\u00a9 2023 wikiHow, Inc. All rights reserved. 11. Certain larger molecules are not filterable into the tissue, therefore they are more concentrated in the blood. Other Factors: Age, gender, and pregnancy have an influence on laboratory testing. 1. 8. This article has been viewed 43,712 times. Be methodical in your search for a vein. This image is not<\/b> licensed under the Creative Commons license applied to text content and some other images posted to the wikiHow website. Wait 2 minutes before reapplying the tourniquet. 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. What equipment is needed for a venipuncture? 2017;50(10-11):568-573. Ernst, Dennis J. Loosen the tourniquet. Lippi G, Salvagno GL, Montagnana M, Franchini M, Guidi GC. The fluid may dilute the specimen, so collect from the opposite arm. 1. Povidone-iodine wipes/swabs - Used if blood culture is to be drawn. % of people told us that this article helped them. If none of these veins work, then the phlebotomists use the hand veins. A tin can containing air is sealed. containers. Avoid trauma and excessive probing. 2017;148(4):330-335. If this is not successful, remove the needle, take care of the puncture site and redraw at another site. wikiHow, Inc. is the copyright holder of this image under U.S. and international copyright laws. A. given to the patient Puncture no deeper than 2.4mm (approximately 0.1 inches). You will be redirected once the validation is complete. 9. C. Iodine Label all specimens per accepted guidelines. Wikipedia. (b) How would you prepare tetracaine from p-nitrobenzoic acid? Do not place too tightly or leave on more than 2 minutes (and no more than a minute to avoid increasing risk for hemoconcentration). Staying safe online: Avoid these types of websites - USWired How To Draw Blood | Phlebotomy Coach The blood is normally drawn from a vein on the top of the hand or from the inside of the elbow. You should not perform this technique unless you are certain that the needle is in the immediate vicinity of the vein. 8. Using a sterile lancet, puncture the fingertip in the fleshy part of the finger, slightly to the sideof the center and across (perpendicular to) the grooves of the fingertip. antecubital fossa What are the best veins for venipuncture? Since newborns do not often bleed immediately, use gentle pressure to produce a rounded drop of blood. Contains a gel separator and clot activator. Have the patient make a fist and flex the arm, which helps engorge muscles to fill veins. Hematoma formation is a problem in older patients. window.addEventListener('message', function (){ (b) the power developed by the output shaft. Specimen Collection Procedure - PERFORMING A VENIPUNCTURE | Akron 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. Posture: Postural changes (supine to sitting etc.) Avoid excessive pressure that may squeeze tissue fluid into the, mix the blood. IF AN INCOMPLETE COLLECTION OR NO BLOOD IS OBTAINED: Change the position of the needle. B. evacuated tube Edematous extremities with swollen tissue alter the results. Whole blood specimens may not be able to be analyzed if microscopic clots are present. 5. Avoid a probing, traumatic venipuncture. 10. Have the patient hold a small gauze pad over the puncture site for a couple of minutes to stop the bleeding. Sites to avoid: Extensive scarring from burns or surgery The upper extremity on the side that a mastectomy was performed. Additionally, blood samples should not be taken on an arm with a fistula used for dialysis treatments. What are some of the reasons to draw blood? 2. Remove the needle from the patient's arm using a swift backward motion. 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. Collect drops of blood into the collectiondevice by gently massaging the finger. Because of contacts with sick patients and their specimens, it is important to follow safety and infection control procedures. 2009;47(2):143-53. Phlebitis can also occur as a result of vein trauma during insertion, use of an inappropriate I.V. If this is not successful, remove the needle, take care of the puncture site, and redraw. The antecubital fossa is a collection of veins located within the arms inner area, opposite of the elbow, where the arm folds in. What is the most common complication of venipuncture? Apply blood to the printed side of the filter paper. B. the needle is only partially in the vein Asking the patient about their previous blood draw experiences is beneficial, especially if they are a hard stick and know which area works best. Hematoma - may cause erroneous test results. 12. outstretched or raised Effective communication - both verbal and nonverbal - is essential. Hematoma - A venipuncture should not be performed on a hematoma, regardless of how small it may be. Avoid areas of hematoma. f.style.width="100%"; Press down on the gauze once the needle is out of the arm, applying adequate pressure to avoid formation of a hematoma. Enzymes, proteins, lipids, iron, and calcium are significantly increased with changes in position. Collect drops of blood into the collectiondevice by gently massaging the heel. Certain other sites should also be avoided. 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. Once again, please be aware that these are only guidelines for blood draws and nurses should consult with the appropriate hospital personnel regarding performing this procedure on patients. All rights reserved. Follow the same procedure as for performing a finger, Order of Draw for a Capillary Puncture: Proper collection of tubes when. EDTA and sodium citrate tubes should still be filled to the marked fill line to ensure a correct blood-to-additive ratio. Allow another large drop of blood to form. 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. var zf_ifrm_data = evntData.split("|"); The first step to choosing the right vein is to select the appropriate needle gauge. 