what sites should be avoided when performing venipuncture quizlet
Always wear a clean lab coat or gown. This is more common in humeral and femoral punctures than radial punctures. Phelan MP, Reineks EZ, Berriochoa JP, Schold JD, Hustey FM, Chamberlin J, Kovach A. The diagram below indicates in green the proper area to use for heel punctures for blood collection: Prewarming the infant's heel (42 C for 3 to 5 minutes) is important to obtain capillary blood gas samples and warming also greatly increases the flow of blood for collection of other specimens. BD Vacutainer), rather than IV catheter insertions. While venipuncture is considered to be reasonably safe, the present study investigated the incidence of serious complications occurring in an outpatient setting. avoid sites of extensive scarring (burns, surgery, injuries) the 3 rd (middle) or 4 th (ring) finger of the hand. Syringes - may be used in place of the evacuated collection tube for special circumstances. The key elements in labeling are: NOTE: Both of the above MUST match the same on the requisition form. containers. This image is not<\/b> licensed under the Creative Commons license applied to text content and some other images posted to the wikiHow website. Adjust the height and swivel the chair to ensure your body is in line with the vein. B. Yellow This guide follows the steps as outlined in the World Health Organizations Guidelines on Drawing Blood: Best Practices in Phlebotomy. Gloves are to be worn during all blood collection procedures, and changed betweenpatient collections. The most commonly used site for a venipuncture is at the bend of the elbow, also called the antecubital fossa 1. The rubber stoppers are color coded according to the additive that the tube contains. Wikipedia. Do not place too tightly or leave on more than 2 minutes (and no more than a minute to avoid increasing risk for hemoconcentration). INR for patients on warfarin) are often knowledgeable on the veins that are most likely to work. A typical single vial contains about five milliliters, which is about one teaspoon. wikiHow, Inc. is the copyright holder of this image under U.S. and international copyright laws. Concentrations of fluids and medications could affect baseline test results. Collect drops of blood into the collection device by gently massaging the finger. An outpatient must provide identification other than the verbal statement of a name. 12. The infograph below provides a detailed description of the venipuncture steps as found in our how to draw blood resource. What sites should be avoided when drawing blood? window.addEventListener('message', function (){ What can happen if you vigorously shake the tubes? -infection at site Significant increases can be found in total protein, aspartate aminotransferase (AST), total lipids, cholesterol, iron, Affects packed cell volume and other cellular elements. Some individuals are afraid of needles, while others are frightened at the sight of blood. Lines - Drawing from an intravenous line may avoid a difficult venipuncture, but introduces problems. are known to vary lab results of some analytes. You may also remove the tube, wait a few seconds for blood flow to resume, and then engage a short drawtube. When do you release the tourniquet during 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. Order of draw for multiple tube phlebotomy. 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. Do not use a previous puncture site. If blood is not obtained, change the position of the needle carefully by moving it forward or backward. 8. Occupational Safety and Health Administration, United States Department of Labor. Why? Phlebitis can also occur as a result of vein trauma during insertion, use of an inappropriate I.V. What are the contraindications to venipuncture? 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. Watch for formation of a hematoma. C. at a mastectomy site Most commonly, venipuncture will be performed on the Antecubital Fossa, or the inside of the elbow. Adhesive bandages / tape - protects the venipuncture site after collection. 5. In other words, there is no need for another venipuncture procedure. If blood stops flowing into the vacuum tube, the vein may have collapsed. Psychological interventions for needle-related procedural pain and distress in children and adolescents. 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. The blood is normally drawn from a vein on the top of the hand or from the inside of the elbow. What are the helpful hints for finding veins? Which of the following actions should the technician take? Discarding the first set minimizes the effects of any potential additive contamination. Predict a possible value of the thickness of the soap bubble. The vein may have collapsed; resecure the tourniquet to increase venous filling. 3. When the last tube to be drawn is filling, remove the tourniquet. If it is then heated, what can you say about: b) how often the molecules hit the walls of the can. Follow the same procedure as for performing a finger, Order of Draw for a Capillary Puncture: Proper collection of tubes when. and "What is your date of birth?". Phlebitis is inflammation of a vein. on patients who are extremely dehydrated or have poor peripheral circulation. 