Question

identify nursing considerations for each of the following: venipuncture, heel stick and lumbar puncture.

Answer 1

Venipuncture:

A Venipuncture or venous puncture is the collection of blood from a vein. It can be used as the purpose for drawing the blood (phlebotomy) and for intravenous therapy.

Nursing considerations

* Nurse has to select the appropriate site for Venipuncture. Usually the site may be the superficial veins of upper limb or veins of Anticubital fossa.

* Identify the patient properly, make sure to protect the Five rights of drug administration, in case any intravenous therapy .

* Avoid the  site , where there is edema, hematoma, inflammation, vascular graft / fistula, venous fibrosis and also veins of affected side of the body.

* Hand washing should be done before and after the procedure.  

* Explain the procedure to the patient , take the consent as per requirement. In case of children , take the consent from the care takers

* Arrange all the needed articles and maintain aseptic condition during procedure.  

* Prepare the site with the cleansing solution.

* A tourniquette can be used and ask the patient to cooperate with us.

* Document the procedure and send the samples timely.

Heel stick

It is a minimally invasive procedure by which the blood sample from the Newborn baby can be collected through a prick on the baby's heel by using glass tube / capillary tube of narrow gauge or a filter paper.  

Nursing considerations:

* Verify the patient , Newborn, identity correctly

* Arrange all the articles, wash hands

* Identify proper puncure site. The site should be free from edema , skin breakdown, rashes and bruises or scars.

* Clean the site , using a side to side rotation with a chlorhexidine swab for 30 seconds.

* Ask mother or care taker to be ready with some pain management measures or the nurse has to do the measures such as skin - skin holding , pacifiers, breast feeding the infant

* Grasp the foot firmly , apply the slight pressure

* wipe away the first drop after pricking and releasing the area slowly, use second drop for the test strip .

* Elevate foot, apply pressure gently and apply dressing with a small gauze peace and a tape.

* Discard the Lancet properly.

* Document the procedure and results.

Lumbar puncture

Lumbar puncture is a diagnostic as well as therapeutic procedure performed to collect a sample of Cerebrospinal fluid for biochemical, cytological, microbiological analysis or rarely to relieve increased intracranial pressure.

Nursing considerations:

* Explain the procedure to the patient and obtain the informed consent

* Instruct the patient to empty the bladder and bowel before the procedure

* Check the vital signs

* Provide or assist the patient to be in fetal position, lateral decubitus position , near the side of the bed with , neck , hip and knees drawn towards chest.

* After the procedure , apply gentle pressure to the site to prevent bleeding and secure the area with band aid or a small occlusive dressing .

* Send the specimen to the laboratory with proper labels

* Check the vital signs

* Ask the patient or assist the patient to remain flat in the bed for 4 hours.

* Maintain an intake and output chart

* Check the site for any CSF ( cerebrospinal fluid ) or blood leakage.

* Administer analgesics and I.V fluids as per physician's order .

* Document the procedure .