Venipuncture for Blood Specimen and Intravenous infusions

Objectives
-     1.    Define venipuncture
-     2.    Explain the purposes of venipuncture
-     3.    Locate the sites commonly used for venipuncture for blood sampling and establishing an intravenous infusion
-     4.    Compare and contrast various types of equipment used for venipuncture for blood sampling and establishing an intravenous infusion

-     5.    Explain why sites are rotated for clients who have repeated venipunctures
-     6.    List the critical elements when performing a venipuncture
-     7.    Apply universal precautions while performing the procedure for taking a blood sample or establishing an intravenous infusion

-     8.    Label the blood specimen
-     9.    Practice recording appropriate information after the collection of a blood specimen and establishing an intravenous infusion

Venipuncture definition
A technique in which vein is punctured by sharp stylet transcutaneously (thru skin) attached to a syringe or a catheter
Purposes
-     To withdraw specimen of blood
-     To collect blood from a donor
-     To give medication
-     To start an IV infusion
-     To inject radiopaque substance for X- Ray

Sites of Venipuncture
-     For blood sampling
-     Adult:
-     Convenient vein in the forearm
-     For Intravenous
-     Basilic and median cubital vein , crease of elbow
-     Metacarpal vein
-     Veins in arm and forearm
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Next Steps
-     Summarize any actions required of your audience
-     Summarize any follow up action items required of you

Why Venipuncture sites are rotated
To prevent
   SCLEROSIS (hardening of tissue) ,THROMBOSIS (blood clot)
Type of Equipment
-     IV Infusion
-     Antiseptic swab
-     Tape, tourniquet
-     Sterile gauze
-     Splint, Kidney basin
-     IV stand, poles
-     IV catheter G #20- #22 short length
-     IV administration set:
-     Macro= 10- 20 drops/ml of soln
-     Micro= 60- 75 drops/ml of soln

-     Blood Sampling
-     Antiseptic swab
-     Tape, tourniquet
-     Sterile gauze
-     Gloves
-     Sterile syringe;          5- 10 cc
-     Sterile needle;            # 19- 21 Gauge
-     Blood specimen container

Blood Sampling
-     Prepare pt.
-     Explain procedure
-     Wash hands
-     Set up equipment
-     Select and prepare site
-     Start at distal end of vein
-     Shave skin if necessary
-     Dilate the vein
-     Place extremity lower than pt’s heart; Gravity slows venous return and distends the vein
-     Dilating the vein makes it easier to insert the needle properly
-     Apply tourniquet 15 – 20 cm (6 – 8 in) above site

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-     If vein is not sufficiently dilated:
-     Massage or stroke vein directed to the heart
-     Ask pt. to clench and unclench fist
-     Tap the vein with finger tips
If vein fails to distend, remove tourniquet, apply heat to entire extremity for 10 – 15 min.
-     Don gloves and clean site; use circular motion
-     Insert needle; use one thumb to pull skin, taut below entry site
-     Obtain required amount of blood
-     Release the tourniquet
-     Hold dry swab over needle site
-     Remove top from test tube, avoid touching inside; insert blood into tube at one side

-     Withdraw needle, pull in line with the vein
-     Continue pressure then apply tape; ask pt. to apply pressure firmly for 2-3 min. to facilitate clotting and minimize bleeding from insertion site
-     Transfer blood to appropriate tube
-     If with anticoagulant, carefully invert the tube 6 times to be mixed
-     Label the tube
-     Send specimen at once. Blood culture specimen should be sent at once and never refrigerated

Sample  Recording
02/ 10/ 2006
0745 am     blood collected for CBC, U & E, & grouping during doctors’ round @ 0735;
   specimen labeled & sent to lab. antecubital vein used; pressure applied
   no bleeding; no evidence of hematoma —–sig.

Critical Elements
-     Use aseptic technique
-     Avoid venipuncture on areas that are injured or have an infusion
-     Use distal aspect of the vein
-     Release tourniquet when blood obtained
-     Apply pressure at insertion site following venipuncture
-     Send specimen to laboratory immediately

Procedure of Inserting IV Catheter

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-     Apply tourniquet
-     Direct Method: hold catheter bevel up at 15- 20 angle & thrust thru skin into vein
-     Indirect Method: pierce skin, reduce angle and advance catheter into vein. Sudden lack of resistance is felt as catheter enters vein
-     When blood appears, release tourniquet

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-     Remove cap, grasp the hub of catheter with thumb and index finger and insert needle
-     Advance the catheter while withdrawing the needle until you feel resistance, start infusion
-     Inspect site for swelling
Tape the catheter: “U”; “H”; Chevron
-     Place the first tape, sticky side up under the hub and fold the sticky sides down on the skin
-     Place second strip, sticky side down
-     Place third, sticky side up under the catheter hub distal to the second strip and fold across the catheter
-     Apply splint
-     Record starting IV, date, time, type of solution, rate, site

 

Sample  Recording
02/ 10/ 2006
0900 am   IV D5W 500 ml started with drop factor 125 ml/hr to be finished @ 1700 hrs followed by KVO; no discomfort, no swelling, no hematoma noticed——-sig.

Critical Elements
-     Any selected vein should be free of sclerosis, pain, or hematoma
-     Whenever possible larger veins are used
-     Veins located directly over movable joints should be avoided to prevent IV dislodge and infiltration (if IV line to be followed)
-     Veins of lower extremities should be avoided whenever possible- they limit mobility and increase incidence of thrombophlebitis

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