IV Therapy Vein Puncture by TSL

TSL (Tarun Saini Lectures) @8505968383
-:Intravenous Therapy:-
Cannulation (VAD):-
1. Pt-Identification :- By two Identifier Name and DOB / Name
& Id no
2. Delegation :- Don’t Delegate to NAP or LPN
3. Equipment's :-
• VAD- 20 G for Adult , 22G for Older Adult and child
• Torniquets:- BP Cuff- For Older Adult, Rubber Band – Infants
• Antiseptic Swab :- 2% chlorhexidine >>>70% alcohol
• Transparent Dressing /2*2 gauze
2
-:Intravenous Therapy:-
Equipment's :-
• Short Extension Tubing with flush(Saline lock /Heparin lock)
• Prefilled 5 ml Syringe (0.9%NS)
• Clean gloves
• Needle Dispose Container (Puncture Proof/impervious)
• In line filter(0.22 um for non Fat / >1.2 um for lipid solution)
3
Cannulation (VAD)-Procedure
Assessment :-
• Review the HCP Order :- Start IV
• Identify pt by two identifier (Name+DOB/Name+Id no)
• Asses the insertion site and Pt
• Skin Turgor :- should return within 3 sec >> If not Tenting
• Thrust :- early Sign in Hypernatremia and Dehydration but
not reliable in Older Pt (bcz thrust sensation decrease with
age)
• Low Platlet count/Use of anticoagulant:- increase R/o
bleeding 4
Cannulation (VAD)-Procedure
If pt Serum K+, Ca+2, Mg+2 Level already high
• Clarify order with HCP before Administration of solution that
contain high amount of these
• Assess allergy for iodine, adhesive or latex
• Use Vented IV Set >>> for rigid /Glass bottle
• Use non Vented IV set >>> for Flexible container
5
Cannulation (VAD)
Implementation :-
• Hand hygiene
• Prepare short Extension tubing and leave syringe attached by
0.9%ns
• For Continue Infusion :- Prepare IV fluid bag and details
• Open Iv Set (follow Aseptic Tech.) >>>Remove end cap
>>>Attach Extension tubing >>> Leave end cap of Ext. Tubing
• Place Rollar Clamp >>> 1 -2 inch (2 to 5 cm) below drip
chamber and move it to close position
6
Cannulation (VAD)
Implementation :-
• Don’t touch to spike >>>insert into bag
• Clean Rubber stopper in Class bottle befor insertion of spike
If spike accidently touch outside the bag or hands >>>>Discard
IV Tubing and Use new one.
• Compress drip chamber >>> fill ½ (one half)
• Prime tubing with IV solution >>>Slowly open roller clamp
• IV Tubing s/be clear of Air / air bubbles
• To remove small air >>>firmly tap over tubing on bubble
location 7
Cannulation (VAD)
Implementation :-
• Use of long Ext. tubing >>> Enable pt to move freely
• Must apply gloves before VAD insertion
• Can Use of visualization tech. (Ultrasound Based) for vein
identification and selection.
• Perform hand hygiene >>Eye Protection and mask
Apply torniquet:-
• Above antecubital fossa or 4-6inch(10-15cm) above proposed
insertion site.
• Don’t apply too tightly :- should occlude the vein not artery check
presence of radial pulse 8
Implementation :-
• Can apply torniquet on top of thin layer of clothing
• Use BP Cuff instead of Torniquet >>>inflate it to level just below
the pt normal DBP (<50 mm of hg)
• Select vein for VAD:- cephalic ,basilic , medial for adults
Select well dilated vein>> to increase Dilation
• place extremity in dependent postion
• Apply warm to extremity for several minutes (eg warm wash
cloth)
• With index finger palpate the vein by pressing downward
• Note resilient , soft , bouncy feeling while reliving pressure by
finer tip 9
Implementation :-
Avoid vein selection In:-
• Area of tenderness, pain, infection or wound
• Arm with paralysis, mastectomy , dialysis graft
• Site distal to previous vein puncture site, sclerosed, hard vein,
infiltration site , phlebitis, bruised area , area of venous valve
• Fragile dorsal vein in older PT, compromised circulation
• Select non dominant hand if possible
• Release torniquet temporarily
• Apply local anesthetic >>> wait for several min to effect
• If area of insertion site need cleaning :- use soap and water first
and dry 1
0
Implementation :-
• Use antiseptic swab to clean insertion site using friction
• Prefer 2% chlorhexidine
Direction :-
• Frist swab :- horizontal plane
• Second swab :- vertical plane
• Third swab :- Circular motion moving outward and allow
completely to dry
Reapply torniquet/BP Cuff :-
• 10-12 cm (4 – 6 Inch) above anticipated insertion site
• Inflate bp cuff <50 mm of hg
• Check distal pulse 1
1
Implementation :-
Perform Vein Puncture :-
• Anchor vein by thumb :- stretching against direction of insertion 4-5
cm distal to site
• Warn pt of sharp and quick stick
• Insert VAD bavel at 10-30* slightly distal to actual site of vein
puncture
• Use one VAD only once if you need to try again use new one
• Observe for blood return in flowback chamber >>>indicate that
needle has entered into vein
• Lower the catheter until almost flushed>>> advance Catheter ¼ inch
(0.6cm) into vein >>>loosen the stylet >>>Advance catheter into vein
until hub is near vein puncture site. 1
2
• Never reinsert stylet >>>risk of shear and catheter tip embolism
• Stabilize catheter with non dominate hand >>> apply gently but firm
pressure with middle finer 3 cm above insertion site >>>>reduce back
flow of blood
• Gently flush the saline >>> if swelling (infiltration) >>> remove
immediately
• Apply transparent dressing and secure catheter by placing 2.5 cm
piece of transparent tape over catheter hub
• Dispose used stylet or sharps into sharp container
Each nurse should not attempt more then 2 attempts
• Record and inspect for sign of infiltration or phlebitis
• Tenderness is an early sign of phlebitis
• Phlebitis :- Redness, tenderness , warmth 1
3
1
4
Ques-Ans Batch:- (NORCET-6.0)
• Total Test – 70 (Each test 100 MCQ)
• 2 Tests/week for initial 5 months
• Daily Test in Last 6th Months
• Total 7000 MCQ with video Solution(Recorded)
• Validity 6 Months
• Faculty :- Tarun Saini
• Malav Sir, Mahi Sir, Akshaya Sir
• Fee Rs 3999/- for First 100 Students Rs 2999/-
Start From 20/OCT/2023 1
6
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TSL (Tarun Saini Lectures) @8505968383

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