To prevent hemolysis when performing a venipuncture, the phlebotomist should: 1. What should you never do to a site you just cleansed with alcohol? A 21-gauge needle (e.g. Hold
equipment firmly and place fingers against patient's arm, using the flange
for leverage when withdrawing and inserting tubes. If just a routine coagulation assay is the only test ordered, then a single light blue top tube may be drawn. However, if there is no alternative and an arm with an IV line in place must be used for venipuncture, try to choose a site away from and below the location of the IV. Preanalytical phase of the testing process begins for the laboratory when a: Test is ordered by a patient's physician. Avoid placing sample onhot surfaces such as bili-lights or monitors. C. Lancet f.style.transition="all 0.5s ease"; 9. ; worn to protect the patient and the phlebotomist. Lines - Drawing from an intravenous line may avoid a difficult venipuncture, but introduces problems. Nursing Personnel. Most reference ranges are based on normal laboratory test values for: Healthy people in a basal state. What are some of the reasons to draw blood? Hemoconcentration: An increased concentration of larger molecules and formed elements in the blood may be due to several factors: Prolonged tourniquet application (no more than 1 minute). The first attempt is the antecubital fossa area, starting with the median cubital vein, then the cephalic vein, and the basilic vein. If multiple blood samples are to be taken, the phlebotomist must be careful to follow the proper order of draw. 1. Phlebotomy is the practice of drawing blood from patients to gather data about their health. Never attempt venipuncture in an artery. Procedures and Devices for the Collection of Diagnostic Capillary Blood. WHO guidelines on drawing blood: best practices in phlebotomy. Preferred venous access sites, and factors to consider in site selection,
and ability to differentiate between the feel of a vein, tendon and artery. Occupational Safety and Health Administration, United States Department of Labor. Step 3: Venipuncture. 10. This information must match therequisition. Edematous extremities - tissue fluid accumulation alters test results. Any microtainerscontaining additives should be tapped to dislodge additives from the walls and top. Warm the heel from which blood is to be obtained. Re-secure the tourniquet to increase venous filling. on patients who are extremely dehydrated or have poor peripheral circulation. List several effects of exercise, posture, and tourniquet application
upon laboratory values. By holding the needle either by the plastic wings or the hub, phlebotomists can achieve a shallower angle, typically 10-15 degrees. 1. (See, The chlorhexidine is a concern for the premature babies in NICU as it can, be absorbed through the skin. If a patient has an IV giving them fluids in their right arm which arm should be your first choice to draw blood out of? Clean up any blood spills with a disinfectant such as freshly made 10%
bleach. D. Butterfly, Before leaving the patient's bedside, you must make sure that: Observe universal (standard) safety precautions. This image is not<\/b> licensed under the Creative Commons license applied to text content and some other images posted to the wikiHow website. Most commonly, venipuncture will be performed on the Antecubital Fossa, or the inside of the elbow. As always, properly fill out appropriate requisition forms, indicating the test(s) ordered. Some examples of these include notices from banks, online retailers such as Amazon or eBay, and even . Two forms of active identification are required. Remove your gloves and wash your hands. 7. 6. Concentrations of fluids and medications could affect baseline test results. Avoid previous hematoma (draw distal of hematoma) 1. Have the patient drink fluids if dehydrated. Over time and with several repeated punctures, significant amounts of scar tissue builds up. Syringes - may be used in place of the evacuated collection tube for special circumstances. Safely dispose of potentially infectious materials. What should you do with a CBC or lavender top tube before putting them down? Areas of fingers and heels that are cold, swollen, scarred or covered with a rash, should be avoided. This image may not be used by other entities without the express written consent of wikiHow, Inc.
