what sites should be avoided when performing venipuncture quizlet
Allow thefinger to dry or wipe dry with a sterile 22 gauze. Dalal BI, Brigden ML. For children over 6 months and adults, the finger is punctured. A. just prior to needle insertion Consult the nursing unit or your facility's resources prior to drawing from an IV or PICC line or performing venipuncture on an arm with an IV line in place. The median cubital creates less bruising and pain than other draw sites. Clin Biochem. Matt Garcia is an experienced phlebotomist in Vancouver, Canada. Other draw sites, particularly below the waist, are rarely used. (Assume that the total volume is the sum of the individual volumes and that the density and specific heat capacity of the solution are the same as for pure water.). Place labeled specimens in zip lock bag and deliver to the laboratory as soon as possible. Proper patient identification procedures. Allow filter paper to air dry for two (2) hours at room temperature. Avoid previous hematoma (draw distal of hematoma) D. Near a tattoo, Needles are used once and then: Some examples of these include notices from banks, online retailers such as Amazon or eBay, and even . A commercial heel warmer may be used. This image is not<\/b> licensed under the Creative Commons license applied to text content and some other images posted to the wikiHow website. Veins sometimes roll away from the point of the needle and puncture site. Serum red top or amber tube with red top. 9. Previous puncture sites should be avoided. Once you establish blood flow, slightly modify your hand position to stabilize the needle against the arm and prevent further movement. Clean the site to be punctured with an alcohol sponge. C. Lancet 2009;18(2):117-139. Apply blood to the printed side of the filter paper. Fill the microtainer tube(s) as needed. Some DNS services support web filtering, too. Edematous extremities with swollen tissue alter the results. 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. Two forms of active identification are required. A government issued photo identification card such as a driver's license can aid in resolving identification issues. What are the contraindications to venipuncture? Lightly touch the microtainer capillary collection device (or filter paper) to the LARGE drop of blood. Discarding the first set minimizes the effects of any potential additive contamination. Failure to do this results in an unequal blood-to-additive ratio, making the specimen unsuitable for analysis. (b) How would you prepare tetracaine from p-nitrobenzoic acid? Wipe away the first drop of blood with sterile 22 gauze. Do not add blood to a circle already filled orpartially filled with blood. 5. The upper extremity on the side of a previous mastectomy - test results may be affected because of lymphedema. Phlebitis is inflammation of a vein. Hemolysis may occur, with pseudohyperkalemia. Wait 2 minutes before reapplying the tourniquet. -obvious skin infection (including newly tattooed areas). If the puncture is parallel to the lines of the fingerprint, theblood will not form as a drop but will run down the finger making collection difficult. As a phlebotomist, it is critical to know which vein sites offer stable flows for blood draws. If it is then heated, what can you say about: b) how often the molecules hit the walls of the can. Allow another large drop of blood to form. If the patient is sitting in a phlebotomy chair, make sure they are sitting upright with their back against the chair. It may be, necessary, on occasion, to perform a capillary puncture on the toe of a patient, who is severely burned. Reassure the patient that the minimum amount of blood required for testing will be drawn. *NEVER BEND THE ARM*. Have the patient make a fist and flex the arm, which helps engorge muscles to fill veins. -use a smaller gauge needle 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. The use of a tourniquet during a venipuncture procedure makes: A. Move it forward (it may not be in the lumen). -hemorrhage/hematoma. Hematoma formation is a problem in older patients. 3. wikiHow, Inc. is the copyright holder of this image under U.S. and international copyright laws. 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. 4. Intravenous therapy (IV) / blood transfusions - fluid may dilute the specimen, so collect from the opposite arm if possible. puncture site downward and gently applying intermittent pressure to the surrounding tissue (or proximal to the puncture site when the blood is obtained from a finger). Stop the procedure if a hematoma occurs. 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. 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. You should not perform this technique unless you are certain that the needle is in the immediate vicinity of the vein. Elderly patients often have fragile skin and veins that roll quite easily, When a vein rolls, the needle tends to push the vein aside rather than penetrating through. 6. Adjust the angle (the bevel may be against the vein wall). Choosing an appropriate site for venipuncture is crucial for a successful . The first step to choosing the right vein is to select the appropriate needle gauge. Never leave a tourniquet on for more than two minutes. if ( prevIframeHeight != zf_ifrm_ht_nw ) { Clin Lab. 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. 