what sites should be avoided when performing venipuncture quizlet

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7. performing a capillary puncture is as follows: 1. Other Factors: Age, gender, and pregnancy have an influence on laboratory testing. NOTE:Tubes with additives must be thoroughly mixed. The essential elements of the requisition form are: Patient's surname, first name, and middle initial. Remember that veins should ideally feel bouncy. Hematoma - may cause erroneous test results. D. Both A and B, A sharps container is identified by its bright ____ color on patients who are extremely dehydrated or have poor peripheral circulation. D. 70% isopropyl alcohol. wikiHow, Inc. is the copyright holder of this image under U.S. and international copyright laws. 2. For most clinical examinations the blood is obtained: The vacuum (evacuated) tube system (vacutainer) requires the following components: The healthcare worker needs essential items for either venipuncture or microcollection. Needles - The gauge number indicates the bore size: the larger the gauge number, the smaller the needle bore. What Is Venipuncture? The puncture should be made perpendicular to the ridges of the fingerprint so that the drop of blood does not run down the ridges. As a countermeasure, phlebotomists. Allow thefinger to dry or wipe dry with a sterile 22 gauze. Observe all applicable isolationprocedures. Extremity is edematous. 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. -laceration of vein Serum red top or amber tube with red top. Unlike the cephalic and basilic veins, the median cubital vein is not near major nerves or arteries. Transferring a sample from one collection tube to another or mixing blood from different collection tubes must be avoided. or move it backward (it may have penetrated too far). Move it forward (it may not be in the lumen). Make certain that the blood completely saturates all four (4) circles and is visible from bothsides. (Uman et al, 2013). What are the gold top containers used for? The creatine kinase (CK), aspartate aminotransferase (AST), lactate dehydrogenase (LDH), and platelet count may increase. 7. Compared to the standard blood donation which is about sixteen ounces, one ounce is really small. If just a routine coagulation assay is the only test ordered, then a single light blue top tube may be drawn. D. it is wiped with alcohol, Venipuncture at sites with each of the following could effect the results EXCEPT: Never draw over scars or a new tattoo sites. Lines - Drawing from an intravenous line may avoid a difficult venipuncture, but introduces problems. D. discarded in the trash, True or False? Fasting, dietary restrictions, medications, timing, and medical treatment are all of concern and should be noted on the lab requisition. B. the needle is inserted into the patient's arm Which of the following actions should the technician take? Anxiety that results in hyperventilation may cause acid-base imbalances, and increased lactate. The hydrostatic pressure causes some water and filterable elements to leave the extracellular space. Clin Lab Med. Avoid areas of hematoma. This is especially important when collecting EDTA (lavender top) or heparin (green top) tubes. Proper patient identification procedures. 8. What are the light blue top containers used for? var zf_perma = zf_ifrm_data[0]; Try rotating the arm to better expose the cephalic or basilic vein. wikiHow, Inc. is the copyright holder of this image under U.S. and international copyright laws. Clin Lab. Two forms of active identification are required. Label all appropriate tubes at the patient bedside. }, false); Select the proper approved lancet: The BD Microtainer Contact-Activated. C. Lancet Verify the patient's condition. Wipe away the first drop of blood with sterile 22 gauze. Identify the patient. In some instances, the legs or feet are required for use, but a physician or doctor should be completing the draw, not a phlebotomist. Label the specimens before leaving the patients bedside. 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. If none of these veins work, then the phlebotomists use the hand veins. For example, Google offers SafeSearch that can block explicit search results like porn, and it works for all image and video searches, as well as news and general search content. Focus on what you do best, and find someone who can help you communicate that with your target market. 2004;24(4):979-96, vii. Thrombosed veins lack resilience, feel cord-like, and roll easily. Phlebitis can also occur as a result of vein trauma during insertion, use of an inappropriate I.V. A tin can containing air is sealed. You may also remove the tube, wait a few seconds for blood flow to resume, and then engage a short drawtube. Cochrane Database Syst Rev. https://www.osha.gov/laws-regs/standardinterpretations/2007-10-26 and https://www.osha.gov/OshDoc/data_BloodborneFacts/bbfact03.pdf (Accessed June 13, 2022). Cap, rotate and invert the microtainer to mix the blood collected. Contains acid citrate dextrose. (See picture.) 7. Holder/Adapter - use with the evacuated collection system. The median cubital vein is used the most for its accessibility. Give an example of each. 2017;50(10-11):568-573. 1. This type of venipuncture procedure is a little different, and sometimes can be a little more involved. Within the antecubital fossa, this vein poses the least amount of risk. Pre-warm the region of the vein to reduce vasoconstriction and increase blood flow. Be sure to dispose of the lancet in the appropriate sharps container. As a countermeasure, phlebotomists anchor the vein with their hand to stabilize it for the draw. 