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\u00a9 2023 wikiHow, Inc. All rights reserved. Thrombosed veins lack resilience, feel cord-like, and roll easily. -keep extremity below heart level for a few minutes. Avoid excessive probing ("fishing"). A scooping motion to collect blood and strong repetitive pressure (milking) MUST be avoided, as both procedures may result in hemolysis or tissue-fluid contamination fo the specimen. obvious areas of skin infections Northfield, IL: College of American, NCCLS. Diagn Microbiol Infect Dis. Grasp the patient's arm firmly using your thumb to draw the skin taut and anchor the vein. 23-gauge needles (e.g. Enzymes, proteins, lipids, iron, and calcium are significantly increased with changes in position. When finished, clean the site and apply pressure with a clean gauze to stop the bleeding. This information must be given when requesting microbiology, cytology, fluid analysis, or other testing where analysis and reporting is site specific. Each time a vein is accessed with a needle, scar tissue forms as part of the body's healing process. Allow another large drop of blood to form. Use a butterfly to compensate for patient movement. (Partial penetration may allow blood to leak into the soft tissue surrounding the vein by way of the needle bevel). Obtain from the practitioner complete and current information about
diagnosis, treatment, and any known prognosis, in terms the patient can
reasonably be expected to understand. The puncture should be made perpendicular to the ridges of the fingerprint so that the drop of blood does not run down the ridges. What Is Venipuncture? The performance of routine vascular access procedures by skilled phlebotomists requires, at a minimum, the use of gloves to prevent contact with blood. Place blood collection equipment away from patients, especially children and psychiatric patients. Apply the tourniquet 3-4 inches above the selected puncture site. with their hand to stabilize it for the draw. (c) How would you prepare tetracaine from benzene? Why? This image is not<\/b> licensed under the Creative Commons license applied to text content and some other images posted to the wikiHow website. *NEVER BEND THE ARM*. What is an Approved Phlebotomy School in California. Therefore, your anchor should be gentle but firm to prevent the vein from moving away from you. 8. Patients who are dehydrated, obese, terminally ill, or hard sticks often get their blood drawn in other locations rather than the antecubital fossa. } Recommended order of collection for microtainer specimens: 7. While hand veins may be utilized for blood draws and intravenous infusions, veins in the feet and legs should be avoided for adults. 2. Needles - The gauge number indicates the bore size: the larger the gauge number, the smaller the needle bore. 5 Common Capillary Puncture Blood Collection Sites - Neoteryx An artery has been punctured (characterized by bright red, pulsating blood), A nerve has been nicked (patient may complain of an electrical sensation up and down the limb), A hematoma starts to form (a bubble under the skin starts to rapidly appear at the site), The patient loses consciousness or starts seizing. Regardless of the source of payment, request and receive an itemized and detailed explanation of the total bill for services rendered in the hospital. Using the smallest acceptable needle size can help reduce the risk of bleeding or hematoma . 2009;18(2):117-139. Also consider adjusting the angle of the needle. wikiHow, Inc. is the copyright holder of this image under U.S. and international copyright laws. Blood Collection Procedure: Capillary - University of Florida Label the collection tubes at the bedside or drawing area. Avoid prolonged tourniquet application or fist clenching. 3. Websites that masquerade as the ones you trust. PhlebotomyU offers Certified Phlebotomy Technician (CPT I) courses for aspiring phlebotomists. performing a capillary puncture is as follows: 1. Begin by selecting the proper, approved lancet, such as: BD Microtainer Quikheel Lancet, 2.5 mm for full-term babies (green), BD Microtainer Quickheel Preemie Lancet, 1.75 mm for neonatal, Unistick2 Neonatal 18G, 1.2mm Lancet for neonatal babies less than, Prepare the heel by cleaning it with a Chlorhexadine wipe. How many time should you invert them? Allow the blood to soak through and completely fill the pre-printed circle on the filter paper. When finished, clean the site and apply pressure with clean gauze to stop the bleeding. 13 Websites to Avoid If You Value Your Time | PCMag To prevent hemolysis (which can interfere with many tests): Mix tubes with anticoagulant additives gently 4-6 times, Avoid drawing the plunger back too forcefully, if using a needle and syringe, or too small a needle, and avoid frothing of the sample. This image is not<\/b> licensed under the Creative Commons license applied to text content and some other images posted to the wikiHow website. Joslin JO. This image is not<\/b> licensed under the Creative Commons license applied to text content and some other images posted to the wikiHow website. Ernst, Dennis J. Because of contacts with sick patients and their specimens, it is important to follow safety and infection control procedures. -obvious skin infection (including newly tattooed areas). D. Blue, Which of the following conditions should prevent a site from being selected for venipuncture? 12. How To Draw Blood | Phlebotomy Coach Venipuncture Flashcards | Quizlet In most of these cases, the skin on the hand is pierced and a vein is accessed so medications or fluids can be given intravenously. This makes every subsequent poke harder and harder because scar tissue is more fibrous and tougher to puncture. If blood stops flowing into the vacuum tube, the vein may have collapsed. Giavarina D, Lippi G. Blood venous sample collection: Recommendations overview and a checklist to improve quality. What is the most common complication of venipuncture? Properly fill out appropriate requisition forms, indicating the test(s) ordered. Have the patient position their arm on the armrest. Have the patient make a fist and flex the arm, which helps engorge muscles to fill veins. If superficial veins are not readily apparent, you can force blood into
the vein by massaging the arm from wrist to elbow, tap the site with index and
second finger, apply a warm, damp washcloth to the site for 5 minutes, or lower
