Definition
Venipuncture is the process of puncturing a vein with needle for obtaining intravenous access for the purpose intravenous therapy or for blood sampling of venous blood.
Purposes
- To administer fluids intravenously.
- To administer bolus medication for investigations or treatment.
- To draw blood specimen.
- To administer total parenteral nutrition.
- To administer blood and blood products.
Contraindications
- An arteriovenous fistula in the extremity.
- Mastectomy on the same side of the arm/a surgically compromised extremity.
- Presence of phlebitis, infiltration or sclerosis.
Articles Used
A clean tray containing:
- Sterile needle/angiocath/butterfly needle of appropriate size.
- Sterile cotton swabs in a bowl with antiseptic/alcohol pads.
- Tourniquet.
- Tapes for fixing catheter/needle.
- Syringe of required size for blood draws (optional).
- Specimen bottle (optional).
- Syringe loaded with medicine (optional).
- Infusion set made ready for administration.
- Towel/mackintosh for protecting linen.
- Gloves.
- IV pole.
- Kidney tray/paper bag.
Procedure
| NURSING ACTIONS | RATIONALE | |
| 1. | Before procedure Check physician’s order and nursing care plan. | Ensures that right procedure is being done for right patient. |
| 2. | Identify client. | |
| 3. | Explain procedure to patient that there will be a slight discomfort initially. If required, demonstrate procedure on a doll for children. | Reduces anxiety and ensures client cooperation. |
| 4. | Make sure that clothing can be removed over IV tubing if needed. Provide client with a gown if necessary. | Prevents dislodgment of needle. |
| 5. | During procedure Wash hands. | Prevents transfer of microorganisms. |
| 6. | Select venipuncture site. Unless contraindicated select the nondominant arm of the client. Look for veins that are relatively straight. Consider the insertion point and catheter length so that the wrist/elbow will be away from the catheter tip. | It is difficult to initiate and maintain IV access if using sclerotic veins. Joint flexion increases risk of irritation of vein walls by the catheter. |
| 7. | Dilate the vein. Place extremity in a dependent position (lower than heart). Apply a tourniquet firmly about 15-20 cm (6-8 inches) above the vein puncture site, explain that tourniquet will feel tight. The tourniquet must be tight enough to obstruct venous flow but not tight enough to obstruct arterial supply. If the vein is not sufficiently dilated, massage/stroke the vein distal to the site in the direction of venous flow towards the heart. Encourage the client to clench and unclench the fist. Lightly tap the vein. If all the above steps fail, remove the tourniquet and apply heat to the entire extremity for 10-15 minutes. | Gravity slows venous return and distends the vein. Distending the vein makes insertion of needle easy. Obstructing arterial flow inhibits venous filling. If a radial pulse is felt, arterial flow is not obstructed. This action helps in filling the vein Contracting the muscle compresses the distal veins, forcing blood along the veins and distending them. Tapping the vein may distend it. Heat dilates superficial blood vessels causing them to fill. |
| 8. | Don clean gloves. | Prevents nurses from exposure to blood. |
| 9. | Clean venipuncture site. Clean with antiseptic swab from center outward in circular motion for several inches. Permit solution to dry on the skin. | This movement carries microorganisms away from site of entry. Povidone-iodine should be in contact with skin for atleast 1 minute to be effective. |
| 10. | Insert the needle/catheter. Use nondominant hand to pull the skin taut below the entry site. Hold catheter/needle at 15-30° angle with bevel up, insert the catheter through the skin and into vein in one thrust. A sudden lack of resistance is felt as needle enters the vein. Once blood is seen in the lumen or when a lack of resistance is felt, reduce the angle of catheter till it is almost parallel to the skin and advance the needle and catheter approximately 0.5-2 cm. Remove the needle slowly while inserting the cannula inside the vein. When fully inside, loosen tourniquet. Remove needle from inside the angiocath completely and attach syringe with medication/syringe for blood draws/IV infusion tube as required or recap the angiocath using the cap attached at the end of the needle/stillette. | This stabilizes the vein and makes skin taut for needle entry. Holding the needle at 15-30° reduces the risk of counter puncture. Reducing the angle of catheter lowers the risk of counter puncture. Engorged vein is easier to visualize, puncture and advance the cannula. Prevent spillage of blood. |
| 11. | Tape the catheter using three strips of adhesive tapes. Place one strip with sticky side up under the catheter hub. Fold over each side so that sticky sides are against the skin. Place second strip with sticky side down over catheter hub. Place third strip with sticky side down over catheter hub/infusion tubing. | Prevents dislodgment of needle. |
| 12. | Dress and label the venipuncture site as per agency policy. Label the dressing with date, time of insertion, size of needle used, catheter used and initials. | Reduces risk of infection. |
| 13. | After procedure Remove gloves and wash hands. | |
| 14. | Discard all soiled equipment appropriately. | |
| 15. | Document all relevant data and report any observation. |
Special Considerations
Catheter size should be selected based on the age, type and location of infusion.
| Specific criteria | Colour code | Size |
| Blood transfusion | Pink/ blue/yellow | Large bore catheter preferably 20G or larger. |
| Specific flow rate 330 mL/min 220 mL/min 105 mL/min 65 mL/min 35 mL/min 20 mL/min | Orange Ash Green Pink Blue Yellow | 14G 16G 18G 20G 22G 24G |
| Smaller veins >1 year old1 – 8 years old>8 years old | Blue /yellow, Blue /pink/yellow Green /blue/pink | 22G or 24G 20,22, or 24G 18,20 or 22G |
| Adult patients requiring fluid resuscitation (trauma or shock patient) | Green | Large bore IV’s preferably 18G or larger |
REFERENCES
- Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
- Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
- Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwers, ISBN-13:978-9388313285
- Adrianne Dill Linton, Medical-Surgical Nursing, 8th Edition, 2023, Elsevier Publications, ISBN: 978-0323826716
- Donna Ignatavicius, Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care, 11th Edition ,2024, Elsevier Publications, ISBN: 978-0323878265
- Lewis’s Medical-Surgical Nursing, 12th Edition,2024, Elsevier Publications, ISBN: 978-0323789615
- AACN Essentials of Critical Care Nursing, 5th Ed. Sarah. Delgado, 2023, Published by American Association of Critical-Care Nurses ISBN: 978-1264269884
- Ernstmeyer K, Christman E, editors. Nursing Fundamentals [Internet]. 2nd edition. Eau Claire (WI): Chippewa Valley Technical College; 2024. PART IV, NURSING PROCESS. Available from: https://www.ncbi.nlm.nih.gov/books/NBK610818/
Stories are the threads that bind us; through them, we understand each other, grow, and heal.
JOHN NOORD
Connect with “Nurses Lab Editorial Team”
I hope you found this information helpful. Do you have any questions or comments? Kindly write in comments section. Subscribe the Blog with your email so you can stay updated on upcoming events and the latest articles.
