UNIT 3: VENEPUNCTUREHours: 6 Theory

6 Hours practical

Specific Objectives

At the end of the unit, the student will be able to:

1. Define the relevant terms as listed.

2. Explain the rationale for venepuncture.

3. Describe the structure and functions of selected body systems.

Cardiovascular

Respiratory

Renal

Integumentary

4. Explain the importance of fluid and electrolytes in the management of homeostasis.

5. Explain the physiology of fluid and electrolytes in the maintenance of homeostasis

6. Demonstrate knowledge of the prevention of nosocomial infection.

7. Outline the principles of venepuncture in adults and children

8. Describe the roles of the nurse in venepuncture.

9. Describe the qualities of a venepuncturist/phlebotomist.

10. Describe the management of patient/client undergoing venepuncture using the Nursing process.

11. Describe the dangers of venepuncture to client and self.

12. Explain the complications of venepuncture.

13. Select sites for venepuncture.

14. Demonstrate the venepuncture procedures with the aid of a mannequin.

15. Demonstrate beginning skills in performing venepuncture on a least five (5) patients/clients.

16. Explain the principles of documentation of venepuncture.

CONTENT

1.0 DEFINITION OF TERMS

Anticoagulant,Intravenous , Artery , Lumen, Asepsi, Nosocomial infections, Bevel, Pulse , Blood Pressure (BP),Phlebotomy , Bore, Sclerosis,Branula/Cannula, Syringe, Catheter, Tourniquet, Cephalic,Vacutainer , Central Venous Pressure, Valve, Gauge, Vein, Haematoma, Venepuncture Homeostasis, Hypodermic.2.0 RATIONALE FOR VENEPUNCTURE

Fluid replacement

Drug Therapy

Hyperalimentation

Collection of blood/samples

Others

3.0 REVIEW HUMAN BIOLOGY

3.1 CARDIOVASCULAR SYSTEM

Divisions:

Heart Blood Blood vessels Circulation blood

Heart:

Location

Structure

Function

Conduction mechanism

Blood:

Constituents

Groups

cells

plasma

coagulation Blood vessels: Types

Structure

Function

Circulation:

Pulmonary

Systemic

Portal

cerebral

RESPIRATORY SYSTEM

Divisions:

Nose

Pharynx

Trachea

Bronchi

Bronchioles

Lungs

Location

Structure

Function

Physiology of respiration

Role of the respiratory system in maintaining acid-base balance

3.2RENAL SYSTEM

Divisions:

Kidney

Structure-urethra

Function-bladder

Urethra

Role in fluid and electrolyte balance

3.3INTEGUMENT SYSTEM

Divisions: Epidermis

Dermis

Structure and function

4.0REVIEW NOSOCOMIAL INFECTIONS

Nosocomial infections

Universal precautions

PRINCIPLES OF VENEPUNCTURE

Veins are thin walled therefore care must be taken in puncturing the veins so that the needle does not go through the entire vein.

Maintaining aseptic technique throughout the procedure.

Application of tourniquet must be just enough to slow venous return.

Visualize/palpate vein before attempting to puncture vein.

Gently lift skin (getting under the skin) before puncturing vein to prevent spurting of blood.

Always enter vein with needle bevel side uppermost at an angle of 15-30.

If possible, use non-dominant limb (less activity).

Venepunctue is contraindicated in site that has signs of infection, infliltration and thrombosis.

Administer drugs safely in an existing intravenous system

Homeostasis

Others

5.0 ROLE OF THE NURSE IN VENEPUNCTURE

Respect patient/client rights

Maintain asepsis

Prevent injury to self and client

Act according to policy/guidelines if injury occurs

Counsel client and family

Document data

6.0 QUALITIES OF THE VENEPUNCTURE

The nurse performing venepuncture should be:

Patient explain reasons for and details of the procedure.

