Dry the cleaned area with a dry cotton sponge. 7. Am J Clin Pathol. 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. Specimens; Approved StandardSixth Edition. When using a syringe and needle, avoid drawing the plunger back too forcibly. The use of a tourniquet during a venipuncture procedure makes: A. Blindly maneuvering the needle within the skin is painful to the patient and you run the risk of hitting a nerve, tendon, or artery. 5. ACDA or ACDB (pale yellow top). Erroneous test results may be obtained when the blood is not thoroughly mixed with the additive. Safely discard potentially infectious materials. containers. Do not place too tightly or leave on more than 2 minutes (and no more than a minute to avoid increasing risk for hemoconcentration). The best locations for fingersticks are the 3rd (middle) and 4th (ring) fingers of the non-dominant hand. Change your approach when dealing with uncooperative patients, such as pediatrics and those with neurodevelopmental or psychiatric disorders. Never leave a tourniquet on for more than two minutes. Not making it mobile friendly. })(); The cephalic vein is a safe secondary option if the median cubital vein is not working. The key elements in labeling are: NOTE: Both of the above MUST match the same on the requisition
form. var evntData = event.data; Make certain that the blood completely saturates all four (4) circles and is visible from bothsides. If a vein feels hard, it may be scarred or sclerosed. An electric motor draws a current of 10 amp with a voltage of 110V110 \mathrm{~V}110V. The output shaft develops a torque of 10.2Nm10.2 \mathrm{~N} \cdot \mathrm{m}10.2Nm and a rotational speed of 1000 RPM. 2006;52(5-6):217-30. The hydrostatic pressure causes some water and filterable elements to leave the extracellular space. The fluid may dilute the specimen, so collect from the opposite arm. Complications of venipuncture | How to avoid | Aimvein 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. This is a general guide for troubleshooting a venipuncture scenario in which blood flow is not initially established upon needle insertion. 5. Proper patient identification MANDATORY. The 6 Mistakes to Avoid When Building a Business Website (and - Medium Stress: May cause transient elevation in white blood cells (WBC's)
and elevated adrenal hormone values (cortisol and catecholamines). Children, particularly under the age of 10, may experience pain and anxiety during the phlebotomy procedure. D. All of the above, Needles are sterile until: Phlebotomy Exam Questions - TAU 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. Which of the following actions should the technician take? Avoid UE on same side of mastectomy (lymphedema) However, drawing blood from the hand is affiliated with higher levels of pain and less control. Phlebotomists are considered to have occupational exposure to blood borne pathogens. Many drugs will have "peak" and "trough" levels that vary according to dosage levels and intervals. Avoid excessive pressure that may squeeze tissue fluidinto the drop of blood. It is observed that if the tourniquet is left on longer than 2 minutes, changes in the value of a total protein test occur. Avoid excessive pressure that may squeeze tissue fluid into the drop of blood. We use cookies to make wikiHow great. 11. Lippi G, Salvagno GL, Montagnana M, Franchini M, Guidi GC. B. the needle is inserted into the patient's arm A government issued photo identification card such as a driver's license can aid in resolving identification issues. Also consider adjusting the angle of the needle. Place blood collection equipment away from patients, especially children and psychiatric patients. Follow the same procedure as for performing a finger, Order of Draw for a Capillary Puncture: Proper collection of tubes when. -use correct angle of needle insertion It doesn't matter . B. precautions Capillary Specimens may be used immediately for point-of-care testing. How can you decrease the risk of hematoma formation? Never draw over scars or a new tattoo sites. Describe and perform the venipuncture process including: Appropriate clothing and protective equipment. D. after needle removal, When drawing blood you should always follow universal ______ There may be no vacuum in the tube being used. However, drawing blood from the hand is affiliated with higher levels of pain and less control. 6. Collect drops of blood into the . Thrombosed veins lack resilience, feel cord-like, and roll easily. For all NICU babies, once you have, collected the blood, wipe off the area with a sterile saline wipe, to remove. hemorrhage or hematoma at site of puncture, remove tourniquet Assess the patient's physical disposition (i.e. A variety of techniques can be employed to reduce pain and anxiety. Allsurfaces are cleaned daily with bleach. 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. All of the following are common types of equipment used for venipuncture EXCEPT: C. Iodine Use a smaller tube with less vacuum. D. Both A and B, A sharps container is identified by its bright ____ color 5. 6. What is the best position to perform venipuncture in? 8. Position the patient with the arm extended to form a straight-line form shoulder to wrist. C. Lancet -18, 20, 22 gauge needles. If just a routine coagulation assay is the only test ordered, then a single light blue top tube may be drawn. If you are using a butterfly, try to retie the tourniquet around the patient's arm to increase pressure and re-establish blood flow. Syringes - may be used in place of the evacuated collection tube for special circumstances. 