1. Chapter 7 Advanced Vascular Access Skills

2. Phlebotomy
Act of obtaining blood from a vein for therapeutic or diagnostic purposes
More commonly used to obtain blood specimens for laboratory analysis
Practiced for centuries as “blood Letting” where the vein was sliced and blood was allowed to drain in a bowl.

3. Syringe and Needle Venipuncture
Typically used for a single blood draw.

4. Vacuum Tube System Venipuncture
Typically used for mutiple samples

5. Vacuum tube system Characteristics of the tube system
Can be glass or plastic
Sealed and has a vacuum that draws the blood into it
Varying sizes
substances in tubes called additives
Advantages
transfer of blood specimen unnecessary
Many tubes can be drawn at the same time

6. Parts of the vacuum tube system
Multisample needle
Has a rubber sheath on one end
Tube holder
Plastic and disposable
Blood tube
Many types, some specific to the
test being done

7. Before Collecting Venipuncture Specimen
Do I have the right person?
Do I have the right paperwork?
What method is to be used to collect the specimen?
Do I have the right type of specimen container?
Is the specimen container properly labeled?
What is the correct date and time?
What storage and delivery method must I use?

8. Preparing for Venipuncture
Tourniquet
Assists in identification of a vein
Blocks venous flow
Types
Resuable (bp cuff, cloth, velcro)
Disposable (flat strip of latex or vinyl)

9. Tourniquet safety
Use
Place 3-6 inches above needle insertion site (see pge 137)
Apply so that it can be released with one pull
Should feel a radial pulse
Can block blood flow if too tight
Never leave in place more than 2-3 minutes
Can cause nerve damage and hemolysis

10. Applying a Tourniquet
See Figure 7-6.

11. When to Avoid Taking a Blood Specimen
1.Arms that have the following:
intravenous line in place
hemodialysis access device, such as a graft or fistula
same side as a recent mastectomy
affected arm of a patient who has had a stroke
2. A site that is
swollen or infected
Hematoma
broken skin
3. A vein that feels hard or cord-like or does not “spring back”

12. Veins Used for Venipuncture

13. How to Insert a Needle

14. Vacuum Tube System Venipuncture GENERAL GUIDELINES
clean surface.
Bed is positioned comfortably and person is seated or supine.
All information is on the requisition
Identify the patient

15. Ask person to make a fist and clean the site.
Apply the tourniquet 3 to 6 inches above the site to find a vein then release
Assemble the equipment being used
Reapply the tourniquet
Apply gloves
in.

16. Vacuum Tube System Venipuncture (cont)
With bevel of needle facing up and at a 15- to 30-degree angle to skin, insert the needle into the vein
Place vacuum tube into the tube holder. Let vacuum tube fill.
Release the tourniquet
Repeat until all of the ordered blood specimens have been obtained.
Hold gauze pad over needle.
Remove the needle from the vein by pulling it straight out.

17. Vacuum Tube System Venipuncture (cont)
Open the adhesive bandage and apply it.
Dispose of the tube holder and needle.
Complete the specimen labels.

18. RISKS ASSOCIATED WITH VENIPUNCTURE
HEMATOMA
INFECTION

19. Intravenous Therapy
Involves administering fluids, medication, nutrition, or blood products directly into the patient’s bloodstream
Uses either a peripheral or central line

20. Peripheral Line

21. Peripheral Line (cont)
Report to the Nurse Immediately
Swelling at the site
Skin at the insertion site that is pale or cool to touch
Fluid not dripping into the drip chamber or the rate has slowed
Blood backing up in the tubing
Tubing that has become disconnected
A solution bag that is empty
Infiltration—leaking intravenous fluid into the tissues around the vein
Pain and discomfort along the vein
Fever
Red streaks up the arm
An arm that looks swollen or puffy
A dressing over the insertion site that is wet, soiled or loose

22. Central Line

23. Central Line (cont)

24. Central Line (cont)

25. Peripherally Inserted Central Catheter (PICC)

26. Implanted Venous Access Device

27. Caring for Person Receiving Intravenous Therapy
Be careful not to dislodge lines
Observe site and report any swelling, redness, pain, or leakage immediately to the nurse
Be sure to keep tubing connected and not kinked
Observe tubing to make sure there is no blood backing up
Observe solution bag to make sure it is not empty
Observe fluid in drip chamber is dripping

28. Removing a Peripheral Line
Doctor’s order is required
Place supplies on a clean surface; check that flow of fluids through peripheral line has stopped
Place bed at comfortable working height, with person in comfortable position, allowing access to site
Put on gloves and remove the adhesive dressing covering the insertion site

29. Removing a Peripheral Line (cont)
Hold a gauze pad over site; remove catheter from vein by pulling it straight out
Hold gauze pad in place, applying pressure 2 to 3 minutes; place gauze in cuffed plastic bag
Observe the end of the catheter to make sure the entire catheter was removed
Clean the insertion site; open the adhesive bandage and apply it to the insertion site

30. Removing a Peripheral Line (cont)
Remove your gloves and dispose of them in a facility-approved waste container
Check to make sure that the bleeding has stopped; adjust the person’s clothing, as necessary
Make sure that the bed is lowered to its lowest position; dispose of disposable items

31. Question Tell whether the following statement is true or false.
As a nursing assistant, it is not within your scope of practice to insert or remove a central line.
True
False

32. Answer
A. True
As a nursing assistant, it is not within your scope of practice to insert or remove a central line.

33. Question
You should never perform venipuncture on a person who has which of the following?
A. An arm that has an intravenous line in place
B. An arm with a hemodialysis access device
C. An arm that is on the same side as a recent mastectomy
D. All of the above

34. Answer D. All of the above
Taking a blood specimen from an arm that has an intravenous line can result in inaccurate test results.
Taking a blood specimen from an arm with a hemodialysis access device can result in damage to the graft or fistula.
Taking blood from same side as mastectomy and stroke are conditions that can cause impaired circulation and put the person at risk for more complications from the venipuncture procedure.

35. Question
If a tourniquet is left on the arm too long, what could happen to the patient?
Nothing
Tissue and nerve damage
Air embolism
An infection

36. Answer B. Tissue and nerve damage
A tourniquet that is too tight or that is left in place for too long can block arterial blood flow, which in turn can lead to tissue or nerve damage.

37. Question Tell whether the following statement is true or false.
Nursing assistants are allowed to insert peripheral lines.
True
False

38. Answer
B. False
Only licensed personnel are allowed to insert peripheral lines.