VENIPUNCTURE

REYN CORPUZ RRT,IVT

VENIPUNCTURE

• Venipuncture is the process of obtaining intravenous access for

the purpose of intravenous therapy or diagnosis.
VENIPUNCTURE
INTRAVENOUS THERAPY
- Is therapy that delivers fluids directly into a vein. The intravenous route of administration can
be used both for injections, using a syringe at higher pressures; as well as for infusions,
typically using only the pressure supplied by gravity. Intravenous infusions are commonly
referred to as drips.

- Is the fastest way to deliver medications and fluid replacement throughout

the body.

USED FOR:
- fluid volume replacement
- correct electrolyte imbalances
- deliver medications
- blood transfusions.
INDICATIONS:

- Maintenance of hydration and prevention of further

dehydration to patients who are unable to tolerate sufficient
volumes of oral fluids and/or medications.
- Parenteral Nutrition
- Chemotherapy and other drugs
- Transfusion of blood and other components
CONTRAINDICATION

• Administration of irritant fluids or drugs through peripheral

access
(ex. Highly concentrated, high osmolarity solutions like
Sodium Chloride, Hypertonic Potassium Chloride, etc.)
ADVANTAGES

• Immediate Effect
• Control over the rate of administration
• Patient cannot tolerate drugs/ fluids orally
• Some drugs cannot be absorbed by any other route
• Pain and irritation is avoided compared to some
substances when given SC/ IM
Five R’s

• Document the five “rights” of medication administration:

o Right patient
o Right medication
o Right route
o Right amount
o Right time
MEDICATIONS

Imperative for radiographer to be knowledgeable of all

medications administered in the department, including:
o Name
o Dosages
o Indications
o Contraindications
o Adverse reactions
PATIENT EDUCATION
Important to explain:
o Procedural steps
o Expected duration
o Limitations and restrictions associated with procedure performance

- Anxiety can cause vasoconstriction making venipuncture more painful

- Information can ease patient’s fear and reduce discomfort of procedure
- Provide honest, factual,and appropriate information ∙ Be honest about pain
that might be felt and note that pain experience is different for each patient
PATIENT ASSESSMENT
History of allergies
o Include food and medication allergies
o Used to determine potential for adverse reaction to contrast

Current medications
o Some Medications for diabetes interact adversely with contrast

Surgical procedures
o Used to determine site for venipuncture

Past and current disease processes

o Used to determine appropriate amount of contrast

Lab values for BUN and creatinine

o Indicators of normal kidney function
INFECTION CONTROL

∙ Venipuncture may cause

infection if performed
incorrectly
∙ Strict Aseptic techniques
and universal precautions
must be used
∙ IV filters can reduce the
risk of infection, reduces rate
of injection too
INTEGUMENTARY SYSTEM
- The integumentary system consists
of the skin (cutaneous membrane)
and its accessory organs.

Skin is composed of three layers of

tissue:
- epidermis
- dermis
- subcutaneous layer
1. the outer epidermis (made of stratified
squamous epithelium ),
2. the middle dermis
(made of fibrous connective tissue ), and the
3. inner subcutaneous layer or hypodermis
(made of adipose tissue and loose connective
tissue).

Accessory organs include the hair (hair root and hair shaft) , hair
follicle , pili arrector muscle,
sebaceous gland , sudoriferous gland , nails , and mammary gland.
VASCULAR SYSTEM
• The vascular system supplies oxygen to the body and removes waste through
five types of blood vessels:

1. Arteries - Transport high- pressure blood from the heart to smaller arteries and
arterioles.
2. Arterioles - Connect arteries and capillaries.
3. Veins - Act as reservoir of blood and transport low-pressure blood from venules to
heart
4. Venules - Connect capillaries and veins.
5. Capillaries - Allow gas exchange, nutrient transfer and waste removal between
blood and tissue fluid.
VASCULAR SYSTEM
arteries are way thicker than veins
arterioles are smallest artery
capillaries are tiny hair like (microcirculation) change of nutrients among the
arterioles and capillaries
venules - smallest veins
veins- lumens are larger than the arteries

arteries - carry oxyginated blood (red)

veins - carrie sunoxygenated blood (blue)
but for the lungs there is an exception ( pulmonary trunk Artery carries oxygen
poor blood) while the pulmonary veins carries oxygen rich blood transported
back to the heart.
Layers of Blood Vessels
arteries:
large - more elastic
muscular - small (more smooth muscle)
arterioles - tunica adventitia (externa)/ tunica media/ tunica intima(interna)
endothelial tissue and basal cell( membrane that controls the contraction and
relaxation adhesion.)

