Podcast
Questions and Answers
Why is it important to avoid placing tape directly over the clear dressing window after securing an IV catheter?
Why is it important to avoid placing tape directly over the clear dressing window after securing an IV catheter?
- To allow for visual inspection of the IV insertion site without removing the dressing. (correct)
- To ensure the dressing remains breathable and reduces moisture buildup.
- To make it easier to remove and replace the dressing during routine IV maintenance.
- To prevent the tape adhesive from irritating the patient's skin.
During IV placement, what is the rationale for releasing the tourniquet after the catheter is advanced and before flushing the IV?
During IV placement, what is the rationale for releasing the tourniquet after the catheter is advanced and before flushing the IV?
- To allow for proper assessment of blood return in the catheter.
- To minimize patient discomfort and prevent nerve damage. (correct)
- To reduce the risk of hematoma formation at the insertion site.
- To prevent excessive pressure in the vein and ensure accurate flow rate.
Why is it important to flush the IV with normal saline after the catheter is inserted?
Why is it important to flush the IV with normal saline after the catheter is inserted?
- To verify proper catheter placement and patency, ensuring there are no obstructions. (correct)
- To dilute any medications that may have been previously administered through the IV line.
- To anesthetize the area around the insertion site and reduce patient discomfort.
- To clean the insertion site and reduce the risk of infection.
What immediate action should be taken if a patient complains of pain, swelling, and redness at the IV insertion site during an infusion?
What immediate action should be taken if a patient complains of pain, swelling, and redness at the IV insertion site during an infusion?
If air is accidentally introduced into the IV line, creating a risk of air embolism, what is the MOST appropriate immediate nursing intervention?
If air is accidentally introduced into the IV line, creating a risk of air embolism, what is the MOST appropriate immediate nursing intervention?
Why is it crucial to limit tourniquet application to a maximum of 1 minute during venipuncture?
Why is it crucial to limit tourniquet application to a maximum of 1 minute during venipuncture?
Why is a quick wipe with an alcohol swab for skin preparation before venipuncture discouraged?
Why is a quick wipe with an alcohol swab for skin preparation before venipuncture discouraged?
During venipuncture, what is the primary reason for anchoring the vein?
During venipuncture, what is the primary reason for anchoring the vein?
At what angle should the needle be inserted into the vein during venipuncture?
At what angle should the needle be inserted into the vein during venipuncture?
During insertion of a catheter into a vein, what is the significance of observing a second flashback in the catheter?
During insertion of a catheter into a vein, what is the significance of observing a second flashback in the catheter?
Why is it important to apply pressure on the vein beyond the catheter tip after inserting the catheter but before attaching the extension tubing?
Why is it important to apply pressure on the vein beyond the catheter tip after inserting the catheter but before attaching the extension tubing?
After attaching the saline-flushed extension tubing, what is the next crucial step?
After attaching the saline-flushed extension tubing, what is the next crucial step?
What type of dressing is recommended for covering the venipuncture insertion site?
What type of dressing is recommended for covering the venipuncture insertion site?
A patient with a history of mastectomy on the left side requires intravenous access. Considering the guidelines for site selection, where should the IV placement be avoided?
A patient with a history of mastectomy on the left side requires intravenous access. Considering the guidelines for site selection, where should the IV placement be avoided?
When selecting a vein for venipuncture, which characteristic indicates that the vein is healthy and suitable for cannulation?
When selecting a vein for venipuncture, which characteristic indicates that the vein is healthy and suitable for cannulation?
A nurse is preparing to insert an IV on a patient who will be transported to another facility for further treatment. Which site selection consideration is most important in this scenario?
A nurse is preparing to insert an IV on a patient who will be transported to another facility for further treatment. Which site selection consideration is most important in this scenario?
After applying a tourniquet, a nurse is having difficulty locating a suitable vein for IV insertion. Which of the following methods is LEAST likely to help improve venous access?
After applying a tourniquet, a nurse is having difficulty locating a suitable vein for IV insertion. Which of the following methods is LEAST likely to help improve venous access?
A physician orders intravenous fluids, antibiotics and blood products to be administered simultaneously. What type of IV access device would be most appropriate for this patient?
