V ENIPUNCTURE & B LOOD D RAWING N OTES ;) Starting the IV

A NATOMY & P HYSIOLOGY Skin is 1 st barrier you must cross Epidermis - (1 st 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

S ENSORY R ECEPTORS 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

V EINS VS. A RTERIES Arteries 3 layers thick Thick walled Wall 25% of diameter No valves pulsates

V EINS VS. A RTERIES CONT. Veins Thin walled Wall 10% of diameter Greater distensibility Valves present Stores blood

3 L AYERS 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

V EINS U SED Digital Metacarpal Cephalic Basilic Accessory cephali Antebrachial Most facilities require a physician’s order to use lower extramities

P RECANNULATION 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

S ITE S ELECTION 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

N URSING GOALS FOR C HOOSING S ITE 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

V EIN D IALATION 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)

C ANNULATION 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

C ANNULATION 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

M ORE C ANNULATION 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 degree angle to puncture the vein & skin After piercing the vein and flashback occurs, lower the angle of the catheter and needle (stylet)

C ANNULATION – V EIN E NTRY 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

C ATHETER S TABILIZATION U method H method Chevron Method Do not tape over the site

D RESSING M ANAGEMENT Gauze Transparent semipermeable membrane dressing Change every hours No ointment or anything should be under the TSM Apply only to hub and wings Seal securely

P OST -C ANNULATION Labeling Must be done on insertion site Tubing Solution container All must have date, time,nurse’s initials

P OST -C ANNULATION CONT. Equipment disposal Patient education: activity, alarms, assessment by nurse Rate calculations Monitoring & documentation