what sites should be avoided when performing venipuncture quizlet

\u00a9 2023 wikiHow, Inc. All rights reserved. Mastering Pediatric Phlebotomy. Center, for Phlebotomy Education, Inc. performing a capillary puncture is as follows: 1. What is an Approved Phlebotomy School in California. What are the best veins for venipuncture? Label collection tubes after identification of the patient. What should you do with a CBC or lavender top tube before putting them down? 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. While venipuncture is considered to be reasonably safe, the present study investigated the incidence of serious complications occurring in an outpatient setting. Northfield, IL: College of American, NCCLS. 5. Clin Chem Lab Med. Veins sometimes roll away from the point of the needle and puncture site. There are three phlebotomy vein sites located in the arm most utilized by medical professionals and three additional draw sites that are last resorts. Areas of the body that look infected, scarred, or burned must also be avoided. Inadvertently nicking a nerve causes intense pain. Stress: May cause transient elevation in white blood cells (WBC's) and elevated adrenal hormone values (cortisol and catecholamines). wikiHow, Inc. is the copyright holder of this image under U.S. and international copyright laws. 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. Avoid excessive pressure that may squeeze tissue fluidinto the drop of blood. -obvious skin infection (including newly tattooed areas). 1. Diurnal Rhythms: Diurnal rhythms are body fluid and analyte fluctuations during the day. } Use a butterfly to compensate for patient movement. 2019;95(1):15-19. doi: 10.1016/j.diagmicrobio.2019.04.001. The patient should either sit in a chair, lie down or sit up in bed. Never leave a tourniquet on for more than two minutes. Apply blood to the printed side of the filter paper. Needle disposal unit - needles should NEVER be broken, bent, or recapped. B. above an IV line An OSHA acceptable, puncture proof container markedBiohazardous. Position the patient so that the hand is easily accessible. 2006;52(5-6):217-30. Check for timing instructions for drawing the appropriate samples. Avoid previous hematoma (draw distal of hematoma) 9. B. Betadine 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. What are the light blue top containers used for? They are also. Fasting, dietary restrictions, medications, timing, and medical treatment are all of concern and should be noted on the lab requisition. if( evntData && evntData.constructor == String ){ 2011-2023 Phlebotomy Coach. 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. How far above a venipuncture sight should you place a tourniquet? Label the collection tubes at the bedside or drawing area. Answer. Warning: Some phlebotomists use a method of anchoring called the "C-hold", in which the index finger pulls upwards superiorly while the thumb pulls downwards inferiorly. 3. 6. The median cubital creates less bruising and pain than other draw sites. 4. What are the gray top containers used for? 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. Ask the patient orcaregiver to state the patients name and date of birth. Nursing Personnel. A test that has been ordered may be cancelled due to problems unrelated to drawing the specimen, and these are the most common causes for cancellations: A test may be cancelled due to a technical problem in the specimen collection process: Identification of the specimen is suspect. 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. In this elbow pit, phlebotomists have easy access to the top three vein sites used in phlebotomy: Median cubital vein. Sometimes you may get initial blood flow, but then it stops when you change tubes. It is an employer's responsibility to provide, clean, repair, replace, and/or dispose of personal protective equipment/clothing. Remember that veins should ideally feel bouncy. (See Use of Band-Aids in the Post Phlebotomy. 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. A. Edema 10. Use a smaller tube with less vacuum. This article was co-authored by Matt Garcia. Document that the venipuncture was performed distal to (below) an infusion site. wikiHow, Inc. is the copyright holder of this image under U.S. and international copyright laws. Avoid excessive pressure that may squeeze tissue fluidinto the drop of blood. Avoid bruising the infant's heel when obtaining blood. Change your approach when dealing with uncooperative patients, such as pediatrics and those with neurodevelopmental or psychiatric disorders. 2013 Oct 10;(10):CD005179. 11. -infection at site Airborne precautions may be considered to provide a level of safety against infectious diseases such as tuberculosis, influenza, and COVID-19. apply pressure for at least 10 minutes. Deliver specimens promptly to the laboratory. 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. 