what sites should be avoided when performing venipuncture quizlet

\u00a9 2023 wikiHow, Inc. All rights reserved. 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. Thrombosed veins lack resilience, feel cord-like, and roll easily. 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). 5. PST (light green top). The median cubital creates, The dorsal venous network is the next most common vein site for phlebotomists. 2011-2023 Phlebotomy Coach. Have the patient hold a small gauze pad over the puncture site for a couple of minutes to stop the bleeding. Foot veins are a last resort because of the higher probability of complications. Dry the cleaned area with a dry cotton sponge. Other Factors: Age, gender, and pregnancy have an influence on laboratory testing. Specimens; Approved StandardSixth Edition. Wipe away the first drop of blood with sterile 22 gauze. Tip: When using a butterfly and sodium citrate is the first to be collected in the order of draw, a discard tube must always be filled first to purge the air from the tubing. Stop the procedure and remove the needle if: Thanks to all authors for creating a page that has been read 43,712 times. What are some of the reasons to draw blood? World Health Organization. iframe.style.height = zf_ifrm_ht_nw; wikiHow, Inc. is the copyright holder of this image under U.S. and international copyright laws. Phelan MP, Reineks EZ, Berriochoa JP, Schold JD, Hustey FM, Chamberlin J, Kovach A. Wikipedia. Contaminated surfaces must be cleaned with freshly prepared 10% bleach solution. -test tubes Adhesive bandages / tape - protects the venipuncture site after collection. Tourniquet - Wipe off with alcohol and replace frequently. What is the procedure to draw blood from an arm with an IV in it? 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. This seats the bevel into the lumen of the vein, and is also the technique used to insert an IV catheter. Select a vein other than the one with the IV. What should you never do to a site you just cleansed with alcohol? Kiechle FL. Use a butterfly to compensate for patient movement. -cotton sponges 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. However, if there is no alternative and an arm with an IV line in place must be used for venipuncture, try to choose a site away from and below the location of the IV. www.mlo-online.com is using a security service for protection against online attacks. D. Blue, Which of the following conditions should prevent a site from being selected for venipuncture? Consider three elements with the following abbreviated electron configurations: X=[Ar]4s23d5Y=[Ar]4s23d104p1Z=[Ar]4s23d104p6\mathrm{X} = \mathrm{[Ar]4s^23d^5}~~~\mathrm{Y}=\mathrm{[Ar]4s^23d^{10}4p^1}~~~\mathrm{Z}=\mathrm{[Ar]4s^23d^{10}4p^6} Fill the capillary tube(s) or micro collection device(s) as needed. Allow thefinger to dry or wipe dry with a sterile 22 gauze. Arteries pulsate, are very elastic, and have a thick wall. If multiple blood samples are to be taken, the phlebotomist must be careful to follow the proper order of draw. Label all specimens per accepted guidelines. A key element for successful venipuncture is choosing the best vein. -18, 20, 22 gauge needles. If the blood flow is diminished, repeat the capillary PUNCTURE to complete the collection. Specimens from infants under the age of 6 months are typically collected by heelstick. 7. Adjust the angle (the bevel may be against the vein wall). C. placed in the sharps container var zf_ifrm_ht_nw = ( parseInt(zf_ifrm_data[1], 10) + 15 ) + "px"; (Partial penetration may allow blood to leak into the soft tissue surrounding the vein by way of the needle bevel). Avoid excessive pressure that may squeeze tissue fluid into the, mix the blood. A clinical study is performed to determine the optimal time for application of the tourniquet during phlebotomy. What are the red top containers used for? Some examples of these include notices from banks, online retailers such as Amazon or eBay, and even . Clin Lab. Contains acid citrate dextrose. Re-anchor the vein. How many time should you invert them? You will be redirected once the validation is complete. B. collection device 2006;52(5-6):217-30. Impact of Use of Smaller Volume, Smaller Vacuum Blood Collection Tubes on Hemolysis in Emergency Department Blood Samples. 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. Label all specimens per accepted guidelines. The antecubital fossa is a collection of veins located within the arm's inner area, opposite of the elbow, where the arm folds in. Pediatric Pointers. Center for Phlebotomy Education, Inc. Ernst, Dennis J. and Catherine Ernst. (function() { 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. What is the most common site for blood sampling? Edematous extremities - tissue fluid accumulation alters test results. Clin Chem Lab Med. 