what sites should be avoided when performing venipuncture quizlet
Some DNS services support web filtering, too. Confidentiality of all communications and other records pertaining to the patient's care. Concentrations of fluids and medications could affect baseline test results. Airborne precautions may be considered to provide a level of safety against infectious diseases such as tuberculosis, influenza, and COVID-19. Joslin JO. To determine the best vein, use both sight and touch. What are the helpful hints for finding veins? Palpate and trace the path of veins with the index finger. This article has been viewed 43,712 times. If this is not successful, remove the needle, take care of the
puncture site, and redraw. The first step to choosing the right vein is to select the appropriate needle gauge. Re-secure the tourniquet to increase venous filling. What are the contraindications to venipuncture? Hyperextend the patient's arm. True or False? The vein may have collapsed; resecure the tourniquet to increase venous
filling. A. in the region of a hematoma Tip: In spite of a difficult draw, remember to invert your tubes. It may be obstructing blood flow. Know the identity and professional status of individuals providing
service and to know which physician or other practitioner is primarily
responsible for his or her care. The median cubital vein and the cephalic vein in the wrist area should be avoided when possible. Patches of purple or yellow may suggest bruising after a recent venipuncture. The best locations for fingersticks are the 3rd (middle) and 4th (ring) fingers of the non-dominant hand. 9. 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. Additionally, blood samples should not be taken on an arm with a fistula used for dialysis treatments. Select the proper approved lancet: The BD Microtainer Contact-Activated. the 3 rd (middle) or 4 th (ring) finger of the hand. Do not obtain specimens from an arm having a cannula, fistula, or vascular graft. The line must be flushed first. Notify your supervisor or patientsphysician if unsuccessful. It doesn't matter . The recommended location for blood collection on a newborn baby or infant is the heel. It is an employer's responsibility to provide, clean, repair, replace, and/or dispose of personal protective equipment/clothing. The needle should form a 15 to 30 degree angle with the
surface of the arm. or move it backward (it may have penetrated too far). D. discarded in the trash, True or False? 5. Promptly send the specimens with the requisition to the laboratory. D. after needle removal, When drawing blood you should always follow universal ______ The median cubital vein is used the most for its accessibility. Ernst, Dennis J. 2009 Feb;131(2):195-204. Drawing the patient in a reclined position. This is a general guide for troubleshooting a venipuncture scenario in which blood flow is not initially established upon needle insertion. Be sure to dispose of the lancet in the appropriate sharps container. 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. If an inpatient is able to
respond, ask for a full name and always check the armband or bracelet for confirmation. 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. 8. -laceration of vein Move it forward (it may not be in the lumen). D. all of the above, Common causes of hematomas that form during a venipuncture include: However, drawing blood from the hand is affiliated with higher levels of pain and less control. Pediatric Pointers. Center for Phlebotomy Education, Inc. Ernst, Dennis J. and Catherine Ernst. B. the needle is inserted into the patient's arm Certain other sites should also be avoided. Any microtainerscontaining additives should be tapped to dislodge additives from the walls and top. C. all disposable equipment has been discarded properly 4. Inadvertently nicking a nerve causes intense pain. 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. Extensive scarring or healed burn areas should be avoided Specimens should not be obtained from the arm on the same side as a mastectomy. 3. 12. 5. -hemorrhage/hematoma. performing a capillary puncture is as follows: 1. Background: Venipuncture is the most common invasive medical procedure performed by health care providers. 4. Be methodical in your search for a vein. Kiechle, Frederick L. So Youre Going to Collect a Blood Specimen: An, Introduction to Phlebotomy, 11th Edition. Follow institution's guidelines regarding treatment and follow-up. The rubber stoppers are color coded according to the additive that the tube contains. Puncture only the uppermost wall of the vein, Remove the tourniquet before removing the needle, Make sure the needle fully penetrates the upper most wall of the vein. Most reference ranges are based on normal laboratory test values for: Healthy people in a basal state. 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 service requires full JavaScript support in order to view this website. 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. While the median cubital, cephalic, and basilic veins are the most popular draw sites for blood draws, phlebotomists may resort to other draw sites if their ability to draw is restricted. Adjust the angle (the bevel may be against the vein wall). -use a smaller gauge needle 9. Hematoma - may cause erroneous test results. Prepare the equipment, the patient and the puncture site. 4. chemistries, serology, immunnology, blood bank. proteins). 