Anatomy and Physiology

of the
Circulatory and Vascular Systems
 Course Description
• This course covers the anatomical structure
and physiological processes of the Vascular,
Peripheral and Integumentary Systems.
 Objectives
• To identify appropriate sites for venipuncture
by strengthening knowledge of the anatomy
and physiology of circulatory and vascular
system, peripheral and integumentary systems
including its risks and complication.
 Course Content
• Review of the Circulatory System with Special
emphasis in the peripheral areas.
• Peripheral IV line insertion and selection
 Chain of Infection
Circulatory System

• Arterial
• Venous
 Chain of Infection
Arterial System

• Arteries
 Chain of Infection
Venous System

• Veins
 Chain of Infection
3 Layers of Vein

• Tunica Intima
• Tunica Media
• Tunica
Adventitia
 Chain
Key Points of Infection
Prior to IV Initiation
• Medical order
• Vascular access selection
• Site assessment
• IV solution, drugs &
materials
preparation
 Chain of Infection
Medical Order
• Name of patient
• Type and amount IV solution
• Medication, dose, frequency
• Flow rate
 ChainAccess
Vascular of Infection
Selection
• Patient’s age, condition & diagnosis
• Vein integrity, size & location
• Type & duration of therapy
• Patient’s infusion history
• Patient’s preference for
location, as appropriate
 Chain of Infection
Site Assessment
• Assess veins on both dorsal & ventral areas
• Begin with distal veins
• Avoid the following areas:
– flexion
– pain upon palpation
– for planned procedure
– bifurcated or branched veins
– sclerosed or thrombosed veins
– veins below a previous IV infiltration
– arm with arteriovenous shunt or fistula
 PIV SiteChain of Infection
Selection and Insertion
• Check for the following:
- clarity of IV solution
- expiration date of IV solution,
drug, IV set & cannula
- medication, dose, frequency
- add-on devices
needleless connector, stopcock
- functionality of the
infusion pump
 PIV Site Selection and Insertion
• No more than 2 attempts at
insertion should be made by any
one IV practitioner whenever
feasible.
PIV Site Selection and Insertion

• Use strategies to "Save the Vein"

when selecting a PIV site with Renal
patients, including using the dorsum
of the hand of the non-access limb
for PIVs.
PIV Site Selection and Insertion

• Avoid using areas of flexion, areas of

pain on palpation, compromised veins,
areas near valves, areas where there are
planned surgical procedures, or the
extremity on the side of breast surgery
with axillary node dissection, after
radiation therapy to that side, with the
presence of lymphedema, or the
affected side after a stroke.
PIV Site Selection and Insertion
• Use of the veins in the antecubital
fossa should be used for emergent
access only due to associated high
rates of phlebitis and nerve injuries.
Consider the use of alternate veins in
the lower arm and hand before using
the antecubital fossa.
PIV Site Selection and Insertion
• Use of the veins in the inner aspect
of the wrist should be avoided due
to high rates of phlebitis and nerve
injuries. Venipuncture should be
initiated at least 2 in and/or 5 cm
above the crease of the wrist in an
adult patient and 1 in above the
crease of the wrist of a baby.
PIV Site Selection and Insertion
• The use of veins in the lower extremities
does not require an Order. These veins
should not be used routinely in the adult
population and should be limited to
emergent access due to high rates of
phlebitis associated with this site. Any
patient who requires an IV in a lower limb
due to access problem with an upper limb
should be considered for the insertion of a
central venous catheter (CVC).
PIV Site Selection and Insertion
• In infants and toddlers, the foot may be
considered, however, are less desirable
due to poorer circulation. Veins located in
the feet of children of walking age and
the dominant hand should be avoided if
possible.
PIV Site Selection and Insertion
• Pediatricians may initiate an IV in scalp
veins in special circumstances.
PIV Site Selection and Insertion
• Obese patients are considered difficult
vascular-access patients. IV site
assessment should be conducted during
the initial patient assessment or
preoperative examination. Traditional
methods of vascular access placement
have low success rates in the obese
population.
PIV Site Selection and Insertion
• External Jugular Peripheral Intravenous
Catheters (EJ PIVs)
– Are used for emergent access or for individual
situations when other veins cannot be accessed.
– May only be inserted by a Physician.
– Contraindicated for use with power injectors or
contrast media.
– Dwell times must be limited to prevent formation of
fibrin sheaths. Plan immediately to place an
alternative vascular access device.
– Patients with an EJPIV must have alternate access
established before transfer to a non-Critical Care
unit.
 Ability
is what you’re capable of doing.
Motivation
determines what you do.
Attitude
determines how well you do it
Thank You