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. Anxiety that results in hyperventilation may cause acid-base imbalances, and increased lactate. The sides and the tip of the. A. the plastic sleeve is removed Perform the venipuncture, collecting the sample(s) in the appropriate container(s). Therefore, your anchor should be gentle but firm to prevent the vein from moving away from you. 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. When would you use a butterfly/infustion set? Performing a Venipuncture on an Arm Containing an Intravenous Line - LabCE 1. (See, The chlorhexidine is a concern for the premature babies in NICU as it can, be absorbed through the skin. Blood Collection Process: Venipuncture - University of Florida Observe all applicable isolationprocedures. A. given to the patient What Is Venipuncture? Procedures, Risks & Fears - Phlebotomy Coach Apply the tourniquet 3-4 inches above the selected puncture site. Have the patient drink fluids if dehydrated. 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. 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. % of people told us that this article helped them. -hemorrhage/hematoma. Squeeze puncture site to promote bleeding. Switch to the other arm if you can't find anything. www.mlo-online.com is using a security service for protection against online attacks. Greet the patient and identify yourself and indicate the procedure that will take place. Phlebotomy Essentials 5th Edition Chapter 9. Remember that veins should ideally feel bouncy. This image is not<\/b> licensed under the Creative Commons license applied to text content and some other images posted to the wikiHow website. Place labeled specimens in zip lock bag and deliver to the laboratory as soon as possible. 9. Any microtainerscontaining additives should be tapped to dislodge additives from the walls and top. Websites that masquerade as the ones you trust. The content of this article is not intended to be a substitute for professional medical advice, examination, diagnosis, or treatment. Kiechle FL. Phlebitis can also occur as a result of vein trauma during insertion, use of an inappropriate I.V. C. all disposable equipment has been discarded properly or move it backward (it may have penetrated too far). The first step to choosing the right vein is to select the appropriate needle gauge. Valenstein PN, Sirota RL. Located in the antecubital fossa, the median cubital vein is a well anchored, stable vein that rarely rolls during venipuncture. Identify the patient using two different identifiers, asking open ended questions such as, "What is your name?" What are the helpful hints for finding veins? Have the patient position their arm on the armrest. Because of contacts with sick patients and their specimens, it is important to follow safety and infection control procedures. 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. 2. Each time a vein is accessed with a needle, scar tissue forms as part of the body's healing process. diet, exercise, stress, basal state). Use pillows or foam wedges to elevate the arm and help with extension. Approach the patient in a friendly, calm manner. Dorsal hand veins are often utilized for intravenous infusions but are viable options for blood draw sites. When multiple vials of blood are collected it can seem like a large amount. To enhance students careers, meet the needs of healthcare providers and improve patient care by providing high quality, cost effective phlebotomy education through industry leading curriculum, current technology and extensive hands on experience. 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. Position the infant with the head slightly elevated. Laboratory coats or work smocks are not typically needed as personal protective equipment during routine venipuncture, but an employer must assess the workplace to determine whether certain tasks, workplace situations, or employee skill levels may result in an employee's need for laboratory coats or other personal protective equipment to prevent contact with blood. Clean up any blood spills with a disinfectant such as freshly made 10%
bleach. If an inpatient is able to
respond, ask for a full name and always check the armband or bracelet for confirmation. IF AN INCOMPLETE COLLECTION OR NO BLOOD IS OBTAINED: Change the position of the needle. f.style.width="100%"; It brings the entire family 4. Recommended order of collection for microtainer specimens: 7. Journal of Exotic Pet Medicine. Cannula/fistula/heparin lock - hospitals have special policies regarding
these devices. Patient identification is critical for safety. (2017). Loosen the tourniquet. https://www.osha.gov/laws-regs/standardinterpretations/2007-10-26 and https://www.osha.gov/OshDoc/data_BloodborneFacts/bbfact03.pdf (Accessed June 13, 2022). If it is then heated, what can you say about: b) how often the molecules hit the walls of the can. Phlebitis is inflammation of a vein. What is the procedure to draw blood from an arm with an IV in it? Cephalic vein. Inadvertently nicking a nerve causes intense pain. Hold the baby's foot firmly to avoid sudden movement. 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. However, do not use too high a temperature warmer, because baby's skin is thin and susceptible to thermal injury. Wayne, PA: Clinical and Laboratory Standards Institute; 2008. NOTE: The use of post-exposure prophylaxis following blood exposure to HIV
has shown effectiveness (about 79%) in preventing seroconversion. Gloves - can be made of latex, rubber, vinyl, etc. Airborne precautions may be considered to provide a level of safety against infectious diseases such as tuberculosis, influenza, and COVID-19. Try another tube. He holds a Diploma in Medical Laboratory Assistance and is certified under the British Columbia Society of Laboratory Science. 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.