Venipuncture for Blood Specimen and Intravenous infusions

Venipuncture

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
Sites of Venipuncture

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

Blood Sampling

–     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

IV Catheter

–     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

 

–     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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