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. site. 9. The median cubital vein and the cephalic vein in the wrist area should be avoided when possible. C. laws 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. 2011-2023 Phlebotomy Coach. Switch to the other arm if you can't find anything. hemorrhage or hematoma at site of puncture, remove tourniquet D. Blue, Which of the following conditions should prevent a site from being selected for venipuncture? Dispose of items in appropriate containers. 2013 Oct 10;(10):CD005179. -antiseptic swabs Phlebotomists are considered to have occupational exposure to blood borne pathogens. 6. Nursing Personnel. 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. C. Red Diagn Microbiol Infect Dis. Asking the patient about their previous blood draw experiences is beneficial, especially if they are a hard stick and know which area works best. ROUTINE CAPILLARY PUNCTURE BLOOD COLLECTION GUIDELINES. diet, exercise, stress, basal state). 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. 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. A. given to the patient If this is not successful, remove the needle, take care of the puncture site and redraw at another site. INR for patients on warfarin) are often knowledgeable on the veins that are most likely to work. 7. While most patients veins are compatible with a standard needle gauge, others require a. . What are the gray top containers used for? EDTA and sodium citrate tubes should still be filled to the marked fill line to ensure a correct blood-to-additive ratio. Arteries pulsate, are very elastic, and have a thick wall. Povidone-iodine wipes/swabs - Used if blood culture is to be drawn. 3. Carry out hand hygiene before and after each patient procedure, before putting on and after removing gloves. Adapted from Phlebotomy for Nurses and. Use of hair nets and face masks to decrease blood culture contamination rates. Some images used in this set are licensed under the Creative Commons through Flickr.com.Click to see the original works with their full license. 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. if ( prevIframeHeight != zf_ifrm_ht_nw ) { Avoid UE on same side of mastectomy (lymphedema) Blood samples drawn from an IV line should be documented and analyzed with care. 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. Contains a gel separator and clot activator. B. Hematoma This information must match therequisition. Make the cut across the heelprint lines so that a drop of blood can well up and not run down along the lines. Capillary puncture should not be used. 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. Procedure for Capillary Puncture of the Finger: The best site for a finger puncture is just off the center of the finger pad of. How many time should you invert them? A. Syringe The basic patient rights endorsed by the JCAHO follow in condensed form are given below. Avoid a probing, traumatic venipuncture. Am J Clin Pathol. World Health Organization. You will be redirected once the validation is complete. The median cubital creates, The dorsal venous network is the next most common vein site for phlebotomists. This preliminary action allows you to safely adjust the needle's position. The recommended location for blood collection on a newborn baby or infant is the heel. (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.). The vein may have collapsed; resecure the tourniquet to increase venous filling. Collect drops of blood into the collectiondevice by gently massaging the finger. Apply an adhesive bandage. increase the circulation of blood to the area. Why? You should always contact your doctor or other qualified healthcare professional before starting, changing, or stopping any kind of health treatment. 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 angle should you insert the needle at? Because most laboratory specimens contain bacteria, it is not necessary to wash hands before collecting them, The tourniquet applied prior to venipuncture is removed: While venipuncture is considered to be reasonably safe, the present study investigated the incidence of serious complications occurring in an outpatient setting. 6. How should you have the patient position their arm after the venipuncture is complete? It is large and near the skins surface, making it easier for phlebotomists to see before anchoring the vein. IV lines are very useful in hospitals because some patients require frequent blood tests. C. sterile gauze pads Butterflies are incredibly valuable tools for tackling difficult draws, owing to their precision, shorter shaft length, and maneuverability. Some examples of these include notices from banks, online retailers such as Amazon or eBay, and even . 3. Re-secure the tourniquet to increase venous filling. (a) the electric power required. What are the helpful hints for finding veins? 4. Arteries pulsate, are most elastic, and have a thick wall. He holds a Diploma in Medical Laboratory Assistance and is certified under the British Columbia Society of Laboratory Science. Phlebotomy is the practice of drawing blood from patients to gather data about their health. 1. window.addEventListener('message', function (){ 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. 