VENIPUNCTURE Kyle Thornton DMI 63. Senate Bill 571 Filed on 8/26/97 Allows technologist’s to...
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Transcript of VENIPUNCTURE Kyle Thornton DMI 63. Senate Bill 571 Filed on 8/26/97 Allows technologist’s to...
VENIPUNCTUREVENIPUNCTURE
Kyle ThorntonKyle Thornton
DMI 63DMI 63
Senate Bill 571Senate Bill 571
Filed on 8/26/97Filed on 8/26/97 Allows technologist’s to perform venipuncture Allows technologist’s to perform venipuncture
under under general supervision of a physiciangeneral supervision of a physician Technologist must obtain 10 hours of Technologist must obtain 10 hours of
accredited education on venipunctureaccredited education on venipuncture Technologist must perform Technologist must perform 10 successful 10 successful
injections under direct supervisioninjections under direct supervision of a of a physician, registered nurse, or CRT physician, registered nurse, or CRT w/venipuncture certificationw/venipuncture certification
Before you stick, know:Before you stick, know:
Right pt?Right pt? Right contrast (medication)?Right contrast (medication)? Right concentration?Right concentration? Right amount?Right amount? Right site?Right site? Labs?Labs? Conflicting meds?Conflicting meds? Allergies?Allergies?
Informed ConsentInformed Consent
Pt has right to know and participate in Pt has right to know and participate in his/her own health carehis/her own health care
Pt must be informed of following:Pt must be informed of following: Nature of treatment/procedureNature of treatment/procedure Any risk, complicationsAny risk, complications, expected benefits or , expected benefits or
effects of such treatmenteffects of such treatment Any alternativesAny alternatives to procedure and their risks to procedure and their risks
and benefitsand benefits
Types Of ConsentTypes Of Consent
Consent: Consent: the affirmation to have one’s body the affirmation to have one’s body touched by otherstouched by others
ImpliedImplied consent consent By actionBy action
ExpressedExpressed consent consent VerbalVerbal
WrittenWritten consent consent• All are binding in courtAll are binding in court
WhoWho May Consent May Consent
Any person Any person over 18over 18 who is declared who is declared conscious and competentconscious and competent
Spouse’s consentSpouse’s consent Spouses have no authoritySpouses have no authority to consent for to consent for
each othereach other Minor’s consentMinor’s consent
Can only consent if emancipatedCan only consent if emancipated Only parents and legal guardians can consentOnly parents and legal guardians can consent State can consent State can consent if life threateningif life threatening or during regular or during regular
school hoursschool hours
TerminologyTerminology
Heparin lockHeparin lock An IV device plugged on the hub endAn IV device plugged on the hub end Used to maintain venous access w/out adding fluidsUsed to maintain venous access w/out adding fluids
ParenteralParenteral Not by mouthNot by mouth
Total parenteral nutritionTotal parenteral nutrition All nutrition needs met by parenteral routesAll nutrition needs met by parenteral routes
Terminology Terminology (cont’d)(cont’d)
CatheterCatheter A tubular, flexible, hollow instrument for A tubular, flexible, hollow instrument for
withdrawing or injecting fluidswithdrawing or injecting fluids
AngiocatheterAngiocatheter A catheter used specifically for blood vesselA catheter used specifically for blood vessel
Terminology Terminology (cont’d)(cont’d)
Butterfly needleButterfly needle An IV device with a An IV device with a
rigid metal needle and rigid metal needle and a short segment of a short segment of tubingtubing
Infection ControlInfection Control
Universal PrecautionsUniversal Precautions Hand washingHand washing Non-sterile glovesNon-sterile gloves GownsGowns Protective eyewearProtective eyewear Needles and syringesNeedles and syringes Sharp instrument containersSharp instrument containers All All bloodblood must be considered potentially must be considered potentially
infectiousinfectious
If Needle Stick OccursIf Needle Stick Occurs
ImmediatelyImmediately wash with soap and water wash with soap and water
Follow institution protocolsFollow institution protocols Report incident within 24 hoursReport incident within 24 hours Report incident immediately to supervisorReport incident immediately to supervisor Notify infection control officerNotify infection control officer
Site Selection And AnatomySite Selection And Anatomy
NeverNever use an arm with any of the following: use an arm with any of the following: FistulaFistula Shunt (Shunt (a hole or passage which moves, or allows movement of a hole or passage which moves, or allows movement of
