VENIPUNCTURE

TECHNIQUE
ON
ADULT AND CHILDREN
Venipuncture

- is the process of obtaining intravenous access for the purpose of

intravenous therapy or for blood sampling of venous blood.

Venipuncture Steps:

• Greet and identify patient

• Select and assemble equipment
• Perform the draw using aseptic technique and Standard Precautions
• Provide post-puncture care
• Label specimens properly
• Handle and transport specimens correctly
Venipuncture Equipment

• Safety Needles, 22g or less.

• Butterfly needles. 21g or less.
• Syringes.
• Vacutainer tube holder.
• Transfer Device
• Blood Collection Tubes.
• Tourniquets
• Antiseptic
• 2x2 Gauze
• Sharps disposable container
• Bandages or tape
• Gloves
Commonly used veins:

- basilica and cephalic veins (forearms)

- median cubital, cephalic and basilica veins (antecubital fossa)
- radial vein (radical area)
- dorsal metacarpal vein (the hand)
- veins in the foot
- femoral and saphenous veins (thigh)
- veins in the scalp (for infants)

Position:

- lying supine or sitting

• straight chair with arm
• use pillow or towel if necessary
Applying the Tourniquet
Selecting the Site:

 Position arm at downward angle

 Ask patient to make a fist
 Examine antecubital area first
 Palpate vein with fingertip

Cleansing the Site:

- Use aseptic technique

• Use antiseptic (70% alcohol pad)
• Use concentric circles
• Begin at the site and move outward
Performing the Venipuncture

 Reapply the tourniquet

 Visually confirm the site
 Anchor the vein
 Insert the needle

Correct Angle Vein

Unsuccessful Venipuncture
 Angle in performing venipuncture:
15 to 30 degree angle

Butterfly Set

 Use only when standard draw is not

possible
 Do not use with evacuated tubes if patient
has fragile veins

Butterfly Venipuncture

 Assemble evacuated tubes for specimen

transfer
 Follow same procedure as for standard
venipuncture
Dermal Puncture

 Preferred method for young patients

- Infants
- Very small children
 May also be used for other patients
- Obese
- Elderly
- Severely burned

Planning the Puncture :

 Examine the fingers

 Choose a finger for the puncture
 Plan to cut across the fingerprint
Preparing for Dermal Puncture
Yes Yes

No
 Examine the requisition slip
 Greet and identify the patient
No No
 Explain the procedure
 Verify any diet restrictions
 Wash your hands
 Put on gloves
Selecting the Puncture Site:

 Site choice for performing a dermal puncture in an infant under 1

y/o: HEEL
Performing a Dermal Puncture

 Clean the site with alcohol

 Allow to dry completely
 Hold the finger to stretch skin tightly
 Puncture the finger
 Evacuated Tube System
Venipuncture

 The most commonly used means of

collecting specimens.
 It consists of a needle device, a
tube holder, and an air-evacuated
tube.
 You attach the needle device to the
tube holder, insert the needle into
the vein, and engage the tube.
Butterfly Venipuncture

 Use only when standard draw is not

possible
 Do not use with evacuated tubes if
patient has fragile veins
 Assemble evacuated tubes for
specimen transfer
 Follow same procedure as for
standard venipuncture
Syringe Venipuncture

 should be performed when it is necessary to reduce the stress

exerted on a vein and prevent vascular collapse.
 Syringes may be used when difficult blood draws are anticipates
(e.g, hand veins, small veins, fragiles veins, etc.).
Dorsal Hand Vein Technique

 Appropriate for neonates and

infants who are younger than 2
years old.

