Monitoring and Documentation

1. Monitoring and Documentation Principles of IV Therapy BSN336

2. Phillips 15 step venipuncture method • Before initiating cannulation follow steps 1-5 • Step 1: Checking the Physician’s Order • Step 2: Hand Hygiene • Step 3: Equipment Preparation • Step 4: Patient Assessment and Psychological preparation • Step 5: Site Selection and Vein Dilatation

3. Phillips steps (cont) • Vein Dilitation(cont) • Type of solution • Condition of vein • Duration of Therapy • Cannula size • Patient age • Patient preference • Patient acitvity • Presence of disease or previous surgery • Presence of shunt or graft • Patient receiving anticoagulation therapy • Patient with allergies

4. Vein Dilatation(cont) • Ways to increase blood flow in the upper extremities • Factors affecting the capacity for dilatation • Blood pressure • Presence of valves • Sclerotic veins • Multiple previous I.V. sites

5. Ways to dilate vein • Gravity • Fist clenching • Tapping • Warm compresses • Blood pressure cuff • Tourniquet • Multiple tourniquets • Transillumination • Ultrasonography

6. Cannulation • The site must tolerate the rate flow • The site must be capable of delivering the medications ordered • The site must tolerate the gauge of cannula needed • The patient must be comfortable with the site chosen • The site nust not impede the patient’s activities of daily living

7. Tips for selecting veins • A suitable vein should feel relatively smooth, pliable with valves well spaced • Veins will be difficult to stabilize in a patient who has recently lost weight • Debilitated patients and those taking corticosteroids have fragile veins that bruise easily • Sclerotic veins are common among narcotics addicts

8. Tips for selecting veins(cont) • Sclerotic veins are common among the elderly population • Dialysis patients usually know which veins are good for venipuncture • Start with distal veins and work proximally • Veins that feel bumpy, like running your finger over a cat’s tail, are usually thrombose or extremely valvular

9. Phillips tips(cont) • Step 6: Needle Selection • Step 7: Gloving • Step 8: Site Preparation • Step 9: Vein Entry • Step 10: Catheter Stabilization and Dressing Management • Step 11: Labeling

10. Phillips tips(cont) • Step 12: Equipment Disposal • Step 13: Patient Education • Step 14: Rate Calculations • Step 15: Monitoring and Documentation

11. Documentation • Date and time of insertion • Manufacturer’s brand name and style of device (lot number • The gauge and length of the device • Specific name and location of the accessed vein • The infused solution and rate of flow • Infusing by gravity or pump

12. Documentation • The number attempts for a successful I.V. starts • Condition of extremity prior to access • The patient’s specific comments related to the procedure • Patient response, excessive anxiety, patient movement, or an untoward response • Signature

13. Documentation of observation • Tenderness • Temperatures at and around the site • Discoloration • Swelling • Draining • Actions taken by the nurse

14. Discontinuation of I.V. Cannula Discontinue if the integrity of the cannula is compromised or the physician orders the discontinuation. • Put on gloves • Obtain a dry 2-inch by 2-inch gauze pad. Avoid alcohol • Loosen the tape and apply the gauze pad loosely over the site

15. Discontinuation of I.V. Cannula • Remove the cannula and transparent dressing as one unit, without pressure over the site • After the catheter is removed, apply direct pressure with the sterile gauze pad over the site • An adhesive bandage may be applied to the venipuncutre site after bleeding is controlled. • Document site apperance, how tolerated, appearance of catheter

16. Phlebotomy Technique • Preparation of the healthcare worker • Assessing the patient’s physical disposition • Identifying the patient • Approaching the patient • Selecting a puncture site • Selecting and preparing equipment and supplies

17. Phlebotomy technique (cont) 7. Preparing the puncture site 8. Choosing a venipuncture method 9. Collecting the samples in the appropriate tubes and in the correct order 10. Labeling the samples 11. Assessing the patient after withdrawal of the blood specimen

18. Phlebotomy technique (cont) 10. Labeling the samples 11. Assessing the patient after withdrawal of the blood specimen 12. Considering any special circumstances that occurred during the phlebotomy procedures 13. Assessing criteria for sample recollection or rejection 14. Prioritizing patients and sample tubes.

19. Test Requisitions • Patients full name • Patient’s identification or medical record number • Patients date of birth • Types of test to be performend • Date of test • Room number and bed (if applicable) • Physician’s name and/or code

20. Test Requisitions • Test Status (timed, stat, fasting, etc.) • Billing information (optional) • Special precautions (potential bleeder, faints easily, HIV, HepB or C

21. Lab tubes