fluidfluid from one part of the from one part of the bodybody to another) to another)
Decreased sensationDecreased sensation EdemaEdema On the side of a mastectomyOn the side of a mastectomy
Begin as Begin as distaldistal as you can as you can Anything distal to insertion site is Anything distal to insertion site is unusableunusable for for
24 hours24 hours
Site Selection And AnatomySite Selection And Anatomy
Best insertion site:Best insertion site:Hand for pts under 60Hand for pts under 60
Best insertion site:Best insertion site: Cephalic or basilic for patients over 60Cephalic or basilic for patients over 60
VeinsVeins should be pliant and resiliant should be pliant and resiliant
Venous AnatomyVenous Anatomy
Most common veins used are:Most common veins used are:
BasilicBasilicCephalicCephalic MetacarpalMetacarpal
Blood color Blood color Bright redBright red Dark redDark red PulsationPulsation PresentPresent AbsentAbsent Valves Valves AbsentAbsent PresentPresent Location Location Deep onlyDeep only Superficial &Superficial &
((surrounded by muscle)surrounded by muscle) deepdeep
Differences Between Differences Between ArteriesArteries And And VeinsVeins
44 Things To Do Things To Do BeforeBefore Venipuncture Venipuncture
Verify:Verify:
Dr’s orderDr’s order Pt identityPt identity AllergiesAllergies GlucophageGlucophage
Selection Of EquipmentSelection Of Equipment
Gauge of needleGauge of needle Length of needleLength of needle Type of needleType of needle TourniquetTourniquet Iodine, Phisohex, Iodine, Phisohex,
or alcoholor alcohol
Tape/TegadermTape/Tegaderm 2X2 or 4X4 gauze2X2 or 4X4 gauze GlovesGloves ContrastContrast Normal salineNormal saline BandaidsBandaids
Selection Of Equipment Selection Of Equipment (cont’d)(cont’d)
Venipuncture EquipmentVenipuncture Equipment
Avoid contamination!Avoid contamination!
Highest momentsHighest moments of risk of contamination: of risk of contamination:
Opening venipuncture deviceOpening venipuncture device Performing venipuncturePerforming venipuncture Infusing medication or contrastInfusing medication or contrast Changing solutionsChanging solutions
IV Set-Up ProcedureIV Set-Up Procedure
SafeSafe Re-cap Methods Re-cap Methods
Venipuncture ProcedureVenipuncture Procedure
Apply tourniquet 8 inches above siteApply tourniquet 8 inches above site Cleanse site for 1 minuteCleanse site for 1 minute Stabilize vein and insert needle, bevel upStabilize vein and insert needle, bevel up Watch for backflowWatch for backflow Connect syringeConnect syringe Secure needleSecure needle
Pre-Injection Pre-Injection ProcedureProcedure
Hypodermic needles w/syringesHypodermic needles w/syringes
Assorted needlesAssorted needles
Hypodermic needlesHypodermic needles
AngiocathetersAngiocatheters
Injection ProcedureInjection Procedure
Removing the IVRemoving the IV
Remove tape (carefully)Remove tape (carefully) Pull needle out quicklyPull needle out quickly Immediately apply pressureImmediately apply pressure Elevate the armElevate the arm Examine the siteExamine the site Apply dressingApply dressing
Needle Removal and Discard ProcedureNeedle Removal and Discard Procedure
Special ConsiderationsSpecial Considerations
Must be a physician’s orderMust be a physician’s order Radiologist must be within immediate areaRadiologist must be within immediate area EmergencyEmergency equipment must be available equipment must be available Allergies must be checked for prior to Allergies must be checked for prior to
injectioninjection BUN and Creatinine must be checked BUN and Creatinine must be checked
within 72 hourswithin 72 hours
Special ConsiderationsSpecial Considerations (cont’d)(cont’d)
Normal BUN - 5 - 25 Normal BUN - 5 - 25 (Blood Urea Nitrogen)(Blood Urea Nitrogen)
Normal Creatinine - 0.5 - 1.4Normal Creatinine - 0.5 - 1.4
If values abnormal, notify radiologistIf values abnormal, notify radiologist
Explain procedure to ptExplain procedure to pt
Special ConsiderationsSpecial Considerations (cont’d)(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
Possible Side EffectsPossible Side Effects
Infiltration/ExtravasationInfiltration/Extravasation Swelling, tenderness, rednessSwelling, tenderness, redness
Adverse reactionAdverse reaction to contrast to contrast Mild - hives, nausea, vomitingMild - hives, nausea, vomiting Severe - shortness of breath, shockSevere - shortness of breath, shock
Typical Emergency MedicationsTypical Emergency Medications
AntihistamineAntihistamine Blocks histamine releaseBlocks histamine release
SteroidSteroid Controls inflammationControls inflammation
EpinephrineEpinephrine Promotes vasoconstrictionPromotes vasoconstriction
The EndThe End