5. Summarize the problems that may be encountered in accessing a vein, including the procedure to follow when a specimen is not obtained. B. evacuated tube Procedures and Devices for the Collection of Diagnostic Capillary Blood. Recognize complications associated with the phlebotomy procedure. Collection tubes can vary in size for volume of blood drawn, appropriate to the tests ordered with sample size required, and vary in the kind of additive for anticoagulation, separation of plasma, or preservation of analyte. Identification errors in pathology and laboratory medicine. Tip: In spite of a difficult draw, remember to invert your tubes. Capillary puncture should not be used. Factitious biochemical measurements resulting from hematologic conditions. A face mask reduces risk for blood culture specimen contamination. 1. Assess the need for sample recollection and/or rejection. Feel for the median cubital first, the cephalic vein second, and the basilic vein third. B. Hematoma Venipuncture Quiz Flashcards | Quizlet Using a sterile lancet, puncture the most medial or lateral portion of the plantar surface of theheel, medial to a line drawn posteriorly from the mid great toe to the heel. 2. Laboratory coats or work smocks are not typically needed as personal protective equipment during routine venipuncture, but an employer must assess the workplace to determine whether certain tasks, workplace situations, or employee skill levels may result in an employee's need for laboratory coats or other personal protective equipment to prevent contact with blood. The most common complications are bleeding at the puncture site or hematoma formation. Answer. PDF Venipuncture - Central Zone - Alberta Health Services Within the antecubital fossa, this vein poses the least amount of risk. Promptly send the specimens with the requisition to the laboratory. C. After all specimens have been collected Other Factors: Age, gender, and pregnancy have an influence on laboratory testing. Position the infant with the head slightly elevated. increase the circulation of blood to the area. Let's take a look at the types of websites you and your staff need to be wary of and how to avoid them. The blood is bright red (arterial) rather than venous. Areas in which two veins join should be avoided where possible, as valves are often present. Always wear a clean lab coat or gown. Hold the baby's foot firmly to avoid sudden movement. All other items used for the procedure must be disposed of according to properbiohazardous waste disposal policy. Select the proper approved lancet: The BD Microtainer Contact-Activated. As a countermeasure, phlebotomists anchor the vein with their hand to stabilize it for the draw. Stabilize the needle as you're inserting your tubes. Confidentiality of all communications and other records pertaining to the patient's care. var iframe = document.getElementById("zf_div_SBGg-3DTNCwt65i9A6n_zU3SneyGD89SSqM_7F_nCas").getElementsByTagName("iframe")[0]; This seats the bevel into the lumen of the vein, and is also the technique used to insert an IV catheter. (See Use of Band-Aids in the Post Phlebotomy. Try rotating the arm to better expose the cephalic or basilic vein. 5. If this is not successful, remove the needle, take care of the puncture site and redraw at another site. Diagn Microbiol Infect Dis. f.style.height="352px"; 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. Contains acid citrate dextrose. NOTE:Tubes with additives must be thoroughly mixed. 6. The thumb has a pulse and is likely to bleed excessively. Penetrate the skin at a 30 to 45 angle at first (even less with a butterfly), then once you get a flash, reduce the angle by bringing the needle assembly down closer to the arm and advance the needle a tiny bit further into the vein. jugular) or a central venous catheter is out of the scope of practice of a certified phlebotomist and should only be performed by a physician or advanced nurse. Fill the capillary tube(s) or micro collection device(s) as needed. Assess the patient's physical disposition (i.e. are known to vary lab results of some analytes. Place a pillow under the patient's arm if additional support is needed. 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. BD Vacutainer), rather than IV catheter insertions. Scan the skin for lines of blue indicating a prominently visible vein. 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. True or False? What are the gold top containers used for? When 25.0 mL of 0.500 M H2S04 is added to 25.0 mL of 1.00 M KOH in a coffee-cup calorimeter at 23.50C23.50 ^ { \circ } \mathrm { C }23.50C the temperature rises to 30.17C30.17 ^ { \circ } \mathrm { C }30.17C . 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. In this elbow pit, phlebotomists have easy access to the top three vein sites used in phlebotomy: The median cubital vein, also known as the antecubital vein, is the most common vein for phlebotomy. Venepuncture Procedure - OSCE | How to Take Blood | Geeky Medics Blood Collection Techniques in Exotic Small Mammals. When would you use a butterfly/infustion set? Document that the venipuncture was performed distal to (below) an infusion site. Wear gloves and a lab coat or gown when handling blood/body fluids. Change your approach when dealing with uncooperative patients, such as pediatrics and those with neurodevelopmental or psychiatric disorders. Valenstein PN, Sirota RL. The first attempt is the antecubital fossa area, starting with the median cubital vein, then the cephalic vein, and the basilic vein. Take enough time to assess the vein before beginning the venipuncture procedure. C. laws Patients in these populations are often nervous and may flail their limbs. 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. Tourniquet - Wipe off with alcohol and replace frequently. 