intravenous sites

8/3/2019 Intravenous Sites

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Intravenous Sites

Intravenous Cannula

Venesection


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Intravenous Sites


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Assessment

Factors to be considered:

Condition of the vein

Type of fluid or medication to be infusedDuration of therapy Patients age and size

Whether the patient is right- or left-handedPatients medical history and current health status


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Assessment

Attributes of an ideal vein are:

Engorged, bouncy & soft

Refill after it has been depressedFeel roundBe well supported by surrounding structures

Be straight & free of valves Not hard, flat, or bumpy


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Methods for improving venous access:

Apply a tourniquetLower the level of the arm below the heart

Ask the patient to open and close their fist

Light tapping / rubbing of the veins Warm compresses over the selected vein Warm water

Relax the patient / consider the environment


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Veins to be avoided:

Thrombosed, fibrosed or sclerosedInflamed or bruised or painful

Thin or fragile

MobileNear bony prominences and jointsNear sites of infection or edema

Avoid the valves


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Vein selection Arm veins are mostcommonly used.

The metacarpal,cephalic, basilic, andmedian veins and theirbranches arerecommended sitesbecause of their sizeand ease of access.

Leg veins are rarely usedbecause of high risk of thromboembolism.


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Vein selection Antecubital Fossa

Brachial Artery

Ulnar Artery

Radial

Artery

Basillic

Cephalic

Median CubitalVein

Veins Arteries


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BASILLIC

VEIN

DORSAL VENOUS

NETWORK

CEPHALIC VEIN

DORSALMETACARPAL

VEINS

DIGITAL

DORSAL

VEIN


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Vein selection

The antecubital fossa is avoided, except as a last resort.Close proximity with other arteriesFlexion of elbow may displace cannula

The veins in the dorsal hand may be utilized if large boreaccess (18 gauge or larger) is not required. Care must betaken to find a vein that is straight and will accept the entirelength of the catheter.


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Intravenous Cannula


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Intravenous Cannula

A intravenous cannula is a flexible tube which wheninserted into the body is used either to withdraw fluid orinsert medication.

Cannulae normally come with a trocar (a sharp pointedneedle) attached which allows puncture of the body to getinto the intended space.


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A venous cannula is inserted into a vein, primarily for theadministration of intravenous fluids, obtaining bloodsamples and administering medicines.


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Intravenous CannulationColour Gauge Flow

Ml/minUses

Orange 14 275 Rapid transfusions of wholeblood. Emergency situations.

Grey 16 173 Rapid transfusions of wholeblood. Emergency situations

Green 18 100 Blood transfusions

Pink 20 60 IV infusions. Bolus

Blue 22 25Bolus. Maintenance infusions

Yellow 24 13 Bolus medications. Short terminfusions. Neonates

Purple 26 Neonates


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VENESECTION


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Venesection

Venesection is the generic term for a procedure thatinvolves the cutting of a vein in any way, but it most

commonly refers to the drawing of blood from a vein. Venous blood is usually taken from the median cubital vein, which is located on the arm, opposite the elbow.


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Venesection

Blood donation is also usually done out of this vein, butblood drawn for testing, which is the main purpose

of venesection, is normally taken in quantities of about 0.17to 0.84 fluid ounces (5 to 25 ml). Venesection is also known as phlebotomy and venipuncture.


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Vacutainer

Vacutainer is a registered brandof test tube specifically designedfor venipuncture.

The test tubes are covered with acolor-coded plastic cap. They ofteninclude additives that mix with theblood when collected (see below),

and the colour of the tube's plasticcap indicates which additives thattube contains.


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Benefits:

Quicker collection than other methodsClosed systemExact amount of blood obtained

Reduces the risk of haemolysis of the sampleReduces the risk of needle stick injury


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Order of draw

The order of draw refers to the sequence in which these tubesshould be filled.

Containers containing coagulants

Gold or 'Tiger' Red/Black top: Clot activator and gel forserum separationRed top PLASTIC tubes: Contains a clot activator and isused when serum is needed

Orange or Grey/Yellow 'Tiger' Top: Contain Thrombin,a rapid clot activator, for STAT serum testing


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Order of draw

Containers containing anticoagulantsGreen - Contains Sodium Heparin or Lithium Heparinused for plasma determinations

Light Green or Green/Gray 'Tiger': For plasmadeterminations in chemistry Grey - These tubes contain fluoride and oxalate.Fluoride prevents enzymes in the blood from working,so a substrate such as glucose will not be gradually used up during storage. Oxalate is an anticoagulant.


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Order of draw

Purple or lavender - contains EDTA (the potassiumsalt, or K2EDTA). This is a strong anticoagulant andthese tubes are usually used for full bloodcounts (CBC) and blood films. Lavender top tubes aregenerally used when whole blood is needed foranalysis. Can also be used for some blood bank procedures such as blood type and screen, but otherblood bank procedures, such as crossmatches must bein a pink tube in most facilities.


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Order of draw

Light blue - Contain a measured amount of citrate. Citrateis a reversible anticoagulant, and these tubes are usedfor coagulation assays. Because the liquid citrate dilutes theblood, it is important the tube is full so the dilution isproperly accounted for.Dark Blue - Contains sodium heparin, an anticoagulant.

Also can contain EDTA as an additive or have no additive.

These tubes are used for trace metal analysis.Pink - Similar to purple tubes (both contain EDTA) theseare used for blood banking.

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