 Often utilized for intravenous

infusions but are viable options
for blood draw sites.
 SAFETY
 Observe universal (standard) safety precautions.
 Observe all applicable isolation procedures.
 PPE’s will be worn at all times.
 Wash hands in warm, running water with a appropriate hand
washing product.
 Gloves are to be worn during all phlebotomies, and changed between
patient collections.
 Palpation of phlebotomy site may be performed without gloves
providing the skin is not broken.
 A lab coat or gown must be worn during blood collection procedures.
 Needles and hubs are single use and are disposed of in an
appropriate ‘sharps’ container as one unit.
• Needles are never recapped, removed, broken, or bent after
phlebotomy procedure.
• Gloves are to be discarded in the appropriate container
immediately after the phlebotomy procedure.
• All other items used for the procedure must be disposed of
according to proper biohazardous waste disposal policy.
• Contaminated surfaces must be cleaned with freshly prepared
10% bleach solution. All surfaces are cleaned daily with bleach.
• In the case of an accidental needlestick, immediately wash the
area with an antibacterial soap, express blood from the wound, and
contact your supervisor.
 TROUBLESHOOTING HINTS FOR
BLOOD COLLECTION
If a blood sample is not attainable:
 Reposition the needle.
 Ensure that the collection tube is completely pushed onto the back
of the needle in the hub.
 Use another tube as vacuum may have been lost.
 Loosen the tourniquet.
 Probing is not recommended. In most cases, another puncture in a
site below the first site is advised.
 A patient should never be stuck more than twice unsuccessfully by
a phlebotomist. The Supervisor should be called to assess the
patient.
 Documentation Activity
 Site and location of vein used, the appearance of the site,
and the condition and type of dressing used over the
blood draw site
 Date, time, and blood samples drawn
 Patient teaching
 Any unexpected outcomes, related nursing interventions,
health care provider notification, and the patient’s
response to treatment
 Communication of laboratory results to the provider (if
applicable)
COMPLICATIONS
OF
IV THERAPY
 Systemic Complications
Local Complications
 Embolism
 Infiltration - Pulmonary
 Extravasation - Air
 Thrombosis - Catheter
 Thrombophlebitis  Hematoma
 Phlebitis  Systemic Function
 Speedshock
 Ciculatory overload
 Allergic reaction
Local Complications

 Infiltration
- results when the infusion cannula becomes dislodged from the
vein and fluids are infused into the surrounding.

S/S :
- increasing edema at the site of the infusion
- discomfort, burning, pain at site
- feeling of tightness at site
- decreased skin temperature around site
- blanching at site
- absent backflow of blood
- slower flow rate
Cause:
- device dislodged from vein or perforated vein

Nursing Interventions:
- remove the device
- apply warm soaks to aid absorption
- elevate the limb
- notify the doctor if severe
- assess circulation
- restart the infusion
- document the pt’s condition and your interventions

Prevention:
- check the I.V site frequently
- don’t obscure area above site with tape
- teach the pt to report discomfort, pain, swelling
 Extravasation
- it occurs when fluids seep out from the lumen of a vessel into the
surrounding tissue

Causes:
- damage to the posterior wall of the vein
- occlusion of the vein proximal to the injection site

S/S:
- swelling
- discomfort
- burning
- tightness
- coolness in the adjacent skin
- slow flow rate
Nursing Interventions:

- immediately stop the infusion and remove the device

- elevate the affected limb
- apply cold compress to decrease edema and pain
- apply moist heat to facilitate the absorption of fluid grossly
infiltrated sites

Drug associated with Extravasation Necrosis

 Thrombosis
- occurs when blood flow through a vein is obstructed by a local
thrombus.
- catheter-related thrombosis arises as a result of injury to the
endothelial cells of the venous wall.

S/S:
- painful, reddened and swollen vein
- sluggish or stopped I.V flow

Cause:
- Injury to endothelial cells of vein wall, allowing platelets to adhere and
thrombus form
Nursing Interventions:
- remove the device; restart the infusion in the opposite limb if
possible
- apply warm soaks
- watch for I.V therapy - related infection

Prevention:
- use proper venipuncture techniques to reduce injury to the vein
 Thrombophlebitis
- occurs when thrombosis is accompanied by inflammation
- infusions allowed to continue after thrombophlebitis develops will
slow and eventually stop, indicating progression to an obstructive
thrombophlebitis.
- various terms can be used to distinguish the type of phlebitis a
patient experiences.

S/S:
- local tenderness
- swelling
- induration
- a red line detectable above the IV site
 Phlebitis
Causes:
- injury during venipuncture
- prolonged use of the same I.V site
- irritating/incompatible I.V additives
- use of vein that is too small for the flow rate
- use of needle size too large for the vein size

S/S:
- pain
- vein that is sore, hard, cord like and warm to touch
- red line above the site
- signs of infection
Nursing Interventions:
- upon assessment of phlebitis, removal the needle
- avoid multiple insertion
- application of warm compress
- continuously monitor the patient-vital signs

Common medication that can cause Phlebitis

Systemic Complications

 Embolism

Pulmonary embolism

- associated with venous access devices is usually the result of

thrombus that has become detached from the wall of the vein. It is
carried by the venous circulation to the right side of the heart and
then into the pulmonary artery.

- circulatory and cardiac abnormalities are caused by full or partial

obstruction of pulmonary artery, with possible progression to
pulmonary hypertension and right-sided heart failure.
Air embolism
- occurs most frequently with the use of central venous access devices.
- occurs with the insertion of an IV catheter, during manipulation of
the catheter or catheter site when the device is removed, or when IV
lines associated with the catheter are disconnected.

