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Monitoring and Documentation
Principles of IV Therapy
BSN336
Phillips 15 step venipuncture method
Before initiating cannulation follow steps 1-5 Step 1: Checking the Physician’s Order Step 2: Hand Hygiene Step 3: Equipment Preparation Step 4: Patient Assessment and
Psychological preparation Step 5: Site Selection and Vein Dilatation
Phillips steps (cont)
Vein Dilitation(cont) Type of solution Condition of vein Duration of Therapy Cannula size Patient age Patient preference Patient acitvity Presence of disease or previous surgery Presence of shunt or graft Patient receiving anticoagulation therapy Patient with allergies
Vein Dilatation(cont)
Ways to increase blood flow in the upper extremitiesFactors affecting the capacity for dilatation
Blood pressurePresence of valvesSclerotic veinsMultiple previous I.V. sites
Ways to dilate vein
Gravity Fist clenching Tapping Warm compresses Blood pressure cuff Tourniquet Multiple tourniquets Transillumination Ultrasonography
Cannulation
The site must tolerate the rate flow The site must be capable of delivering the
medications ordered The site must tolerate the gauge of cannula
needed The patient must be comfortable with the site
chosen The site nust not impede the patient’s activities
of daily living
Tips for selecting veins
A suitable vein should feel relatively smooth, pliable with valves well spaced
Veins will be difficult to stabilize in a patient who has recently lost weight
Debilitated patients and those taking corticosteroids have fragile veins that bruise easily
Sclerotic veins are common among narcotics addicts
Tips for selecting veins(cont)
Sclerotic veins are common among the elderly population
Dialysis patients usually know which veins are good for venipuncture
Start with distal veins and work proximally
Veins that feel bumpy, like running your finger over a cat’s tail, are usually thrombose or extremely valvular
Phillips tips(cont)
Step 6: Needle SelectionStep 7: GlovingStep 8: Site PreparationStep 9: Vein EntryStep 10: Catheter Stabilization and
Dressing ManagementStep 11: Labeling
Phillips tips(cont)
Step 12: Equipment DisposalStep 13: Patient EducationStep 14: Rate CalculationsStep 15: Monitoring and Documentation
Documentation
Date and time of insertionManufacturer’s brand name and style of
device (lot numberThe gauge and length of the deviceSpecific name and location of the
accessed veinThe infused solution and rate of flowInfusing by gravity or pump
Documentation
The number attempts for a successful I.V. starts
Condition of extremity prior to access The patient’s specific comments related to the
procedure Patient response, excessive anxiety, patient
movement, or an untoward response Signature
Documentation of observation
TendernessTemperatures at and around the siteDiscolorationSwellingDrainingActions taken by the nurse
Discontinuation of I.V. Cannula
Discontinue if the integrity of the cannula is compromised or the physician orders the discontinuation.
1. Put on gloves
2. Obtain a dry 2-inch by 2-inch gauze pad. Avoid alcohol
3. Loosen the tape and apply the gauze pad loosely over the site
Discontinuation of I.V. Cannula
4. Remove the cannula and transparent dressing as one unit, without pressure over the site
5. After the catheter is removed, apply direct pressure with the sterile gauze pad over the site
6. An adhesive bandage may be applied to the venipuncutre site after bleeding is controlled.
7. Document site apperance, how tolerated, appearance of catheter
Phlebotomy Technique
1. Preparation of the healthcare worker2. Assessing the patient’s physical
disposition3. Identifying the patient4. Approaching the patient5. Selecting a puncture site6. Selecting and preparing equipment and
supplies
Phlebotomy technique (cont)
7. Preparing the puncture site
8. Choosing a venipuncture method
9. Collecting the samples in the appropriate tubes and in the correct order
10. Labeling the samples
11. Assessing the patient after withdrawal of the blood specimen
Phlebotomy technique (cont)
10. Labeling the samples
11. Assessing the patient after withdrawal of the blood specimen
12. Considering any special circumstances that occurred during the phlebotomy procedures
13. Assessing criteria for sample recollection or rejection
14. Prioritizing patients and sample tubes.
Test Requisitions
Patients full name Patient’s identification or medical
record number Patients date of birth Types of test to be performend Date of test Room number and bed (if applicable) Physician’s name and/or code
Test Requisitions
Test Status (timed, stat, fasting, etc.)Billing information (optional)Special precautions (potential bleeder,
faints easily, HIV, HepB or C
Lab tubes