inflammation

EpinephrineEpinephrine Promotes vasoconstrictionPromotes vasoconstriction

The EndThe End