5. obvious areas of skin infections Please enable cookies on your browser and try again. The performance of routine vascular access procedures by skilled phlebotomists requires, at a minimum, the use of gloves to prevent contact with blood. Stabilize the needle as you're inserting your tubes. Interruptions and distractions during medical encounters and procedures should be avoided. D. Butterfly, Before leaving the patient's bedside, you must make sure that: Adhesive bandages / tape - protects the venipuncture site after
collection. If an IV is in place, samples may be obtained below but NEVER above the IV site. 2. Label all appropriate tubes at the patient bedside. As always, properly fill out appropriate requisition forms, indicating the test(s) ordered. The creatine kinase (CK), aspartate aminotransferase (AST), lactate dehydrogenase (LDH), and platelet count may increase. Determine the final temperature of the R-134a and the final specific internal energy. 12. -laceration of vein Effects of Exercise: Muscular activity has both transient and
longer lasting effects. Our students gain a vast amount of experience with phlebotomy vein sites through our hands-on and engaging curriculum and externship program. Answer. The patient shall be informed if the hospital proposes to engage
in or perform human experimentation or other research/educational profits
affecting his or her care or treatment. The blood is bright red (arterial) rather than venous. You should not perform this technique unless you are certain that the needle is in the immediate vicinity of the vein. A clinical study is performed to determine the optimal time for application of the tourniquet during phlebotomy. The index finger can be calloused or sensitive and the little finger does not have enough tissue to prevent hitting the bone with the lancet. When using a syringe inserted into the line, blood must be withdrawn slowly to avoid hemolysis. Consult a specialist at the patient's own request and expense. Patient identification is critical for safety. 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. Blood is commonly obtained from the median cubital vein on the anterior forearm. Clin Lab Med. Airborne precautions may be considered to provide a level of safety against infectious diseases such as tuberculosis, influenza, and COVID-19. Phlebotomy is not a one size fits all; each patient is different and may have their blood drawn at other sites with varying needle sizes. Have the patient make a fist and flex the arm, which helps engorge muscles to fill veins. The content of this article is not intended to be a substitute for professional medical advice, examination, diagnosis, or treatment. www.mlo-online.com is using a security service for protection against online attacks. Never attempt venipuncture in an artery. A. B. collection device Too tight of a tourniquet may cause the vein to collapse upon needle insertion. Specimen Collection Procedure - PERFORMING A VENIPUNCTURE | Akron It is observed that if the tourniquet is left on longer than 2 minutes, changes in the value of a total protein test occur. Matt Garcia is an experienced phlebotomist in Vancouver, Canada. CLSI document H04-A6. In other words, there is no need for another venipuncture procedure. It is large and near the skins surface, making it easier for phlebotomists to see before anchoring the vein. Avoid puncturing a finger that is cold or cyanotic, swollen, scarred, or covered with a rash. Switch to the other arm if you can't find anything. Apply only ONE drop of blood per circle. For an inpatient the nursing staff can be contacted to aid in identification prior to proceeding. Step 3: Venipuncture. Wipe away the first drop of blood with a piece of clean, dry cotton. For children over 6 months and adults, the finger is punctured. BD Eclipse green-capped) is used for most routine and uncomplicated venipunctures. How should you have the patient position their arm after the venipuncture is complete? If you stick yourself with a contaminated needle: Remove your gloves and dispose of them properly. Contains acid citrate dextrose. What are some of the reasons to draw blood? Dispose of contaminated materials in appropriate waste receptacles. A 21-gauge needle (e.g. 4. Blood samples drawn from an IV line should be documented and analyzed with care. For a detailed breakdown of each step of the venipuncture test scroll down. site. Watch for formation of a hematoma. Patients in these populations are often nervous and may flail their limbs. Erroneous test results may be obtained when the blood is not thoroughly mixed with the additive. What are the helpful hints for finding veins? By signing up you are agreeing to receive emails according to our privacy policy. If multiple blood samples are to be taken, the phlebotomist must be careful to follow the proper order of draw. Then the medical technician or phlebotomist will wrap a flexible band on the upper part of the arm to apply some pressure to that area making the vein enlarge with blood. Gauze sponges - for application on the site from which the needle is
