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CANNULATION & VENESECTION

CANNULATION & VENESECTION. AMANDA HARPER CLINICAL SKILLS COORDINATOR. LEARNING OUTCOMES OF THE WORKSHOP. Assessment of patient Demonstrate the correct technique for performing cannulation & venesection as per SUHT policy & procedure Selection of the appropriate device

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CANNULATION & VENESECTION

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  1. CANNULATION & VENESECTION AMANDA HARPER CLINICAL SKILLS COORDINATOR

  2. LEARNING OUTCOMES OF THE WORKSHOP • Assessment of patient • Demonstrate the correct technique for performing cannulation & venesection as per SUHT policy & procedure • Selection of the appropriate device • Identify and recognise the complications that are associated with cannulation & venesection • Correct documentation as per SUHT policy

  3. Patient Assessment & Vein Selection

  4. 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

  5. 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

  6. 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?

  7. 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’

  8. Veins to be avoided: - • 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 IVline running

  9. 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

  10. WHICH VEIN?

  11. Antecubital Fossa Cephalic 1st Intercostal Brachial Artery Basillic Radial Median Cubital Vein Radial Artery Median Ulnar Artery Ulnar Veins Arteries Nerves

  12. DIGITAL DORSAL VEIN DORSAL METACARPAL VEINS DORSAL VENOUS NETWORK CEPHALIC VEIN BASILLIC VEIN

  13. VEINS TO BE USED ARE: • METACARPAL VEINS • CEPHALIC VEIN • BASILIC VEIN • MEDIAN CUBITAL VEIN

  14. GROUP EXERCISE In pairs, use a tourniquet to identify each others: • Veins • Arteries • Valves • Ligaments

  15. CANNULA SELECTION

  16. 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.

  17. SGH, exceptions to this rule: -

  18. VENESECTION DEVICE SELECTION

  19. 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

  20. 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

  21. 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

  22. ORDER OF DRAW • NO ADDITIVES (Green, Red, Dark Blue) • COAGULATION (Light Blue) • OTHER ADDITIVES (Gold, Lilac,Pink &Grey) EXCEPTIONto this is when Blood Cultures have been requested, these MUST BEfilledfirst–aerobic (Blue)followed byanaerobic (Pink)

  23. Risks and Complications of Cannulation & Venesection

  24. Infection Haemorrhage Haematoma Vaso-vagal episode Needle phobias Catheter embolism (cannulation) Transfixation Pain Nerve damage Arterial puncture Allergies Needlestick injury Risks - During Insertion

  25. Transfixation SkinVein wallVein wall

  26. Haematoma/Bruising • Transfixation • Tourniquet too tight / left on too long / use of RUBBER GLOVE! • Arterial puncture • Repeated insertion sites

  27. Future Complications of Cannulation • Phlebitis — septic / mechanical / chemical • Infection • Drug reaction / Allergy • Infiltration • Extravasation • Thrombosis / Embolism • Speed shock • Fluid overload

  28. Phlebitis • TYPES OF:

  29. Infiltration • “The inadvertent administration of non-vesicant(non-toxic) 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. • Examplesof fluidinclude: Normal Saline & 5% Dextrose

  30. Extravasation • “the inadvertent administration of a vesicant substance(toxic) into the tissues surrounding a vein.” (Royal Marsden Manual, 2004) • Examples of fluid include: 10% Dextrose, Chemotherapy & Potassium

  31. Thrombus Formation • Correct flushing technique - pulsated push-pause & positive pressure, prevents blood being left in the cannula & removes debris from the internal catheter wall (use 5mls of Normal Saline). • Flushing blocked cannula can lead to pulmonary embolus (30% PMs show undiagnosed PE).

  32. Signs of Cannula Related Infection • Phlebitis • Pyrexia • Feeling unwell • Raised white blood cell count

  33. 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

  34. 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

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