The use of a tourniquet during a venipuncture procedure makes: A. Allow to air dry. Potassium A phlebotomy technician is removing his gloves after a venipuncture procedure. While venipuncture is considered to be reasonably safe, the present study investigated the incidence of serious complications occurring in an outpatient setting. An outpatient must provide identification other than the verbal statement of a name. Safely dispose of potentially infectious materials. Mastering Pediatric Phlebotomy. Center, for Phlebotomy Education, Inc. A. A key element for successful venipuncture is choosing the best vein. 2006;52(5-6):217-30. For an inpatient DO NOT DRAW BLOOD IF THE ARMBAND OR BRACELET IS MISSING. Since newborns do not often bleed immediately, use gentle pressure to produce a rounded drop of blood. Reassure the patient that the minimum amount of blood required for testing will be drawn. (function() { Allow it to air, Grasp the foot, and using a sterile lancet, press firmly against the heel to, Collect the drops of blood into the collection device by gently squeezing, the foot. Cephalic vein. -do not rapidly insert the needle. Veins on the underside of the wrist should be avoided. BD Eclipse green-capped) is used for most routine and uncomplicated venipunctures. What Is Venipuncture? As a countermeasure, phlebotomists anchor the vein with their hand to stabilize it for the draw. Do not use a previous puncture site. Larger tube sizes typically provide for collection of samples from 6 to 10 mL. A 21-gauge needle (e.g. Sites to avoid: Extensive scarring from burns or surgery The upper extremity on the side that a mastectomy was performed. Phelan MP, Reineks EZ, Berriochoa JP, Schold JD, Hustey FM, Chamberlin J, Kovach A. } Intravenous therapy (IV) / blood transfusions - fluid may dilute the specimen, so collect from the opposite arm if possible. Ask the patient to lie on their back. Adhesive bandages / tape - protects the venipuncture site after collection. Never draw above an IV site. Of course, the phlebotomist may understand this, however, the patient may not. -tourniquet Tourniquet - Wipe off with alcohol and replace frequently. D. all of the above, Julie S Snyder, Linda Lilley, Shelly Collins, Zoology Chapter 16 & 17: Invertebrate Deutero. This image is not<\/b> licensed under the Creative Commons license applied to text content and some other images posted to the wikiHow website. Avoid bruising the infant's heel when obtaining blood. Located in the antecubital fossa, the median cubital vein is a well anchored, stable vein that rarely rolls during venipuncture. Remember -- the rst vein found is not always the best vein. Basilic vein. var f = document.createElement("iframe"); B. just after needle insertion, but prior to vacutainer activation The median cubital vein, a superficial vein that forms a connection point between the cephalic and basilic veins of the arm is large, and therefore easier to see and feel. 5. Clinical and Laboratory Standards Institute. iframe.style.height = zf_ifrm_ht_nw; d.appendChild(f); Perform the venipuncture, collecting the sample(s) in the appropriate container(s). Venipuncture sites should be carefully assessed for contraindications, such as pain, wounds, decreased circulation, a previous cerebral vascular accident (CVA), dialysis fistulas, or a mastectomy on the same side. Sometimes you may get initial blood flow, but then it stops when you change tubes. Children, particularly under the age of 10, may experience pain and anxiety during the phlebotomy procedure. While most patients veins are compatible with a standard needle gauge, others require a butterfly needle. Procedure for Capillary Puncture of the Finger: The best site for a finger puncture is just off the center of the finger pad of, the 3rd (middle) or 4th (ring) finger of the hand. Consider three elements with the following abbreviated electron configurations: X=[Ar]4s23d5Y=[Ar]4s23d104p1Z=[Ar]4s23d104p6\mathrm{X} = \mathrm{[Ar]4s^23d^5}~~~\mathrm{Y}=\mathrm{[Ar]4s^23d^{10}4p^1}~~~\mathrm{Z}=\mathrm{[Ar]4s^23d^{10}4p^6} Stress: May cause transient elevation in white blood cells (WBC's) and elevated adrenal hormone values (cortisol and catecholamines). Avoid puncturing a finger that is cold or cyanotic, swollen, scarred, or covered with a rash. Place labeled specimens in zip lock bag and deliver to the laboratory as soon as possible. Wipe away the first drop of blood with sterile 22 gauze. Follow the procedure as outlined above for greeting and identifying the patient. As always, properly fill out appropriate requisition forms, indicating the test(s) ordered. When storing a blood specimen what temp should it be at 2-8 degrees c If a patient starts to seize during a draw what should you do Stop the draw When should you use a capillary instead of venipuncture A patients veins are inaccessible What can cause a hemolysis in a specimen Shaking a tube vigorously Phlebotomy is the practice of drawing blood from patients to gather data about their health. 