withdrawn. For example, serum cortisol levels are highest in early morning but are decreased in the afternoon. 2013 Oct 10;(10):CD005179. There are some slight risks associated with venipuncture which may include excessive bleeding, feeling light-headed, fainting, nerve damage, hematoma (accumulation of blood under the skin), and infection. Check for any allergies to antiseptics, adhesives, or latex by observing for armbands and/or by asking the patient. Lancets are disposed of in an appropriate sharps container as one unit. The median cubital creates less bruising and pain than other draw sites. 5. Have an assistant stabilize the arm by firmly locking the elbow joint. Wipe away the first drop of blood with sterile 22 gauze. Check the requisition form for requested tests, patient information, and any special requirements. Peripheral Intravenous Catheter Insertion - Video - JoVE Make the cut across the heelprint lines so that a drop of blood can well up and not run down along the lines. NHA Exam Questions Flashcards | Chegg.com on patients who are extremely dehydrated or have poor peripheral circulation. When there is an IV line present, blood can be drawn from this line. Giavarina D, Lippi G. Blood venous sample collection: Recommendations overview and a checklist to improve quality. Avoid placing sample onhot surfaces such as bili-lights or monitors. Change your approach when dealing with uncooperative patients, such as pediatrics and those with neurodevelopmental or psychiatric disorders. What are the light blue top containers used for? Copyright 2023 - PhlebotomyU | Website Design & SEO by, Phlebotomy: 5 Tips on Finding Difficult Veins. -cotton sponges -obvious skin infection (including newly tattooed areas) -extensive scarring -don't use same side as mastectomy -avoid previous hematoma -avoid arm w/ fistula/cannula -edamtous extremity What is the most common site for blood sampling? 7. This type of venipuncture procedure is a little different, and sometimes can be a little more involved. 6. Blood should NEVER be poured from one tube to another since the tubes can have different additives or coatings (see illustrations at end). 4. Reassure the patient that the minimum amount of blood required for testing will be drawn. A. just prior to needle insertion As a phlebotomist, it is critical to know which vein sites offer stable flows for blood draws. Of course, the phlebotomist may understand this, however, the patient may not. Butterflies are incredibly valuable tools for tackling difficult draws, owing to their precision, shorter shaft length, and maneuverability. % of people told us that this article helped them. Stop the procedure and remove the needle if: Thanks to all authors for creating a page that has been read 43,712 times. Coagulation tests (protime and prothrombin time), Tube is designed to contain no contaminating metals, Trace element testing (zinc, copper, lead, mercury) and toxicology, Antiglycolytic agent preserves glucose up to 5 days, HLA tissue typing, paternity testing, DNA studies, Inactivates thrombin and thromboplastin; contains virtually no lead. Significant increases can be found in total protein, aspartate aminotransferase (AST), total lipids, cholesterol, iron, Affects packed cell volume and other cellular elements. Apply the tourniquet 3-4 inches above the selected puncture site. Patient care following completion of venipuncture. Once again, please be aware that these are only guidelines for blood draws and nurses should consult with the appropriate hospital personnel regarding performing this procedure on patients. A warm compress or heel warmer should be used to warm, fingers and heels that are cold, or if a capillary blood gas is being drawn, to. The area where the blood is to be drawn from is first cleaned with a germ-killing solution. Even if several vials of blood have to be drawn it usually amounts to no more than one ounce. Cap, rotate and invert the collection device to mix the blood collected. The vein may have collapsed; resecure the tourniquet to increase venous
filling. Identify the additive, additive function, volume, and specimen