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. 3. Place labeled specimens in zip lock bag and deliver to the laboratory as soon as possible. Mastering Pediatric Phlebotomy. Center, for Phlebotomy Education, Inc. Palpate and trace the path of veins with the index finger. try{ Stop the procedure if a hematoma occurs. The thumb has a pulse and is likely to bleed excessively. Collect drops of blood into the collectiondevice by gently massaging the finger. -do not rapidly insert the needle. Tip: BD Vacutainer tubes use a translucent stopper to identify short draw variants. Observe universal (standard) safety precautions. wikiHow, Inc. is the copyright holder of this image under U.S. and international copyright laws. 7. Contains lithium heparin anticoagulant and a gel separator. Have the patient make a fist and flex the arm, which helps engorge muscles to fill veins. Any microtainerscontaining additives should be tapped to dislodge additives from the walls and top. The service requires full JavaScript support in order to view this website. Psychological interventions for needle-related procedural pain and distress in children and adolescents. Using the requisition for reference, ask a patient to provide additional information such as a birthdate. Children, particularly under the age of 10, may experience pain and anxiety during the phlebotomy procedure. Green Syringes - may be used in place of the evacuated collection tube for special circumstances. An assortment of needles and syringes of different sizes Tourniquet Alcohol and alcohol swabs Gauze or cotton balls Laboratory forms and blood-specimen labels Transportation bags and sharps container Step 2: Prepping The Patient Once you have the necessary supplies, it's time to ready the patient. Hold equipment firmly and place fingers against patient's arm, using the flange for leverage when withdrawing and inserting tubes. Firmly grasp the flanges of the tube holder to avoid advancing the needle further into the vein as you change tubes. Apply the tourniquet below the IV site. -tourniquet Do not use the tip of the finger or the center of the finger. 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. Needles are available for evacuated systems and for use with a syringe, single draw or butterfly system. Blood is commonly obtained from the median cubital vein on the anterior forearm. 3. It is large and near the skins surface, making it easier for phlebotomists to see before anchoring the vein. If another site is not available, collect the specimen distal to the hematoma. Position the patient so that the hand is easily accessible. D. it is wiped with alcohol, Venipuncture at sites with each of the following could effect the results EXCEPT: Avoid previous hematoma (draw distal of hematoma) -thrombosis Preanalytical phase of the testing process begins for the laboratory when a: Test is ordered by a patient's physician. This is a general guide for troubleshooting a venipuncture scenario in which blood flow is not initially established upon needle insertion. Loosen the tourniquet. Contains a gel separator and clot activator. Assess the need for sample recollection and/or rejection. Most commonly, venipuncture will be performed on the Antecubital Fossa, or the inside of the elbow. Not making it mobile friendly. Because most laboratory specimens contain bacteria, it is not necessary to wash hands before collecting them, The tourniquet applied prior to venipuncture is removed: The most common complications are bleeding at the puncture site or hematoma formation. the chlorhexidine residue before tying a piece of gauze around the foot. Procedure for Capillary Puncture of the Finger: The best site for a finger puncture is just off the center of the finger pad of. Patient identification is critical for safety. 4. Needles should be placed in a proper disposal unit IMMEDIATELY after their use. advantageous in certain adult populations, such as: those with severe burns, obese patients, those with thrombotic tendencies, and for point-of-care testing, when a small volume of blood is needed. 4. window.addEventListener('message', function (){ Blindly maneuvering the needle within the skin is painful to the patient and you run the risk of hitting a nerve, tendon, or artery. 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. Interruptions and distractions during medical encounters and procedures should be avoided. Serum red top or amber tube with red top. D. 70% isopropyl alcohol. Also consider adjusting the angle of the needle. 