A physician orders intravenous fluids, antibiotics and blood products to be administered simultaneously. What type of IV access device would be most appropriate for this patient?
Why is it essential to avoid areas where veins bifurcate when placing an IV?
Why is it essential to avoid areas where veins bifurcate when placing an IV?
A nurse is preparing to insert an IV. After applying the tourniquet, the patient reports pain and numbness in their hand. What is the most appropriate immediate action?
A nurse is preparing to insert an IV. After applying the tourniquet, the patient reports pain and numbness in their hand. What is the most appropriate immediate action?
Which statement accurately describes the correct application of a tourniquet for venipuncture?
Which statement accurately describes the correct application of a tourniquet for venipuncture?
Flashcards
IV Dressing Securement
IV Dressing Securement
Secure the IV extension set to the patient's arm with tape, avoiding the dressing window, and label the dressing with the date and time.
IV Placement Steps
IV Placement Steps
- Universal precautions. 2. Tourniquet. 3. Palpate vein. 4. Needle insertion & flash. 5. Catheter advance, needle withdraw. 6. Release tourniquet. 7. Flush saline. 8. Attach tubing. 9. Anchor catheter.
Infiltration/Extravasation
Infiltration/Extravasation
Fluid leaking into surrounding tissue.
Thrombophlebitis
Thrombophlebitis
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Air Embolism
Air Embolism
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IV Cannulation
IV Cannulation
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Purpose of IV Cannulation
Purpose of IV Cannulation
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IV Access Devices
IV Access Devices
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IV Site Selection: Avoid...
IV Site Selection: Avoid...
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Vein Selection: Palpation
Vein Selection: Palpation
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Improve Venous Access
Improve Venous Access
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Tourniquet Function
Tourniquet Function
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Tourniquet application
Tourniquet application
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Tourniquet Time Limit
Tourniquet Time Limit
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Asepsis in Venipuncture
Asepsis in Venipuncture
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Venipuncture: Initial Steps
Venipuncture: Initial Steps
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Venipuncture: Preparation
Venipuncture: Preparation
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Venipuncture: Site Prep
Venipuncture: Site Prep
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Anchoring the Vein
Anchoring the Vein
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Catheter Advancement
Catheter Advancement
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Extension Tubing Connection
Extension Tubing Connection
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Study Notes
- Venipuncture involves the placement of a cannula inside a vein to provide venous access
Purpose of IV placement
- Obtaining a blood sample
- Fluids can be administered
- Medications can be administered
- Total Parenteral Nutrition (TPN) can be administered
- Chemotherapy can be administered
- Blood products can be administered
IV Access Devices
- Peripheral catheter
- Peripherally Inserted Central Catheter (PICC line)
- Central line placement possible in the jugular, subclavian, and femoral veins
IV Cannula Parts
- Consists of Safety Needle Cover
- Flashback Chamber indicates successful insertion
- Needle
- Catheter
- Needle Grip for handling
- Hub & Wings for stabilization
Supplies Needed
- Tourniquet to distend veins
- Cotton balls for cleaning
- Gauze for wound care
- Alcohol pads for sterilization
- IV catheter (20 or 22 gauge) for insertion
- Extension set/connector for tubing attachment
- 5 mL Saline flush for catheter maintenance
- Saline bag for fluid administration
- IV tubing set to connect fluid bag to catheter
- IV start kit
- Sharps container for safe disposal
Site Selection Considerations
- Avoid extensive scarring and healed burn areas
- Avoid areas containing trauma
- Do not place IVs on the same side as a mastectomy
- Do not put IVs in areas of hematoma
- Avoid placing an IV in an arm with a cannula, fistula, or vascular graft
- In patients being transported to a facility for additional medical care, place the IV distally
- Avoid areas where the vein bifurcates
Venipuncture should be avoided in the following situations
- On the arm on the side of a mastectomy, as results may be inaccurate due to lymph edema