Tolerant willing to answer clients questions simply and appropriately

Kind ability to approach the client in an unhurried manner gaining clients full cooperation.

Knowledgeable must know the principles of venepuncture and able to carry out procedure safely and effectively.

Competent displays self assurance and competence in carrying out tasks and in relating to patients.

7.0MANAGEMENT OF THE VENEPUNCTURE USING THE NURSING PROCESS

Assessment

Nursing diagnosis

Planning

Implementation

Evaluation

8.0 DANGERS OF VENEPUNCTURE TO CLIENT/HEALTH CARE PROVIDER Physical trauma

Exposure to infection

9.0 COMPLICATIONS OF VENEPUNCTURE

Oedema

Infections

Necrosis

Embolism

Phlebitis

Others: Antigen/antibody reaction etc.

10.0SITES FOR VENEPUNCTURE

Antecubital fossa

Anterior aspect of the forearms

Dorsum of hands and feet

Area covering saphenous vein research

Scalp vein.

11.0-12.0PROCEDURE

Select sites for venepuncture Demonstration of procedures using mannequin Perform venepuncture on a client/patient for blood letting and/or initiation of intravenous therapy

Administration of drug in an existing intravenous system.

13.0 14.0 PRINCIPLES OF DOCUMENTATION IN VENEPUNCTURE

Type and amount of fluid or drug administered

Date and time of administration

Effects or adverse reaction (Date and time)

Signature and title of venepuncture

15.0 VENEPUNCTURE SKILLS

Perform unaided a minimum of five venepunctures.

PERFORMANCE EVALUATION

In the initial contact hours student would have performed five (5) venepunctures

Demonstrate competence in performing thirty (30) successful venepunctures before screening for Nursing Council Examination

These experience for gaining competence is ongoing after the completion of the initial eighteen hours and should include a minimum of:

five initiation of intravenous infusion,

five withdrawals of blood samples,

five administration of drugs in an existing intravenous infusion system

Documentation of competency in performing thirty (30) venepunctures.

RELATED NURSING SKILLS

Management of patients with anaphylactic shock

Cardio-pulmonary resuscitation

Application of splints

Locating pressure points

Bandaging

Aseptic technique

Sterilization of equipment

Preparation of antiseptics and disinfectants

Disposal of used sharps and other disposable articles

Collection of specimen for laboratory.

PROCEDURE FOR ADMINISTERING INTRAVENOUS THERAPY (IV)

ASSESSMENT

1.Assess need for I.V. therapy:

Health history- ask about: Loss of fluid, Diarrhea Fever Fluid intake Urinary output Allergy to tape/antiseptic

Determine clients need for psychological support. Assess need for client teaching about IV therapy.Physical Examination

Determine vital signs: temperature, pulse, respiration, blood pressure for baseline data. Evaluate skin turgor (eyes, tongue, lips), to determine hydration status.

To test urine not only for specific gravity.

Identify appropriate site for venepuncture.

a. Vein should be superficial, readily palpable, easily followed and large enough for the needle to be inserted smoothly.

b. Placement of cannula is based on joints, e.g. antecubital space, wrist.

c. If possible, the cannula is not placed on joints, a splint must be used to immobilize the joint.

d. Assess type and size of cannula necessary. (Blood requires a large size cannula, at least # 18).

Determine the length of time necessary for therapy so that the appropriate equipment can be selected.

PLANNING

1.0 Goals/Outcomes

IV therapy initiated and maintain without difficulty.

Catheter inserted into selected vein without complications.

Fluids, additives and medications administered without adverse effects on the client.

Blood and Blood products administered through appropriate tubing and

equipment.

IV site remains free from redness, edema, and purulent discharge.

IV infusion rate accurately calculated and reassessed throughout the therapy.

IV equipment removed without complications.

2.0Equipment

Prepare try or trolley with the following:

Tourniquet or blood pressure cuff

Antimicrobial wipe for example 70% ethyl alcohol.

