Transcript Document

Venepuncture
& Peripheral IV Cannulation
Study Day
June 2009
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Aim
• Explore the legal and professional issues
in the extended role
• Discuss health and safety issues in
venepuncture and cannulation
• Describe infection control issues in
venepuncture and cannulation
• Explore practical aspects of venepuncture
and cannulation
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Venepuncture
Procedure of entering a vein with a needle
for the purpose of:
• Obtaining a representative sample of
blood for diagnostic purposes
• Monitoring levels of blood components
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Peripheral IV Cannulation
• The procedure of puncturing a patient’s
skin to allow insertion of a temporary
plastic tube into a vein for the purpose of:
• Bolus injection
• Short term infusion
• Blood transfusion
• Rapid infusion of medication or fluid.
(Jackson 2003)
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Legal and professional
• As a professional you are personally
accountable for actions and omissions in
your practice and must always be able to
justify your decisions.
• You must work within the limits of your
competence
•
NMC 2008
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NMC Code of Conduct
• Consent
• Keeping your
knowledge and skills
up to date
• Keeping clear and
accurate records
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Consent
• You must ensure that you gain consent
before you begin any treatment or care
• You must uphold peoples rights to be fully
involved in decisions about their care
• No adult can validly give consent for another
adult unless legally authorised to do so Adults with Incapacity Act (2000)
• It is not necessary to document consent to
routine and low-risk procedures e.g. taking a
blood sample.
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Four Arenas of Accountability
To the public
To the patient
To the employer
To the profession
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Health & Safety
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H&S applicable to venepuncture and
cannulation includes:
Sharps injury procedures
Extended role training
Policy for the disposal of sharps
Prevention and protection from blood
borne viruses.
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Preparation for procedure
• The patient – explanations, education re cannula
care, assessment
• Equipment – integrity of packaging and expiry
dates
• Environment – clean, clear, clutter free, good
lighting
• Cannula – smallest cannula to suit purpose
• Veins – choose large veins for irritant drugs
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Technique
• Asepsis
• Vein stabilised
• Smooth accurate
placement
• Correct use of
tourniquet
• Correct vein
assessment
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For cannulation:
Stylet never be re
introduced
Cannula flushed
Connections secure
Cannula secure
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Visual inspection – veins should be
visible
• Sites to avoid
• on or near site of
infection
• Small superficial
veins
• Bruised areas
• Areas of scarring
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• Limb where IV
infusion is running
• Near phlebitis
• Oedematous areas
• Previous
Venepuncture sites
• Limb affected by
injury/disease
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Tourniquet
• Know how to use it
before approaching
patient!
• 10cm above site (3
finger breadths)
• 2 fingered gap
• Apply tourniquet to the
upper arm ensuring it
does not obstruct
arterial flow
• Check patient is
comfortable
• A latex glove must
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Palpation – veins should be bouncy
• Sites/veins to avoid
• Thrombosed hard
veins
• Fibrosed veins
• Sclerosed veins
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• Inflamed veins
• AV fistula
• Axillary Clearance/
Mastectomy
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Venepuncture
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Blood collection
• Collection bottles - Attach directly to
needle or butterfly using an adapter.
• Syringe – do not advocate. However if
you do then transfer blood to the
appropriate specimen bottles as soon as
possible ensuring the correct quantity is
placed in each container.
• Label bottles as soon as possible
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Via venous access device
• Peripheral catheters should not be used
for routine blood sampling
• If necessary – do not use a prevacuumed system.
• Use syringe 10mls or less.
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Cannulation
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Cannulation
Speed and
viscosity of
infusion
Size of
cannula
Site of vein
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Colour
Gauge Flow Rate Infusion
mls/min
Orange
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343
Rapid blood transfusion
Emergencies
Grey
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196
Rapid blood
transfusion.
Emergencies
Green
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90
Pink
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Blood products,
medicines, fluids
General crystalloid use,
Blue
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Paediatrics, oncology.
Yellow
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Paediatrics, oncology.
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Neonates, elderly
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Complications
Missed vein
Haematoma
Transfixation
Phlebitis
Blockage of cannula
Needlestick injury
Infection
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Cannula embolism
Pulmonary embolism
Damage to surrounding
nerves
Arterial puncture
Catheter fracture
Thromboembolism
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COMPLICATIONS
COMPLICATION
Extravasation occurs when
the infused fluid enters the
subcutaneous tissue rather
than the vessel as intended.
RECOMMENDATION
Re-site the cannula to prevent
tissue necrosis. Consider
alternative site.
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Infiltration / Extravasation
• Infiltration occurs when - a non vesicant
medication/solution leaks into the
subcutaneous tissue.
• Extravasation occurs when – a vesicant
medication/solution leaks into the
subcutaneous tissue.
• NB – Vesicant – any substance that causes blistering or tissue
necrosis and requires management to limit tissue damage
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Managing extravasation
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Stop infusion at once
Withdraw drug
Leave cannula insitu
Elevate limb to reduce oedema
Apply hot/cold pack
Subsequent management depends upon
drug involved and degree of damage.
Maybe local extravasation policy i.e. use
of antidote.
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Preventing complications
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Ensure staff are trained and supervised
Supervised practice and competence assessed
Practice continually updated
Ensure correct preparation of patient, equipment
and environment
• Aseptic non touch technique
• Managed aftercare
• Documentation
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Documentation
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Venepuncture
Which bloods taken
Site
Adverse events
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• Cannulation
• Type and gauge – Vasofix
22g
• Site – left hand
• Date/time of insertion
• Dressing must be labelled
with date, time & initials
• Number and location of
attempts
• Name of person inserting
Cannula
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Aftercare
• Patient education
• Asepsis for all cannula manipulations such
as medicine administration and dressing
changes.
• Avoid over manipulation of cannula by
using needle free devices.
• Secure connections.
• Regular monitoring and flushing
• Planned removal of cannula
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Flushing
• All flushing solutions
should to be prescribed
• 10ml syringes used for
flushing
• Use a positive pressure
technique (push-pause
method injecting 1ml at a
time to create turbulent
flow)
• Compatibility of sodium
chloride with drug
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