what sites should be avoided when performing venipuncture quizletwhat sites should be avoided when performing venipuncture quizlet

Therefore, your anchor should be gentle but firm to prevent the vein from moving away from you. (2017). What two things should you make sure you discuss with your patients prior to venipuncture? 9. Choosing an appropriate site for venipuncture is crucial for a successful . A tin can containing air is sealed. Wayne, PA: Clinical and Laboratory Standards Institute; 2008. Ernst, Dennis J. This makes every subsequent poke harder and harder because scar tissue is more fibrous and tougher to puncture. The infograph below provides a detailed description of the venipuncture steps as found in our how to draw blood resource. Not making it mobile friendly. C. Iodine This complication of peripheral I.V. (b) How would you prepare tetracaine from p-nitrobenzoic acid? 5. PROBLEMS OTHER THAN AN INCOMPLETE COLLECTION: A hematoma forms under the skin adjacent to the puncture site - release the tourniquet immediately and withdraw the needle. Use of hair nets and face masks to decrease blood culture contamination rates. How can you tell if you are palpating a vein? 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. 10. While venipuncture is considered to be reasonably safe, the present study investigated the incidence of serious complications occurring in an outpatient setting. A. given to the patient Expect that any discussion or consultation involving the patient's case will be conducted discretely and that individuals not directly involved in the case will not be present without patient permission. Interruptions and distractions during medical encounters and procedures should be avoided. Avoid excessive pressure that may squeeze tissue fluidinto the drop of blood. To determine the best vein, use both sight and touch. Dispose of contaminated materials in appropriate waste receptacles. As a phlebotomist, it is critical to know which vein sites offer stable flows for blood draws. B. above an IV line Which element has the highest ionization energy? Avoid a probing, traumatic venipuncture. It is large and near the skins surface, making it easier for phlebotomists to see before anchoring the vein. Take enough time to assess the vein before beginning the venipuncture procedure. There are some slight risks associated with venipuncture which may include excessive bleeding, feeling light-headed, fainting, nerve damage, hematoma (accumulation of blood under the skin), and infection. iframe.style.height = zf_ifrm_ht_nw; There may be no vacuum in the tube being used. With risk for blood spatter a face shield provides protection. Ask the patient orcaregiver to state the patients name and date of birth. 2011-2023 Phlebotomy Coach. What are the gold top containers used for? For a detailed breakdown of each step of the venipuncture test scroll down. 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. Blood is commonly obtained from the median cubital vein on the anterior forearm. 7. Obtain from the practitioner complete and current information about diagnosis, treatment, and any known prognosis, in terms the patient can reasonably be expected to understand. Properly fill out appropriate requisition forms, indicating the test(s) ordered. A lab coat or gown must be worn during blood collection procedures. When wearing gloves, change them between each patient and wash your hands frequently. *NEVER BEND THE ARM*. This image is not<\/b> licensed under the Creative Commons license applied to text content and some other images posted to the wikiHow website. Allsurfaces are cleaned daily with bleach. therapy is usually associated with acidic or alkaline solutions or solutions that have a high osmolarity. B. precautions 3. 2. followed pre-lab instructions. What are the best veins for venipuncture? Venipuncture (sometimes referred to as venapuncture, venepuncture or even venu puncture) is the collection of blood from a vein which is usually done for laboratory testing. The first drop contains excess tissue fluid and must be wiped away. A. standards The rubber stoppers are color coded according to the additive that the tube contains. 70% isopropyl alcohol The hydrostatic pressure causes some water and filterable elements to leave the extracellular space. Look for visual clues which may help assess the patient's condition. A. Syringe What are the complications that can occur when performing a venipuncture? Always thank the patient and excuse yourself courteously when finished. 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} Hold the baby's foot firmly to avoid sudden movement. 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. 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. Verify the patient's condition. 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. However, drawing blood from the hand is affiliated with higher levels of pain and less control. 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. 6. Phlebotomists are considered to have occupational exposure to blood borne pathogens. 8. The most common complications are bleeding at the puncture site or hematoma formation. Uman LS, Birnie KA, Noel M, et al. 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. 2. C. placed in the sharps container 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. Tetracaine is a substance used as a spinal anesthetic. Back the needle out until the bevel is just below the skin. Apply an adhesive bandage. D. Blue, Which of the following conditions should prevent a site from being selected for venipuncture? Avoid excessive pressure that may squeeze tissue fluid into the drop of blood. 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. 