VENIPUNCTURE & BLOOD DRAWING NOTES ;)Starting the IV
ANATOMY & PHYSIOLOGY
Skin is 1st barrier you must cross Epidermis - (1st line of defense against infection);
outtermost layer Dermis – contains blood vessels, hair follicles,
sweat glands, small muscles & nerves; reacts quickly to pain & pressure = MOST painful layer during venipuncture
Fascia – covering of blood vessels – infection can spread quickly through this layer
SENSORY RECEPTORS
4 of the 5 receptors affect IV therapy Mechanoreceptors-process skin & deep tissue
sensations Thermoreceptors-process heat, cold & pain Nocireceptors-process pain Chemoreceptors-process osmotic change in
blood and BP To reduce pain, keep skin taut & move quickly through
the skin w/ venipuncture
VEINS VS. ARTERIES
Arteries 3 layers thick Thick walled Wall 25% of diameter No valves pulsates
VEINS VS. ARTERIES CONT.
Veins Thin walled Wall 10% of diameter Greater distensibility Valves present Stores blood
3 LAYERS
Tunica adentitia (externa)–Outermost layer of connective tissue-sometimes may feel a “pop” as you puncture this layer
Tunica media-middle layer of muscular & elastic tissue w/ nerves for constriction/dialation & responds to pain or pressure
Tunica intima (interna)-innermost layer of endothelial tissues
VEINS USED
Digital Metacarpal Cephalic Basilic Accessory cephali Antebrachial Most facilities require a physician’s order to
use lower extramities
PRECANNULATION
CHECK PHYSICIANS ORDER-should have all components required for order
Wash hands-#1 method to prevent infection Prepare equipment Assess patient & psychologically prepare Select site & dilate
SITE SELECTION
Type of solution Condition of vein Length of therapy Cannula size (should be as small as possible) Patient age Disease process &/or surgery Presence of shunt or graft Patients receiving anticoagulation therapy Patient w/ allergies
NURSING GOALS FOR CHOOSING SITE
Site must tolerate the flow rate Site must be able to tolerate medication Site must tolerate gauge of cannula needed Patient must be comfortable with site Site must not stop the patient’s ADL’s
VEIN DIALATION
Gravity Fist Clenching Tapping (flick vein to release histamines that
dilate vein) Warm compresses (10 mins) Blood pressure cuff Tourniquet-apply 6-8 inches above site-leave
on only3-6 mins! Multiple tourniquets (for obese or sclerotic
veins) Transillumination (use side lighting)
CANNULATION
Select appropriate cannula Only 2 attempts are recommended to avoid
unnecessary trauma to patient & to avoid using all available veins
Be sure & inspect cannula before venipuncture
CANNULATION CONT.
Gloves-protects the nurse from exposure Site preparation
Avoid shaving hair = microabrasions Cleanse w/ antimicrobial solutions
Tincture of iodine or iodophor 70% isopropyl alcohol or chlorohexadine
MORE CANNULATION
Vein entry (re-apply tourniquet) Gloves must be on! Direct method (1step)-penetrate all layers with
one motion Indirect method (2 steps)-enter along side the
vein, then puncture the vein-MOST appropriate method for beginners
Hold needle, bevel up at 30-45 degree angle to puncture the vein & skin
After piercing the vein and flashback occurs, lower the angle of the catheter and needle (stylet)
CANNULATION – VEIN ENTRY CONT.
After the catheter tip and bevel are in the vein, advance the catheter forward off the needle & into the vein
Cautiously advance the cannula into the vein- hold the catheter hub and slide the catheter off
While stylet is still partially inside the catheter, release the tourniquet
Remove stylet Connect adaptor to the hub
CATHETER STABILIZATION
U method H method Chevron Method Do not tape over the site
DRESSING MANAGEMENT
Gauze Transparent semipermeable membrane
dressing Change every 48-72 hours No ointment or anything should be under the
TSM Apply only to hub and wings Seal securely
POST-CANNULATION
Labeling Must be done on insertion site Tubing Solution container All must have date, time,nurse’s initials
POST-CANNULATION CONT.
Equipment disposal Patient education: activity, alarms,
assessment by nurse Rate calculations Monitoring & documentation
