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Intravenous Sites
Intravenous Cannula
Venesection
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Intravenous Sites
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Assessment
Factors to be considered:
Condition of the vein
Type of fluid or medication to be infusedDuration of therapy Patients age and size
Whether the patient is right- or left-handedPatients medical history and current health status
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Assessment
Attributes of an ideal vein are:
Engorged, bouncy & soft
Refill after it has been depressedFeel roundBe well supported by surrounding structures
Be straight & free of valves Not hard, flat, or bumpy
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Methods for improving venous access:
Apply a tourniquetLower the level of the arm below the heart
Ask the patient to open and close their fist
Light tapping / rubbing of the veins Warm compresses over the selected vein Warm water
Relax the patient / consider the environment
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Veins to be avoided:
Thrombosed, fibrosed or sclerosedInflamed or bruised or painful
Thin or fragile
MobileNear bony prominences and jointsNear sites of infection or edema
Avoid the valves
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Vein selection Arm veins are mostcommonly used.
The metacarpal,cephalic, basilic, andmedian veins and theirbranches arerecommended sitesbecause of their sizeand ease of access.
Leg veins are rarely usedbecause of high risk of thromboembolism.
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Vein selection Antecubital Fossa
Brachial Artery
Ulnar Artery
Radial
Artery
Basillic
Cephalic
Median CubitalVein
Veins Arteries
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BASILLIC
VEIN
DORSAL VENOUS
NETWORK
CEPHALIC VEIN
DORSALMETACARPAL
VEINS
DIGITAL
DORSAL
VEIN
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Vein selection
The antecubital fossa is avoided, except as a last resort.Close proximity with other arteriesFlexion of elbow may displace cannula
The veins in the dorsal hand may be utilized if large boreaccess (18 gauge or larger) is not required. Care must betaken to find a vein that is straight and will accept the entirelength of the catheter.
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Intravenous Cannula
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Intravenous Cannula
A intravenous cannula is a flexible tube which wheninserted into the body is used either to withdraw fluid orinsert medication.
Cannulae normally come with a trocar (a sharp pointedneedle) attached which allows puncture of the body to getinto the intended space.
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A venous cannula is inserted into a vein, primarily for theadministration of intravenous fluids, obtaining bloodsamples and administering medicines.
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Intravenous CannulationColour Gauge Flow
Ml/minUses
Orange 14 275 Rapid transfusions of wholeblood. Emergency situations.
Grey 16 173 Rapid transfusions of wholeblood. Emergency situations
Green 18 100 Blood transfusions
Pink 20 60 IV infusions. Bolus
Blue 22 25Bolus. Maintenance infusions
Yellow 24 13 Bolus medications. Short terminfusions. Neonates
Purple 26 Neonates
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VENESECTION
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Venesection
Venesection is the generic term for a procedure thatinvolves the cutting of a vein in any way, but it most
commonly refers to the drawing of blood from a vein. Venous blood is usually taken from the median cubital vein, which is located on the arm, opposite the elbow.
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Venesection
Blood donation is also usually done out of this vein, butblood drawn for testing, which is the main purpose
of venesection, is normally taken in quantities of about 0.17to 0.84 fluid ounces (5 to 25 ml). Venesection is also known as phlebotomy and venipuncture.
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Vacutainer
Vacutainer is a registered brandof test tube specifically designedfor venipuncture.
The test tubes are covered with acolor-coded plastic cap. They ofteninclude additives that mix with theblood when collected (see below),
and the colour of the tube's plasticcap indicates which additives thattube contains.
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Benefits:
Quicker collection than other methodsClosed systemExact amount of blood obtained
Reduces the risk of haemolysis of the sampleReduces the risk of needle stick injury
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Order of draw
The order of draw refers to the sequence in which these tubesshould be filled.
Containers containing coagulants
Gold or 'Tiger' Red/Black top: Clot activator and gel forserum separationRed top PLASTIC tubes: Contains a clot activator and isused when serum is needed
Orange or Grey/Yellow 'Tiger' Top: Contain Thrombin,a rapid clot activator, for STAT serum testing
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Order of draw
Containers containing anticoagulantsGreen - Contains Sodium Heparin or Lithium Heparinused for plasma determinations
Light Green or Green/Gray 'Tiger': For plasmadeterminations in chemistry Grey - These tubes contain fluoride and oxalate.Fluoride prevents enzymes in the blood from working,so a substrate such as glucose will not be gradually used up during storage. Oxalate is an anticoagulant.
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Order of draw
Purple or lavender - contains EDTA (the potassiumsalt, or K2EDTA). This is a strong anticoagulant andthese tubes are usually used for full bloodcounts (CBC) and blood films. Lavender top tubes aregenerally used when whole blood is needed foranalysis. Can also be used for some blood bank procedures such as blood type and screen, but otherblood bank procedures, such as crossmatches must bein a pink tube in most facilities.
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Order of draw
Light blue - Contain a measured amount of citrate. Citrateis a reversible anticoagulant, and these tubes are usedfor coagulation assays. Because the liquid citrate dilutes theblood, it is important the tube is full so the dilution isproperly accounted for.Dark Blue - Contains sodium heparin, an anticoagulant.
Also can contain EDTA as an additive or have no additive.
These tubes are used for trace metal analysis.Pink - Similar to purple tubes (both contain EDTA) theseare used for blood banking.
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