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. The patient has the right to refuse participation in such activity. if ( zf_ifrm_data.length == 2 ) { Tetracaine is a substance used as a spinal anesthetic. This image is not<\/b> licensed under the Creative Commons license applied to text content and some other images posted to the wikiHow website. Stabilize the needle as you're inserting your tubes. Allow another large drop of blood to form. 1-kg of R-134a initially at 600 kPa and 25C25^{\circ} \mathrm{C}25C undergoes a process during which the entropy is kept constant until the pressure drops to 100 kPa. Wipe away the first drop of blood with a piece of clean, dry cotton. Verify the patient's condition. Avoid drawing blood from a hematoma; select another draw site. D. Both A and B, A sharps container is identified by its bright ____ color apply pressure for at least 10 minutes. Diagn Microbiol Infect Dis. 3. Pre-warm the region of the vein to reduce vasoconstriction and increase blood flow. Cannula/fistula/heparin lock - hospitals have special policies regarding these devices. Practice hygiene for the patient's protection. Too tight of a tourniquet may cause the vein to collapse upon needle insertion. What are the complications that can occur when performing a venipuncture? Drawing blood from major vessels (e.g. LTD: Performing a Capillary Puncture Version 7, General Guidelines for a Capillary Puncture: Capillary punctures are ideal for, small children when only a small volume of blood is needed. Remove the first glove so that it turns inside out during removal A phlebotomy technician is preparing to dispose of contaminated sharps. chemistries, serology, immunnology, blood bank. 5. Feel for the median cubital first, the cephalic vein second, and the basilic vein third. 1. INR for patients on warfarin) are often knowledgeable on the veins that are most likely to work. The Patient's Bill of Rights has been adopted by many hospitals as declared by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). The equipment used during the venipuncture test can vary, but the following are most commonly used for routine venipuncture: Phlebotomists may choose to draw blood from several different sites of the body. This image is not<\/b> licensed under the Creative Commons license applied to text content and some other images posted to the wikiHow website. 11. If an IV is in place, samples may be obtained below but NEVER above the IV site. An electric motor draws a current of 10 amp with a voltage of 110V110 \mathrm{~V}110V. The output shaft develops a torque of 10.2Nm10.2 \mathrm{~N} \cdot \mathrm{m}10.2Nm and a rotational speed of 1000 RPM. -Vacutainer barrel Avoid areas of hematoma. By holding the needle either by the plastic wings or the hub, phlebotomists can achieve a shallower angle, typically 10-15 degrees. (c) How would you prepare tetracaine from benzene? 2. Track marks are not only found on IV drug users, but also on chronically ill patients requiring repeated vascular access and blood draws and may be a sign of an anticipated difficult draw. C. laws Scan the skin for lines of blue indicating a prominently visible vein. Extremity is edematous. Povidone-iodine wipes/swabs - Used if blood culture is to be drawn. -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? Observe universal (standard) safety precautions. wikiHow, Inc. is the copyright holder of this image under U.S. and international copyright laws. 2. Carry out hand hygiene before and after each patient procedure, before putting on and after removing gloves. 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. 8. 12. Do not place too tightly or leave on more than 2 minutes (and no more than a minute to avoid increasing risk for hemoconcentration). are known to vary lab results of some analytes. The maximum number of times an individual should attempt a venipuncture on a patient is two, True or False? Airborne precautions may be considered to provide a level of safety against infectious diseases such as tuberculosis, influenza, and COVID-19. Giavarina D, Lippi G. Blood venous sample collection: Recommendations overview and a checklist to improve quality. Fill the microtainer tube(s) as needed, adhering to the order of draw. If using a needle and syringe, avoid drawing the plunger back too forcefully. 12. 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. var zf_ifrm_ht_nw = ( parseInt(zf_ifrm_data[1], 10) + 15 ) + "px"; Place blood collection equipment away from patients, especially children and psychiatric patients. A. Applyan adhesive bandage. 3. Use pillows or foam wedges to elevate the arm and help with extension. } Dispose of items in appropriate containers. Once you establish blood flow, slightly modify your hand position to stabilize the needle against the arm and prevent further movement. Document that the venipuncture was performed distal to (below) an infusion site. When wearing gloves, change them between each patient and wash your hands frequently. Tip: If you realize you've collected in the wrong order of draw, remove the tube, insert the correct one, fill it halfway before discarding it, then insert a new tube and fill it completely. All rights reserved. Avoid excessive probing ("fishing"). This image is not<\/b> licensed under the Creative Commons license applied to text content and some other images posted to the wikiHow website. He previously worked in a high-volume outpatient lab and is currently employed in an acute care hospital and Level III trauma center in downtown Vancouver. What is the most common site for blood sampling? Be informed of the hospital rules and regulations regarding patient conduct. Cap, rotate and invert the collection device to mix the blood collected. Asking the patient about their previous blood draw experiences is beneficial, especially if they are a hard stick and know which area works best. 