1. VENIPUNCTURE DMI 63

2. Senate Bill 571 Filed on 8/26/97 Allows technologist’s 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

3. Before you stick, know: Right patient? Right contrast (medication)? Right concentration? Right amount? Right site? Labs? Conflicting meds? Allergies?

4. 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

5. Types Of Consent Consent is the affirmation to have one’s body touched by others Implied consent  By action Expressed consent  Verbal Written consent All are binding in court

6. Who May Consent Any person over 18 who is declared conscious and competent Spouse’s consent  Spouses have no authority to consent for each other Minor’s 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

7. 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

8. 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

9. 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

10. 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

11. 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

12. Venous Anatomy

13. Differences Between Arteries And Veins

14. Four Things To Do Before Venipuncture Verify:  Dr’s order  Patient identity  Allergies  Glucophage

15. 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

16. Venipuncture Equipment

17. Avoid contamination Highest moments of risk of contamination:  Opening the venipuncture device  Performing the venipuncture  Infusing medication or contrast  Changing solutions

18. IV Set-Up Procedure

19. Safe Re-cap Methods

20. 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

21. Pre-Injection Procedure

22. Hypodermic needles w/syringes

24. Assorted needles

25. Hypodermic needles

26. More hypodermic needles

27. Angio Catheter

28. Butterfly Needles

29. Angiocatheters

30. Injection Procedure

31. Removing The IV Remove tape (carefully) Pull needle out quickly Immediately apply pressure Elevate the arm Examine the site Apply dressing

32. Needle Removal and Discard Procedure

33. Special Considerations There must be a physician’s 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

34. 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

35. Possible Side Effects Infiltration/Extravasation  Swelling, tenderness, redness Adverse reaction to contrast  Mild - hives, nausea, vomiting  Severe - shortness of breath, shock

36. Typical Emergency Medications Antihistamine  Blocks histamine release Steroid  Controls inflammation Epinephrine  Promotes vasoconstriction