Intravenous Sites Intravenous Cannula Venesection

Intravenous Sites

Assessment
Factors to be considered:

Condition of the vein Type of fluid or medication to be infused Duration of therapy Patients age and size Whether the patient is right- or left-handed Patients medical history and current health status

Assessment
Attributes of an ideal vein are:

Engorged, bouncy & soft Refill after it has been depressed Feel round Be well supported by surrounding structures Be straight & free of valves Not hard, flat, or bumpy

Methods for improving venous access:

Apply a 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

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 edema Avoid the valves

Vein selection

Arm veins are most commonly used. The metacarpal, cephalic, basilic, and median veins and their branches are recommended sites because of their size and ease of access. Leg veins are rarely used because of high risk of thromboembolism.

Vein selection
Antecubital Fossa
Cephalic Brachial Artery Basillic Median Cubital Vein Radial Artery Ulnar Artery

Veins

Arteries

DIGITAL
DORSAL VEIN

DORSAL METACARPAL VEINS

DORSAL VENOUS NETWORK

CEPHALIC VEIN

BASILLIC VEIN

Vein selection

The antecubital fossa is avoided, except as a last resort. Close proximity with other arteries Flexion of elbow may displace cannula

The veins in the dorsal hand may be utilized if large bore access (18 gauge or larger) is not required. Care must be taken to find a vein that is straight and will accept the entire length of the catheter.

Intravenous Cannula

Intravenous Cannula

A intravenous cannula is a flexible tube which when inserted into the body is used either to withdraw fluid or insert medication. Cannulae normally come with a trocar (a sharp pointed needle) attached which allows puncture of the body to get into the intended space.

A venous cannula is inserted into a vein, primarily for the administration of intravenous fluids, obtaining blood samples and administering medicines.

Intravenous Cannulation
Colour Gauge Flow Ml/min Orange 14 275 Grey 16 173 Uses
Rapid transfusions of whole blood. Emergency situations.
Rapid transfusions of whole blood. Emergency situations

Green Pink Blue Yellow

Purple

18 20 22 24
26

100 60 25 13

Blood transfusions
IV infusions. Bolus Bolus. Maintenance infusions Bolus medications. Short term infusions. Neonates Neonates

VENESECTION

Venesection

Venesection is the generic term for a procedure that involves the cutting of a vein in any way, but it most commonly refers to the drawing of blood from a vein. Venous blood is usually taken from the median cubital vein, which is located on the arm, opposite the elbow.

Venesection

Blood donation is also usually done out of this vein, but blood drawn for testing, which is the main purpose of venesection, is normally taken in quantities of about 0.17 to 0.84 fluid ounces (5 to 25 ml). Venesection is also known as phlebotomy and venipuncture.

Vacutainer

Vacutainer is a registered brand of test tube specifically designed for venipuncture. The test tubes are covered with a color-coded plastic cap. They often include additives that mix with the blood when collected (see below), and the colour of the tube's plastic cap indicates which additives that tube contains.

Benefits:

Quicker collection than other methods Closed system Exact amount of blood obtained Reduces the risk of haemolysis of the sample Reduces the risk of needle stick injury

Order of draw
The order of draw refers to the sequence in which these tubes should be filled.

Containers containing coagulants Gold or 'Tiger' Red/Black top: Clot activator and gel for serum separation Red top PLASTIC tubes: Contains a clot activator and is used when serum is needed Orange or Grey/Yellow 'Tiger' Top: Contain Thrombin, a rapid clot activator, for STAT serum testing

Order of draw

Containers containing anticoagulants Green - Contains Sodium Heparin or Lithium Heparin used for plasma determinations Light Green or Green/Gray 'Tiger': For plasma determinations in chemistry Grey - These tubes contain fluoride and oxalate. Fluoride prevents enzymes in the blood from working, so a substrate such as glucose will not be gradually used up during storage. Oxalate is an anticoagulant.

Order of draw

Purple or lavender - contains EDTA (the potassium salt, or K2EDTA). This is a strong anticoagulant and these tubes are usually used for full blood counts (CBC) and blood films. Lavender top tubes are generally used when whole blood is needed for analysis. Can also be used for some blood bank procedures such as blood type and screen, but other blood bank procedures, such as crossmatches must be in a pink tube in most facilities.

Order of draw

Light blue - Contain a measured amount of citrate. Citrate is a reversible anticoagulant, and these tubes are used for coagulation assays. Because the liquid citrate dilutes the blood, it is important the tube is full so the dilution is properly accounted for. Dark Blue - Contains sodium heparin, an anticoagulant. Also can contain EDTA as an additive or have no additive. These tubes are used for trace metal analysis. Pink - Similar to purple tubes (both contain EDTA) these are used for blood banking.