\u00a9 2023 wikiHow, Inc. All rights reserved. Sharps Disposal Container. Warning: Make sure you are confident that the structure you're palpitating is indeed a vein. finger should be avoided. the 3 rd (middle) or 4 th (ring) finger of the hand. The infograph below provides a detailed description of the venipuncture steps as found in our how to draw blood resource. Watch for formation of a hematoma. Arteries pulsate, are very elastic, and have a thick wall. Summarize the problems that may be encountered in accessing a vein, including the procedure to follow when a specimen is not obtained. The dorsal venous network is the next most common vein site for phlebotomists. 9. All of the following are common types of equipment used for venipuncture EXCEPT: Make sure the venipuncture site is dry before proceeding with draw. Label the specimens before leaving the patients bedside. A requisition form must accompany each sample submitted to the laboratory. Back the needle out until the bevel is just below the skin. -use a smaller gauge needle Subcutaneous tissue feels squishy and muscle feels hard. By holding the needle either by the plastic wings or the hub, phlebotomists can achieve a shallower angle, typically 10-15 degrees. 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. Identify the additive, additive function, volume, and specimen considerations to be followed for each of the various color coded tubes. The median cubital creates, The dorsal venous network is the next most common vein site for phlebotomists. Wipe away the first drop of blood with a sterile 22 gauze. Patches of purple or yellow may suggest bruising after a recent venipuncture. A test that has been ordered may be cancelled due to problems unrelated to drawing the specimen, and these are the most common causes for cancellations: A test may be cancelled due to a technical problem in the specimen collection process: Identification of the specimen is suspect. D. after needle removal, When drawing blood you should always follow universal ______ The performance of routine vascular access procedures by skilled phlebotomists requires, at a minimum, the use of gloves to prevent contact with blood. The first attempt is the antecubital fossa area, starting with the median cubital vein, then the cephalic vein, and the basilic vein. -tourniquet Provide for their comfort as much as possible, and gain the patient's cooperation. 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. Clean up any blood spills with a disinfectant such as freshly made 10% bleach. Have the patient position their arm on the armrest. Have the patient hold a small gauze pad over the puncture site for a couple of minutes to stop the bleeding. Dry the cleaned area with a dry cotton sponge. https://www.osha.gov/laws-regs/standardinterpretations/2007-10-26 and https://www.osha.gov/OshDoc/data_BloodborneFacts/bbfact03.pdf (Accessed June 13, 2022). He holds a Diploma in Medical Laboratory Assistance and is certified under the British Columbia Society of Laboratory Science. What Is Venipuncture? Drawing blood for laboratory analysis is most often a routine and uneventful procedure. Cleanse the heel with alcohol prep, then dry with a sterile 22 as alcohol can influence testresults. 3. -use correct angle of needle insertion -antiseptic swabs A. given to the patient }, false); List several effects of exercise, posture, and tourniquet application upon laboratory values. What are the complications that can occur when performing a venipuncture? 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. Collect drops of blood into the collectiondevice by gently massaging the finger. catheter size for the vein, or prolonged use of the same I.V. Gloves - can be made of latex, rubber, vinyl, etc. 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. The antecubital fossa is a collection of veins located within the arm's inner area, opposite of the elbow, where the arm folds in. 2. followed pre-lab instructions. When using a syringe avoid drawing the plunger back too forcefully. 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. It doesn't matter . Precautions include a medical grade face mask. Avoid previous hematoma (draw distal of hematoma) The use of a tourniquet during a venipuncture procedure makes: The most common site(s) for the venipuncture procedure is/are the following: The tourniquet should not be left on a patient more than 1 minute when performing a venipuncture because it is uncomfortable and causes: The needle should always be inserted at the puncture site with the: The correct needle position for a venipuncture is a ______ degree angle with the bevel facing _____. Hematoma - may cause erroneous test results. Look at the dorsum of the hand as a last resort. Do not obtain specimens from an arm having a cannula, fistula, or vascular graft. diet, exercise, stress, basal state). Avoid a probing, traumatic venipuncture. Avoid excessive pressure that may squeeze tissue fluid into the drop of blood. 9. Adapted from Phlebotomy for Nurses and. As a countermeasure, phlebotomists anchor the vein with their hand to stabilize it for the draw. wikiHow, Inc. is the copyright holder of this image under U.S. and international copyright laws. Automated systems may include labels with bar codes. 7. When would you use a butterfly/infustion set? Allow another large drop of blood to form. 8. Diurnal Rhythms: Diurnal rhythms are body fluid and analyte fluctuations during the day. (a) How would you prepare tetracaine from the corresponding aniline derivative, ArNH2_22? Unlike the cephalic and basilic veins, the median cubital vein is not near major nerves or arteries. Notify your supervisor or patientsphysician if unsuccessful. Second - coagulation tube (light blue top). 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. 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. 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. Remove your gloves and wash your hands. While this may be effective in some difficult draws, the risk of a needlestick injury is higher if the patient has a withdrawal reflex and the needle recoils back into your finger. Answer. 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 phlebotomist, it is critical to know which vein sites offer stable flows for blood draws. 6. Follow institution's guidelines regarding treatment and follow-up. Pediatric Pointers. Center for Phlebotomy Education, Inc. Ernst, Dennis J. and Catherine Ernst. An example of a simple requisition form with the essential elements is shown below: A properly labeled sample is essential so that the results of the test match the patient. Collect drops of blood into the collection device by gently massaging the finger. 2. The upper extremity on the side of a previous mastectomy - test results may be affected because of lymphedema. 4. Additionally, a hematoma may compress the nerve and lead to long-term damage. 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. Foot veins are a last resort because of the higher probability of complications. Extremity is edematous. 2009 Feb;131(2):195-204. 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. B. evacuated tube Using the smallest acceptable needle size can help reduce the risk of bleeding or hematoma . Remove the first glove so that it turns inside out during removal A phlebotomy technician is preparing to dispose of contaminated sharps. Antiseptic. A key element for successful venipuncture is choosing the best vein. Hold equipment firmly and place fingers against patient's arm, using the flange for leverage when withdrawing and inserting tubes. 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?". -test tubes Identify the patient. Regardless of the source of payment, request and receive an itemized and detailed explanation of the total bill for services rendered in the hospital. Select the proper approved lancet: The BD Microtainer Contact-Activated. After the needle selection, phlebotomists begin to look and feel for a viable vein. 1. This image may not be used by other entities without the express written consent of wikiHow, Inc.
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