My classmate helped to start an Anesthesia Honor Society here at Temple University and for the past couple of weeks we have been practicing placing IV’s into one another. If this is something you would like to get started at your school I would suggest talking with your oral and maxillofacial surgery faculty/anesthesia faculty or another trained faculty member to help you with this activity.
Our activity consisted of a presentation by a student that reviewed the armamentarium, anatomy, and procedure of venipuncture. We then split up and started practicing. Here is a small review/video I made of our meeting:
WATCH VIDEO OF HOW TO START AN IV
Anatomy:
In theory, venipuncture may be done in any superficial vein of a sufficient size
Sites for venipuncture on the arm:
- Dorsum of the hand
- Wrist
- Forearm
- Antecubital Fossa
Veins of the hands and palm drain into the dorsal venous network. Veins in this network include the cephalic v. and the basilic v. At the antecubital fossa (inner part of arm opposite the elbow) we find the cephalic, median cephalic, median, median basilic and basilic veins. These end up draining into the axillary and cephalic veins to the subclavian to the brachiocephalic and finally to the superior vena cava (SVC).
Venipuncture:
Make sure to get pre-op vitals. Dilate the veins using a tourniquet as seen in the video about 6 inches above the site of venipuncture. This will dilate the veins because it stops the venous flow back to the heart, but does not stop blood flow in the arteries. Blood can still come into the arm, but it does not exit = dilation. Patient may make a tight fist or pump fist to help the veins bulge. Look and feel for a vein. The feel is like a rubbery rebound. Cleanse area with alcohol. Hold the vein steady by pulling on the skin below the vein in the opposite direction that you will be inserting the needle. Bevel should be up. Hold at a 30 degree angle and insert into skin and hopefully the vein. There will be resistance followed by an easy penetration feeling…like you have entered into a small tunnel. Advance the needle or if using a catheter, advance the catheter while removing the needle at the same time. Release the tourniquet. Confirm that the line is in a vein. You can now hook up the IV bag. When removing make sure to place firm pressure on the penetration site so stop the bleeding.
Complications:
- IV bag not running: Bag is too close to the heart, tourniquet is still on the arm, the IV is infiltrating the tissue. May lead to a hematoma.
- Hematoma
most common) Improper application of pressure. Painless discoloration under the skin. Management: Remove tourniquet and needle. Apply pressure to area. Ice can be used to constrict vessels. - Venospasm: A protective mechanism…vein appears to disappear when irritated. May cause a burning sensation.
- Intra-arterial injection: (most significant). Although rare, this can be very serious and should not be taken lightly. Arteries have a band of muscle around them which will constrict upon irritation. Indications: Pulsating return of blood into tubing. Brighter cherry colored blood. Severe pain. Decreased radial pulse. Color/Temperature change from lack of blood. Management: Leave needle in place. Administer procaine 1% 2-10 ml (anesthetic, vasodilator, dilutent) accompany patient to ER.
Good luck!
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Our dental work is still regulated, but it goes much smoother vs. the dental school where there are more students per faculty member, no assistants, and we are required to do everything. (set up, break down, insurance, billing, hygiene, scheduling, etc.) I am not knocking dental school, because it is what it is, but it was nice to get a good look at what lies at the end of the tunnel.