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. For a detailed breakdown of each step of the venipuncture test scroll down. If this is not successful, remove the needle, take care of the puncture site, and redraw. Wayne, PA: Clinical and Laboratory Standards Institute; 2008. Recommended order of collection for microtainer specimens: 7. If possible, speak with the patient during the process. Several essential steps are required for every successful collection procedure: Patient comfort. Remember -- the rst vein found is not always the best vein. Pediatric Pointers. Center for Phlebotomy Education, Inc. Ernst, Dennis J. and Catherine Ernst. Lippi G, Salvagno GL, Montagnana M, Franchini M, Guidi GC. 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. 3. Individually packaged 70% isopropyl alcohol wipes. A thin soap bubble of index of refraction 1.33 is viewed with light of wavelength 550.0 nm and appears very bright. Normal reference ranges are often noted according to age. Loosen the tourniquet. You must check the timing of these variations for the desired collection point. Be informed of the hospital rules and regulations regarding patient conduct. NOTE: The use of post-exposure prophylaxis following blood exposure to HIV has shown effectiveness (about 79%) in preventing seroconversion. -use correct angle of needle insertion BD Vacutainer), rather than IV catheter insertions. It is an employer's responsibility to provide, clean, repair, replace, and/or dispose of personal protective equipment/clothing. Blindly maneuvering the needle within the skin is painful to the patient and you run the risk of hitting a nerve, tendon, or artery. 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. This article has been viewed 43,712 times. In this elbow pit, phlebotomists have easy access to the top three vein sites used in phlebotomy: Median cubital vein. wikiHow, Inc. is the copyright holder of this image under U.S. and international copyright laws. Hemoconcentration: An increased concentration of larger molecules and formed elements in the blood may be due to several factors: Prolonged tourniquet application (no more than 1 minute). Hematoma - A venipuncture should not be performed on a hematoma, regardless of how small it may be. Do not place too tightly or leave on more than 2 minutes (and no more than a minute to avoid increasing risk for hemoconcentration). Most commonly, venipuncture will be performed on the Antecubital Fossa, or the inside of the elbow. Matt Garcia is an experienced phlebotomist in Vancouver, Canada. 2. What is the most common site for blood sampling? outstretched or raised Gloves are to be worn during all blood collection procedures, and changed betweenpatient collections. avoid sites of extensive scarring (burns, surgery, injuries) Always thank the patient and excuse yourself courteously when finished. Cannula/fistula/heparin lock - hospitals have special policies regarding these devices. C. the seal is broken A. just prior to needle insertion D. Butterfly, Before leaving the patient's bedside, you must make sure that: 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. Wear gloves and a lab coat or gown when handling blood/body fluids. 12. Do not use the central portion of the heel because you might injure the underlying bone, which is close to the skin surface. Joslin JO. Also found in the antecubital fossa, the basilic vein serves as a last resort for blood draws. What should you do with a CBC or lavender top tube before putting them down? There are three phlebotomy vein sites located in the arm most utilized by medical professionals and three additional draw sites that are last resorts. wikiHow, Inc. is the copyright holder of this image under U.S. and international copyright laws. What sites should be avoided when drawing blood? 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 . To determine the best vein, use both sight and touch. Position the patient so that the hand is easily accessible. Dispose of needles immediately upon removal from the patient's vein. Which of the following is the most likely mechanism for alteration in protein values in this situation? 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. Copyright 2023 - PhlebotomyU | Website Design & SEO by, Phlebotomy: 5 Tips on Finding Difficult Veins. Check the requisition form for requested tests, patient information, and any special requirements. 11. Lancets are disposed of in an appropriate sharps container as one unit. 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. They are also. Most reference ranges are based on normal laboratory test values for: Healthy people in a basal state. If a vein feels hard, it may be scarred or sclerosed. Collect drops of blood into the collectiondevice by gently massaging the heel. All approved lancets utilized at Akron Childrens are for single use and feature, Heel punctures are performed on infants less than 6 months of age, or on, older premature infants who are the approximate size of a full-term 6 month, old. When wearing gloves, change them between each patient and wash your hands frequently. Additionally, blood samples should not be taken on an arm with a fistula used for dialysis treatments. By holding the needle either by the plastic wings or the hub, phlebotomists can achieve a shallower angle, typically 10-15 degrees. The upper extremity on the side of a previous mastectomy - test results may be affected because of lymphedema. What are the best veins for venipuncture? Avoid excessive pressure that may squeeze tissue fluid into the drop of blood. Clean the site to be punctured with an alcohol sponge. are known to vary lab results of some analytes. Allow another large drop of blood to form. Have the patient position their arm on the armrest. Follow the procedure as outlined above for greeting and identifying the patient. The antecubital fossa is a collection of veins located within the arms inner area, opposite of the elbow, where the arm folds in. Contains lithium heparin anticoagulant and a gel separator. Start with the arm closest to you and palpate the antecubital fossa. Identification errors in pathology and laboratory medicine. As a phlebotomist, it is critical to know which vein sites offer stable flows for blood draws. 