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. Phlebitis is inflammation of a vein. wikiHow, Inc. is the copyright holder of this image under U.S. and international copyright laws. Giavarina D, Lippi G. Blood venous sample collection: Recommendations overview and a checklist to improve quality. What caution should you observe when using a Vacutainer? In general, blood should not be drawn from an arm with a fistula or cannula without consulting the attending physician. While most patients veins are compatible with a standard needle gauge, others require a. . 3. The patient who is at ease will be less focused on the procedure. 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. Safely dispose of potentially infectious materials. 5. Never draw blood through a hematoma. While most patients veins are compatible with a standard needle gauge, others require a butterfly needle. Wipe away the first drop of blood with a piece of clean, dry cotton. Using a sterile blood lancet, puncture the side of the heel in the appropriate regions shown above in green. Please enable cookies on your browser and try again. var zf_perma = zf_ifrm_data[0]; 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. 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. The first step to choosing the right vein is to select the appropriate needle gauge. Blood collection tubes must be drawn in a specific order to avoid cross-contamination of additives between tubes. CLSI document H04-A6. Perform the venipuncture. Wait 2 minutes before reapplying the tourniquet. Dispose of contaminated materials/supplies in designated containers. Dorsal hand veins are often utilized for intravenous infusions but are viable options for blood draw sites. This article has been viewed 43,712 times. 7. Follow institution's guidelines regarding treatment and follow-up. Normal reference ranges are often noted according to age. -18, 20, 22 gauge needles. Never draw from a thrombosed or scarred vein. 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. The patient should make a fist without pumping the hand. The median cubital creates less bruising and pain than other draw sites. Confidentiality of all communications and other records pertaining to the patient's care. Specimens; Approved StandardSixth Edition. 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. 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. Adapted from Phlebotomy for Nurses and. 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. For an inpatient the nursing staff can be contacted to aid in identification prior to proceeding. The median cubital vein and the cephalic vein in the wrist area should be avoided when possible. Make certain that the blood completely saturates all four (4) circles and is visible from bothsides. A typical single vial contains about five milliliters, which is about one teaspoon. and "What is your date of birth?". Greet the patient and identify yourself and indicate the procedure that will take place. Am J Clin Pathol. Let's take a look at the types of websites you and your staff need to be wary of and how to avoid them. 9. Areas of fingers and heels that are cold, swollen, scarred or covered with a rash, should be avoided. (c) the rate of heat transfer. Avoid excessive pressure that may squeeze tissue fluid into the, mix the blood. Patient care following completion of venipuncture. Drawing blood from major vessels (e.g. Expect reasonable safety congruent with the hospital practices and environment. What sites should be avoided when drawing blood? A face mask reduces risk for blood culture specimen contamination. Effects of Exercise: Muscular activity has both transient and longer lasting effects. This process is automatic. Reasonable informed participation in decisions involving the patient's health care. The line must be flushed first. Never draw above an IV site. What are the light blue top containers used for? Primary effect is hemoconcentration of non-filterable elements (i.e. In this elbow pit, phlebotomists have easy access to the top three vein sites used in phlebotomy: Median cubital vein. Which of the following is the most likely mechanism for alteration in protein values in this situation? Significant increases can be found in total protein, aspartate aminotransferase (AST), total lipids, cholesterol, iron, Affects packed cell volume and other cellular elements. Allow it to air, Grasp the foot, and using a sterile lancet, press firmly against the heel to, Collect the drops of blood into the collection device by gently squeezing, the foot. If the patient is sitting in a phlebotomy chair, make sure they are sitting upright with their back against the chair. if ( prevIframeHeight != zf_ifrm_ht_nw ) { Phlebitis can also occur as a result of vein trauma during insertion, use of an inappropriate I.V. jugular) or a central venous catheter is out of the scope of practice of a certified phlebotomist and should only be performed by a physician or advanced nurse. 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. Some examples of these include notices from banks, online retailers such as Amazon or eBay, and even . The median cubital vein is used the most for its accessibility. PhlebotomyU offers Certified Phlebotomy Technician (CPT I) courses for aspiring phlebotomists. Look at the dorsum of the hand as a last resort. }, false); Also consider adjusting the angle of the needle. Place a pillow under the patient's arm if additional support is needed. wikiHow, Inc. is the copyright holder of this image under U.S. and international copyright laws. This image is not<\/b> licensed under the Creative Commons license applied to text content and some other images posted to the wikiHow website. Basilic vein. Venipuncture (sometimes referred to as venapuncture, venepuncture or even venu puncture) is the collection of blood from a vein which is usually done for laboratory testing. 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. Journal of Exotic Pet Medicine. var zf_ifrm_ht_nw = ( parseInt(zf_ifrm_data[1], 10) + 15 ) + "px"; 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. This image may not be used by other entities without the express written consent of wikiHow, Inc.