Sterile cannula or needle; winged-tipped needle; intermittent infusion set or over-

the-needle catheter.

IV solution in either bottle or bag, as ordered by physician/health agency policy.

Administration set: drip system, which includes drip chamber and IV tubing.

Extension tubing to lengthen the original tubing or to provide extra ports for the administration of additional medication.

IV pole freestanding, bed-attached, or ceiling-affixed.

Sterile 2x2 gauze square.

Tape (ask client about adhesive tape allergy)

Sterile two-by-two inch strips of adhesive dressing.

Filter to be used whenever the IV system has been entered to administer drugs or whenever an infusion catheter is to be inserted into large central vein.

Arm board for immobilization.

3.0Additional Equipment

For intermittent infusion

Three syringes with needles Several extra needles Vials of saline solution4.0 Preparation

For selection of puncture site

Vein should be superficial, easily palpated and followed, and large enough for a needle to be smoothly inserted. Veins should be free of sclerosis, hematomas, pain and redness. Veins should be free of sclerosis, hematomas, pain and redness.

Veins should be selected according to the IV solution that will be infused. Larger veins are preferable for caustic solutions blood and viscous fluid.

Distal end of veins should be punctured first. Proximal ends should be preserved for further IV therapy. Cannula or needles should be placed in the arm that is not used for writing. Cannula or needles should not be placed near joints, which require immobilization.

5.0 For Selection of Cannula or Needle

Winged-tipped needles: these are to be used short-term therapy with adults and in normal therapy with children, infants, and elderly clients who have small or fragile veins.

For neonates, use a 25-27 gauge needle; for older children, use a 21-25 gauge needle.

Intermittent infusion set is used in short-term therapy to permit the intermittent administration of drugs directly into clients vein without exposing the client to the expensed and annoyance of continuous intravenous drip. This system allows blood to be withdrawn and blood transfusions to be performed without the pain of repeated venepuntures.

6.0 For Selection of IV Fluid and Tubing for Infusion

Wash your hands before preparing IV equipment.

Compare the type and amount of solution with physicians orders/health agency

policy.

Check IV solution container for expiration date and for signs of contamination or deterioration.

Hold in both a dark and bright light to examine for discoloration, cloudiness, or

particulate matter, which indicates a problem.

Examine glass bottles for cracks or leaks; examine bags for tears. Inject any required additives through the medication port in the container before inserting IV tubing.

Select IV tubing according to the viscosity of the solution that will be infused.

7.0For Setting up Administration Set with Glass Container

Remove metal cap, metal disc, from IV bottle.

Close control clamp on IV tubing administration set and insert the spike into the port, holding the neck of the port tightly to prevent slipping and possible contamination.

Invert the IV container and fill the drip chamber.

Hang the IV container on the IV pole.

Open the IV tubing control clamp and clear the tubing of air by allowing fluid to run through. Readjust the adaptor cap or place covered needle over tubing insertion site to maintain sterility before infusion is established.

Before taking IV equipment to clients room, tell client what you will be doing and what type of equipment you will be using.INTERVENTION

1.0Performing a venepuncture with an over-the needle catheter

Inform patient/client of procedure. Wash hands. Prepare IV equipment. Select a moderate to large vein and apply tourniquet. Just prior to insertion of catheter, carefully remove needle cover. Inspect both needle and catheter. With bevel of needle up, insert needle and catheter together as one unit into the clients skin. Insert the cannula into the vein.

Advance catheter and needle gently as one unit into the lumen and observe for flash back of blood in the hub.

As soon as the catheter and needle are fully in place, release the tourniquet.

Gently withdraw the needle from inside the catheter with one hand placing your fingertip firmly above the catheter tip to occlude the vein and prevent sudden bleeding.

Connect hub to administration set.

Open clamp on set briefly and observe drip chamber. Fluid should flow rapidly without obstruction, and there should not be any sudden swelling at IV site.