Monday 16 April 2007

PHERIPHERAL VENOUS CANNULATION AND VENEPUNCTURE WORKSHEET

Ini adalah worksheet peripheral venous cannulation and venepuncture course dari Sydney South West Area Health Service yang saya ikuti dulu. Mudah-mudahan bermanfaat bagi anda yang akan mengikuti course yang sejenis.

1. List the three layers found in Arteries and Veins?
Tunica interna
Tunica media
Tunic externa

2. Circle which vessel contains valves?
Arteries Veins

3. Describe the purpose of valves, which are found in above vessel.
The valves prevent back flow and in this way aid the flow of blood returning to the heart.

4. Please label the diagram below:
Maaf diagramnya tidak ada. Jawabannya dimulai dari

Sebelah kiri:
* Cephalic Vein

* Cephalic Vein
* Median Cubital Vein

* Median Vein
* Basilic Vein

Sebelah Kanan:
* Median Veins - Cephalic
* Cubital Vein
* Basilic Vein

* Basilic Vein

* Cephalic Vein

* Metacarpal Vein
* Dorsal Vein

5. What are the indication for performing IV cannulation?
For IV therapy and IV medication.

6. List the indication for performing venepuncture.
For various blood test.

7. What are the five legal consideration when performing venepuncture &/or cannulation procedure?
Verbal consent from patient
Medical order
Confidential documentation duty of care
Compliance with Hospital policy.
Compliance with procedural guidelines.

8. Explain the five basic rules for reducing the risk of infection when performing venepuncture &/or cannulation.
Correct hand washing technique.
Correct IV site preparation.
Maintenance of aseptic technique.
Correct choice of site.
Secure cannula firmly in place.

9. What protective equipment is used by the nurse when performing venepuncture &/or cannulation?
A protective eyewear, gloves, kidney dish, protect IV cannula/vacutaneous system and sharp bin.

10. Describe how you would identify your patient prior to the procedure of venepuncture &/or cannulation?
Ask patient her/his full name, date of birth, medical record number against both armband and clinical record such as notes, label (venepuncture)

11. List the nursing considerations when positioning a tourniquet on a patient’s limb for venepuncture &/or cannulation?
Ensure tourniquet is functional, sate and clean.
Do not have the tourniquet on too tight or for too long
Use tourniquet approx 5-10 cm above the venous access site.

12. What is the maximum tourniquet application time and state the reason?
3 minutes. Will cut the circulation to lower site.

13. Selection of a vein for IV cannulation / venepuncture depends upon.
1. Patient’s age
2. Reason for insertion
3. Size of cannula
4. Condition of vein
5. Expected duration
6. Patient co-operation
7. Position of vein
8. Solution/ fluid ordered
9. Required floe rate

14. List four sites to avoid when selecting a cannulation /venepuncture site.
1 . Bruised, tender or phlebitis areas
2. Hardened or sclerotic veins
3. Flexion areas
4 . Veins in lower limbs

15. List the most appropriate cannulation site
Cephalic vein
Metacarpal vein
Basilic vein

16. List the contraindications for performing IV cannulation.
No patient consent
No doctor order
Patient who have special medical conditions listed in hospital policy such as burns, children, infected skin.

17. What safety aspects of the cannulation / venepuncture equipment should the nurse check prior to use?
Ensure the equipments are intact and undamaged/
Ensure within the expiry date.

18. What are the four (4) complication associated with IV cannulation and venepuncture?
Haematoma.
Infiltration.
Phlebitis.
Thrombophlebitis.

19. Complete the following sentence.
The skin site is cleaned with alcohol wipe (chlorhexidine) and allowed to dry for 30 second to prevent infection and irritation when performing cannulation.

20. How many unsuccessful IV cannulation/venepuncture attempts can you have on any one patient?
Cannulation two times venepuncture two times

21. You have just inserted the IV cannula, and you notice a haematoma has formed. What action do you take?
Remove cannula, apply pressure to the site at least two minutes, monitor the site and document it.

22. When inserting the cannula, how do you ensure it will not cause a sharps injury. Give your rationale.
Ensure sharp bin inclose range, always use kidney dish when removing the sharp/ needle out. Pull back until click is heard. Always using needle lock, therefore there is no naked needle left.

23. What documentation is required when cannulation has been undertaken?
Cannulation size, site used, along with any other associated patient management provided.

24. The patient has complaint of pain and swelling around the site 36 hours after insertion of the cannula. What action do you take?
Remove cannula, note the site for pain or swelling or other sign of infection. Document the findings.

25. What safe labelling procedure should you follow when labelling the blood tubes?
Before and after taking the blood (venepuncture), patient’s name, medical report number, date of birth and test/s required must be checked with patient (family/staff mamber if it unable).

26. List the equipment you will need to prepare for a venepuncture proceure.
Alcohol swabs
Disposable gloves
Vacutainer
Tourniquet
Vacutainer needle + barrel
Needle (s)
Biohazard bag (s)
Evacuated specimen tube (s)
Gauze/wool swabs
IV pressure/ bandaid/ macropore
Pads sharp bin

27. In preparing the venepuncture needle system, what safety aspect should the RN/EN on the needle system?
Ensure equipment intact and not damage. Needle are sealed and check expiry date.

28. How many times can a vacutainer be engaged before the vacuum is lost?
Once

29. Identify the order in which blood specimens should be collected when collecting several specimens from a single venepuncture?
Number 1,2,3,4 &5 in order of collection. Type of Tube.
5 Addictive tube (green, grey, mauve, yellow, pink)
1 Blood cultures
3 Coagulation tube (blue)
2 No addictive tube
4 Serum tube with gel separator (white)

30. If drawing blood from a cannula that is newly inserted or from an arterial line… what volume of blood should you discard before collecting the first blood specimen?
Nil

31. If collecting blood via butterfly needle and there is citrate in the blood tube…how much blood do you discard first to remove the dead space in the butterfly tubing?
½ mls if 21 G needle used.

32. Circle the correct procedure for venipuncture. (A B or C)
A. Removed the vacutainer tube from needle, release the tourniquet, remove the needle and apply direct pressure to the needle site.
B. Release the tourniquet, remove the needle with the engaged vacutainer tube, apply digital pressure to the vessel above the needle site before removing the needle.
C. Release the tourniquet, remove the vacutainer tube from the needle, apply digital pressure to the vessel above the needle site before removing the needle, removing the needle and apply direct pressure to the needle site.