Venepuncture

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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 patients 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

• HS 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

• 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

• 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 never be used

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Palpation veins should be bouncy

• Sites/veins to avoid
• Thrombosed hard veins
• Fibrosed veins
• Sclerosed veins

• 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 pre-vacuumed system.
• Use syringe 10mls or less.

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Cannulation
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Cannulation
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Complications
Missed vein Haematoma Transfixation Phlebitis Bloc
kage of cannula Needlestick injury Infection
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

• 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

• 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

• Venepuncture
• Which bloods taken
• Site
• Adverse events

• 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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