capillaries - all endothelium and loose connective tissue

venules - only tunica intima

viens - predominant tunica adventitia
Vein Selection

The three main veins of the

antecubital fossa that are
frequently used:
1. Cephalic
2. Basilic
3. Median Cubital Vein
- These veins are usually large, easy to find, and
accommodating of larger IV Catheters.

- The are usually visualized, palpated and accessed

because
of their superficial nature and size. However, their position
over the flexor surface of the
elbow makes these veins prone to mechanical phlebitis,
and the cannula prone to failure
from kinking or dislodgement.
Vein selection
- Digital Veins of the fingers are small and rarely used
- The metacarpal veins and the dorsal venous arch are easily visualized and palpated.
- The radial end of the dorsal venous arch continues to form the cephalic vein while the
ulnar end of the dorsal venous arch forms the basilica vein; all of these are suitable for
cannulation.
- The cephalic and basilica veins continue in the forearm. The basilica vein is often
overlooked because it is inconspicuous, not easy to stabilize and can be difficult to access
due to its location. However, the cephalic vein is large, easily stabilized and accessible.
- The median cubital vein runs diagonally across the antecubital fossa connecting the
basilica and cephalic veins.
- The median cubital vein is absent in 20 percent of the population (Moore and Dalley,
1999).
Choosing The Right Vein
Prioritize the ideal veins for venipuncture
- Prime factors to consider
o Suitability of location
o Condition of vein
o Purpose of infusion
o Durations of therapy
- Begin with distal veins
- Watch out for bifurcated or branched veins.
- anything that distal to insertion site is unusable for 24 hrs.
- Arm veins are the best source from which to obtain blood
Aging alters the structure and appearance of the skin.
The dermal layers become thinner and there is less subcutaneous
tissue to support the blood vessels.
The veins of the older people are often easier to see because of the
reduction in subcutaneous tissue, particularly on the dorsum of the
hand.
The vessels are also more mobile, more fragile and often tortuous
and thrombosed.
The dorsum of the hand should be avoided in older people.
Choosing The Right Vein
- A cannula should not be placed in areas of localized:
- edema
- dermatitis
- cellulitis
- side of mastectomy
- arteriovenous fistulae
- wounds
- skin grafts
- fractures
- stroke
- planned limb surgery
- venous cannulation
Choosing The Right Vein
- The patient may prefer the non-dominant limb to be selected for
cannulation to promote independence and comfort.

- An ideal vein is ‘soft and bouncy’ when palpated. Veins that are tender,
thrombosed or hard should be avoided

- Valves may prevent blood withdrawal and cannula advancement, and,

therefore, should be avoided. Valves appear as small bulges within the
peripheral veins which can be confirmed by palpation

- Palpation also allows the practitioner to differentiate between arteries and

veins.
- Veins contain valves, crescent shaped folds of
endothelium, which assist blood flow back to the heart.
- Arteries are pulsatile and should be carefully avoided.
Strategies for Preventing Infection
1. Standard and Transmission Based Precautions
2. Hand Hygiene
3. Aseptic Technique
4. Skin Antiseptics
5. Catheter Dressings
6. Catheter Stabilization
7. Anti-microbial/ Antiseptic-Impregnated Catheters
8. Central Line Bundle
9. Other Aspects of Post Insertion Care
Skin must be prepared and cleaned
∙ If hair is present, clip them for better visualization of vein
∙ Antiseptic used for cleaning should be in contact with skin for at least30
seconds
o Iodine tincture 1% to2%
o Isopropyl alcohol 70%
∙ Skin cleaned in circular motion from center of injection site to about a
2”circle
∙ Once cleaning swab is placed on skin it should not be lifted off until
cleaning is complete
∙ Local anesthetic may be used before IVaccess
o administered topical or by injection
Venipuncture Supplies and Equipment

