ANATOMY AND PHYSIOLOGY

The Integumentary and Vascular System

Integumentary System
an anatomical barrier from pathogens and damage between the internal and external environment in bodily defense.

Two Main Layers:

1. Epidermis outer layer composed of squamous cells. 2. Dermis inner, thicker layer consisting of blood vessels, hair follicles, sweat glands, small muscles, and nerves.

Sensory Receptors
Mechanoreceptors skin tactile perceptions Thermoreceptors process cold, warmth, and pain Nociceptors process pain

The Vascular System

Vascular System
is concerned with the transport of blood and lymph through the body.

Variations:
1. Arteries carries blood from the heart to the body. 2. Veins carries blood from the capillaries towards the heart. 3. Capillaries resembles a hair follicle.

Layers of the Blood Vessel:

1. Tunica Adventitia outermost layer; which consist mainly of connective tissue fibers; blends with the connective tissue surrounding the vessel; supports and surrounds a vessel.

2. Tunica Media middle layer; is formed by a layer of circumferential smooth muscle and variable amounts of connective tissue; collapses or distends as pressure changes.

3. Tunica Intima innermost layer; delimits the vessel wall towards the lumen of the vessel and comprises of endothelial lining and connective tissue.

Peripheral Vascular
Vascular system that runs across the periphery.

MAJOR TYPES OF VEINS (ARM) 1.) Digital Veins 2.) Metacarpal Veins best choice 3.) Cephalic Veins 4.) Basilic Veins

Major Types of Veins:

1. Digital lateral and dorsal portions of fingers 2. Metacarpal dorsum of hand 3. Cephalic along radial bone of forearm 4. Basilic runs up to the ulnar bone

Peripheral Vascular System

Key Points Prior to IV Initiation

1. Physicians order 2. Patient assessment 3. IV set and equipment preparation 4. Medications

Physicians Order
1. Initiation is based upon the written order of a licensed physician. 2. The order must indicate: a. Patients name b. Type and amount of solution b. Flow rate c. Type, dose, and frequency of medications to be incorporated/pushed. d. Orders affecting the procedure

Patient Assessment
1. 2. 3. 4. 5. 6. 7. 8. Clinical status of the patient Patients diagnosis Patients age Dominant arm Condition of the vein/skin Cannula size Type of solution Duration of therapy

Choosing the Right Vein

Prioritize the ideal veins for venipuncture. Begin with distal veins. Watch out for bifurcated or branched veins.

Choosing the Right Vein

Do not perform venipuncture at the palm side of the wrist and cephalic veins of the wrist. Palpate for arterial pulse in order to avoid puncturing the arteries if the site chosen is cephalic or the inner aspect of the arm.

Choosing the Right Vein

Other sites to avoid include: Veins below a previous IV infiltration. Veins below a phlebitic area. Sclerosed or thrombosed veins. Areas of skin inflammation, disease, bruising, or breakdown. An arm affected by a radical mastectomy, edema, blood clot, or infection. An arm with an arteriovenous shunt or fistula.

IV Set and Equipment Preparation

1. Check for expiration date. 2. Check for clarity. 3. Check label against physicians written prescription. 4. Label any medications added. 5. Functionality of infusion pumps, PCA.

Medications
1. Nurses should have a knowledge on all medications administered including: a. Dosages b. Drug interactions c. Possible clinical effects

Venipuncture Techniques (do not include)

1. Vein dilatation 2. Site preparation 3. Catheter insertion 4. Securing the catheter

Vein Dilatation
1. Tourniquet place 6-8 inches above the venipuncture site. 2. Gravity position the extremity below the heart. 3. Fist clenching open and close his fist. 4. Warm compress maximum of 10 minutes. 5. Multiple tourniquet technique use of 2-3 tourniquets.

Site Preparation
1. Do not shave site. Remove hair with clippers only. 2. Depilatories are not recommended. 3. Cleanse with one of the following solutions: a. 2% Chlorhexidine gluconate b. Povidone-iodine c. 70% Isoprophyl alcohol 4. Work from the center outward in a circular motion.

Catheter Insertion
1. Hold skin taut. 2. Adjust angle of insertion. 3. Puncture vein and observe flashback. 4. Release tourniquet.

5. Upon flashback visualization, lower catheter parallel to skin. 6. Advance needle and catheter together 1/8 inch. 7. Thread catheter into vein.

8. Place middle finger over vein distal to catheter tip 9. Stabilize catheter hub with index finger 10.Withdraw needle with a swift, continuous motion parallel to the skin 11.Dispose of needle immediately into sharps container

Securing the Catheter

Basic Methods: 1. Chevron method 2. U method 3. H method

Chevron Method
Cut a strip of tape then place under the cannula, parallel to the hub. Cross the end of the tape over the cannula.

U Method
Cut a strip of tape and place it under the hub of the cannula. Bring each side of the tape up, folding it over the wings of the cannula in a U shape.

H Method
Cut three strips of tape and place one strip over each wing of the cannula. Place the third strip over the wings perpendicular to the first two.

Reminder for all methods:

Always apply a label after securing the catheter. On the label, write the following: Date of insertion Time of insertion Type of catheter used Gauge used Your initials

Maintaining Peripheral IV Therapy:

1. Changing the dressing 2. Changing the IV solution 3. Changing the administration set 4. Changing the IV site

Changing the Dressing:

The insertion site should be inspected and palpated for tenderness daily, through intact dressing. Gauze dressing should be changed routinely every 48 hours. A semipermeable dressing should be changed whenever its integrity is compromised.

Changing the IV solution:

Do not allow an IV container to hang for more than 24 hours. Before changing the IV container, check the new one for cracks, leaks, and other damages. Check the solution for discoloration, turbidity, and particulates. Note date and time the solution was mixed and the expiration date.

Changing the Administration Set:

Change the administration set every 72 hours and whenever you note or suspect contamination. As much as possible, change the administration set when you start a new venous access device during routine site rotation.

Changing the IV Site:

As a standard of care, rotate the site every 48-72 hours. If limited venous access will prevent you from changing sites, notify the doctor of the situation. Be prepared to change the entire system when you detect signs of thrombophlebitis, cellulitis, or IV therapy related bacteremia.

Discontinuing Peripheral IV:

Be careful to avoid manipulating the device in the skin to prevent skin organisms from entering the bloodstream. Never use an alcohol pad to clean the site when discontinuing an infusion. If the patient feels lingering tenderness at the IV site, apply warm, moist packs.