South African Haemophilia Foundation (SAHF) Medical and Scientific Advisory Council (MASAC) Treatment Guidelines - Treatment of Bleeding Episodes

Vein Infusion

Preparation for solo home therapy infusion

Preparation for solo home therapy infusion

1
Stay calm and be well prepared. Mix your Factor and have everything you need close at hand.
2
Hitting the bullseye on one try will depend on preparation and skill.
3
Ensure you are comfortable and warm to prevent vasoconstriction.
4
Believe in yourself you know what you’re doing.
5
Understand that some needle pricks hurt more than others.
6
Observe good infection control measures.
7
Disinfect and clean with an alcohol pad on the insertion site vigorously and widely. Cleaning a wider area may shows up another vein.
8
Make sure that the alcohol has already dried on the skin before inserting because this may sting if damp alcohol is still present.
9
Using a alcohol swab minimize microorganisms in the area and also helps to visualize the chosen vein more clearly.
10
Good cleaning assists the tape and dressing adhere tightly to clean dry skin.
11
Assess the vein condition before inserting the needle.
12
A well-hydrated person has firm, supple, and easy-to-reach veins.
13
Well-hydrated veins are bouncy, making them the right fit for insertion.
14
Take your time. The following tips will help.
15
Feel rather than look. If you can’t see a suitable vein, trust your fingers even more than your eyes.
16
You will get to know which veins are “good ones” based on your previous IV history.
Go to next section: 2. Vein Selection
Vein Selection

Vein Selection

1
Start choosing from the lowest veins first then work up the arm.
2
Do not tighten your tourniquet to tight.
3
The tourniquet should be placed tightly enough to hinder venous flow, but not too tight to impede arterial flow.
4
Tighten to an appropriate pressure to make the veins dilate.
5
The tourniquet cuff should be in a good position to release easily.
6
Apply the tourniquet snugly, about 20 to 25 cm above the needle insertion site.
Go to next section: 3. Increasing Vein Visibility
Making the Vein More Visible

Making the Vein More Visible

1
Gravity is your friend. Hang your arm down on the side of the bed.
2
Full and distended veins are easier to see.
3
Use warm compress for 10 to 20 minutes.
4
Apply warm, moist compress or warm towels over the area.
5
A warmer temperature helps the vein to dilate and make it more visible to the surface.
6
Do not slap the vein. Veins have nerve endings that react to painful stimuli causing them to contract, therefore, making it harder to locate the vein.
7
Flick or tap the vein. Rather than slapping, use your thumb and second finger to flick the vein; this releases histamines beneath the skin and causes vein dilation.
9
When disinfecting the insertion site, rub the alcohol pad in the direction of the venous flow . This will improve the filling of the vein by pushing the blood past the valves.
8
Fist clenching. Clench and unclench your fist to compress veins and distend them; this helps in venous filling.
Go to next section: 4. Insertion & Infusion
Inserting the needle and Infusing

Inserting the needle and Infusing

1
Stabilize the vein. If injecting on back of the hand hold a tight fist.
2
If possible, anchor the loose plastic tubing of the butterfly between the fingers of the hand you are injecting into.
3
Bevel up. Make sure the bevel of the needle faces upwards as this is the sharpest part of the needle. Believe me; the needle will glide easily if inserted this way.
4
Make the shot at a 15 degree angle over the skin.
5
Insert into your non-dominant hand first. This will allow you to still perform simple functions using your dominant hand.
6
However, if you miss on this arm swap to the dominant hand.
7
Advance the needle carefully.
8
Do not probe for a vein, don’t let your needle dig for a vein.
9
When this does happen, this may be a sign that you’ve missed your target.
10
Sometimes, you may only need to pull back the needle and insert in another direction, doing so is better than starting the procedure over again.
11
“The Flashback.” Once you can see that there is a backflow of blood (i.e., “Flashback”)
12
Happy days! you have found a vein. Release the tourniquet.
13
Don’t go all in. Know when to stop.
14
Once you hit the vein and see a flash of blood back, stop and lower your angle of approach. Advancing it further may puncture through the vein.
15
Remember you only need your vein for the duration of the infusion, 10-20 minutes
16
Strap the butterfly needle with tape.
17
Don’t rush into starting the Factor.
18
Once inserted and secured, initiate the IV infusion slowly.
19
Rushing to start the fluid might blow the vein.
20
Any swelling or pain above the needle might mean the Factor is leaking into the tissue. STOP the infusion.
21
You are going to have to remove the needle and try somewhere else.
22
Always strap the puncture site firmly using a large ball of sterile cotton wool.
23
Leave the strapping over the puncture site in place for 10 - 20 minutes
24
Use flexible/stretchy plastic strapping to create good pressure on the puncture site
25
Use 10mm masking tape as strapping to hold the needle n place. It’s much easier to remove than regular strapping.