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CANNULATION & VENESECTION

CANNULATION & VENESECTION. LEARNING OUTCOMES OF THE WORKSHOP. To be able to assess the patient To be able to take a blood sample using a vacutainer system To be able to site / change a cannula To be able to name the complications of cannulation and venesection.

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CANNULATION & VENESECTION

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  1. CANNULATION & VENESECTION

  2. LEARNING OUTCOMES OF THE WORKSHOP • To be able to assess the patient • To be able to take a blood sample using a vacutainer system • To be able to site / change a cannula • To be able to name the complications of cannulation and venesection

  3. Patient Assessment & Vein Selection

  4. THE ASSESSMENTCONSIDER THE FOLLOWING POINTS: • Age / size / history / condition / dependency of the patient • History of previous cannulation / venesection • Type / length of treatment required • Number of tests ordered • What medication is the patient on? • Fluid status • History of blood disorders

  5. Conditions that affect the position of the device: - • Amputation • Stroke • Mastectomy or other Breast / Lymph Surgery • Renal Fistula • Lymphoedema or Cellulitsis • Diabetes / Vascular Disease / Arthritis • Trauma / Fractures / Burns • Social History

  6. Questions to ask the patient • OBTAIN CONSENT • Have you had a cannula / blood test before? • Were there any complications / adverse reactions? • Do you have any allergies? • Consider needle phobia • Would you like a local topical anaesthetic before I insert the cannula or take blood? • Which is your dominant arm?

  7. Attributes of an ‘ideal’ vein are: - • Be engorged, bouncy & soft • Refill after it has been depressed • Be visible • Feel round • Be well supported by surrounding structures • Be straight & ‘free of valves’

  8. Veins to be avoided are: - • Thrombosed, fibrosed or sclerosed • Inflamed or bruised or painful • Thin or fragile • Mobile • Near bony prominences and joints • Near sites of infection or oedema • AVOID THE VALVES • For venesectionavoid the arm with an IV line running

  9. Methods for improving venous access: • Apply a disposable tourniquet • Lower 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

  10. WHICH VEIN?

  11. Antecubital Fossa Cephalic 1st Intercostal Brachial Artery Basillic Radial Median Cubital Vein Radial Artery Median Ulnar Artery Ulnar Veins Arteries Nerves

  12. DIGITAL DORSAL VEIN DORSAL METACARPAL VEINS DORSAL VENOUS NETWORK CEPHALIC VEIN BASILLIC VEIN

  13. VEINS TO BE USED ARE: • METACARPAL VEINS • CEPHALIC VEIN • BASILIC VEIN • MEDIAN CUBITAL VEIN

  14. GROUP EXERCISE In pairs, use a tourniquet to identify each others: • Veins • Arteries • Valves • Ligaments

  15. CANNULA SELECTION

  16. Selecting the right cannulaTwo key points to consider: • What is the cannula going to used for? • The condition, location and size of the vein selected? You should try to select the smallest gauge possible that will accommodate the intravenous therapy that is prescribed.

  17. VENESECTION DEVICE SELECTION

  18. VACUTAINER • Quicker collection than other methods • Closed system • Exact amount of blood obtained • Reduces the risk of haemolysis of the sample • Reduces the risk of needlestick injury

  19. BOTTLES & BLOOD FORMS • E-QUEST SYSTEM for blood requests & results within SUHT • ALWAYS ensure that the GROUP &SAVEor CROSSMATCH request has been correctly completed & signed for by the requesting MEDICAL PRACTIONER

  20. Serum AB Levels E.D.T.A. FBC & ESR Cross Match Group & Save Coagulation INR / APTR Glucose Lithium Heparin, PST, U&E’s, Bone & Liver Trace Elements

  21. ORDER OF DRAW • No Additives ( Green, Red, Dark Blue) • Coagulation Screen (Light Blue) • Other Additives (Gold, Grey, Lavender& Pink) EXCEPTION: Blood Cultures always FILL FIRST

  22. Risks and Complications of Cannulation & Venesection

  23. Infection Haemorrhage Haematoma Vaso-vagal episode Needle phobias Allergies Transfixation Pain Nerve damage Arterial puncture Needlestick injury Risks - During Insertion

  24. Transfixation SkinVein wallVein wall

  25. Haematoma/Bruising • Transfixation • Tourniquet too tight / too long / use of RUBBER GLOVE! • Arterial puncture • Repeated insertion sites

  26. Future Complications of Cannulation • Phlebitis — septic / mechanical / chemical • Infiltration • Extravasation • Thrombosis / Embolism • Speed shock / Fluid overload

  27. Phlebitis • TYPES OF:

  28. Infiltration • “The inadvertent administration of non-vesicant solution/medication into surrounding tissues." (Royal Marsden Manual, 2004) • The cannula may still appear to be patent, so early recognition is vital to avoid tissue damage.

  29. Extravasation • “the inadvertent administration of a vesicant substance into the tissues surrounding a vein.” (Royal Marsden Manual, 2004)

  30. Site preparation • As cannulation / venesection is performed using an aseptic non-touch technique it is imperative that the vein is cleaned PRIORTO THEPROCEDURE, wearing clean non-latex gloves • Clean the vein for 30 seconds with 2% chlorhexidine in 70% alcohol solution, cleaning the vein in a criss-cross motion • Allow vein to air dry • DO NOTre-touch or palpatethe vein oncecleaned • Consider hair clipping if appropriate

  31. DOCUMENTATION • SEE CANNULA CARE PLAN includes: • Time & date of blood sample / cannula insertion • Site of insertion • Gauge and batch number of the cannula • What blood samples have been taken • Number of attempts (MAX 2 per person) • Any complications noted (e.g. haematoma) • Print & sign your name • Evidence verbal consent has been obtained

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