Venipuncture & Peripheral IV InsertionAvailable on Blackboard: Professor Hidle’s skills videos 1) Intravenous cannulization 2) Venous accessClinical indicationsSelecting anatomical sites: Venipuncture and PIV insertionAssessing for suitable veinsPowerPoint PresentationAnatomical SitesSlide 8Slide 9Slide 10Slide 11Slide 12IV Consideration in ChildrenSlide 14Accessing VeinsPreparing the child and caretakersSlide 17Equipment needed (will go over in demonstration)Slide 19Slide 20Procedure for IV insertion and securing the siteSlide 22Slide 23The “gentler” IVBenzocaine (Hurricane Spray) - ALERTComplicationsSlide 27Slide 28Slide 29Slide 30Slide 31Slide 32Slide 33Venous SpasmPeripheral Nerve Palsy:Points to Remember:Points to rememberHow to best prevent complication of infection (cellulitis)?Slide 39VENIPUNCTURECollection TubesLABORATORY TUBE COLORSSlide 43Slide 44Slide 45Slide 46Slide 47ORDER OF COLLECTING BLOODIV FLUID RATE CALCULATIONMaintenance Fluids: Hourly Rate35 kg child: 1x maintenance IVFOther examples using hourly rate (anwers at the end of slides)Another way….. Per 24 hoursSlide 54AnswersAnswers cont.THE END!Venipuncture & Peripheral Venipuncture & Peripheral IV InsertionIV InsertionBy By Prof. Unn Hidle & Prof. Pat DillonProf. Unn Hidle & Prof. Pat DillonUpdated Spring, 2010Updated Spring, 2010Available on Blackboard:Available on Blackboard:Professor Hidle’s skills videosProfessor Hidle’s skills videos1) 1) Intravenous cannulizationIntravenous cannulization2) 2) Venous accessVenous accessClinical indicationsClinical indicationsVenipunctureVenipuncture: : Blood testsBlood testsMonitoring blood levelsMonitoring blood levelsPeripheral IVPeripheral IV: : Fluid maintenance (decreased/absent PO, NG or GT Fluid maintenance (decreased/absent PO, NG or GT intake)intake)Fluid boluses for dehydrationFluid boluses for dehydrationNutritional supplementation (TPN, lipidsNutritional supplementation (TPN, lipidsAdministration of medications/treatmentsAdministration of medications/treatmentsBlood transfusions Blood transfusionsSelecting anatomical sites: Selecting anatomical sites: Venipuncture and PIV insertionVenipuncture and PIV insertionThe site chosen for venipuncture varies with the The site chosen for venipuncture varies with the client’s age, the length of time the infusion is to client’s age, the length of time the infusion is to run, the type of solution used, and the condition run, the type of solution used, and the condition of veins. of veins. In general, for adults, veins in the hand and are In general, for adults, veins in the hand and are commonly used, while for infants, veins in the commonly used, while for infants, veins in the scalp and dorsal foot veins may be used.scalp and dorsal foot veins may be used.Larger veins are preferred for infusion that need to Larger veins are preferred for infusion that need to be given rapidly and for solution that could be be given rapidly and for solution that could be irritating. irritating.Assessing for suitable veinsAssessing for suitable veinsVein patencyVein patency (scar tissue): Veins that have (scar tissue): Veins that have previously been used for IV insertion may have previously been used for IV insertion may have been damaged by phlebitis, infiltration or been damaged by phlebitis, infiltration or sclerosissclerosis““Rolling veins”Rolling veins” : Highly visible veins and : Highly visible veins and “popping up” – tends to roll away from the “popping up” – tends to roll away from the needleneedleSkin turgorSkin turgor (dehydration): Veins less palpable (dehydration): Veins less palpable and access more difficultand access more difficultEdema:Edema: Veins less palpable Veins less palpableFistulas/shuntsFistulas/shuntsThe site selected depends on accessibility The site selected depends on accessibility and convenienceand convenienceConsider the Consider the child’s developmental, cognitive, and mobility needsFor veins in the extremities, it is best to For veins in the extremities, it is best to start with the most distal sites.start with the most distal sites. If the vein is damaged, using distal sites If the vein is damaged, using distal sites initially preserves access to the vein in initially preserves access to the vein in proximal sitesproximal sitesAnatomical SitesAnatomical SitesMedian cubital veinMedian cubital vein – usually saved for – usually saved for PICC line insertion; inconvenient in PICC line insertion; inconvenient in children as it limits motilitychildren as it limits motilityBasilic veinBasilic veinCephalic veinCephalic veinMedial antebrachial veinMedial antebrachial veinDorsal hand veinsDorsal hand veinsScalp veinsScalp veins – used for infants – used for infants Dorsal foot veinsDorsal foot veins – used for infants – used for infantsAnatomical sites in InfantsAnatomical sites in InfantsBlood Drawing in InfantsBlood Drawing in InfantsThe recommended location for blood collection on a newborn baby or infant is the heel. The diagram below indicates in green the proper area to use for heel punctures for blood collection.Pre-warm the infant's heel (42 C for 3 to 5 minutes - may use “infant heel warmer”). Clean the site with an alcohol sponge. Hold the baby's foot firmly to avoid sudden movement.Using a sterile blood lancet and clean gloves, ONLY puncture appropriate region & do not use previous puncture site. Wipe away the first drop of blood. Do not use excessive pressure or heavy massaging because the blood may become diluted with tissue fluid AND damage to RBC can occur and affect blood test results.IV Consideration in ChildrenIV Consideration in ChildrenMost infants have 1-2 possible IV sites on Most infants have 1-2 possible IV sites on each hand, arm, and foot and 4-8 sites on each hand, arm, and foot and 4-8 sites on the scalp.the scalp.Although scalp IV are easily accessible, Although scalp IV are easily accessible, they are used only when attempts at other they are used only when attempts at other sites have failedsites have failedSuperficial scalp veins have Superficial scalp veins have no valves and and fluid can be infused in either directionfluid can be infused in either directionA rubber band is used from brow to A rubber band is used from brow to occiput as a tourniquet when needed.occiput as a tourniquet when needed.It