Venipuncture PPT

Question 1

In order to access an extremity for venipuncture on a patient with a prior mastectomy, what must one have to access the extremity involved in the lymph node removal?

Answer 1

Physician’s order

Question 2

What happens to the veins when a patient is apprehensive or is cold and fearful of the procedure?

Answer 2

The veins constrict and disappear making venipuncture more difficult

Question 3

Vasovagal response

Answer 3

Reaction based on fear

Question 4

What type of information must one obtain from a patient prior the venipuncture procedure?

Answer 4

• Possible allergies
• Current medications
• Prior surgeries to include mastectomy with lymph node involvement

Question 5

Types of Syringe

Answer 5

Plastic disposable syringes: glass syringe

Question 6

3 components of Syringe

Answer 6

-Tip: where needle attaches to syringe
(Contains a locking device to hold needle securely)
-Barrel
-Plunger: fits inside the barrel

Question 7

Needles

Answer 7

Disposable; one use only

Question 8

Needle length Measured

Answer 8

in inches
Varies from ½ inch to 4½ inches
Generally 1 to 1½” is used for IV injections

Question 9

Types of needles

Answer 9

• Hypodermic needle
• Butterfly set
• Over-the-cannula needle

Question 10

Butterfly sets

Answer 10

• Stainless steel needle with plastic appendages on both sides (wings)
• Aids in insertion and stabilization of needle 6” of tubing with a connector at the end

Question 11

Over-the-needle cannula

Answer 11

• Once venipuncture is established, the catheter slips off the needle into the vein – steel needle is removed
• Recommended for long-term therapy or for rapid infusions

Question 12

What are the components to a needle?

Answer 12

• Hub – part that attaches to syringe
• Cannula/shaft – length of needle
• Bevel – slanted portion of needle tip

Question 13

What is the average range for the GFR, BUN and creatinine levels?

Answer 13

• GFR = 90 to 130
• BUN = 10 to 20 mg/dL
• Creatinine = 0.05 to 1.2 mg/dL

Question 14

As the gauge of the needle increases, the diameter of the bore

Answer 14

decreases

Question 15

Which is larger an 18 gauge or a 22 gauge needle?

Answer 15

18 gauge

Question 16

Where are the veins typically located for IV access for use in radiologic examinations?

Answer 16

• Anterior forearm
• Posterior hand
• Antecubital space

Question 17

Are you allowed to use the anterior wrist for starting an IV?

Answer 17

No

Could damage radial nerve

Question 18

Feet and legs for IV access require an order on all patients

Answer 18

3 years and older

Question 19

What equipment is needed for starting an IV?

Answer 19

Gloves
Tourniquet
Alcohol or betadine
Tape/tegaderm 
Needle (22 gauge)
Syringes (3cc saline/60cc contrast)
Contrast
Extension tubing
Cotton ball/gauze
Band-aid

Question 20

When applying the tourniquet, how far above the intended site of puncture must it be positioned?

Answer 20

6” to 8”

Question 21

How much should the BP cuff be inflated if using it to secure a site for venipuncture?

Answer 21

60 to 80 mm/Hg

Question 22

What is the difference between an artery and vein

Answer 22

• Arteries contain more pressure (If you feel a pulse you have an artery and not a vein)
• Veins lie closer to the surface

Question 23

What is the procedure for starting an IV?

Answer 23

Apply tourniquet
Tight enough to distend vessels but not occlude them
One hand release technique
Locate desired vein
Open and close fist to promote venous distention
Clean surface of the skin with an antiseptic
Circular motion/NSEW direction
Don gloves
Hold the patient’s arm with the nondominant hand and use the thumb to anchor the selected vein
Anchor vein distally with finger by stretching skin against direction of insertion – taunt surface (less pain)
Place needle bevel up at a 20-30° angle to the skin’s surface
Enter just distal to site of insertion and parallel to vein – top entry not a side entry into vein
Use a quick controlled entry to enter skin and vein decreasing angle; look for return of blood in the flashback chamber
Advance needle or catheter into vein and release tourniquet
Do not touch needle or catheter – allows bacteria to enter skin
Anchor needle with tape or tegaderm

Question 24

If both walls of the vein are punctured with the needle a hematoma will develop

Answer 24

Needle should immediately be removed and direct pressure is applied to the puncture site

Question 25

If the venipuncture attempt is unsuccessful

Answer 25

Do not reinsert same needle; a new needle is required Do not reinsert a stylet into the catheter once it has been removed – a new catheter is required ONLY ONE DEVICE PER ATTEMPT NO MORE THAN 2 ATTEMPTS – NOTIFY IV NURSE!

Question 26

At what angle should the needle be placed when it is about to enter the skin’s surface?

Answer 26

20 to 30 degrees

Question 27

How many attempts should be made before the IV team needs to be called?

Answer 27

No more than 3 attempts

Question 28

What is infiltration?

Answer 28

A process where fluid has passed into the tissue instead of the vein

Question 29

What is extravasation?

Answer 29

The most common cause is needle displacement

Question 30

What are some symptoms associated with a mild anaphylactic reaction?

Answer 30

``` Dizziness Shaking Altered taste Itching Pallor Flushing Chills Sweats Rash/hives Nasal stuffiness swelling eyes/face anxiety ```

Question 31

Moderate Reactions to Contrast Media

Answer 31

``` Tachycardia Bradycardia Hypertension Generalized or diffuse erythema Dyspnea Bronchospasm wheezing Laryngeal edema Mild hypotension ```

Question 32

Severe Reactions to Contrast Media

Answer 32

``` Laryngeal edema Profound hypotension Unresponsiveness Cardiopulmonary arrest Clinical manifested arrhythmias Convulsions ```

Question 33

Document

Answer 33

Size, type and location of needle Number of venipuncture attempts Name of technologist who performed procedure Indicate how patient handled contrast

Question 34

5 rights of medication administration

Answer 34

``` Right patient Right medication Right route Right amount Right time ```