Cannulas/ Needles
IV Cannulation- is a technique in
which a cannula is placed inside a
vein to provide venous access.
Venous access allows sampling of
blood, as well as administration of
fluids, medications, parenteral
nutrition, chemotherapy, and blood
products.
different colors of the cannula represent its different sizes and
gauge:
orange - 14G / 250ml/min / rapid blood transfusion , rapid fluid
replacement
gray - 16G / 225ml/mn
white - 17G / 200ml/mn
green - 18G / 100ml/mn
pink - 20G / 60ml/mn
blue - 22G / 40 ml/mn / most infusion
yellow - 24G / 20ml/mn / neonate and pedia
purple - 26G / 10ml/mn
Venipuncture Supplies and Equipment
All are single-use only, disposed of properly
after one use
Parts
o Hub = attached to syringe
o Cannula or shaft = length of needle
o Bevel = slanted portion attip
o Gauge = diameter of needle bore
Types
o Hypodermic
o Butterfly sets
o Angiocatheters
o hypodermic
∙ Butterfly sets and angiocatheters usually used by
radiographers for IV administration
∙ Needle type depends on:
o Patient assessment
o Institutional policy
o Technologist’s preference
butterfly - or scalp vein set
∙ hypodermic needles –
generally used for
phlebotomy
Venipuncture Supplies and Equipment
Microset- IV tubing is used for someone receiving
smaller doses of IV fluids or medications. You have
to turn the tubing on, once you connect it to
the tubing, and control the flow rate by standing
there and visually counting the number of drops
that come out in 60 seconds.

Macrosets- The drop factor is the amount of drops

(gtts) per minute. IV tubing is either macro tubing
(10, 15, or 20 gtts/min) .
gtts min - drops per minute
microset - 45-60 drops to make 1mL
macrosets - 10 - 20 drops to make 1mL

macroset - (adult) no tip / allows fast fluid infusion , fluid resuscitation (replacement /
replenishment) , fluid boluses
disadvantage: potential for fluid overload , difficult to titrate

microset - (pedia) with tip / easy to titrate, avoids fluid overload

disadvantage: does not allow fluid resuscitation , does not allow fluid boluses

(titrate - changes to medication doses to achieve the best clinical response / reach the best
intended benefits of the treatment while minimizing side effect)
(bolus - rapid infusion of fluids over a short period of time / gives to the patient who has
hypotension or hypovolemic)

hypovolemia - loss body fluid (diarrhea, vomiting, diuretics)

Solution Containers

Glass Containers Plastic Container

Venipuncture Supplies and Equipment
Tourniquet is used by the phlebotomist to assess and determine
the location of a suitable vein for venipuncture.
Proper application of a tourniquet will partially impede venous blood flow back
toward the heart and cause the blood to temporarily pool in the vein so the vein is
more prominent and the blood is more easily obtained. The tourniquet is applied
three to four inches above the needle insertion point
and should remain in place no longer than one minute to prevent
hemoconcentration.
Venipuncture Supplies and Equipment

Syringes
∙ Parts
o Tip = where needle attached
o Barrel = has calibration
markings and holds medication
o Plunger = fits snugly inside
barrel and allows user to instill
medication
Venipuncture Supplies and Equipment

Transparent film Dressing

• Adhesive-free window minimizes
adhesive contact with needle and
patient's skin, reducing the risk of the
dressing sticking to needle during
removal.
• Dressing flexes with skin for greater
patient comfort.
• Transparent dressing permits clear
visibility around the
insertion site area.
• Up to 7-day wear time
Venipuncture Supplies and Equipment

HEPARIN LOCK
- Consists of a venous catheter
established for a certain length of
time to make a vein available for
medications that have to be
administered at frequent intervals
- Some meds are given at
intervals through heplocks
o prevents veinscarring
o sclerotic veins area result off
requent injection at the same site
Venipuncture Supplies and Equipment
IV Poles

IV, or intravenous poles are devices used to hold

bags of fluid or medicine that is being given to a
patient at a steady flow.
This is done by hanging a bag of fluid on a hook near
the top of the pole. The fluid then runs through a tube
and into a patient’s veins.

