VENIPUNCTURE: an art for intravenous therapy AGNES R.

DOMINGO, RN MICU Head nurse DEFINITION: a sterile invasive procedure permits insertion of catheter into a vein. MODES IN VENIPUNCTURE: Peripheral IV Therapy (PIV) Central Venous Therapy ADVANTAGES & DISADVANTAGES OF A PIV Less invasive Easily infiltrates Less time to insert Limited to short term use Quick to place during emergencies Requires no sedation INDICATIONS: Hydration Administration of drugs, blood and blood components Administration of nutrition Administration of dye in diagnostic procedures RISKS: Bleeding, infiltration or infections Adverse effects on rapid infusion of some drugs* Cannot be used continuously The A B C D E of Venipuncture: AKO of the IV therapist Buddy or the patient Catheter and other equipment or medical devices Documentation Evaluation AKO the self or the IV Therapist Skills Knowledge Attitude Appearance

BUDDY the patient Patients Assessment Clinical status Age and weight Dominant arm Condition of veins and skin Type of solution The patient might be: Apprehensive Make the patient relax Provide privacy Allow patient to use CR prior to venipuncture Position comfortably in bed Allow time for patient education

 Answer patients questions clearly & patiently

CATHETER, MEDICAL DEVICES & EQUIPMENT Success on venipuncture lies on the choice of catheter

FACTORS IN PREPARING THE DEVICE / EQUIPMENT Integrity of the infusate Functionality of the equipment/ device Compatibility of the cannula, infusion set, infusate, drugs Patients preference POINTS TO BE CHECKED PRIOR TO IV THERAPY Physicians order IV equipment preparation Medications IV administration sets Electronic infusion device IV STARTS Comparing peripheral venipuncture sites

HINTS FOR SELECTING SUITABLE VEIN FOR PIV Choose the largest vein Always use the distal end of the vein firs For a short-term infusion, select the : - antecubital fossa, or medial basilic or medial cephalic veins For a long-term IV (>24 hrs), try one of the following sites: - Hand - Forearm METHODS OF DISTENDING A VEIN PRIOR TO INSERTION If the arm is used, Lower the arm Apply a warm compress Massage the area towards the venous flow Apply torniquet 2-6 inches above insertion site. Have the patient periodically clench his fist Apply manual pressure to distal & proximal ends of the vein Well-filled but fragile veins, puncture without torniquet

METHODS FOR INSERTING THE CATHETER Indirect Method (from the side) Direct Method CHANGING A PERIPHERAL IV DRESSING Wash hands & put on sterile gloves Hold the catheter in place with your nondominant hand Gently remove the tape & the dressing. Assess the venipuncture site If you detect these signs: - apply pressure to the area with sterile gauze - remove the catheter or needle. - Maintain pressure on the area until bleeding stops - apply an adhesive bandage. - Reinsert the IV device at another site. If no complications:

- hold the needle or catheter at the hub - clean around the site with povidone-iodine or alcohol swab. - Allow the area to dry completely. Retape the device Apply a transparent semi-permeable dressing or Apply gauze & secure it. KNOW WHEN TO QUIT If the requested access is not possible. If you are becoming frustrated If the patient-nurse relationship is being damaged Patient has unreasonable number of attempts. Vascular access requires special skills of a doctor

TROUBLESHOOTING INSERTION TECHNIQUE An improper torniquet placement Failure to release torniquet once catheter is in Inserting too deep & missing the vein Ruptured vein on insertion Pain during insertion Getting stuck in the wall of the vein Improper taping of the IV tubing across the cannula Failure to penetrate the vein