12. Second - coagulation tube (light blue top). Have the patient drink fluids if dehydrated. If multiple blood samples are to be taken, the phlebotomist must be careful to follow the proper order of draw. Drawing blood for laboratory analysis is most often a routine and uneventful procedure. Finger - Usually the third or fourth finger is preferred in adults and children. The creatine kinase (CK), aspartate aminotransferase (AST), lactate dehydrogenase (LDH), and platelet count may increase. C. Iodine This complication of peripheral I.V. Remember -- the rst vein found is not always the best vein. 2017;148(4):330-335. Lightly touch the microtainer capillary collectiondevice (or filter paper) to the LARGE drop of blood. It brings the entire family f.style.width="100%"; B. Yellow Collect drops of blood into the collection device by gently massaging the finger. Position the patient. 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. Significant increases can be found in total protein, aspartate aminotransferase (AST), total lipids, cholesterol, iron, Affects packed cell volume and other cellular elements. To request course information, contact PhlebotomyU today. -use a smaller gauge needle The phlebotomist's role requires a professional, courteous, and understanding manner in all contacts with the patient. 8. Follow the same procedure as for performing a finger, Order of Draw for a Capillary Puncture: Proper collection of tubes when. Patient identification is critical for safety. You must check the timing of these variations for the desired collection point. If you are using a butterfly, try to retie the tourniquet around the patient's arm to increase pressure and re-establish blood flow. Move it forward (it may not be in the lumen). Palpate and trace the path of veins with the index finger. Tourniquet - Wipe off with alcohol and replace frequently. (function() { This type of venipuncture procedure is a little different, and sometimes can be a little more involved. Avoid trauma and excessive probing. NOTE: The use of post-exposure prophylaxis following blood exposure to HIV has shown effectiveness (about 79%) in preventing seroconversion. The line must be flushed first. Edematous extremities with swollen tissue alter the results. A. standards Povidone-iodine wipes/swabs - Used if blood culture is to be drawn. Identify the additive, additive function, volume, and specimen considerations to be followed for each of the various color coded tubes. 1. Otherwise, satisfactory samples may be drawn below the IV by following these procedures: Turn off the IV for at least 2 minutes before venipuncture. wikiHow, Inc. is the copyright holder of this image under U.S. and international copyright laws. Swiftly insert the needle through the skin and into the lumen of the vein. The fluid may dilute the specimen, so collect from the opposite arm. The patient who is at ease will be less focused on the procedure. 2004;24(4):979-96, vii. A clinical study is performed to determine the optimal time for application of the tourniquet during phlebotomy. www.mlo-online.com is using a security service for protection against online attacks. A. just prior to needle insertion The performance of routine vascular access procedures by skilled phlebotomists requires, at a minimum, the use of gloves to prevent contact with blood. Certain other sites should also be avoided. The best locations for fingersticks are the 3rd (middle) and 4th (ring) fingers of the non-dominant hand. It is large and near the skins surface, making it easier for phlebotomists to see before anchoring the vein. An example of a simple requisition form with the essential elements is shown below: A properly labeled sample is essential so that the results of the test match the patient. Verify the patient's condition. wikiHow, Inc. is the copyright holder of this image under U.S. and international copyright laws. Impartial access to treatment or accommodations that are available or medically indicated, regardless of race, creed, sex, national origin, or sources of payment for care. A typical single vial contains about five milliliters, which is about one teaspoon. 8. Contaminated surfaces must be cleaned with freshly prepared 10% bleach solution. Hyperextend the patient's arm. The content of this article is not intended to be a substitute for professional medical advice, examination, diagnosis, or treatment. Be sure to dispose of the lancet in the appropriate sharps container. If you stick yourself with a contaminated needle: Remove your gloves and dispose of them properly. Several veins in the antecubital fossa provide excellent access. Impact of Use of Smaller Volume, Smaller Vacuum Blood Collection Tubes on Hemolysis in Emergency Department Blood Samples. Do not bend, break, recap, or resheath needles to avoid accidental needle puncture or splashing of contents. site. Select the appropriate microtainers for the specimens to be collected. Reassure the patient that the minimum amount of blood required for testing will be drawn. It may be, necessary, on occasion, to perform a capillary puncture on the toe of a patient, who is severely burned. If none of these veins work, then the phlebotomists use the hand veins. This image is not<\/b> licensed under the Creative Commons license applied to text content and some other images posted to the wikiHow website. 