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. Identification errors in pathology and laboratory medicine. Approach the patient in a friendly, calm manner. Fill the microtainer tube(s) as needed. 1. 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. 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. Determine the final temperature of the R-134a and the final specific internal energy. It may be obstructing blood flow. Hematoma formation is a problem in older patients. Sanders AM, Agger WA, Gray AM, Fischer CM, Kamprud EA. Allow to air dry. If a patient has an IV giving them fluids in their right arm which arm should be your first choice to draw blood out of? The puncture should be made perpendicular to the ridges of the fingerprint so that the drop of blood does not run down the ridges. Wipe away the first drop of blood with a sterile 22 gauze. Additionally, blood samples should not be taken on an arm with a fistula used for dialysis treatments. Blood should NEVER be poured from one tube to another since the tubes can have different additives or coatings (see illustrations at end). therapy is usually associated with acidic or alkaline solutions or solutions that have a high osmolarity. Allow another large drop of blood to form. Position the infant with the head slightly elevated. (See, The chlorhexidine is a concern for the premature babies in NICU as it can, be absorbed through the skin. By signing up you are agreeing to receive emails according to our privacy policy. Press down on the gauze once the needle is out of the arm, applying adequate pressure to avoid formation of a hematoma. 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. D. mandates, The most common antiseptic used in venipuncture is: Collect drops of blood into the collectiondevice by gently massaging the heel. Therefore, your anchor should be gentle but firm to prevent the vein from moving away from you. www.mlo-online.com is using a security service for protection against online attacks. 2017;50(10-11):568-573. How should you have the patient position their arm after the venipuncture is complete? Avoid excessive probing ("fishing"). Mix and label all appropriate tubes at the patient bedside. (Uman et al, 2013). 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. Intravenous therapy (IV) / blood transfusions - fluid may dilute the specimen, so collect from the opposite arm if possible. Most reference ranges are based on normal laboratory test values for: Healthy people in a basal state. C. laws Various sizes are available. Even if several vials of blood have to be drawn it usually amounts to no more than one ounce. 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. Because of contacts with sick patients and their specimens, it is important to follow safety and infection control procedures. Certain other sites should also be avoided. Such terms as "needs to," "must," "require" and "should" are used to explain how medical professionals should perform capillary blood collection procedures. Clinical and Laboratory Standards Institute. Finger - Usually the third or fourth finger is preferred in adults and children. Allow it to air, Grasp the finger, and using a sterile lancet, press firmly against the finger. If an IV is in place, samples may be obtained below but NEVER above the IV site. Puncture no deeper than 2.4mm (approximately 0.1 inches). We use cookies to make wikiHow great. Preferred venous access sites, and factors to consider in site selection, and ability to differentiate between the feel of a vein, tendon and artery. 3. Avoid a probing, traumatic venipuncture. Blood clots, and the serum is separated by centrifugation, Chemistries, Immunology and Serology, Blood Bank (Crossmatch), Serum separator tube (SST) contains a gel at the bottom to separate blood from serum on centrifugation, Plasma Separating Tube (PST) with Lithium heparin, Anticoagulates with lithium heparin; Plasma is separated with PST gel at the bottom of the tube, Hematology (CBC) and Blood Bank (Crossmatch); requires. Step 3: Venipuncture. It is observed that if the tourniquet is left on longer than 2 minutes, changes in the value of a total protein test occur. Unlike the cephalic and basilic veins, the median cubital vein is not near major nerves or arteries. The line must be flushed first. Normal reference ranges are often noted according to age. Identify the patient. When using a syringe and needle, avoid drawing the plunger back too forcibly. To request course information, contact PhlebotomyU today. This image may not be used by other entities without the express written consent of wikiHow, Inc.
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