Sites:

Prominent subcutaneous veins on dorsum of palm & wrist, Radial aspect of wrist, antecubital fossa & ventral aspect of forearm, Anterior to medial malleolus on leg.

Technique:

Prepare & fill the drug in the syringe and attach a No.22 scalp vein needle to it. (Ordinary needle may also be used if single drug is to be injected.) Drive out all the air from the scalp vein needle.

Ask an assistant to hold the arm tightly so as to occlude the veins, just above the proposed site of injection. A rubber tourniquet or a BP cuff raised to diastolic pressure may be used for distending the veins, but in practice, holding the arm by hand is most convenient.

Spend a few seconds to make the vein turgid. Even if it is visible, make it more prominent and turgid.

i.                     Rub the site, side to side, with spirit swab.

ii.                   Ask the patient to clench the fist, repeatedly

iii.                  Lightly tap the vein over the site of puncture.

iv.                  Compress the distal limb with you hand in a pumping motion to press the blood into the vein

Palpate the vein 7 clen the site of injection with a spirit swab. (do not move the swab backwards as that will empty the vein. Move it side to side)

With left thumb, pull the skin slightly to provide countertraction.

Holding the scalp vein in right hand, pierce the skin just to the right of the vein, at an angle of 30°, with bevel facing up.

As soon as skin is punctured, make the needle horizontal, parallel to the vein then direct it towards the vein and advance it into the vein. Immediately on entering the vein the needle should again be made parallel to the vein & advanced slightly along the lumen of the vein for ½ to 1cm.

These changes in the direction of the needle become natural & automatic with experience – and the success of venupuncture lies in this step.

Entry into the vein is recognized by:

i.                     immediate free flow of blood into the scalp vein (or syringe)

ii.                   the characteristic feel of puncturing the vein wall which becomes more easily appreciated as experience grows

iii.                  if veins are collapsed, or if needle is vry small eg No. 24 (in infants) blood may not flow back by itself. So you must aspirate with a syringe to confirm.

Release the proximal pressure or tourniquet. Confirm once again th backflow of blood on aspirating with the syringe, and then start injecting the drug very slowly.

During injection:

i.                     all intravenous drugs must be injected very slowly. Never give any drug fast I.V.

ii.                   constantly watch over the tip of the needle for swelling. Sometimes, the bevel of the needle may be partially out – so blood can be seen on aspiration, but swelling appears during injection.

iii.                  If a swelling appears, stop the inaction, remove the needle & puncture another vein.

iv.                  Intravenous injection is painless. (except for some irritant drugs.) if patient complains of pain at the site of injection, while you are pushing the drug, then certainly, it is leaking out of the vein.