6. Posture: Postural changes (supine to sitting etc.) The fifth finger tends to have less soft tissue overlying the bone. For the CLSI Updated Phlebotomy Procedures please click here. Effects of Exercise: Muscular activity has both transient and longer lasting effects. LTD: Performing a Capillary Puncture Version 7, General Guidelines for a Capillary Puncture: Capillary punctures are ideal for, small children when only a small volume of blood is needed. 9. Have the patient position their arm on the armrest. Children, particularly under the age of 10, may experience pain and anxiety during the phlebotomy procedure. Patient care following completion of venipuncture. 2017;50(10-11):568-573. try{ Previous puncture sites should be avoided. 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. Source of specimen. However, drawing blood from the hand is affiliated with higher levels of pain and less control. The patient should make a fist without pumping the hand. B. Betadine Puncture no deeper than 2.4mm (approximately 0.1 inches). -thrombosis C. sterile gauze pads catheter size for the vein, or prolonged use of the same I.V. 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. The area where the blood is to be drawn from is first cleaned with a germ-killing solution. Remember -- the rst vein found is not always the best vein. This enables the bloodto form as a drop on the fingertip. BD Eclipse black-capped) have a smaller diameter and may be more suitable for smaller veins. Arm with fistula or cannula placement Finger - Usually the third or fourth finger is preferred in adults and children. 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. Practice hygiene for the patient's protection. wikiHow, Inc. is the copyright holder of this image under U.S. and international copyright laws. It brings the entire family Choosing an appropriate site for venipuncture is crucial for a successful . Draw 5 ml of blood and discard before drawing the specimen tubes for testing. 23-gauge needles (e.g. Document that the venipuncture was performed distal to (below) an infusion site. This information must match therequisition. Loosen the tourniquet. In some cases, a phlebotomist may have to switch sites if they find the blood is not properly flowing from the vein. Recognize complications associated with the phlebotomy procedure. If this is not successful, remove the needle, take care of the puncture site, and redraw. 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} This image is not<\/b> licensed under the Creative Commons license applied to text content and some other images posted to the wikiHow website. Which element has the highest ionization energy? The service requires full JavaScript support in order to view this website. Arteries pulsate, are most elastic, and have a thick wall. After the needle selection, phlebotomists begin to look and feel for a viable vein. B. collection device the chlorhexidine residue before tying a piece of gauze around the foot. 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. 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. prevent falls, should the patient lose consciousness. 8. Is the seating comfortable and has the patient been seated for at least 5 minutes to avoid being rushed or confused? This makes every subsequent poke harder and harder because scar tissue is more fibrous and tougher to puncture. 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. Make certain that the blood completely saturates all four (4) circles and is visible from bothsides. Try rotating the arm to better expose the cephalic or basilic vein. site. } Allow filter paper to air dry for two (2) hours at room temperature. (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.). 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. This type of venipuncture procedure is a little different, and sometimes can be a little more involved. The phlebotomist's role requires a professional, courteous, and understanding manner in all contacts with the patient. The hydrostatic pressure causes some water and filterable elements to leave the extracellular space. Summarize the problems that may be encountered in accessing a vein, including the procedure to follow when a specimen is not obtained. 2. f.style.height="352px"; Clean the site to be punctured with an alcohol sponge. When using a syringe inserted into the line, blood must be withdrawn slowly to avoid hemolysis. Give an example of each. Potential source of test error, particularly from hemolysis, Most lines are flushed with a solution of heparin to reduce the risk of thrombosis, Discard a sample at least three times the volume of the line before a specimen is obtained for analysis. Normal reference ranges are often noted according to age. How can you decrease the risk of hematoma formation? If this is not successful, remove the needle, take care of the puncture site and redraw at another site. Factitious biochemical measurements resulting from hematologic conditions. wikiHow, Inc. is the copyright holder of this image under U.S. and international copyright laws. Ask the patient to lie on their back. The needle may have pulled out of the vein when switching tubes. He holds a Diploma in Medical Laboratory Assistance and is certified under the British Columbia Society of Laboratory Science. Patient identification is critical for safety. Apply the tourniquet below the IV site. Always thank the patient and excuse yourself courteously when finished. Identify the patient using two different identifiers, asking open ended questions such as, "What is your name?" 7. 