N4322 IV Initiation & Venipuncture Lab 2019

Venipuncture to obtain blood specimens or initiate peripheral intravenous therapy is a skill that may be
considered a fundamental nursing competence or be restricted to nurses in specific clinical settings depending
on agency policies. Student participation in these skills is informed by agency policies and requires supervision
of a clinical instructor, nurse preceptor, or staff nurse who is competent in these areas of nursing
responsibilities.

Objectives

Following the lab, students will be able to:

 Describe anatomy and physiology relevant to venipuncture;
 Identify factors that inform site selection and contraindications for venipuncture both for blood
specimen collection, and when initiating IV therapy;
 Identify the equipment needed to obtain a blood specimen;
 Demonstrate how to obtain a venous blood specimen;
 Select the equipment needed to initiate IV therapy;
 Demonstrate initiation of peripheral IV therapy;
 Complete accurate documentation related to the insertion of a peripheral IV and initiation of IV therapy.

Lab Preparation:

1) Required readings:

Kozier, B., Erb, G., Berman, A., Snyder, S. J., Buck, M., Yiu, L., Stamler, L. L. (2014).
Fundamentals of Canadian Nursing: Concepts, process, and practice (3rd Canadian ed.).
Upper Saddle River, NJ: Pearson Education Inc. p. 1357-1358, 1441-1462.

Original study guide created by N. Logue (2014, 2017)

Edited by A. March (2015; 2018; 2019) Page 1
 2) Required videos:

https://unb.kanopy.com/video/nursing-client-activities-and-specimen-collection?pos=8

 Venipuncture

https://www.youtube.com/watch?v=_Xq4S9fqZBY

 PIV Insertion

3) Complete the Horizon Health Self-Learning Module:

Peripheral IV Therapy (PIV) Initiation and Maintenance for Newborns, Children, Youth, and
Adults for RNs & LPNs
 PDF on D2L

4) Review Horizon Health Regional Phlebotomy Manual (Version 3)

 PDF on D2L

5) Review Horizon Health Peripheral IV Policy: HHN-CL-NU-029

 PDF on D2L

6) Complete Horizon e-Learning

 Phlebotomy
o Venipuncture Learning Exercise

 Send Certificate of Completion to Lab Instructor by Study Guide due date/time.

7) Answer the Case Study Questions

Ms. Maillet has been admitted to Internal Medicine with a diagnosis of infective endocarditis. The primary care
provider’s prescriptions include:
 Blood cultures (aerobic & anaerobic) 2 sets on admission, prior to initiating antibiotic therapy
 CBC, electrolytes, magnesium, ionized calcium, phosphate, urea, creatinine, random glucose now
 IV saline lock: Flush with 10 mLs 0.9% NaCl q12h
 IV 1000 mLs 0.9% NaCl @ 100 mL/hr
 Vital signs q4h (T, P, R, BP, O2)
 Pan-culture (blood, urine, and sputum) for oral T >38.5
 Vancomycin 1 gm IV q12h x6 weeks
 Consult for transthoracic echocardiogram (TTE)
 Consult for PICC

Ms. Maillet arrives to the nursing unit without an IV in situ and the prescribed bloodwork has not been
collected.
Original study guide created by N. Logue (2014, 2017)
Edited by A. March (2015; 2018; 2019) Page 2
 1. As the student nurse assisting in the admission process, what are your top 4 priority assessments and
interventions?
 Pain
 Signs of increased infection
 Circulation
 Skin
 Vital signs
 Intake and output
 IV therapy
 Lab results

2. How will you explain the IV insertion procedure to Ms. Maillet?

 I choose an appropriate venipuncture site, then I will place your extremity in a dependent
position.
 I will then apply a tourniquet tightly 15 to 20cm above the venipuncture site.
 I will then apply clean gloves and clean the site with a topical antiseptic swab using a circular
motion.
 Using my non-dominant hand, I will pull the skin taught below the entry site, with my dominant
hand I will hold the needle, bevel up, at a 15-30-degree angle and insert the catheter through the
skin and into the vein in one motion.
 Once there is blood seen in the lumen of the needle, I will lower the catheter until parallel to the
skin and advance the needle 0.5 to 1cm farther until the hub is at the venipuncture site.
 If successful, I will then remove the tourniquet and put pressure on the vein proximal to the
catheter to eliminate blood flow out of the catheter.
 After stabilizing the catheter hub, I will remove the needle and attach the end of the infusion
tubing to the catheter hub.

