Venous puncture

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Procedures/steps:

  1. Assess for clinical factors/conditions that will respond to or be affected by IV fluid administration
    • Peripheral edema
    • Body weight
    • Dry skin and mucus membranes
    • Distended neck veins
    • Blood pressure changes
    • Irregular pulse rhythm, increased rate
    • Auscultation of crackles or rhonchi in lungs
    • Skin turgor
    • Anorexia, nausea and vomiting
    • Thirst
    • Decreased urine output
    • Behavioural change
    • Decreased capillary refill
  2. Assess client’s previous or perceived experience with IV therapy and arm placement preference
  3. Explain procedure to patient
  4. Prepare equipment
  5. Universal Precautions: open sterile packages using sterile aseptic technique
  6. Prepare IV infusion tubing and solution
  7. Insert infusion set into fluid bag, remove protector cap from tubing insertion spike, do not touch spike, and insert spike into opening of IV bag
  8. Prime infusion tubing by filling with IV solution; compress drip chamber and release, allowing it to fill one-third to one-half full
  9. Remove protector cap on end of tubing (some tubing can be primed without removal of cap) and slowly open roller clamp to allow fluid to travel from the drip chamber through the tubing. Close roller clamp once the tubing is primed with IV fluid
  10. Ensure that the tubing is free of air and air bubbles. If air and air bubbles are present, tap tubing firmly where air bubbles are located
  11. Replace cap on end of infusion tubing
  12. Prepare heparin or normal saline lock for infusion
  13. Apply disposable gloves
  14. Identify accessible vein for placement of IV cannula. Apply tourniquet around arm above anticubital fossa or 4 to 6 inches above proposed insertion site. Check for radial pulse (may use a blood pressure cuff instead of tourniquet)
  15. Select well dilated vein. Stroking the extremity from distal to proximal below the proposed site may foster venous distension. Vigorous friction and multiple tapping of the veins, especially in older adults may cause haematoma and/or venous constriction
  16. Release tourniquet temporarily and carefully
  17. Place connection of infusion set or IV plug nearby maintaining sterility
  18. Use antiseptic swab agent to cleanse insertion site
  19. Reapply tourniquet 4 to 5 inches above insertion site
  20. Perform venipuncture
  21. Observe for blood return through flashback chamber of catheter or tubing of winged cannula, indicating that the bevel of the needle has entered the vein. Lower needle until almost flush with skin, continue to hold the skin taut, and advance catheter into vein until the hub rests at venipuncture site
  22. Stabilize the cannula with one hand and release tourniquet with the other. Apply gentle pressure with middle finger of non-dominant hand 1.25 inches above the insertion. Keep cannula stable with index finger, slide the catheter off the stylet, remove the stylet, and place directly into sharps container
  23. Quickly connect end of the prepared saline lock or the infusing tubing to end of cannula, secure the connection
  24. Intermittent infusion: Hold the heparin/saline lock firmly with the nondominant hand and clean with alcohol, insert prefilled syringe containing flush solution into injection cap. Flush injection cap slowly with flush solution
  25. Continuous infusion: Begin infusion by slowly opening the clamp of the IV tubing
  26. Secure cannula
  27. Apply sterile dressing over site
  28. Loop tubing alongside the arm and place a second piece of tape directly over the tape covering the transparent dressing
  29. For IV fluid administration, recheck flow rate
  30. Write date and time of IV placement, cannula gauge size and length and the health care professional's initials (nurse's) on dressing
  31. Dispose of all sharps in the appropriate sharps container, remove gloves and wash hands
  32. Instruct client how to move or turn without pulling on the IV catheter
  33. Peripheral IV access should be changed every 72-96 hours and more frequently if complications occur
  34. When solution has less than 100ml remaining, next solution should be available at the client’s bedside

Source: www.pocketsnips.org

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Was mir auffällt ist die Uhr am Handgelenk. Hygiene!!!
#2 at 24.09.2013 from Guest (Guest)
  1
Sieht so aus als würde hier keine Metallkanüle entfernt werden. Der Zugang bleibt so in der Vene wie sie auch punktiert wurde.
#1 at 22.03.2013 from Guest (Guest)
  0
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