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VENIPUNCTURE

VENIPUNCTURE. DMI 63. 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

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VENIPUNCTURE

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  1. VENIPUNCTURE 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 patient? • Right contrast (medication)? • Right concentration? • Right amount? • Right site? • Labs? • Conflicting meds? • Allergies?

  4. Informed Consent • The patient has a right to know and participate in his/her own health care • Patient must be informed of the following: • The nature of the treatment/procedure • Any risk, complications, expected benefits or effects of such treatment • Any alternatives to the procedure and their risks and benefits

  5. Types Of Consent • Consent is the affirmation to have one’s body touched by others • Implied consent • By action • Expressed consent • Verbal • Written consent • All 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 • Minor’s consent • Can only consent if emancipated • Only parents and legal guardians can consent • The state can consent if life threatening or during regular school hours

  7. Heparin lock An IV device plugged on the hub end Used to maintain venous access w/out adding fluids Parenteral Not by mouth Total parenteral nutrition All nutrition needs met by parenteral routes Catheter A tubular, flexible, hollow instrument for withdrawing or injecting fluids Angiocatheter A catheter used specifically for blood vessel Butterfly needle An IV device with a rigid metal needle and a short segment of tubing Terminology

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

  9. If Needle Stick Occurs • Immediately wash with soap and water • Follow institution protocols • These should include: • Report incident within 24 hours • Report incident immediately to supervisor • Notify infection control officer

  10. Site Selection And Anatomy • Never use an arm with any of the following: • Fistula • Shunt • Decreased sensation • Edema • On the side of a mastectomy • Begin as distal as you can • Anything distal to insertion site is unusable for 24 hours

  11. Site Selection And Anatomy • Best insertion site: • Hand for patients under 60 • Best insertion site: • Cephalic or basilic for patients over 60 • Veins should be pliant and resiliant • Most common veins used are: • Basilic, cephalic, and metacarpal

  12. Venous Anatomy

  13. Differences Between Arteries And Veins

  14. Four Things To Do Before Venipuncture • Verify: • Dr’s order • Patient identity • Allergies • Glucophage

  15. Gauge of needle Length of needle Type of needle Tourniquet Iodine, Phisohex, or alcohol Tape/Tegaderm 2X2 or 4X4 gauze Gloves Contrast Normal saline Bandaids Selection Of Equipment

  16. Venipuncture Equipment

  17. Avoid contamination • Highest moments of risk of contamination: • Opening the venipuncture device • Performing the venipuncture • Infusing medication or contrast • Changing solutions

  18. IV Set-Up Procedure

  19. Safe Re-cap Methods

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

  21. Pre-Injection Procedure

  22. Hypodermic needles w/syringes

  23. Assorted needles

  24. Hypodermic needles

  25. More hypodermic needles

  26. Angio Catheter

  27. Butterfly Needles

  28. Angiocatheters

  29. InjectionProcedure

  30. Removing The IV • Remove tape (carefully) • Pull needle out quickly • Immediately apply pressure • Elevate the arm • Examine the site • Apply dressing

  31. Needle Removal and Discard Procedure

  32. Special Considerations • There must be a physician’s order • A radiologist must be within the immediate area • Emergency equipment must be available • Allergies must be checked for prior to injection • BUN and Creatinine must be checked within 72 hours

  33. More Special Considerations • Normal BUN - 5 - 25 • Normal Creatinine - 0.5 - 1.4 • If values abnormal, notify radiologist • Explain procedure to patient • 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

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

  35. Typical Emergency Medications • Antihistamine • Blocks histamine release • Steroid • Controls inflammation • Epinephrine • Promotes vasoconstriction

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