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CANNULATION & VENESECTION. LEARNING OUTCOMES OF THE WORKSHOP. To be able to assess the patient To be able to take a blood sample using a vacutainer system To be able to site / change a cannula To be able to name the complications of cannulation and venesection.

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Cannulation venesection

CANNULATION & VENESECTION


Learning outcomes of the workshop
LEARNING OUTCOMES OF THE WORKSHOP

  • To be able to assess the patient

  • To be able to take a blood sample using a vacutainer system

  • To be able to site / change a cannula

  • To be able to name the complications of cannulation and venesection


Patient assessment vein selection

Patient Assessment & Vein Selection


The assessment consider the following points
THE ASSESSMENTCONSIDER THE FOLLOWING POINTS:

  • Age / size / history / condition / dependency of the patient

  • History of previous cannulation / venesection

  • Type / length of treatment required

  • Number of tests ordered

  • What medication is the patient on?

  • Fluid status

  • History of blood disorders


Conditions that affect the position of the device
Conditions that affect the position of the device: -

  • Amputation

  • Stroke

  • Mastectomy or other Breast / Lymph Surgery

  • Renal Fistula

  • Lymphoedema or Cellulitsis

  • Diabetes / Vascular Disease / Arthritis

  • Trauma / Fractures / Burns

  • Social History


Questions to ask the patient
Questions to ask the patient

  • OBTAIN CONSENT

  • Have you had a cannula / blood test before?

  • Were there any complications / adverse reactions?

  • Do you have any allergies?

  • Consider needle phobia

  • Would you like a local topical anaesthetic before I insert the cannula or take blood?

  • Which is your dominant arm?


Attributes of an ideal vein are
Attributes of an ‘ideal’ vein are: -

  • Be engorged, bouncy & soft

  • Refill after it has been depressed

  • Be visible

  • Feel round

  • Be well supported by surrounding structures

  • Be straight & ‘free of valves’


Veins to be avoided are
Veins to be avoided are: -

  • Thrombosed, fibrosed or sclerosed

  • Inflamed or bruised or painful

  • Thin or fragile

  • Mobile

  • Near bony prominences and joints

  • Near sites of infection or oedema

  • AVOID THE VALVES

  • For venesectionavoid the arm with an IV line running


Methods for improving venous access
Methods for improving venous access:

  • Apply a disposable tourniquet

  • Lower the level of the arm below the heart

  • Ask the patient to open and close their fist

  • Light tapping / rubbing of the veins

  • Warm compresses over the selected vein

  • Warm water

  • Relax the patient / consider the environment


WHICH

VEIN?


Antecubital Fossa

Cephalic

1st Intercostal

Brachial Artery

Basillic

Radial

Median Cubital Vein

Radial Artery

Median

Ulnar Artery

Ulnar

Veins

Arteries

Nerves


DIGITAL

DORSAL

VEIN

DORSAL

METACARPAL

VEINS

DORSAL

VENOUS

NETWORK

CEPHALIC

VEIN

BASILLIC

VEIN


Veins to be used are
VEINS TO BE USED ARE:

  • METACARPAL VEINS

  • CEPHALIC VEIN

  • BASILIC VEIN

  • MEDIAN CUBITAL VEIN


Group exercise
GROUP EXERCISE

In pairs, use a tourniquet to identify each others:

  • Veins

  • Arteries

  • Valves

  • Ligaments


Cannula selection

CANNULA SELECTION


Selecting the right cannula two key points to consider
Selecting the right cannulaTwo key points to consider:

  • What is the cannula going to used for?

  • The condition, location and size of the vein selected?

    You should try to select the smallest gauge possible that will accommodate the intravenous therapy that is prescribed.


Venesection

VENESECTION

DEVICE SELECTION


Vacutainer
VACUTAINER

  • Quicker collection than other methods

  • Closed system

  • Exact amount of blood obtained

  • Reduces the risk of haemolysis of the sample

  • Reduces the risk of needlestick injury


Bottles blood forms
BOTTLES & BLOOD FORMS

  • E-QUEST SYSTEM for blood requests & results within SUHT

  • ALWAYS ensure that the GROUP &SAVEor CROSSMATCH request has been correctly completed & signed for by the requesting MEDICAL PRACTIONER


Serum

AB Levels

E.D.T.A.

FBC & ESR

Cross Match Group & Save

Coagulation INR / APTR

Glucose

Lithium Heparin, PST, U&E’s, Bone & Liver

Trace Elements


Order of draw
ORDER OF DRAW

  • No Additives ( Green, Red, Dark Blue)

  • Coagulation Screen (Light Blue)

  • Other Additives (Gold, Grey, Lavender& Pink)

    EXCEPTION:

    Blood Cultures always FILL FIRST



Risks during insertion

Infection

Haemorrhage

Haematoma

Vaso-vagal episode

Needle phobias

Allergies

Transfixation

Pain

Nerve damage

Arterial puncture

Needlestick injury

Risks - During Insertion


Transfixation

SkinVein wallVein wall


Haematoma bruising
Haematoma/Bruising

  • Transfixation

  • Tourniquet too tight / too long / use of RUBBER GLOVE!

  • Arterial puncture

  • Repeated insertion sites


Future complications of cannulation
Future Complications of Cannulation

  • Phlebitis — septic / mechanical / chemical

  • Infiltration

  • Extravasation

  • Thrombosis / Embolism

  • Speed shock / Fluid overload


Phlebitis
Phlebitis

  • TYPES OF:


Infiltration
Infiltration

  • “The inadvertent administration of non-vesicant solution/medication into surrounding tissues."

    (Royal Marsden Manual, 2004)

  • The cannula may still appear to be patent, so early recognition is vital to avoid tissue damage.


Extravasation
Extravasation

  • “the inadvertent administration of a vesicant substance into the tissues surrounding a vein.”

    (Royal Marsden Manual, 2004)


Site preparation
Site preparation

  • As cannulation / venesection is performed using an aseptic non-touch technique it is imperative that the vein is cleaned PRIORTO THEPROCEDURE, wearing clean non-latex gloves

  • Clean the vein for 30 seconds with 2% chlorhexidine in 70% alcohol solution, cleaning the vein in a criss-cross motion

  • Allow vein to air dry

  • DO NOTre-touch or palpatethe vein oncecleaned

  • Consider hair clipping if appropriate


Documentation
DOCUMENTATION

  • SEE CANNULA CARE PLAN includes:

  • Time & date of blood sample / cannula insertion

  • Site of insertion

  • Gauge and batch number of the cannula

  • What blood samples have been taken

  • Number of attempts (MAX 2 per person)

  • Any complications noted (e.g. haematoma)

  • Print & sign your name

  • Evidence verbal consent has been obtained