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