5. Remove your gloves and wash your hands. https://www.osha.gov/laws-regs/standardinterpretations/2007-10-26 and https://www.osha.gov/OshDoc/data_BloodborneFacts/bbfact03.pdf (Accessed June 13, 2022). For a detailed breakdown of each step of the venipuncture test scroll down. B. precautions Asking the patient about their previous blood draw experiences is beneficial, especially if they are a hard stick and know which area works best. 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 Select the proper approved lancet: The BD Microtainer Contact-Activated. 3. Watch for formation of a hematoma. What equipment is needed for a venipuncture? 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. This image is not<\/b> licensed under the Creative Commons license applied to text content and some other images posted to the wikiHow website. Warning: Do not make lateral (side-to-side) movements with the needle. Last draw - additive tubes in this order: SST (red-gray or gold top). Stop the procedure if a hematoma occurs. Allow it to air, Grasp the finger, and using a sterile lancet, press firmly against the finger. with their hand to stabilize it for the draw. 2009;47(2):143-53. Venipuncture can also happen when patients have intravenous (IV) lines started. What are the contraindications to venipuncture? X=[Ar]4s23d5Y=[Ar]4s23d104p1Z=[Ar]4s23d104p6. It doesn't matter . 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. Phlebitis can also occur as a result of vein trauma during insertion, use of an inappropriate I.V. Prepare the patient's arm using an alcohol prep. }catch(e){} A face mask reduces risk for blood culture specimen contamination. 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. Extensive scarring or healed burn areas should be avoided Specimens should not be obtained from the arm on the same side as a mastectomy. 6. Needles - The gauge number indicates the bore size: the larger the gauge number, the smaller the needle bore. (b) How would you prepare tetracaine from p-nitrobenzoic acid? Once you establish blood flow, slightly modify your hand position to stabilize the needle against the arm and prevent further movement. Dry the cleaned area with a dry cotton sponge. IF AN INCOMPLETE COLLECTION OR NO BLOOD IS OBTAINED: Change the position of the needle. Order of draw for multiple tube phlebotomy. Please enable JavaScript on your browser and try again. -tourniquet Clin Biochem. diet, exercise, stress, basal state). Label all appropriate tubes at the patient bedside. For operation at steady state, determine for the motor, each in kW\mathrm{kW}kW Some individuals are afraid of needles, while others are frightened at the sight of blood. Dispose of items in appropriate containers. C. sterile gauze pads A. excessive probing with the needle 23-gauge needles (e.g. 12. Hold equipment firmly and place fingers against patient's arm, using the flange for leverage when withdrawing and inserting tubes. If there is a concern regarding contamination by tissue fluids or thromboplastins, then one may draw a non-additive tube first, and then the light blue top tube. ROUTINE CAPILLARY PUNCTURE BLOOD COLLECTION GUIDELINES. A thin soap bubble of index of refraction 1.33 is viewed with light of wavelength 550.0 nm and appears very bright. Needles should be placed in a proper disposal unit IMMEDIATELY after their use. The hydrostatic pressure causes some water and filterable elements to leave the extracellular space. The sides and the tip of the. CLSI document H04-A6. Apply an adhesive bandage. Precautions include a medical grade face mask. Check the requisition form for requested tests, patient information, and any special requirements. Draw 5 ml of blood and discard before drawing the specimen tubes for testing. Cochrane Database Syst Rev. The median cubital creates, The dorsal venous network is the next most common vein site for phlebotomists. Approach the patient in a friendly, calm manner. B. just after needle insertion, but prior to vacutainer activation together for emotional support and understanding across multiple locations to reach you in the community where you live. (Uman et al, 2013). So You're Going to Collect a Blood Specimen: An Introduction to Phlebotomy, 13th Edition (2010), College of American Pathologists, Northfield, IL. Adjust the angle (the bevel may be against the vein wall). Previous puncture sites should be avoided. if ( (iframe.src).indexOf('formperma') > 0 && (iframe.src).indexOf(zf_perma) > 0 ) { Compare and contrast the two major types of neuronal pathways. When multiple vials of blood are collected it can seem like a large amount.