5. C. Iodine Using a sterile lancet, make a skin puncture just off the center of the finger pad. Let's take a quick, high-level look at the venipuncture procedure. Focus on what you do best, and find someone who can help you communicate that with your target market. 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. Fill the microtainer tube(s) as needed, adhering to the order of draw. } When multiple vials of blood are collected it can seem like a large amount. Look for visual clues which may help assess the patient's condition. Blindly maneuvering the needle within the skin is painful to the patient and you run the risk of hitting a nerve, tendon, or artery. 10. Keep in mind that elderly patients often have fragile veins. If none of these veins work, then the phlebotomists use the hand veins. Avoid UE on same side of mastectomy (lymphedema) As always, properly fill out appropriate requisition forms, indicating the test(s) ordered. 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. Apply only ONE drop of blood per circle. D. Blue, Which of the following conditions should prevent a site from being selected for venipuncture? The median cubital creates, The dorsal venous network is the next most common vein site for phlebotomists. Collect drops of blood into the collectiondevice by gently massaging the finger. Effective communication - both verbal and nonverbal - is essential. 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. B. above an IV line drawing from hand or foot 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. (a) the electric power required. After assembling the appropriate equipment, follow the next steps to perform a proper venipuncture. Veins sometimes roll away from the point of the needle and puncture site. Using the requisition for reference, ask a patient to provide additional information such as a birthdate. Allow another large drop of blood to form. 9. There are three phlebotomy vein sites located in the arm most utilized by medical professionals and three additional draw sites that are last resorts. Also consider adjusting the angle of the needle. Green A. D. Both A and B, A sharps container is identified by its bright ____ color Avoid excessive probing ("fishing"). Cochrane Database Syst Rev. How many time should you invert them? finger should be avoided. The first drop contains excess tissue fluid and must be wiped away. A needle is then gently inserted into the vein. Wipe away the first drop of blood with sterile 22 gauze. Deliver specimens promptly to the laboratory. 7. What are the green/lavender top containers used for? Collect drops of blood into the collectiondevice by gently massaging the heel. 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. This image is not<\/b> licensed under the Creative Commons license applied to text content and some other images posted to the wikiHow website. Use of hair nets and face masks to decrease blood culture contamination rates. 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. 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. Needles are available for evacuated systems and for use with a syringe, single draw or butterfly system. Identify the patient. Tip: BD Vacutainer tubes use a translucent stopper to identify short draw variants. 1. When wearing gloves, change them between each patient and wash your hands frequently. Collect drops of blood into the . Matt Garcia is an experienced phlebotomist in Vancouver, Canada. 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. 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. 7. True or False? 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: Select the proper approved lancet: The BD Microtainer Contact-Activated. wikiHow, Inc. is the copyright holder of this image under U.S. and international copyright laws. It may be, necessary, on occasion, to perform a capillary puncture on the toe of a patient, who is severely burned. Gas tubes (must warm the site before collecting the specimen), 4. Wear gloves and a lab coat or gown when handling blood/body fluids. Safely discard potentially infectious materials. The performance of routine vascular access procedures by skilled phlebotomists requires, at a minimum, the use of gloves to prevent contact with blood. 2004;24(4):979-96, vii. Specimens from infants under the age of 6 months are typically collected by heelstick. To prevent hemolysis when performing a venipuncture, the phlebotomist should: 1. Regardless of the source of payment, request and receive an itemized and detailed explanation of the total bill for services rendered in the hospital. Follow the procedure as outlined above for greeting and identifying the patient. Do not use the central portion of the heel because you might injure the underlying bone, which is close to the skin surface. 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. Phlebotomists are considered to have occupational exposure to blood borne pathogens. 5. Which of the following is the most likely mechanism for alteration in protein values in this situation? Last draw - additive tubes in this order: SST (red-gray or gold top). 