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. Apply firm pressure for more than 5 minutes. Interruptions and distractions during medical encounters and procedures should be avoided. with their hand to stabilize it for the draw. In other words, there is no need for another venipuncture procedure. -keep extremity below heart level for a few minutes. Position the patient with the arm extended to form a straight-line form shoulder to wrist. Proper patient identification MANDATORY. What are the best veins for venipuncture? Never draw blood through a hematoma. The antecubital fossa is a collection of veins located within the arm's inner area, opposite of the elbow, where the arm folds in. 10. Collect drops of blood into the . The best locations for fingersticks are the 3rd (middle) and 4th (ring) fingers of the non-dominant hand. wikiHow, Inc. is the copyright holder of this image under U.S. and international copyright laws. 6. The performance of routine vascular access procedures by skilled phlebotomists requires, at a minimum, the use of gloves to prevent contact with blood. Let's take a look at the types of websites you and your staff need to be wary of and how to avoid them. Collect drops of blood into the collectiondevice by gently massaging the heel. var zf_perma = zf_ifrm_data[0]; Phlebitis can also occur as a result of vein trauma during insertion, use of an inappropriate I.V. When would you use a butterfly/infustion set? Be careful not to withdraw the needle completely or else you risk losing the tube's vacuum and starting a hematoma when the bevel exits the skin. D. after needle removal, When drawing blood you should always follow universal ______ wikiHow, Inc. is the copyright holder of this image under U.S. and international copyright laws. if ( (iframe.src).indexOf('formperma') > 0 && (iframe.src).indexOf(zf_perma) > 0 ) { How to Troubleshoot a Difficult Venipuncture. WHO guidelines on drawing blood: best practices in phlebotomy. Never attempt venipuncture in an artery. Have the patient hold a small gauze pad over the puncture site for a couple of minutes to stop the bleeding. D. mandates, The most common antiseptic used in venipuncture is: As a countermeasure, phlebotomists. What caution should you observe when using a Vacutainer? Performing a venipuncture on a child under one year of age . Other draw sites, particularly below the waist, are rarely used. Refuse treatment to the extent permitted by law. Needle disposal unit - needles should NEVER be broken, bent, or recapped. https://www.osha.gov/laws-regs/standardinterpretations/2007-10-26 and https://www.osha.gov/OshDoc/data_BloodborneFacts/bbfact03.pdf (Accessed June 13, 2022). If blood stops flowing into the vacuum tube, the vein may have collapsed. Areas of fingers and heels that are cold, swollen, scarred or covered with a rash, should be avoided. A face mask reduces risk for blood culture specimen contamination. Please enable JavaScript on your browser and try again. Therapeutic Drug Monitoring: different pharmacologic agents have patterns of administration, body distribution, metabolism, and elimination that affect the drug concentration as measured in the blood. With risk for blood spatter a face shield provides protection. Guidelines established by the Clinical and Laboratory Standards Institute (CLSI) dictate that a phlebotomist shall not attempt a venipuncture more than two times, and a maximum of three attempts shall be undertaken on a patient. 9. If another site is not available, collect the specimen distal to the hematoma. What is the most common complication of venipuncture? Filter paper should touch only the blood and not the heel or finger. Matt Garcia is an experienced phlebotomist in Vancouver, Canada. Through a combination of revolutionary treatments and extraordinary patient experiences, our care does more than heal. (See Use of Band-Aids in the Post Phlebotomy. Wash hands in warm, running water with an appropriate hand washing product, or if notvisibly contaminated, with a commercial foaming hand wash product before and aftereach patient collection. Not making it mobile friendly. Antiseptic. 2009;47(2):143-53. very small or difficult vein, Ch 46 Phlebotomy & Ch 47 Hematology (MULTIPLE, Chapter 47: Phlebotomy and Blood Collection, Positive and negative feedback & examples, Meds Vanessa doesn't need because she sleeps, Medical Terminology: Learning Through Practice, April Lynch, Jerome Kotecki, Karen Vail-Smith, Laura Bonazzoli.
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