1. VENIPUNCTURE Kyle Thornton 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 pt?  Right contrast (medication)?  Right concentration?  Right amount?  Right site?  Labs?  Conflicting meds?  Allergies?

4. Informed Consent  Pt has right to know and participate in his/her own health care  Pt must be informed of following: Nature of treatment/procedure Nature of treatment/procedure Any risk, complications, expected benefits or effects of such treatment Any risk, complications, expected benefits or effects of such treatment Any alternatives to procedure and their risks and benefits Any alternatives to procedure and their risks and benefits

5. Types Of Consent  Consent: the affirmation to have one’s body touched by others  Implied consent By action By action  Expressed consent Verbal Verbal  Written consent All are binding in courtAll 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 Spouses have no authority to consent for each other  Minor’s consent Can only consent if emancipated Can only consent if emancipated Only parents and legal guardians can consent Only parents and legal guardians can consent State can consent if life threatening or during regular school hours State can consent if life threatening or during regular school hours

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

8. Terminology (cont’d)  Catheter A tubular, flexible, hollow instrument for withdrawing or injecting fluids A tubular, flexible, hollow instrument for withdrawing or injecting fluids  Angiocatheter A catheter used specifically for blood vessel A catheter used specifically for blood vessel

9. Terminology (cont’d)  Butterfly needle An IV device with a rigid metal needle and a short segment of tubing An IV device with a rigid metal needle and a short segment of tubing

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

11. If Needle Stick Occurs Immediately wash with soap and water Follow institution protocols Report incident within 24 hours Report incident within 24 hours Report incident immediately to supervisor Report incident immediately to supervisor Notify infection control officer Notify infection control officer

12. Site Selection And Anatomy Never use an arm with any of the following: Fistula Fistula Shunt ( a hole or passage which moves, or allows movement of fluid from one part of the body to another) Shunt ( a hole or passage which moves, or allows movement of fluid from one part of the body to another) fluidbody fluidbody Decreased sensation Decreased sensation Edema Edema On the side of a mastectomy On the side of a mastectomy Begin as distal as you can Anything distal to insertion site is unusable for 24 hours Anything distal to insertion site is unusable for 24 hours

13. Site Selection And Anatomy Best insertion site: Hand for pts under 60 Best insertion site: Cephalic or basilic for patients over 60 Cephalic or basilic for patients over 60 Veins should be pliant and resiliant

14. Venous Anatomy Most common veins used are: BasilicCephalicMetacarpal

15.  Blood color Bright red Dark red  Pulsation Present Absent  Valves Absent Present  Location Deep only Superficial & ( surrounded by muscle) deep Differences Between Arteries And Veins

16. 4 Things To Do Before Venipuncture  Verify: Dr’s order Dr’s order Pt identity Pt identity Allergies Allergies Glucophage Glucophage

17. Selection Of Equipment  Gauge of needle  Length of needle  Type of needle  Tourniquet  Iodine, Phisohex, or alcohol

18.  Tape/Tegaderm  2X2 or 4X4 gauze  Gloves  Contrast  Normal saline  Bandaids Selection Of Equipment (cont’d)

19. Venipuncture Equipment

20. Avoid contamination! Highest moments of risk of contamination: Opening venipuncture device Opening venipuncture device Performing venipuncture Performing venipuncture Infusing medication or contrast Infusing medication or contrast Changing solutions Changing solutions

21. IV Set-Up Procedure

22. Safe Re-cap Methods

23. Venipuncture Procedure  Apply tourniquet 8 inches above site  Cleanse site for 1 minute  Stabilize vein and insert needle, bevel up  Watch for backflow  Connect syringe  Secure needle

24. Pre-Injection Procedure

25. Hypodermic needles w/syringes

27. Assorted needles

28. Hypodermic 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  Must be a physician’s order  Radiologist must be within 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. Special Considerations (cont’d)  Normal BUN - 5 - 25 (Blood Urea Nitrogen)  Normal Creatinine - 0.5 - 1.4  If values abnormal, notify radiologist  Explain procedure to pt

35. Special Considerations (cont’d) 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

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

37. Typical Emergency Medications  Antihistamine Blocks histamine release Blocks histamine release  Steroid Controls inflammation Controls inflammation  Epinephrine Promotes vasoconstriction Promotes vasoconstriction

38. The End