Patient Care Venipuncture

Front 1

Circulatory System

Back 1

-Responsible for delivery of oxygen, nutrients, hormones enzymes and carbon dioxide
- Consists of 2 circuits

Front 2

Pulmonary Circulation

Back 2

Transports deoxygenated blood from the right ventricle of the heart through the lungs and oxygenated blood back to the left atrium of the heart.

Front 3

Systemic Circulation

Back 3

Transports oxygenated blood form the heart's left ventricle throughout the body and deoxygenated blood from the body back to the right atrium of the heart.

Front 4

Arteries

Back 4

Carry oxygenated blood away from the heart

Front 5

Veins

Back 5

Carry deoxygenated blood to the heart.

Front 6

Capillaries

Back 6

Are tiny blood vessels that connect veins and arteries.

Front 7

Left Ventricle

Back 7

All tests are directed towards this part of the heart.

Front 8

Veins and arteries consists of 3 layers

Back 8

1. Tunica initma
2. Tunica media = middle
3. Tunica adventitia

Front 9

The smooth muscles of the tunica media allows the vessel to expand and contract, and causing vasodilation & vasoconstriction.

Back 9

Smooth Muscles Control

Front 10

Expand

Back 10

vasodilation

Front 11

Constrict

Back 11

Vasoconstriction

Front 12

Arteries

Back 12

-Carry oxygen and nutrients to the body
- Thick walled to withstand the pressure from heart's contraction
- Large artery is the aorta

Front 13

Aorta

Back 13

-Arches down & branches into the major arteries of the body.
- Splenic, gastric, hepatic, renal, mesenteric
- It branches upward to the carotids and out to the arms
- Then bifurcates into the right and left iliac arteries.

Front 14

Bifurcation

Back 14

Spitting of the aorta to the extremities.

Front 15

Arteries keep branching smaller and smaller until they are

Back 15

arterioles

Front 16

Arterioles connect with

Back 16

capillaries

Front 17

Capillaries allow the exchange of

Back 17

gases, nutrients, and waste products with body tissues.

Front 18

Capillaries connect with

Back 18

venules, and small veins

Front 19

Capillary blood most closely resembles

Back 19

arterial blood then venous blood.

Front 20

Veins

Back 20

-Carry deoxygenated blood back to the heart.
- Same 3 layers as arteries but veins are less muscular.
- Veins have one way valves that prevent back flow from flowing backwards.

Front 21

Blood consists of

Back 21

plasma, and formed elements.

Front 22

Plasma

Back 22

Straw colored fluid consisting of H20, C02, proteins, glucose, hormones, clotting factors.
- Plasma is about 55% of blood volume.
-Formed elements: red blood cells, erythrocytes, WBC, platelets.

Front 23

Coagulation

Back 23

Clot

Front 24

Hemostasis

Back 24

stoppage of blood loss

Front 25

Hemorrhage

Back 25

site of blooding.
- At bleeding site, platelets adhere together (aggregate) and form a plug.
- Platelet activity stimulates plasma fibrinogen to make a fibrin clot.
- Clot and plug are later dissolved during would healing.
- Plasma w/o coagulation factors is called serum.

Front 26

Thrombosis

Back 26

formation of platelet plug and fibrin clot inside a blood vessel.

Front 27

DVT

Back 27

A deep vein thrombosis, dx using a vascular ultrasound.
- Occurs when one is sedentary for an extended period of time, hospital stays, plane rides.
- Clot can break loose and wind up in lungs, causing a pulmonary embolism (PE)

Front 28

Anticoagulation

Back 28

-Clotting mechanisms is complete.
- Many drugs are used to prevent clotting.

Front 29

Heparin

Back 29

activates anti-thrombin, which inactivates thrombin.
- ACD (acid citrate dextrose) binds calcium
EDTA - binds calcium

Front 30

Warfarin (Coumadin)

Back 30

inhibits synthesis of calcium-based clotting factors, taken orally.

Front 31

ASA (acetylsalicylic acid or aspirin)

Back 31

Prevents platelet aggregation.

Front 32

Heparin (Cont.)

Back 32

Very powerful anticoagulation.
- Given via IV to many hospital patients.
- Indications PE, DVT, MI, Atrial fibrillation. Used during open hear surgery because of cardiac bypass.
- Used during kidney dialysis.
- Heparin is a very reactive material, do not inject patient with an isotope in tubing that is used for heparin treatment.
-Used i syringe when collecting blood for nuclear medicine procedures, in vitro rbs tagging (Ultratag); wnc tagging with indium or Ceretec

Front 33

ACD

Back 33

Also used in syringe when collecting blood for nuclear medicine procedures.

Front 34

Venipuncture Supplies

Back 34

Syringe and needle = used for single injections also called a straight stick.

Front 35

Butterfly

Back 35

Used for single injections, can be tapes to patient's arm.

Front 36

IV Catheter

Back 36

Used for multiple injections

Front 37

Butterfly & IV Lines

Back 37

need to be primed, or filled with sterile saline, so air is injected into patient.

Front 38

Venipuncture Procedure

Back 38

Assemble your supplies the same exact way every time.
- Place a tourniquet about 4 inches above site.
- Palpate veins using 1 finger.
- Select site
- Wear gloves
- Clean are with antiseptic in a circular motion in the center moving outward.

Front 39

Venipuncture Procedure Cont.

Back 39

Anchor the vein by stretching the skin with your non-dominant thumb.
- Remove needle sheath and bevel up.
- Penetrate skin and watch for flash of blood in needle hub.
- Pull back on syringe slightly to assure needle is in vein.
- Inject slowly.
- Remove needle and deposit in sharps container immediately.

Front 40

Venipuncture Sites

Back 40

First choice is the anecubital area.
- Veins: median cubital, cephalic, basilic
-Check basilic vein for pulse sticking b/c brachial artery runs near by.
-Second choice is the hand.

Front 41

Venipuncture Sites Cont.

Back 41

Use contralateral side for patients with breast caner, lymph node damage or a-v fistulas.
- Vein should feel springy; do not use site if it feels hard under your finger (sclerotic)

Front 42

Sclerosis

Back 42

scar tissue, caused by chemotherapy, IV drug use, some disease processes.
- Geriatric patients have little collagen and subcutaneous to hold veins in place - anchor firmly so vein does not roll away from needle.

Front 43

Complications of Venipuncture

Back 43

Infiltration = needle is not in vein, but in tissue instead.
- Get flashback
- Pull back on syringe & get blood flow
- Anchor the needle by placing your hand on the patient
- Stop immediately if the patient complains of stinging, you see swelling on the injection site and the syringe does not depress freely.

Front 44

Complications of Venipuncture Cont.

Back 44

Missing the vein.
- Do not pull the needle out immediately; feel for the vein, pull back needle (but not out) and attempt to reposition.
- If you need to pull needle out, then use a new needle.

Front 45

Puncturing all the way through the vein =

Back 45

Hemorrhage under the skin aka blowing the vein.
- Try another site
- Slow down and watch for flashback