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. Even if several vials of blood have to be drawn it usually amounts to no more than one ounce. (c) How would you prepare tetracaine from benzene? Such terms as "needs to," "must," "require" and "should" are used to explain how medical professionals should perform capillary blood collection procedures. Collect drops of blood into the collection device by gently massaging the finger. Procedures and Devices for the Collection of Diagnostic Capillary Blood. Gloves are to be worn during all blood collection procedures, and changed betweenpatient collections. Povidone-iodine wipes/swabs - Used if blood culture is to be drawn. Select the appropriate microtainers for the specimens to be collected. f.style.border="none"; Wikipedia. While hand veins may be utilized for blood draws and intravenous infusions, veins in the feet and legs should be avoided for adults. The upper extremity on the side of a previous mastectomy - test results may be affected because of lymphedema. If using a needle and syringe, avoid drawing the plunger back too forcefully. D. Near a tattoo, Needles are used once and then: If the patient is sitting in a phlebotomy chair, make sure they are sitting upright with their back against the chair. 7. This image is not<\/b> licensed under the Creative Commons license applied to text content and some other images posted to the wikiHow website. (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.). To enhance students careers, meet the needs of healthcare providers and improve patient care by providing high quality, cost effective phlebotomy education through industry leading curriculum, current technology and extensive hands on experience. Regardless of the source of payment, request and receive an itemized and detailed explanation of the total bill for services rendered in the hospital. 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. How to Troubleshoot a Difficult Venipuncture. What two things should you make sure you discuss with your patients prior to venipuncture? var evntData = event.data; 2. PhlebotomyU offers Certified Phlebotomy Technician (CPT I) courses for aspiring phlebotomists. Once you establish blood flow, slightly modify your hand position to stabilize the needle against the arm and prevent further movement. Cap, rotate and invert the microtainer to mix the blood collected. Label the specimens before leaving the patients bedside. Use pillows or foam wedges to elevate the arm and help with extension. Try another tube. Factitious biochemical measurements resulting from hematologic conditions. var zf_ifrm_data = evntData.split("|"); A. the tubes are filled and properly labeled The area where the blood is to be drawn from is first cleaned with a germ-killing solution. Perform the venipuncture. For a detailed breakdown of each step of the venipuncture test scroll down. Identification errors in pathology and laboratory medicine. Failure to do this results in an unequal blood-to-additive ratio, making the specimen unsuitable for analysis. Also found in the antecubital fossa, the basilic vein serves as a last resort for blood draws. IV lines are very useful in hospitals because some patients require frequent blood tests. Alcohol not dry in the required amount of time B. Veins less prominent and less filling C. Veins more prominent and easier to puncture D. Blood stop flowing to arteries but not veins A The most common site (s) for the venipuncture procedure is/are the following: 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. Place labeled specimens in zip lock bag and deliver to the laboratory as soon as possible. Clin Lab Med. Additionally, a hematoma may compress the nerve and lead to long-term damage. prevent falls, should the patient lose consciousness. Remember that veins should ideally feel bouncy. Matt Garcia is an experienced phlebotomist in Vancouver, Canada. Certain larger molecules are not filterable into the tissue, therefore they are more concentrated in the blood. D. 70% isopropyl alcohol. Avoid prolonged tourniquet application or fist clenching. Since newborns do not often bleed immediately, use gentle pressure to produce a rounded drop of blood. Blood is collected into an attached vial or tube that is airtight and the flexible band is then removed from the arm. wikiHow, Inc. is the copyright holder of this image under U.S. and international copyright laws. Most commonly, venipuncture will be performed on the Antecubital Fossa, or the inside of the elbow. Although the skill set and procedures may apply to both instances, this content is primarily aimed towards venous blood collection using evacuated tube systems (e.g. Practice hygiene for the patient's protection. Antiseptic. At least two patient identifiers, such as name and date of birth, are needed. 6. 2013 Oct 10;(10):CD005179. These may include listening to music or a story, watching a video, playing with a toy, having a parent provide distraction with talk or touch, using flash cards, and squeezing a rubber ball. Needles should be placed in a proper disposal unit IMMEDIATELY after their use. Sign up for wikiHow's weekly email newsletter. var zf_perma = zf_ifrm_data[0]; Over time and with several repeated punctures, significant amounts of scar tissue builds up. Dry the cleaned area with a dry cotton sponge. 