Indications of venipuncture
- Health screening
- Pre-operative evaulation
- Diagnostic aid –> most common
Relative contraindications of venipuncture
- Patient inability to sit still (young child)
- Skin conditions interfering with access
Complications of venipuncture
- Bleeding
- Infection
- Arterial/nerve injury
Site selection and preparation of venipuncture
- Assemble all supplies first
- Position patient: straighten arm with elbow resting on flat surface
- Apply tourniquet above antecubital fossa
- Distend veins by having pt open and close fist several times
- Choose a vein that is distended
- Clean with alcohol swab in concentric circles starting from the center and working out
- Don’t repalpate the clean area
Most common site for venipuncture
median cubital vein
Angle to insert needle for venipuncture
15-30 degress
When do you release the tourniquet
Before removing the needle
Indications for intravenous catheterization
Administration of fluids and medications
Relative contraindications for IV
- Pt inability to sit still
- Skin conditions interfering with access
Complications of IV
- Bleeding (bruising, hematoma)
- Infiltration of fluid into subcutaneous tissue
- Infection
- Thrombus
preparation for IV
- Assemble all supplies first
- Connect IV tubing to the solution bag and allow the fluid to run through the tubing, eliminating all the air (priming the tubing), then clamp line closed
- Tear several pieces of tape, 4-6 inches in length and place them nearby
Veins for IV
Basilic or cephalic on the dorsal forearm are preferred
- Metacarpal veins on the dorsum of the hand are the easiest to visualize, but are more likely to occlude and are prong to infiltration
Sites to avoid for IV
- Areas of flexion and bony prominences- antecubital fossa- emergencies only
- Near multiple valves, branches
- Pre existing catheter sites
- Ipsilateral mastecomy and/or lymph node dissection
- Ipsilateral arteriovenous fistula or graft
Local anethetic
Lidocaine
causes more pain to administer than starting IV
When should you remove the catheter and start over for an IV?
- The pt complains of pain or burning
- The skin appears to be swelling
- There is not good flow in the drip chamber
central line indications
- Inability to maintain peripheral venous access
- Need to access to central circulation- pacemaker or pulmonary artery catheter
- Infusion of hypertonic or substances that cause sclerosis of peripheral veins
- Hemodialysis
central venous catheter contraindications
- contralateral pneumonectomy
- bleeding diathesis
- operator inexperience
- infection at insertion site
- recent placement of pacemaker
central line complications
- Arterial puncture
- Pneumonthorax
- Thrombosis
- Infection
- Cardiac dysrhythmia
Where can a central line be placed?
subclavian or central jugular vein
EKG indications
- Chest pain of suspective cardiac origin
- Suspected arrhythmia
- Screening for cardiac conditions
- Pre-operative evaluaiton
EKG contraindications
- Pt inability to sit still
- Skin conditions interfering with lead placement
- Need for basic life support
EKG complications
- Skin reaction to adhesive
- Incorrect interpretation of results
What are the 12 EKG leads
- 3 standard limb leads
- 3 augmented limb leads
- 6 pre cordial leads
limb lead placement
White = right and smoke over fire
right arm- white
left arm- black
left leg- red
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