3. What factors should be considered when choosing a site for IV therapy?

 Vein that is easily palpated and feels soft and full, naturally splinted by bone, large enough to
allow adequate circulation around catheter, avoid veins in area of flexion.

4. What equipment should you collect prior to entering the patient’s room to initiate the saline lock?
 Tourniquet
 Tegaderm (date/time of insertion)
 Antiseptic swabs
 IV catheter
 Clean gloves
 IV flush?
 Tape

5. a) Label the veins on these diagrams:

Original study guide created by N. Logue (2014, 2017)

Edited by A. March (2015; 2018; 2019) Page 3
 basilic
median cubital vein

basilic basilic
accessory cephalic vein

medial antebrachial cephalic

vein cephalic
dorsal venous network

radial dorsal
metacarpal
veins

b) What sites are most often used for venipuncture and IV therapy in adults?
 Veins in the hand and arm

c) What sites are most often used for venipuncture and IV therapy on infants?
 Veins in the scalp and dorsal portion of the foot

6. a) Why should you avoid IV insertion in the feet and legs of adults?
 High risk of infection
 Further from central circulation than upper extremities

b) Name 6 other sites to avoid when inserting an IV.

 Bruised, sclerosed or thrombosed veins
 Areas with swelling, disease or skin breakdown
 Areas below traumatized tissue
 Red, swollen veins
 Sites near previously discontinued sites
 Areas below existing phlebitis or infiltrated site
 Limbs where vascular return may be compromised such as affected side of mastectomies, CVAs
or arterial venous grafts
 Antecubital fossa or any areas of flexion – if possible
 Inner aspect of arm and wrist – insertion is more painful, increased risk of bruising, phlebitis and
infiltration

7. Describe 4 nursing interventions that promote venous dilation when a vein is not sufficiently dilated by
tourniquet placement.
 Place extremity in a dependent position
 Have patient pump fist
 Get the patient to drink water and remain hydrated\
Original study guide created by N. Logue (2014, 2017)
Edited by A. March (2015; 2018; 2019) Page 4
  Massage or stroke vein distal to the site and in direction of venous flow to the heart
 Lightly tap vein with fingertips
 Apply warmth

8. Describe 4 measures to minimize infection risks related to peripheral IV therapy.

 Wear gloves
 Cleanse area with chlorhexidine
 Change q4days


9. Why would the primary care provider specify that the initial blood cultures must be collected prior to
beginning antibiotic therapy?
 To have a true reading of what is causing the infection
 To have a baseline

10. Ms. Maillet asks you why you need to send blood work. How will you explain your rationale?
 We are sending blood work to see what exactly is causing your infection so we can choose the
best form of treatment, as well as to see the levels or electrolytes in your body to see what
nutrients and replacement you may need.

11. Why would the physician request a PICC insertion in this case?
 Long term IV therapy ( > 6 weeks)

You collect Ms. Maillet’s blood work as ordered and insert a #20 IV in her right median cubital vein. Her
mainline IV of 0.9% NaCl at 100 mL/hour is currently on standby as she is receiving her first dose of
Vancomycin 1 gm IV. She then reports pain at her IV site, and you notice the area has become edematous and
cool to the touch.

12. What might you suspect upon these assessment findings? What are your next steps in caring for this
client?
 Infiltration
 Stop the infusion and remove the IV

13. Is the median cubital vein a first-choice site selection for IV insertion? Why or why not?
 Usually kept for blood samples, bolus injections of medications, and insertion sites for a
peripherally inserted catheter line

14. What information should be included when documenting an IV insertion procedure?

 Date and time of venipuncture
 Type, length and gauge of needle/catheter
 Venipuncture site
 How many attempts were made? Location of the attempts
 Type of dressing
 Patient response
 Specific safety or infection control precautions
 Type of solution and any additives
Original study guide created by N. Logue (2014, 2017)
Edited by A. March (2015; 2018; 2019) Page 5
  Type and size of filter
 Type of dressing applied to the site
 Patient and caregiver education and responses
 Signature and designation

15. When performing IV insertion in pediatric clients, what unique considerations must the nurse consider?
 Vein size compared to adults
 Upper extremity sites are readily chosen
 Sites in the feet are used in infants and young children who have not yet mastered walking and
can be considered in older children when other sites are unavailable

Original study guide created by N. Logue (2014, 2017)

Edited by A. March (2015; 2018; 2019) Page 6