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. Examples of labeled collection tubes are shown below: THE FOLLOWING ARE NEEDED FOR ROUTINE VENIPUNCTURE: Evacuated Collection Tubes - The tubes are designed to fill with a predetermined volume of blood by vacuum. This image is not<\/b> licensed under the Creative Commons license applied to text content and some other images posted to the wikiHow website. What sites should be avoided when drawing blood? A. standards 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. Select a vein other than the one with the IV. Holder/Adapter - use with the evacuated collection system. hemorrhage or hematoma at site of puncture, remove tourniquet 8. 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. Choosing an appropriate site for venipuncture is crucial for a successful . B. sterilized and reused Impact of Use of Smaller Volume, Smaller Vacuum Blood Collection Tubes on Hemolysis in Emergency Department Blood Samples. Have the patient hold a small gauze pad over the puncture site for a couple of minutes to stop the bleeding. This guide follows the steps as outlined in the World Health Organizations Guidelines on Drawing Blood: Best Practices in Phlebotomy. 2004;24(4):979-96, vii. Lancets are disposed of in an appropriate sharps container as one unit. What Is Venipuncture? 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. What is an Approved Phlebotomy School in California. Gas tubes (must warm the site before collecting the specimen), 4. 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. In this elbow pit, phlebotomists have easy access to the top three vein sites used in phlebotomy: Median cubital vein. Do not use the tip of the finger or the center of the finger. A. given to the patient What is the best position to perform venipuncture in? 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. Previous puncture sites should be avoided. This article was co-authored by Matt Garcia. A. Edema Blood samples drawn from an IV line should be documented and analyzed with care. 1. As a phlebotomist, it is critical to know which vein sites offer stable flows for blood draws. C. sterile gauze pads Greet the patient and identify yourself and indicate the procedure that will take place. var f = document.createElement("iframe"); Automated systems may include labels with bar codes. In some cases, a phlebotomist may have to switch sites if they find the blood is not properly flowing from the vein. Use of hair nets and face masks to decrease blood culture contamination rates. 7. Stabilize the needle as you're inserting your tubes. 1. Larger tube sizes typically provide for collection of samples from 6 to 10 mL. 1. Label all appropriate tubes at the patient bedside. This information must be given when requesting microbiology, cytology, fluid analysis, or other testing where analysis and reporting is site specific. A lab coat or gown must be worn during blood collection procedures. 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. Have the patient position their arm on the armrest. If blood stops flowing into the vacuum tube, the vein may have collapsed. Do not place too tightly or leave on more than 2 minutes (and no more than a minute to avoid increasing risk for hemoconcentration). Contains lithium heparin anticoagulant and a gel separator. It is large and near the skins surface, making it easier for phlebotomists to see before anchoring the vein. Specimens from infants under the age of 6 months are typically collected by heelstick. Warning: Do not make lateral (side-to-side) movements with the needle. catheter size for the vein, or prolonged use of the same I.V. Reasonable informed participation in decisions involving the patient's
health care. 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. Lancet 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. -tourniquet Various sizes are available. Wipe away the first drop of blood with a piece of clean, dry cotton. 4. Never attempt venipuncture in an artery. Here phlebotomists will typically choose from three veins: the median cubital vein, the cephalic vein or the basilic vein. window.addEventListener('message', function (){ Allow it to air, Grasp the finger, and using a sterile lancet, press firmly against the finger. The patient should make a fist without pumping the hand. Contains a gel separator and clot activator. Proper patient identification procedures. Re-anchor the vein. The first drop contains excess tissue fluid and must be wiped away. So You're Going to Collect a Blood Specimen: An Introduction to Phlebotomy, 13th Edition (2010), College of American Pathologists, Northfield, IL. Phlebotomy is the practice of drawing blood from patients to gather data about their health. 4. Contaminated surfaces must be cleaned with freshly prepared 10% bleach solution. 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. Similarly, it's quite easy to get lost in a "Wikipedia wormhole." Indeed, Wikipedia's depth is infinite, as you link from subject to subject, never able to stop. Forward completed/dry collections to the laboratory as soon as possible. However, drawing blood from the hand is affiliated with higher levels of pain and less control. Wayne, PA: Clinical and Laboratory Standards Institute; 2008.
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what sites should be avoided when performing venipuncture quizlet