considerations to be followed for each of the various color coded tubes. Blood is collected into an attached vial or tube that is airtight and the flexible band is then removed from the arm. 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 requisition form must contain the proper information in order to process the specimen. Avoid excessive pressure that may squeeze tissue fluidinto the drop of blood. var f = document.createElement("iframe"); Identification errors in pathology and laboratory medicine. 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 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. Pediatric Pointers. Center for Phlebotomy Education, Inc. Ernst, Dennis J. and Catherine Ernst. Re-anchor the vein. D. all of the above, Julie S Snyder, Linda Lilley, Shelly Collins, Zoology Chapter 16 & 17: Invertebrate Deutero. The most commonly used site for a venipuncture is at the bend of the elbow, also called the antecubital fossa 1. Factitious biochemical measurements resulting from hematologic conditions. Because most laboratory specimens contain bacteria, it is not necessary to wash hands before collecting them, The tourniquet applied prior to venipuncture is removed: Look at the dorsum of the hand as a last resort. Label collection tubes after identification of the patient. While venipuncture is considered to be reasonably safe, the present study investigated the incidence of serious complications occurring in an outpatient setting. UF Health Pathology Laboratories Nontuberculosis Mycobacteria Laboratory, This page uses Google Analytics (Google Privacy Policy), Capillary puncture may be used for obtaining specimens in infants or in adults where. Not making it mobile friendly. }, false); D. Near a tattoo, Needles are used once and then: How to Troubleshoot a Difficult Venipuncture. Lippi G, Blanckaert N, Bonini P, Green S, Kitchen S, Palicka V, Vassault AJ, Mattiuzzi C, Plebani M. Causes, consequences, detection, and prevention of identification errors in laboratory diagnostics. Blood Specimen Collection and Processing The dorsal venous network is the next most common vein site for phlebotomists. BD Vacutainer), rather than IV catheter insertions. Tip: Patients who need regular bloodwork (e.g. Do not use a previous puncture site. The area of the arch should be avoided, as should the posterior, curvature of the heel; a puncture in these areas could cause injury to the, All babies in the neonatal unit must be warmed before performing a. puncture. Palpate and trace the path of veins with the index finger. Extensive scarring or healed burn areas should be avoided Specimens should not be obtained from the arm on the same side as a mastectomy. 2017;148(4):330-335. (c) How would you prepare tetracaine from benzene? If you are using a butterfly, try to retie the tourniquet around the patient's arm to increase pressure and re-establish blood flow. 3. However, do not use too high a temperature warmer, because baby's skin is thin and susceptible to thermal injury. Make certain that the blood completely saturates all four (4) circles and is visible from bothsides. When wearing gloves, change them between each patient and wash your hands frequently. Although the larger and fuller median cubital and cephalic veins of the arm are used most frequently, the basilic vein on the dorsum of the arm or dorsal hand veins are also acceptable for venipuncture. C. all disposable equipment has been discarded properly Clean up any blood spills with a disinfectant such as freshly made 10% bleach. Lines - Drawing from an intravenous line may avoid a difficult venipuncture, but introduces problems. var zf_perma = zf_ifrm_data[0]; This vein can be found along the upper arm to the thumb, but it is commonly drawn from the forearm or antecubital fossa area. C. Scarring Clin Chem Lab Med. Discarding the first set minimizes the effects of any potential additive contamination. Never draw over scars or a new tattoo sites. What should you do with a CBC or lavender top tube before putting them down? INR for patients on warfarin) are often knowledgeable on the veins that are most likely to work. This image is not<\/b> licensed under the Creative Commons license applied to text content and some other images posted to the wikiHow website. 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. Potassium A phlebotomy technician is removing his gloves after a venipuncture procedure. Hyperextend the patient's arm. This is more common in humeral and femoral punctures than radial punctures. Why? The patient should make a fist without pumping the hand. Do not bend, break, recap, or resheath needles to avoid accidental needle puncture or splashing of contents. In the case of an accidental stick, immediately wash the area with an antibacterial soap,express blood from the wound, and contact your supervisor. What is the most common site for blood sampling? A. Using a sterile blood lancet, puncture the side of the heel in the appropriate regions shown above in green. Never draw blood through a hematoma. What are the green/lavender top containers used for? B. the needle is inserted into the patient's arm The puncture should be made perpendicular to the ridges of the fingerprint so that the drop of blood does not run down the ridges. B. Betadine 6. What are the gold top containers used for? Fasting, dietary restrictions, medications, timing, and medical treatment are all of concern and should be noted on the lab requisition. Lightly touch the microtainer capillary collectiondevice (or filter paper) to the LARGE drop of blood.