The nurse is caring for an 84-year-old patient who gets hemodialysis 3 days a week. He is taking corticosteroids and has multiple bruises on his extremities. The patient needs an IV started. When starting the IV, the nurse should:
a. attempt to start the IV in the dorsum of the patient's hand.
b. avoid areas of skin that are red and warm to the touch.
c. use the arm on the side of the patient's dialysis fistula.
d. start the IV in the patient's foot after pa-tient teaching.
B
When assessing patients for potential venipuncture sites, consider conditions that exclude certain sites. For example, because older adults and patients receiving corticosteroids have fragile veins, avoid sites that are easily bumped or moved, such as the dorsal surface of the hand. Venipuncture is contraindicated in a site that has signs of inflammation, infiltration, or thrombosis. An infected site is red, tender, swollen, and possibly warm to the touch. Avoid using an extremity with a vascular (dialysis) graft or fistula or on the same side as a mastectomy (breast surgery). Intravenous insertion in a foot vein is used with children but should be avoided in adults because of the danger of thrombophlebitis.
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