the extremity over the bedside to allow the veins to fill. If using a syringe, make sure the needle is fitted securely on a syringe to avoid frothing. The most common complications are bleeding at the puncture site or hematoma formation. Some images used in this set are licensed under the Creative Commons through Flickr.com.Click to see the original works with their full license. Any attempt to repeat a puncture at the same site increases the risk of complications. PDF Venipuncture - Central Zone - Alberta Health Services Dorsal hand veins are often utilized for intravenous infusions but are viable options for blood draw sites. The patient who is at ease will be less focused on the procedure. The upper extremity on the side of a previous mastectomy - test results may be affected because of lymphedema. An outpatient must provide identification other than the verbal statement of a name. Psychological interventions for needle-related procedural pain and distress in children and adolescents. The sides and the tip of the, Select the proper approved lancet: The BD Microtainer Contact-Activated, Lancet 1.5 mm (lavender) is used for glucometers and the BD Microtainer, Contact-Activated Lancet 2.0 mm (blue) is used any time you need more, Prepare the finger by cleaning it with a Chlorhexadine wipe. Needles should be placed in a proper disposal unit IMMEDIATELY after their use. Automated systems may include labels with bar codes. This image is not<\/b> licensed under the Creative Commons license applied to text content and some other images posted to the wikiHow website. This is a general guide for troubleshooting a venipuncture scenario in which blood flow is not initially established upon needle insertion. Dispose of items in appropriate containers. For a detailed breakdown of each step of the venipuncture test scroll down. Feel for the median cubital first, the cephalic vein second, and the basilic vein third. BD Vacutainer), rather than IV catheter insertions. Stop the procedure if a hematoma occurs. or move it backward (it may have penetrated too far). A. excessive probing with the needle Children, particularly under the age of 10, may experience pain and anxiety during the phlebotomy procedure. Areas of the body that look infected, scarred, or burned must also be avoided. Pre-warm the region of the vein to reduce vasoconstriction and increase blood flow. Do not use the central portion of the heel because you might injure the underlying bone, which is close to the skin surface. The blood is normally drawn from a vein on the top of the hand or from the inside of the elbow. Extensive scarring or healed burn areas should be avoided Specimens should not be obtained from the arm on the same side as a mastectomy. What can happen if you vigorously shake the tubes? Compare and contrast the two major types of neuronal pathways. This image may not be used by other entities without the express written consent of wikiHow, Inc.
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\u00a9 2023 wikiHow, Inc. All rights reserved. Clin Lab Med. While most patients veins are compatible with a standard needle gauge, others require a. . 5. DOC Blood Collection by Venipuncture - Michigan Please enable cookies on your browser and try again. Order of draw for multiple tube phlebotomy. Ask the patient orcaregiver to state the patients name and date of birth. B. the needle is inserted into the patient's arm It is not as close to the skin surface as the median cubital and cephalic veins, which poses a greater risk of damage to the median nerve and brachial artery. 13. Follow the procedure as outlined above for greeting and identifying the patient. 7. Hematoma - A venipuncture should not be performed on a hematoma, regardless of how small it may be. Because most laboratory specimens contain bacteria, it is not necessary to wash hands before collecting them, The tourniquet applied prior to venipuncture is removed: Avoid excessive pressure that may squeeze tissue fluid into the, mix the blood. This seats the bevel into the lumen of the vein, and is also the technique used to insert an IV catheter. Do not bend, break, recap, or resheath needles to avoid accidental needle puncture or splashing of contents. The fluid may dilute the specimen, so collect from the opposite arm. Dispose of contaminated materials/supplies in designated containers. Check the requisition form for requested tests, patient information, and any special requirements. Start with the arm closest to you and palpate the antecubital fossa. Phlebitis can also occur as a result of vein trauma during insertion, use of an inappropriate I.V. Wipe away the first drop of blood with a sterile 22 gauze. www.mlo-online.com is using a security service for protection against online attacks. It is large and near the skins surface, making it easier for phlebotomists to see before anchoring the vein. Firmly grasp the flanges of the tube holder to avoid advancing the needle further into the vein as you change tubes. 9. For the CLSI Updated Phlebotomy Procedures please click here. wikiHow, Inc. is the copyright holder of this image under U.S. and international copyright laws. All of the following are common types of equipment used for venipuncture EXCEPT: try{ What sites should be avoided when drawing blood? The venipuncture procedure is complex, requiring both knowledge and skill to perform. Watch for formation of a hematoma. Complications of venipuncture | How to avoid | Aimvein This vein lies close to the surface of the skin and there is not a large nerve supply. Drawing blood from major vessels (e.g. A. in the region of a hematoma Do not use a previous puncture site. Green 3. 9. 7. While we are ranked among the best children's hospitals in the country, it's our compassionate approach to treatment that makes us truly exceptional. This image is not<\/b> licensed under the Creative Commons license applied to text content and some other images posted to the wikiHow website. The recommended order of draw for plastic collection tubes is: First - blood culture bottle or tube (yellow or yellow-black top). Choosing an appropriate site for venipuncture is crucial for a successful . The blood is normally drawn from a vein on the top of the hand or from the inside of the elbow. Avoid trauma and excessive probing. 6. Label collection tubes after identification of the patient. 2. A. the tubes are filled and properly labeled Finally, when the necessary blood is collected, the needle will be removed and properly disposed of in a Sharps container and the puncture site will be covered to stop the bleeding. -infection at site Second - coagulation tube (light blue top). Hyperextend the patient's arm. A lab coat or gown must be worn during blood collection procedures. A. The infograph below provides a detailed description of the venipuncture steps as found in our how to draw blood resource. 9. Label the specimens before leaving the patients bedside. This image may not be used by other entities without the express written consent of wikiHow, Inc.
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