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\n<\/p><\/div>"}, 7 Easy Ways to Figure Out Your Blood Type (With or Without a Test). What is the best position to perform venipuncture in? Sanders AM, Agger WA, Gray AM, Fischer CM, Kamprud EA. Clin Biochem. Clinical and Laboratory Standards Institute. If multiple blood samples are to be taken, the phlebotomist must be careful to follow the proper order of draw. Warning: Do not make lateral (side-to-side) movements with the needle. Re-anchor the vein. BD Vacutainer), rather than IV catheter insertions. The first step to choosing the right vein is to select the appropriate needle gauge. These items include: Always wear a clean lab coat or gown. This image is not<\/b> licensed under the Creative Commons license applied to text content and some other images posted to the wikiHow website. Phlebotomy Essentials 5th Edition Chapter 9. How should you have the patient position their arm after the venipuncture is complete? The essential elements of the requisition form are: Patient's surname, first name, and middle initial. Avoid UE on same side of mastectomy (lymphedema) What is the most common site for blood sampling? Re-secure the tourniquet to increase venous filling. This guide follows the steps as outlined in the World Health Organizations Guidelines on Drawing Blood: Best Practices in Phlebotomy. Previous puncture sites should be avoided. The use of a tourniquet during a venipuncture procedure makes: A. Am J Clin Pathol. A. wikiHow, Inc. is the copyright holder of this image under U.S. and international copyright laws. This is very painful, risks damage to underlying structures, and widens the needle hole to prolong bleeding time. When multiple vials of blood are collected it can seem like a large amount. 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. Change your approach when dealing with uncooperative patients, such as pediatrics and those with neurodevelopmental or psychiatric disorders. Concentrations of fluids and medications could affect baseline test results. var iframe = document.getElementById("zf_div_SBGg-3DTNCwt65i9A6n_zU3SneyGD89SSqM_7F_nCas").getElementsByTagName("iframe")[0]; wikiHow is where trusted research and expert knowledge come together. A. If possible, speak with the patient during the process. This vein can be found along the upper arm to the thumb, but it is commonly drawn from the forearm or antecubital fossa area. D. after needle removal, When drawing blood you should always follow universal ______ Airborne precautions may be considered to provide a level of safety against infectious diseases such as tuberculosis, influenza, and COVID-19. Diagn Microbiol Infect Dis. 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. (Uman et al, 2013). If you stick yourself with a contaminated needle: Remove your gloves and dispose of them properly. All rights reserved. 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. Drawing blood for laboratory analysis is most often a routine and uneventful procedure. Erroneous test results may be obtained when the blood is not thoroughly mixed with the additive. C. Lancet Posture: Postural changes (supine to sitting etc.) This image is not<\/b> licensed under the Creative Commons license applied to text content and some other images posted to the wikiHow website. wikiHow, Inc. is the copyright holder of this image under U.S. and international copyright laws. The area where the blood is to be drawn from is first cleaned with a germ-killing solution. var evntData = event.data; (function() { 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. Hold a gauze pad over the puncture site for a couple of, minutes to stop the bleeding, and then tie gauze around the foot. The patient should either sit in a chair, lie down or sit up in bed. The equipment used during the venipuncture test can vary, but the following are most commonly used for routine venipuncture: Phlebotomists may choose to draw blood from several different sites of the body. Mix and label all appropriate tubes at the patient bedside. Syringes - may be used in place of the evacuated collection tube for special circumstances. wikiHow, Inc. is the copyright holder of this image under U.S. and international copyright laws. Get instant access to our latest tools and our must-read site updates: What Certifications Are Used For Higher Pay For Phlebotomists? Position the patient's arm in a comfortable extended position that provides adequate access to the planned venepuncture site. 11. Cleanse the fingertip of the 3rd (middle) or 4th (ring) finger with an alcohol prep. -antiseptic swabs You may also remove the tube, wait a few seconds for blood flow to resume, and then engage a short drawtube. In some instances, the legs or feet are required for use, but a physician or doctor should be completing the draw, not a phlebotomist. Stabilize the needle as you're inserting your tubes. The blood is bright red (arterial) rather than venous. Apply blood to the printed side of the filter paper. Nursing Personnel. Avoid excessive pressure that may squeeze tissue fluidinto the drop of blood. Holder/Adapter - use with the evacuated collection system. B. the needle is inserted into the patient's arm If another site is not available, collect the specimen distal to the hematoma. Make the cut across the heelprint lines so that a drop of blood can well up and not run down along the lines. A thin soap bubble of index of refraction 1.33 is viewed with light of wavelength 550.0 nm and appears very bright. var prevIframeHeight = iframe.style.height; -test tubes Gauze sponges - for application on the site from which the needle is withdrawn. Thrombosed veins lack resilience, feel cord-like, and roll easily. The needle should form a 15 to 30 degree angle with the surface of the arm. After assembling the appropriate equipment, follow the next steps to perform a proper venipuncture. 2006;52(5-6):217-30. Order of draw for multiple tube phlebotomy. Place labeled specimens in zip lock bag and deliver to the laboratory as soon as possible. Check the requisition form for requested tests, patient information, and any special requirements. 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. Edematous extremities - tissue fluid accumulation alters test results. It is large and near the skins surface, making it easier for phlebotomists to see before anchoring the vein. As a countermeasure, phlebotomists anchor the vein with their hand to stabilize it for the draw. Serum iron levels tend to drop during the day. 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. The basic patient rights endorsed by the JCAHO follow in condensed form are given below. A commercial heel warmer may be used. 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. When using a syringe and needle, avoid drawing the plunger back too forcibly. outstretched or raised When working with patients who have undergone a mastectomy, draw from the arm on the opposite side of the mastectomy to avoid edematous tissue. Answer. Squeeze puncture site to promote bleeding. Hematoma - may cause erroneous test results.
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