Venipuncture , An important procedure of nursing care.

1. AHIMA ELIAZER
SC NURSING 1ST YEAR
TMCON

3. OBJECTIVE
At the end of the class student will be able to
 Define Venipuncture
 Explain the purpose of venipuncture
 Enlist the indication of venipuncture
 What should be observed during the procedure
 Enlist the equipment used
 Explain the procedure of venipuncture
 Discuss the complication of venipuncture
 Explain the Nursing Responsibilities

5. DEFINITION
 “ enipuncture is the process of obtaining
intravenous access for the purpose of
intravenous therapy or for blood sampling of
venous blood”.

6. In other words
 “Venipuncture is puncturing vein with sterile
cannula/ needle into a vein to supply the
blood with fluids, electrolyte , nutrients and
medication”.

8. INDICATION
 To save the patient in life-threatening situation
 To supply fluids and nutrients to the patient who are
unable to digest or absorb a diet administered mouth
or through the nasal tube

9. To introduce a drug into the
circulation for diagnostic purpose
When blood or blood products are to be
given


10. SOLUTION
USED

11. COMMONLY USED VEINS
 Basilica and cephalic veins (forearm)
 Median cubital, cephalic and basilica veins (
Antecubital fossa)
 Radial vein ( Radical area)
 Dorsal metacarpal vein ( the hand)

13.  Veins in the foot
 Femoral and saphenous veins (thigh)
 Veins in the scalp (for infants )

15. GENERAL INSTRUCTION
 Follow strict aseptic technique
 Administer IV fluids only with a clearly written
prescription

16.  Observe the rights during administration
 Check the expiry date before opening the bottles.
 Do not use any site that is tender, red, edematous
and inflamed

17.  Keep the patient warm and comfortable with
blanket if necessary
 Immobilize the joints with splints when the needle
is placed near a joint
 Frequent observation of the vital signs throughout
the procedure will help to detect many
complication

18.  Never allow the bottle to get empty completely to
prevent the entry of air into the tissues
 Allow the patient to void before the IV infusion is
started.

19.  Maintain the specified rate of flow to prevent
circulatory overload
 If fluids are discolored , cloudy in appearance that
should not be used for infusion

21. EQUIPMENT
 A tray containing
 Sterile IV Solution
 Sterile IV infusion set

22.  Sterile needle of choice ( cannula )

23. PARTS OF CANNULA

24.  Sterile syringe (2 or 5 ml)

25.  Sterile transfer forceps in a jar
 Sterile cotton swabs and gauze pieces
 Surgical spirit
 Kidney tray and paper bag

26.  Bowl with water
 Tourniquet
 Adhesive tape
 Specimen bottle
 Mackintosh and towel
 IV pole

27. PRELIMINARY
ASSESSMENT
 CHECK
 Patient name, age, bed no and diagnosis
 Purpose of infusion
 Doctor’s order
 Level of consciousness
 General condition
 Abilities and limitations
 Need for additional restraints
 Articles available
 Previous experience

30. 
 Prepare the IV solution ; insert the drip set, and the
air went into the bottle openings

31.  Hang the bottle on the IV pole about 18-24inches
high
 Over the clamp and flush the IV fluid through the
tubing and needle into the kidney tray until all air is
removed

32.  Prepare few strips of adhesive tapes and keep ready
for use
 Apply tourniquet firmly 6-8 inches proximal to the
venipuncture site.
 Lightly tap the vein with your fingertips.

33.  Clean the area with surgical spirit
 Insert the needle into vein by holding the needle at a
30’C angle with the hovel up.
 Pierce the skin lateral to the vein

34.  When back flow of blood occurs into the needle and
tubing, insert the needle further up into the vein
about ¾ or 1 inch
 Release the tourniquet and open the clamp to allow
the fluid to run in.

37.  Take consent
 Know the protocols and procedures related to access
device used
 Use a sterile spirit cotton

38.  know the medication or solution to be infused
 Report if any complication occur
 Do not infuse medicine simultaneously with blood
transfusion

39.  Before inserting make sure that the drug is ready for
administration
 Discard the waste and sharp at appropriate bin

40. ABSTRACT
 Abstract: Introduction: Painful medical procedures are the major sources of distress among children;
and for those with chronic diseases, the procedure-related pain can be worse than that of the illness
itself. Objective: The purpose of the study was to determine the effect of local refrigeration prior to
venipuncture on pain-related responses in school age children. Design: Quasi-experimental study.
Setting: This study was undertaken in a paediatric emergency ward of a paediatric centre. Subjects:
The subjects were 80 children 6 to 12 years of age selected by purposive sampling after being referred
to the paediatric emergency ward. Interventions: Two groups were chosen for the study: the test and
control groups, in order to test the effect of local coldness in reducing the pain of venipuncture. In the
test group, the injection site was refrigerated for three minutes using an ice bag. In the control group,
the procedure was performed according to usual routine. Physiological responses (ie. blood pressure,
pulse, and respiration), behavioural responses (using the Children's Hospital of Eastern Ontario Pain
Scale: CHEOPS), and subjective responses (or intensity of pain using the Oucher scale) were measured
in the two groups. A non-invasive (electronic) sphygmomanometer was used before and 5 minutes
after the procedure to measure the physiological responses. The measurement of behavioral responses
by CHEOPS was done at two time points (during the procedure and 5 minutes after the procedure),
measuring six areas of behaviour: cry, facial expressions, child verbal, torso, touch and leg movement
in reaction to painful stimulation. Finally, the subjective responses were measured at 5 minutes after
the procedure. Main outcome measures: In this study the main outcome measures were: range of
physiologic responses, and scores of behavioral and subjective responses. The study hypothesised
there would be a lower score in the test group than the control group in behavioural and subjective
responses and a lower range in physiologic responses.

41.  Results: Results showed no significant difference
between the two groups for physiological responses
(before and after procedure). However behavioural
responses during and after the procedure (p=0.0011),
and subjective responses after the procedure
(p=0.0097) were significantly lower (ie. the test group
had lower scores in behavioural and subjective
responses compared to the control group. Conclusion:
The results of this study suggest that the use of local
refrigeration prior to venipuncture can be considered
an easy and effective intervention of reducing
venipuncture-related pain.

42. IBLIOGRAPHY
 Rebecca Nissanka, Comprehensive textbook of
foundation of nursing Page No. 273-275
 Ratna Prakash , Manipal manual of Nursing
procedure Page No. 145-146
 Sr Nancy, Principles and practice of nursing ,Page
No. 154-155
 Taylor Lillis Fundamentals of nursing , Page No.
326-328