Chapter 7 Advanced Vascular Access Skills

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.

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

Vacuum Tube System Venipuncture Typically used for mutiple samples

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

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

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?

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)

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

Applying a Tourniquet See Figure 7-6.

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”

Veins Used for Venipuncture

How to Insert a Needle

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

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.

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.

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

RISKS ASSOCIATED WITH VENIPUNCTURE HEMATOMA INFECTION

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

Peripheral Line

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

Central Line

Central Line (cont)

Central Line (cont)

Peripherally Inserted Central Catheter (PICC)

Implanted Venous Access Device

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

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

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

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

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

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

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

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.

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

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.

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

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