Catheter embolism
- This can occur during the insertion of a catheter if appropriate
placement techniques are not strictly adhered to.
- The tip of the needle used during the placement of the catheter can
shear off the tip of the catheter.
- The catheter tip then becomes a free-floating embolus.
- This can occur with both over-the-needle and through-the-needle
catheters. If this happens, cardiac catheterization may be required to
remove the embolus.
S/S:
- sudden vascular collapse with the hallmark symptoms of cyanosis,
hypotension, increased venous pressures, and rapid loss of
consciencess.
- respiratory distress
- unequal breath sounds
- weak pulse

Cause:
- empty solution container
- solution container empties; next container pushes air down line
- tubing disconnected from venous access device or I.V bag
Nursing Interventions:

- discontinue the infusion

- place the patient in Trendelenburg position on his left side to allow
air to enter the right atrium and disperse through the pulmonary
artery
- Administer oxygen
- Notify the doctor
-Document the patients condition and your interventions.

 Hematoma
- The seepage off blood into the extravascular tissue.
Causes:

- Coagulation defects
- Inappropriate use of tourniquet
- Unsuccessful insertion attempts
- Little pressure upon removal of cannula
- Frequent assessment of the site
- Upon insertion slowly advance the needle to prevent puncturing
both vein walls
- Discontinue therapy if with edema
- Apply pressure for at least 5 minutes upon removal
 Systemic infection

- Is the successful transmission or encounter of host with

potentially pathogenic organism.
- Major hazard - can be local or systemic (septicemia)
-Caused by: Staphylococcus aureus, Klebsiella, Serratia,
Pseudomonas Aeruginosa

S/S:
- fever, chills, and malaise for no apparent reason
- contaminated I.V site, usually with no visible signs of infection at
site
Causes:
- failure to maintain aseptic technique during insertion or site care
- severe phlebitis, which can set up ideal conditions for organisms
growth
- poor taping
- prolonged indwelling time of device
- immunocompromised patient

Nursing Interventions:
- notify the doctor
- administer medications as prescribed
- culture the site and the device
- monitor the patient’s vital signs
Prevention:
- Use scrupulous aseptic technique
- secure all connections
- Change I.V solutions, tubing and venous accesss device at
recommended times
- Use I.V filters

Management and Prevention Tips

- assess catheter site daily
- accurately document visual inspection and palpation data
- refer to physician for any suspected infection
- use maximal sterile-barrier precautions during insertion (sterile
technique)
- practice good hand hygiene before and after palpating, inserting,
replacing, or dressing any intravascular device.
 Speedshock

- rapid introduction of a foreign substance, usually a medication,

into the circulation.

S/S:
- flushed face
- headache
- tight feeling in the chest
- irregular pulse

In extreme cases:
- Loss of consciousness
Nursing Interventions:

- STOP the infusion

- Careful monitoring of IV flow rate and patient response. Maintain
prescribed rate.
- Know the actions and side effects of the drug being administered
- use of IV pumps when indicated
- begin infusion of 5% dextrose at a KVO rate in emergency cases
- evaluate circulatory and neurologic status
- notify the physician
 Circulatory overload
- an excess of fluid disrupting homeostasis caused by infusion at a
rate greater than the patient’s system is able to accommodate

S/S:
- shortness of beath
- elevated blood presssure
- bounding pulse
- jugular vein distention
- increased respiratory rate
- edema
- crackles or ronchi upon auscultation

Causes:
- roller clamp loosedned to allow run on infusion
- flow rate too rapid
- miscalculation of fluid requirements
Nursing Interrventions:
- Raise the head of the bed
- slow the infusion rate
- administer oxygen as needed
- notify the doctor
Administer medications as ordered

 Allergic reaction
- maybe a local or generalized response to tape, cleansing agent,
medication, solution or intravenous device

S/S:
Local
- wheal
- redness
- itching at the site
Systemic
- runny nose
- tearing
- bronchospasm
- wheezing
- generalized rash

Nursing Interventions
- If reaction occurs, stop the infusion immediately and infuse
normal saline solution
- Maintain a patent airway
- notify the doctor
- administer antihistaminic steroid, anti-inflammatory, and
antipyretic drugs, as ordered.
- Give 0.2 to 0.5ml oif aqeous epinephrine subcutaneously. Repeat
at 3-minute intervals and as needed, as ordered.
Infection Control :
 Venipuncture Hygiene
 Hematomas
 Bruising
 Redness, swelling, and fever
 Avoiding Venipuncture Infections