- In scarred or burned areas, due to the difficulty of puncturing scar tissue
- In an arm where blood is being transfused or an IV cannula is present, as the IV fluid could dilute the specimen
Factors that Can Cause Incorrect Test Results
- Hematoma: An abnormal collection of blood outside a blood vessel due to damage; can lead to incorrect test results if punctured
- Edematous tissue: Swelling caused by fluid retention can alter test results
Procedure for Vein Selection
- Palpate and trace veins with the index finger; arteries pulsate and have a thick wall
- Thrombosed veins lack resilience, feel cordlike, and roll easily
- Force blood into the vein by massaging the arm from wrist to elbow if superficial veins are not readily apparent
- can be achieved by tapping the site
- can be achieved by applying a warm, damp washcloth to the site for 5 minutes
- can be achieved by lowering the extremity over the bedside
- Healthy veins feel soft and bouncy and will refill when depressed
Methods to Improve Venous Access
- Application of a Tourniquet
- Promotes venous distension by impeding venous return
- Should not restrict arterial flow
- Place 7-8 cm above the venipuncture site
- The tourniquet should be left on for no longer than 1 minute because it may cause blood to pool resulting in inaccurate blood results
Skin Preparation
- Asepsis is vital because the skin is breached and a foreign device is introduced into a sterile circulatory system
- Skin cleansing is a debated subject, but it is acknowledged that a quick wipe with an alcohol swab is bad
- Skin must be prepared and cleaned
- Clip hairs if present
- Antiseptic should be on skin for at least 30 seconds
Site Preparation
- Iodine tincture (1% to 2%)
- Isopropyl alcohol (70%)
Venipuncture Procedure: Approach
- Approach and communicate with the patient
- Introduce yourself and check the patient's ID
- Explain the procedure and its purpose
- Gain consent and check for allergies and shunts
- Review the treatment plan and individual's history
- Talk the patient through the procedure in a considerate and courteous manner
Venipuncture Procedure: Sterility
- Wash hands
- Clean and prepare procedure tray according to guidelines
- Collect equipment into the tray
Venipuncture Procedure: Equipment
- Skin cleansing wipes
- Tourniquet
- Gloves
- Gauze swabs
- Adhesive dressing
- Needles
- Blood collection tube(s)
- Sharps container.
Venepuncture Preparation Steps
- The patient should be lying down or in a suitable chair
- Support arm on a pillow to position the patients arm
- Check for contra-indications like trauma or infection
- Select suitable vein
- Clean site for 30 seconds (DO NOT TOUCH AGAIN)
- Let it dry
- Release the tourniquet
Inserting the Needle Tips
- Anchor the vein: Grasp arm with your non-dominant hand and use thumb to pull skin taut
- Insert the needle bevel up at a 15-30 degree angle smoothly
Inserting the Device Tips
- Use the device's push-off tab to separate the catheter from the needle stylet while holding the skin taut
- Advance the catheter while watching for 2nd flashback
- Apply pressure on the vein beyond catheter tip to mitigate blood leakage
Extension Tubing Application
- Release the tourniquet
- Place a 2x2 gauze pad under the catheter hub
- Attach the saline-flushed extension tubing, ensure connection is tight
- Flush the catheter
Dressing Application
- Apply a transparent semipermeable dressing
- Curl the extension set to the side and tape it in place
- Do not place tape over clear dressing window
- Label the dressing with current date and time
- Use tubular netting to secure catheter, pulling back netting every 2 hours for site assessment
Technologies for Venipuncture
- Devices use laser/infrared to visualize veins: -Veinlite -AccuVein -VeinViewer Flex
IV Placement Steps
- Use universal precautions for bloodborne pathogens
- Apply tourniquet to upper arm
- Palpate and locate a vein
- Insert the needle into the vein to get "flash" of blood
- Advance the catheter and withdraw the needle
- Release the tourniquet
- Flush the IV with normal saline
- Attach the IV tubing
- Anchor the IV at the catheter site
I.V Cannulation Complications
- Infiltration and extravasation
- Thrombophlebitis: Peripheral thrombophlebitis is caused by local damage to the venous wall with inflammation and thrombus formation
- Infection is a common complication of IV therapy
- Air embolism
- Arterial placement
- Catheter fracture and embolism
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Description
Venipuncture involves inserting a cannula into a vein for venous access. This allows for blood sampling, fluid and medication administration, and delivery of nutrition, chemotherapy or blood products. Various IV access devices exist, including peripheral catheters and central lines.