IV bags should hang atleast 3 ft above an adult’s pt

heart
Stabilizing the Catheter
IV FLUIDS
HYPOTONIC SOLUTIONS:
- hydrate the cells
- treatment for patient with extreme dehydration
- not for hypotensive patient

ISOTONIC SOLUTIONS:
- no visible changes in cells
- interstitial fluid and most IV solutions are isotonic solutions

HYPERTONIC SOLUTIONS:
- shrinks the cell
- gives to the patient who have edema
- irritating to veins; observe IV site for inflammation
osmotic pressure - ability of a solution to hold water or pull water
into it.
- it is directly related to the concentration of solutes in the solution
higher the solute concentration = greater osmotic pressure, and
greater the tendency of water to move into the solution

tonicity - ability of a solution to change the size and shape of cells by

altering the amount of water they contain.

hypertonic; the solutions draw water out of tissue spaces into the
bloodstream so that the kidneys can eliminate excess fluid
• SOLUTION – composed of solutes ( 1 or more substance) that is dissolved in liquid or gas
(predominant – madami / water)
• DIFFUSION – solutes tend to move from an area of higher concentration of a solute to an
area of lower concentration of solute in solution. (EQUILIBRIUM)
• OSMOSIS – diffusion of solvent (water) from a higher water concentration to the one of
lower water concentration
• HYPERTONIC SOLUTION – contains more solutes than solvent causing it have more
higher solute concentration than there is in the cell; given to patient with edema – resulting
in a cell shrinkage (crenation) – lead to cell death
•
• ISOTONIC – 5% GLUCOSE AND .9% SALINE normal
• HYPOTONIC – more solvent than solute causing it to have less solute concentration than
there is in the cell – for pt w/ extreme dehydration ; water will enter the cell and when burst
(lyse)
CONTRAST MEDIA
IODINATED CONTRAST MEDIA
- Ionic
- Non-Ionic
Test dose - 2cc (wait for 10-15mns for adverse reaction)

Patient Assessment
- Take the history of the patient specifically to allergies – including food, medications
and iodine
- What are their current medications – OHA interact adversely with contrast media
- (OHA - oral hypoglycemic medications; metformin; pt w/ type 2 diabetes mellitus)
- What are the past surgical history – used to determine site for venipuncture
- Laboratory values – BUN level 10-20mg/dl and creatinine level 0.05-1.2mg/dl
- Past and current medical history – to determine appropriate amount of contrast
- Antihistamine Medication
CONTRAST MEDIA
Antihistamine Medications
Diphenhydramine – Benadryl
Loratadine – Alavert, Claritin
Fexofenadine – Allegra
Clemastine – Tavist
Chlorpheniramine – Chlor-Trimeton
Cetirizine – Zyrtec
Brompheniramine - Dimetane
Vein Dilation Techniques
Tourniquet — Latex or nonlatex used most frequently. Placed 6–8 inches above
the venipuncture site. If BP high, move farther from venipuncture site. If BP low,
move as close as possible without risking site contamination.
Gravity — Position the extremity lower than the heart.
Fist clenching — Instruct patient to open and close his/her fist.
Tapping vein — Using thumb and second finger, flick the vein; this releases
histamines beneath the skin and causes dilation (do not slap vein).
Warm compresses — 10 minutes maximum. Do not use microwave!
Blood pressure cuff — Inflate to 300 mm Hg; great for fragile veins
Multiple tourniquet technique — Use 2 to 3 latex tourniquets; apply one high on
arm and leave for 2 minutes; apply second at midarm below antecubital fossa;
collateral veins should appear; apply third if needed.
VENIPUNCTURE STEPS:
1. Radiographer puts on gloves and cleans skin
2. Tourniquet applied 3” to 4” above puncture site
3. Hold limb with non dominant handand anchor vein with thumb
4. Usingdominant hand, positionneedle bevelside up at 45-degree angle to skin
surface
5. Enterskin with quick,sharp, dartingmotion and decrease angle to 15 degrees
after entering vein
6. Look for bloodreturn
7. If no blood return, pull back on plunger slowly to aspirate blood and verify
placement in vein
8. Release tourniquet
9. Anchor needle with tape
10. Administer solution
ADMINISTRATION:
- Hold gauze pad overinjection site and remove needle by pulling straight from
vein
- Apply pressure to site with gauze
- Discard gloves, needles, and gauze in appropriate manner. ∙
- If patient has established IV site, check compatibility before using for contrast
administration
- To administer contrast in existing IV line,stop infusion of medication
- Flush IV line with saline before and after contrast administration
- Restart infusion
INTRAVENOUS COMPLICATIONS:
LOCAL COMPLICATIONS:

