IV Insertion
What angle and positioning of the needle's bevel is needed prior to insertion?
Bevel up, 15 degrees
Name three things that are contraindicated in vein selection
Thin/fragile veins, scarring/injury, veins in the wrist or near major landmarks, limb alerts, lower extremities
How many times do we try to "stick" a patient before we phone a friend?
TWO
How should a patient be positioned prior to a blood draw?
Bed in lowest position/chair with arm raised but not above heart level, extremity within easy reach of provider
A patient needing a lab draw who has a 24G IV:
"Why can't you just pull the blood from the IV they placed a few days ago?"
R/f infection, skewed results d/t hemolysis with a small bore, r/s losing existing access facility protocol and evidenced based practice
Why does the nurse pull the skin taught against the vein?
Allows for anchoring and positioning, prevents "rolling"
The smaller the gauge size (16g, 18g, 20g, 22g, 24g) the _________ the needle size
LARGER
When is the tourniquet removed during a blood draw and why?
After flash is received; allows for the flow of blood while reducing risk for hemolyses
The nurse sent a patient's blood to the lab 90 minutes ago and results have not yet populated. What is the nurse's best course of action?
Call lab, verify specimen was received, document time called and ETA for results, notify provider if necessary
A patient needing a lab draw:
"Why do you need to know my allergies? Am I getting medications today?
Topical allergies to chlorhexidine, a common disinfectant, or latex must be assessed for!
Why do we select the most distal site possible for IV insertion?
Subsequent PIVs cannot be started distally to any complications
Another name for extension tubing, prevents blood back flow and promotes patient comfort/ease of use
Which vein should be avoided due to its proximity to the brachial artery?
Basilic vein
Why could a hemolyzed or contaminated sample endanger a patient?
Risk for incorrect treatment, delay in care, multiple sticks increases r/f trauma/infection
A patient with an IV site that is red/hard:
"This is really painful, is it just because I bent my arm earlier?"
Reassure patient that it was not their fault, replace IV access, notify provider, monitor site, prepare for extravasation protocol if ordered)
What signs would alert the nurse that an artery has been punctured?
"Gushing" blood, plunger of syringe is forced back by the pressure of the blood, extreme discomfort
Obtain sample in the OPPOSITE arm
What are the steps the nurse should take immediately after a sample has been collected and the a bandage/pressure has been held on the insertion site?
Can a needle be reused on the same patient if it is only the second attempt?
NEVER! Increases r/f infection
A patient who has been admitted for a blood transfusion:
"Why can't you just use the butterfly needles like they do at my doctor's office?"
Explain need for 20g size or larger (blood cells may be "destroyed" otherwise), allows for additional fluids if needed, infusion can be done quicker and more safely to prevent trauma to surrounding anatomy
What is a "blown vein" and how can the nurse avoid it?
a blood vessel that's damaged due to a needle insertion causing blood to leak; proper positioning, appropriate size, correct insertion techniques
What is a "hep lock"?
What is the correct order of lab draw?
Blood cultures (sterile), blue, red, gold, green, lavender, grey
What lab may be skewed if a lavender tube is drawn PRIOR to a green tube?
Potassium - tubes with EDTA additives will falsely elevate
A patient who needs an IV placed:
"I really don't want to have a needle stay in my arm... can the medicine be given in pill form?"
Verify NEED for access, explain IV vs PO route considerations, explain procedure, offer comfort