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. 13. 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. 2006;52(5-6):217-30. Wait 2 minutes before reapplying the tourniquet. What two things should you make sure you discuss with your patients prior to venipuncture? } Look for visual clues which may help assess the patient's condition. Safely discard potentially infectious materials. The rubber stoppers are color coded according to the additive that the tube contains. Our courses are designed to provide students with the skills and knowledge necessary to work in a variety of medical settings including: Hospitals, Clinical Laboratories, Clinics, Physicians Offices, Blood Banks and much more. 5. This image is not<\/b> licensed under the Creative Commons license applied to text content and some other images posted to the wikiHow website. B. collection device Preanalytical phase of the testing process begins for the laboratory when a: Test is ordered by a patient's physician. Gas tubes (must warm the site before collecting the specimen), 4. 1. previous experience with vomiting or fainting A. the tubes are filled and properly labeled 2009 Feb;131(2):195-204. 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. Hold the baby's foot firmly to avoid sudden movement. The use of a tourniquet during a venipuncture procedure makes: A. Proper patient identification MANDATORY. The most commonly used site for a venipuncture is at the bend of the elbow, also called the antecubital fossa 1. 8. therapy is usually associated with acidic or alkaline solutions or solutions that have a high osmolarity. 1. This image is not<\/b> licensed under the Creative Commons license applied to text content and some other images posted to the wikiHow website. Factitious biochemical measurements resulting from hematologic conditions. However, do not use too high a temperature warmer, because baby's skin is thin and susceptible to thermal injury. Therefore, your anchor should be gentle but firm to prevent the vein from moving away from you. Primary effect is hemoconcentration of non-filterable elements (i.e. 3. Smaller collection tubes for sample sizes of 2 mL or less may be appropriate in situations where a smaller amount blood should be drawn, as in pediatric patients, or to minimize hemolysis during collection, or to avoid insufficient sample volume in the collection tube. Children, particularly under the age of 10, may experience pain and anxiety during the phlebotomy procedure. Automated systems may include labels with bar codes. Tip: In spite of a difficult draw, remember to invert your tubes. A typical single vial contains about five milliliters, which is about one teaspoon. What caution should you observe when using a Vacutainer? var f = document.createElement("iframe"); Clin Chem Lab Med. A. But since each patient's medical condition varies, so does their veins. Giavarina D, Lippi G. Blood venous sample collection: Recommendations overview and a checklist to improve quality. {"smallUrl":"https:\/\/www.wikihow.com\/images\/thumb\/6\/68\/Troubleshoot-a-Difficult-Venipuncture-Step-1.jpg\/v4-460px-Troubleshoot-a-Difficult-Venipuncture-Step-1.jpg","bigUrl":"\/images\/thumb\/6\/68\/Troubleshoot-a-Difficult-Venipuncture-Step-1.jpg\/aid11732774-v4-728px-Troubleshoot-a-Difficult-Venipuncture-Step-1.jpg","smallWidth":460,"smallHeight":345,"bigWidth":728,"bigHeight":546,"licensing":"

\u00a9 2023 wikiHow, Inc. All rights reserved. 5. It brings the entire family Procedures and Devices for the Collection of Diagnostic Capillary Blood. In general, blood should not be drawn from an arm with a fistula or cannula without consulting the attending physician. Position the patient's arm in a comfortable extended position that provides adequate access to the planned venepuncture site. Patient care following completion of venipuncture. 1. What should you never do to a site you just cleansed with alcohol? Dispose of contaminated materials/supplies in designated containers. To prevent hemolysis (which can interfere with many tests): Mix tubes with anticoagulant additives gently 4-6 times, Avoid drawing the plunger back too forcefully, if using a needle and syringe, or too small a needle, and avoid frothing of the sample. and "What is your date of birth?". The first drop contains excess tissue fluid and must be wiped away. The content of this article is not intended to be a substitute for professional medical advice, examination, diagnosis, or treatment. 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. McCall, R. E., & Tankersley, C. M. (2016). 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.

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