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. Describe and perform the venipuncture process including: Appropriate clothing and protective equipment. The sides and the tip of the. B. collection device var prevIframeHeight = iframe.style.height; This image is not<\/b> licensed under the Creative Commons license applied to text content and some other images posted to the wikiHow website. wikiHow, Inc. is the copyright holder of this image under U.S. and international copyright laws. You must check the timing of these variations for the desired collection point. Do not place too tightly or leave on more than 2 minutes (and no more than a minute to avoid increasing risk for hemoconcentration). D. Blue, Which of the following conditions should prevent a site from being selected for venipuncture? Certain areas are to be avoided when choosing a site: Extensive scars from burns and surgery - it is difficult to puncture the scar tissue and obtain a specimen. This is a general guide for troubleshooting a venipuncture scenario in which blood flow is not initially established upon needle insertion. Try another tube. Ernst, Dennis J. The needle should form a 15 to 30 degree angle with the surface of the arm. B. precautions The hydrostatic pressure causes some water and filterable elements to leave the extracellular space. Common Venipuncture Sites | Healthfully The patient has the right to refuse participation in such activity. Properly fill out appropriate requisition forms, indicating the test(s) ordered. Second - coagulation tube (light blue top). When finished, elevate the heel, place a piece of clean, dry cotton on the puncture site, and hold it in place until the bleeding has stopped. 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. What are the gray top containers used for? 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. Our students gain a vast amount of experience with phlebotomy vein sites through our hands-on and engaging curriculum and externship program. A tin can containing air is sealed. Include your email address to get a message when this question is answered. Potential source of test error, particularly from hemolysis, Most lines are flushed with a solution of heparin to reduce the risk of thrombosis, Discard a sample at least three times the volume of the line before a specimen is obtained for analysis. 7. PDF Collection of Blood Specimens by Skin Puncture -antiseptic swabs It is not uncommon for adults and children to feel some fear when having blood drawn, which is why any discussion of venipuncture should at least bring this topic to focus. Let's take a quick, high-level look at the venipuncture procedure. Make sure the venipuncture site is dry before proceeding with draw. or move it backward (it may have penetrated too far). 5. This preliminary action allows you to safely adjust the needle's position. 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. The needle may have pulled out of the vein when switching tubes. Blood is commonly obtained from the median cubital vein on the anterior forearm. C. the needle has penetrated all the way through the vein d.appendChild(f); Cap, rotate and invert the microtainer to mix the blood collected. Avoid bruising the infant's heel when obtaining blood. Dispose of items in appropriate containers. 13 Websites to Avoid If You Value Your Time | PCMag A. the tubes are filled and properly labeled Cleanse the fingertip of the 3rd (middle) or 4th (ring) finger with an alcohol prep. This is why a required skill for most phlebotomy jobs is to have excellent people skills with the ability to keep the patient calm during the venipuncture procedure. It may be obstructing blood flow. If the blood flow is diminished, repeat the capillary PUNCTURE to complete the collection. Which of the following is the most likely mechanism for alteration in protein values in this situation? Heparin light or dark green top tube, 5. This requisition form must contain the proper information in order to process the specimen. Fill the microtainer tube(s) as needed, adhering to the order of draw. Perform the venipuncture. Collect the drops of blood into the collection device by gently massaging, Avoid excessive pressure that may squeeze tissue fluid into the drop of, When full, cap and then gently invert the collection device 5-10 times to, Hold a gauze pad over the puncture site for a short time to stop the, Dispose of the contaminated materials and lancet in the appropriate waste, Place a band-aid on the patients finger or have someone continue to hold, gauze on the finger. A lab coat or gown must be worn during blood collection procedures. A needle is then gently inserted into the vein. Do not attempt a capillary puncture more than twice. the chlorhexidine residue before tying a piece of gauze around the foot. Warning: Do not make lateral (side-to-side) movements with the needle. Practice hygiene for the patient's protection. Tip: Patients who need regular bloodwork (e.g. Giavarina D, Lippi G. Blood venous sample collection: Recommendations overview and a checklist to improve quality. If you are using a butterfly, try to retie the tourniquet around the patient's arm to increase pressure and re-establish blood flow. Needle disposal unit - needles should NEVER be broken, bent, or recapped. How can you decrease the risk of hematoma formation? C. at a mastectomy site Certain areas are to be avoided when choosing a site: Extensive scars from burns and surgery - it is difficult to puncture the scar tissue and obtain a specimen. NHA Exam Questions Flashcards | Chegg.com