2011-2023 Phlebotomy Coach. A. EMLA Carry out hand hygiene before and after each patient procedure, before putting on and after removing gloves. Specimens; Approved StandardSixth Edition. Dalal BI, Brigden ML. 1. Inadvertently nicking a nerve causes intense pain. The median cubital vein is used the most for its accessibility. diet, exercise, stress, basal state). The first step to choosing the right vein is to select the appropriate needle gauge. Procedure for Capillary Puncture of the Heel: A heel puncture is performed on the lateral or medial plantar surface of the, foot. 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. Venipuncture can also happen when patients have intravenous (IV) lines started. 3. Additionally, a hematoma may compress the nerve and lead to long-term damage. Avoid previous hematoma (draw distal of hematoma) Two forms of active identification are required. Avoid a probing, traumatic venipuncture. 1. previous experience with vomiting or fainting Blood is commonly obtained from the median cubital vein on the anterior forearm. Avoid excessive pressure that may squeeze tissue fluidinto the drop of blood. World Health Organization. A government issued photo identification card such as a driver's license can aid in resolving identification issues. 3. 2006;52(5-6):217-30. Safely dispose of potentially infectious materials. Avoid bruising the infant's heel when obtaining blood. Tip: In spite of a difficult draw, remember to invert your tubes. The puncture should be made perpendicular to the ridges of the fingerprint so that the drop of blood does not run down the ridges. Cap, rotate and invert the microtainer to mix the blood collected. Have an assistant stabilize the arm by firmly locking the elbow joint. Enzymes, proteins, lipids, iron, and calcium are significantly increased with changes in position. Therefore, an arm containing an IV should not be used to draw blood specimens if it can be avoided. This vein can be found along the upper arm to the thumb, but it is commonly drawn from the forearm or antecubital fossa area. remove needle 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. Then the medical technician or phlebotomist will wrap a flexible band on the upper part of the arm to apply some pressure to that area making the vein enlarge with blood. Expect reasonable safety congruent with the hospital practices and environment. Get instant access to our latest tools and our must-read site updates: What Certifications Are Used For Higher Pay For Phlebotomists? 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. Re-anchor the vein. Dispose of items in appropriate containers. NOTE: The use of post-exposure prophylaxis following blood exposure to HIV has shown effectiveness (about 79%) in preventing seroconversion. Approach the patient in a friendly, calm manner. 3. This article was co-authored by Matt Garcia. Dorsal hand veins are often utilized for intravenous infusions but are viable options for blood draw sites. var d = document.getElementById("zf_div_SBGg-3DTNCwt65i9A6n_zU3SneyGD89SSqM_7F_nCas"); What is an Approved Phlebotomy School in California. -tourniquet D. all of the above, Common causes of hematomas that form during a venipuncture include: A warm compress or heel warmer should be used to warm, fingers and heels that are cold, or if a capillary blood gas is being drawn, to. chemistries, serology, immunnology, blood bank. To request course information, contact PhlebotomyU today. Over 52 percent of all web traffic is from mobile devices . wikiHow, Inc. is the copyright holder of this image under U.S. and international copyright laws. ACDA or ACDB (pale yellow top). Compare and contrast the two major types of neuronal pathways. Assess the need for sample recollection and/or rejection. C. After all specimens have been collected What are some of the reasons to draw blood? A. standards Never draw from a thrombosed or scarred vein. 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. Capillary Specimens may be used immediately for point-of-care testing. 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 the case of an accidental stick, immediately wash the area with an antibacterial soap,express blood from the wound, and contact your supervisor. Remove the first glove so that it turns inside out during removal A phlebotomy technician is preparing to dispose of contaminated sharps. Hold the baby's foot firmly to avoid sudden movement. Adjust the angle (the bevel may be against the vein wall). Antiseptic. Erroneous test results may be obtained when the blood is not thoroughly mixed with the additive. Additionally, blood samples should not be taken on an arm with a fistula used for dialysis treatments. Email is the #1 attack vector cybercriminals use to lure you into a malicious website. Cleanse the heel with alcohol prep, then dry with a sterile 22 as alcohol can influence testresults. Dispose of contaminated materials/supplies in designated containers. The median cubital vein and the cephalic vein in the wrist area should be avoided when possible. Lancets are disposed of in an appropriate sharps container as one unit. Hematoma - may cause erroneous test results. Dorsal hand veins are often utilized for intravenous infusions but are viable options for blood draw sites. Phlebotomy is the practice of drawing blood from patients to gather data about their health. Failure to do this results in an unequal blood-to-additive ratio, making the specimen unsuitable for analysis. (b) the power developed by the output shaft. Patients who are dehydrated, obese, terminally ill, or hard sticks often get their blood drawn in other locations rather than the antecubital fossa.