Venous puncture
Procedures/steps:
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
Assess client’s previous or perceived experience with IV therapy and arm placement preference
Explain procedure to patient
Prepare equipment
Universal Precautions: open sterile packages using sterile aseptic technique
Prepare IV infusion tubing and solution
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
Prime infusion tubing by filling with IV solution; compress drip chamber and release, allowing it to fill one-third to one-half full
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
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
Replace cap on end of infusion tubing
Prepare heparin or normal saline lock for infusion
Apply disposable gloves
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)
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
Release tourniquet temporarily and carefully
Place connection of infusion set or IV plug nearby maintaining sterility
Use antiseptic swab agent to cleanse insertion site
Reapply tourniquet 4 to 5 inches above insertion site
Perform venipuncture
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
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
Quickly connect end of the prepared saline lock or the infusing tubing to end of cannula, secure the connection
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
Continuous infusion:
Begin infusion by slowly opening the clamp of the IV tubing
Secure cannula
Apply sterile dressing over site
Loop tubing alongside the arm and place a second piece of tape directly over the tape covering the transparent dressing
For IV fluid administration, recheck flow rate
Write date and time of IV placement, cannula gauge size and length and the health care professional's initials (nurse's) on dressing
Dispose of all sharps in the appropriate sharps container, remove gloves and wash hands
Instruct client how to move or turn without pulling on the IV catheter
Peripheral IV access should be changed every 72-96 hours and more frequently if complications occur
When solution has less than 100ml remaining, next solution should be available at the client’s bedside
Source:
www.pocketsnips.org