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. ; worn to protect the patient and the phlebotomist. diet, exercise, stress, basal state). Contains lithium heparin anticoagulant and a gel separator. 13. Avoid excessive pressure that may squeeze tissue fluid into the drop of blood. All of the following are common types of equipment used for venipuncture EXCEPT: Some examples of these include notices from banks, online retailers such as Amazon or eBay, and even . A. the tubes are filled and properly labeled Never draw blood through a hematoma. Scan the skin for lines of blue indicating a prominently visible vein. Using the requisition for reference, ask a patient to provide additional information such as a birthdate. Preanalytical phase of the testing process begins for the laboratory when a: Test is ordered by a patient's physician. Perform the venipuncture. 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. Free Flashcards about Phlebotomy Chapter 9 - StudyStack wikiHow, Inc. is the copyright holder of this image under U.S. and international copyright laws. Tip: Patients who need regular bloodwork (e.g. B. the insertion site has stopped bleeding Provide for their comfort as much as possible, and gain the patient's cooperation. A requisition form must accompany each sample submitted to the laboratory. 1. previous experience with vomiting or fainting Over 52 percent of all web traffic is from mobile devices . A needle is then gently inserted into the vein. Blood samples drawn from an IV line should be documented and analyzed with care. Discarding the first set minimizes the effects of any potential additive contamination. finger should be avoided. For an inpatient the nursing staff can be contacted to aid in identification prior to proceeding. If the patient is sitting in a phlebotomy chair, make sure they are sitting upright with their back against the chair. We use cookies to make wikiHow great. 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. The first attempt is the antecubital fossa area, starting with the median cubital vein, then the cephalic vein, and the basilic vein. Factitious biochemical measurements resulting from hematologic conditions. Top Vein Sites Used in Phlebotomy | PhlebotomyU | CPT1 Course Confidentiality of all communications and other records pertaining to the patient's care. An OSHA acceptable, puncture proof container markedBiohazardous. NOTE:Tubes with additives must be thoroughly mixed. (See, The chlorhexidine is a concern for the premature babies in NICU as it can, be absorbed through the skin. 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. HealthStar Press, Inc. 2001, updated 1/08. 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. remove needle PDF Selecting The Venipuncture Site - Yola Forward completed/dry collections to the laboratory as soon as possible. After cleansing, allow the venipuncture site to air dry. Label collection tubes after identification of the patient. Several essential steps are required for every successful collection procedure: Patient comfort. 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. 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. Wipe away the first drop of blood with a sterile 22 gauze. Copyright 2023 - PhlebotomyU | Website Design & SEO by, Phlebotomy: 5 Tips on Finding Difficult Veins. Phlebotomy NHA flashcards Flashcards | Chegg.com 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. B. Yellow The fifth finger tends to have less soft tissue overlying the bone. The thumb has a pulse and is likely to bleed excessively. In this elbow pit, phlebotomists have easy access to the top three vein sites used in phlebotomy: Median cubital vein. Label all appropriate tubes at the patient bedside. the chlorhexidine residue before tying a piece of gauze around the foot. 6. Identify the patient using two different identifiers, asking open ended questions such as, "What is your name?" C. placed in the sharps container Subcutaneous tissue feels squishy and muscle feels hard. Venepuncture Procedure - OSCE | How to Take Blood | Geeky Medics When using a syringe and needle, avoid drawing the plunger back too forcibly. 2. } 7. Which of the following is the most likely mechanism for alteration in protein values in this situation? wikiHow, Inc. is the copyright holder of this image under U.S. and international copyright laws. Filter paper should touch only the blood and not the heel or finger. 2011-2023 Phlebotomy Coach. Phlebotomy Exam Questions - TAU At least two patient identifiers, such as name and date of birth, are needed. Joslin JO. Tip: BD Vacutainer tubes use a translucent stopper to identify short draw variants. Do not obtain specimens from an arm having a cannula, fistula, or vascular graft. Concentrations of fluids and medications could affect baseline test results. Have the patient drink fluids if dehydrated. 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. The needle may have pulled out of the vein when switching tubes. It is large and near the skins surface, making it easier for phlebotomists to see before anchoring the vein. 11. f.src = 'https://forms.zohopublic.com/healthservicesacademy/form/RequestCourseInformationCPTIAccelerated/formperma/SBGg-3DTNCwt65i9A6n_zU3SneyGD89SSqM_7F_nCas?zf_rszfm=1'; var zf_ifrm_ht_nw = ( parseInt(zf_ifrm_data[1], 10) + 15 ) + "px"; This is a general guide for troubleshooting a venipuncture scenario in which blood flow is not initially established upon needle insertion. A. the plastic sleeve is removed While most patients veins are compatible with a standard needle gauge, others require a. . If multiple blood samples are to be taken, the phlebotomist must be careful to follow the proper order of draw. Drawing the patient in a reclined position. Use pillows or foam wedges to elevate the arm and help with extension. D. after needle removal, When drawing blood you should always follow universal ______ This image may not be used by other entities without the express written consent of wikiHow, Inc.
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