VENIPUNCTURE

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VENIPUNCTURE

• DMI 63

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Senate Bill 571

• Filed on 8/26/97
• Allows technologists to perform venipuncture
  under general supervision of a physician
• Technologist must obtain 10 hours of accredited
  education on venipuncture
• Technologist must perform 10 successful
  injections under direct supervision of a
  physician, registered nurse, or CRT
  w/venipuncture certification

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Before you stick, know

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

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Informed Consent

• The patient has a right to know and participate
  in his/her own health care
• Patient must be informed of the following
• The nature of the treatment/procedure
• Any risk, complications, expected benefits or
  effects of such treatment
• Any alternatives to the procedure and their risks
  and benefits

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Types Of Consent

• Consent is the affirmation to have ones body
  touched by others
• Implied consent
• By action
• Expressed consent
• Verbal
• Written consent
• All are binding in court

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Who May Consent

• Any person over 18 who is declared conscious and
  competent
• Spouses consent
• Spouses have no authority to consent for each
  other
• Minors consent
• Can only consent if emancipated
• Only parents and legal guardians can consent
• The state can consent if life threatening or
  during regular school hours

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Terminology

• Heparin lock
• An IV device plugged on the hub end
• Used to maintain venous access w/out adding
  fluids
• Parenteral
• Not by mouth
• Total parenteral nutrition
• All nutrition needs met by parenteral routes

• Catheter
• A tubular, flexible, hollow instrument for
  withdrawing or injecting fluids
• Angiocatheter
• A catheter used specifically for blood vessel
• Butterfly needle
• An IV device with a rigid metal needle and a
  short segment of tubing

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Infection Control

• Universal Precautions
• Hand washing
• Non-sterile gloves
• Gowns
• Protective eyewear
• Needles and syringes
• Sharp instrument containers
• All blood must be considered potentially
  infectious

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If Needle Stick Occurs

• Immediately wash with soap and water
• Follow institution protocols
• These should include
• Report incident within 24 hours
• Report incident immediately to supervisor
• Notify infection control officer

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Site Selection And Anatomy

• Never use an arm with any of the following
• Fistula
• Shunt
• Decreased sensation
• Edema
• On the side of a mastectomy
• Begin as distal as you can
• Anything distal to insertion site is unusable for
  24 hours

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Site Selection And Anatomy

• Best insertion site
• Hand for patients under 60
• Best insertion site
• Cephalic or basilic for patients over 60
• Veins should be pliant and resiliant
• Most common veins used are
• Basilic, cephalic, and metacarpal

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Venous Anatomy
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Differences Between Arteries And Veins
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Four Things To Do Before Venipuncture

• Verify
• Drs order
• Patient identity
• Allergies
• Glucophage

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Selection Of Equipment

• Gauge of needle
• Length of needle
• Type of needle
• Tourniquet
• Iodine, Phisohex, or alcohol

• Tape/Tegaderm
• 2X2 or 4X4 gauze
• Gloves
• Contrast
• Normal saline
• Bandaids

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Venipuncture Equipment
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Avoid contamination

• Highest moments of risk of contamination
• Opening the venipuncture device
• Performing the venipuncture
• Infusing medication or contrast
• Changing solutions

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IV Set-Up Procedure
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Safe Re-cap Methods
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Venipuncture Procedure

• Apply tourniquet 8 inches above site
• Cleanse site for one minute
• Stabilize vein and insert needle, bevel up
• Watch for backflow
• Connect syringe
• Secure needle

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Pre-Injection Procedure
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Hypodermic needles w/syringes
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Assorted needles
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Hypodermic needles
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More hypodermic needles
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Angio Catheter
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Butterfly Needles
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Angiocatheters
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InjectionProcedure
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Removing The IV

• Remove tape (carefully)
• Pull needle out quickly
• Immediately apply pressure
• Elevate the arm
• Examine the site
• Apply dressing

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Needle Removal and Discard Procedure
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Special Considerations

• There must be a physicians order
• A radiologist must be within the immediate area
• Emergency equipment must be available
• Allergies must be checked for prior to injection
• BUN and Creatinine must be checked within 72 hours

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More Special Considerations

• Normal BUN - 5 - 25
• Normal Creatinine - 0.5 - 1.4
• If values abnormal, notify radiologist
• Explain procedure to patient
• 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

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Possible Side Effects

• Infiltration/Extravasation
• Swelling, tenderness, redness
• Adverse reaction to contrast
• Mild - hives, nausea, vomiting
• Severe - shortness of breath, shock

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Typical Emergency Medications

• Antihistamine
• Blocks histamine release
• Steroid
• Controls inflammation
• Epinephrine
• Promotes vasoconstriction