COMPLICATION S&S TREATMENT PREVENTION

Hematoma Ecchymoses - Remove catheter - Use indirect method

Site swelling and if indicated. of venipuncture.
discomfort Inability - Apply pressure -Apply tourniquet
to advance catheter with 2-inch just before
Resistance during gauze. venipuncture.
flushing - Elevate extremity. -Use blood pressure
- Cold compresses (BP) cuff for patients
may be applied. with delicate/fragile
skin.
 LOCAL COMPLICATIONS:
Phlebitis -Site erythema, may Discontinue catheter. Choose smallest I.V.
extend over length of Apply warm cannula that is
vein (i.e., streak compresses. Elevate appropriate for
formation) limb. Administer infusion.
-Local swelling Hand hygiene prior
-Palpable cord along analgesics or anti- to placement and I.V.
vein Pain inflammatory access.

medications, if Remove and rotate

ordered. PI.V. site.

Stabilize catheter to
prevent movement at
insertion site

Avoid placing PIV

catheter in areas of
flexion; joint stabilization,
if placed in area of
flexion.
 LOCAL COMPLICATIONS:
Infiltration/ Coolness of skin Stop infusion and Choose smallest I.V.
extravasation around site remove catheter. cannula that is
Taut/blanched skin appropriate for
Edema above or Apply cool/warm infusion.
below insertion site compresses as
indicated by type of Stabilize catheter to
Backflow of blood infusate. prevent mechanical
absent irritation.
Elevate extremity.
Slowed infusion rate Avoid placing PIV in
For extravasation: Follow guidelines if areas of flexion.
extravasation occurs.
Complaints of pain Do not use veins that
Burning or stinging at have a previous
insertion site Blisters venipuncture.

Avoid antecubital
fossa.
LOCAL COMPLICATIONS:
Nerve Injury Immediate sharp Stop venipuncture. Avoid lateral surface
pain during of wrist, antecubital
venipuncture Apply pressure. area, ventral surface
of wrist.
Shooting pain up arm
Pain or tingling in Avoid probing.
hand or fingertips
Reduce risk for
infiltration or
extravasation as
above.
SYSTEMIC COMPLICATIONS:
AIR EMBOLISM Light-headedness Call rapid response Remove all air from
Dyspnea, cyanosis, team. administration sets.
tachypnea,
expiratory wheezes, Place patient in Use Luer-lock
cough Mill wheel Trendelenburg connections.
murmur, chest pain, position.
hypotension Follow protocol for
Administer catheter removal.
Change in mental oxygen as ordered.
status, confusion
coma, seizures Monitor vital signs.
 SYSTEMIC COMPLICATIONS:
Bloodstream Fever and chills Notify the LIP. Hand hygiene
Infection Diaphoresis
Tachycardia Restart new I.V. Aseptic technique
Tachypnea system. with all aspects of
infusion- related care
Change in mental Obtain
status Hypoxemia cultures. Attention to skin
antisepsis prior to
Decreased urine Initiate antimicrobial placement and with
output Hypotension therapy ordered. ongoing site care;
preference for using
Evidence of Monitor the patient alcoholic chlorhexidine
decreased perfusion closely. solutions.
or dysfunction
SYSTEMIC COMPLICATIONS:
Speed Shock Dizziness Stop infusion Monitor the infusion
immediately. rate.
Facial flushing
Call rapid response Administer I.V.
Headache team. push medications
over appropriate
Tightness in chest time frame.

Hypotension

Irregular pulse

Progression of shock