10. -test tubes Which of the following actions should the technician take? Cleanse in a circular
fashion, beginning at the site and working outward. This image is not<\/b> licensed under the Creative Commons license applied to text content and some other images posted to the wikiHow website. Let's take a look at the types of websites you and your staff need to be wary of and how to avoid them. Watch for formation of a hematoma. Follow the same procedure as for performing a finger, Order of Draw for a Capillary Puncture: Proper collection of tubes when. 5. Avoid drawing blood from a hematoma; select another draw site. When wearing gloves,
change them between each patient and wash your hands frequently. Applyan adhesive bandage. Reassure the patient that the minimum amount of blood required for testing will be drawn. This is more common in humeral and femoral punctures than radial punctures. But since each patient's medical condition varies, so does their veins. 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. Do not use a previous puncture site. 3. B. Yellow Needle disposal unit - needles should NEVER be broken, bent, or
recapped. List several effects of exercise, posture, and tourniquet application
upon laboratory values. The 2nd (index) finger tends to have thicker, callused skin. Using the smallest acceptable needle size can help reduce the risk of bleeding or hematoma . Sites that should be avoided include areas with extensive scarring, healed burns, inflamed sites, edematous sites, previous puncture sites, earlobes and thumbs. Pediatric Pointers. Center for Phlebotomy Education, Inc. Ernst, Dennis J. and Catherine Ernst. If an inpatient is able to
respond, ask for a full name and always check the armband or bracelet for confirmation. 1. Even if several vials of blood have to be drawn it usually amounts to no more than one ounce. Once you establish blood flow, slightly modify your hand position to stabilize the needle against the arm and prevent further movement. Because of contacts with sick patients and their specimens, it is important to follow safety and infection control procedures. 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. Place labeled specimens in zip lock bag and deliver to the laboratory as soon as possible. Hematoma - A venipuncture should not be performed on a hematoma, regardless of how small it may be. Am J Clin Pathol. Palpate and trace the path of veins with the index finger. B. the insertion site has stopped bleeding } 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. Normal reference ranges are often noted according to
age. Unlike the cephalic and basilic veins, the median cubital vein is not near major nerves or arteries. Position the patient. Lightly touch the microtainer capillary collectiondevice (or filter paper) to the LARGE drop of blood. Cochrane Database Syst Rev. UF Health Pathology Laboratories Nontuberculosis Mycobacteria Laboratory, This page uses Google Analytics (Google Privacy Policy), Capillary puncture may be used for obtaining specimens in infants or in adults where. Significant increases can be found in total protein, aspartate aminotransferase (AST), total lipids, cholesterol, iron, Affects packed cell volume and other cellular elements. Provide for their comfort as much as possible, and gain the patient's cooperation. Adjust the height and swivel the chair to ensure your body is in line with the vein. A key element for successful venipuncture is choosing the best vein. 5. An OSHA acceptable, puncture proof container markedBiohazardous. Foot veins are a last resort because of the higher probability of complications. Feel for the median cubital first, the cephalic vein second, and the basilic vein third. 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. }, false); This preliminary action allows you to safely adjust the needle's position. wikiHow, Inc. is the copyright holder of this image under U.S. and international copyright laws. 8. wikiHow, Inc. is the copyright holder of this image under U.S. and international copyright laws. 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. 4. Make sure the venipuncture site is dry before proceeding with draw. Needles - The gauge number indicates the bore size: the larger the gauge number, the smaller the needle bore. Adapted from Phlebotomy for Nurses and. Serum red top or amber tube with red top. Specimens from infants under the age of 6 months are typically collected by heelstick. Avoid placing sample onhot surfaces such as bili-lights or monitors. Keep in mind that elderly patients often have fragile veins. Also consider adjusting the angle of the needle. Remove the needle from the patient's arm using a swift backward motion. Gloves - can be made of latex, rubber, vinyl, etc. -18, 20, 22 gauge needles. 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 recommended order of draw for plastic collection tubes is: First - blood culture bottle or tube (yellow or yellow-black top). Any attempt to repeat a puncture at the same site increases the risk of complications. Performing a venipuncture on a child under one year of age . 7. Select the appropriate microtainers for the specimens to be collected. 3. Remove your gloves and wash your hands. Cap, rotate and invert the microtainer to mix the blood collected. An artery has been punctured (characterized by bright red, pulsating blood), A nerve has been nicked (patient may complain of an electrical sensation up and down the limb), A hematoma starts to form (a bubble under the skin starts to rapidly appear at the site), The patient loses consciousness or starts seizing. 13 Websites to Avoid If You Value Your Time | PCMag Label the specimens before leaving the patients bedside. Children, particularly under the age of 10, may experience pain and anxiety during the phlebotomy procedure. Giavarina D, Lippi G. Blood venous sample collection: Recommendations overview and a checklist to improve quality. Place labeled specimens in zip lock bag and deliver to the laboratory as soon as possible. Venipuncture requires good skills in order to perform the procedure not only correctly, but also painlessly. A. standards 3. Step 3: Venipuncture. 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. However, blood samples that are normally taken are actually very small. Consult a specialist at the patient's own request and expense. If it is then heated, what can you say about: b) how often the molecules hit the walls of the can. When would you use a butterfly/infustion set? Allow thefinger to dry or wipe dry with a sterile 22 gauze. Arteries
pulsate, are most elastic, and have a thick wall. Filter paper should touch only the blood and not the heel or finger. Larger tube sizes typically provide for collection of samples from 6 to 10 mL. 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. if( evntData && evntData.constructor == String ){ Most commonly, venipuncture will be performed on the Antecubital Fossa, or the inside of the elbow. Top Vein Sites Used in Phlebotomy | PhlebotomyU | CPT1 Course wikiHow, Inc. is the copyright holder of this image under U.S. and international copyright laws. Blood collection tubes must be drawn in a specific order to avoid cross-contamination of additives between tubes. doi: 10.1002/14651858.CD005179.pub3. ACDA or ACDB (pale yellow top). Dry the cleaned area with a dry cotton sponge. Precautions include a medical grade face mask. Dispose of contaminated materials/supplies in designated containers. List six areas to be avoided when performing venipuncture and the reasons
for the restrictions. Needles should be placed in a proper disposal unit IMMEDIATELY after their use. 9. This image is not<\/b> licensed under the Creative Commons license applied to text content and some other images posted to the wikiHow website. Remove the first glove so that it turns inside out during removal A phlebotomy technician is preparing to dispose of contaminated sharps. Capillary punctures are not suitable for blood culture testing and most coagulation tests. The basic patient rights endorsed by the JCAHO follow in condensed form are given below. ROUTINE CAPILLARY PUNCTURE BLOOD COLLECTION GUIDELINES. Psychological interventions for needle-related procedural pain and distress in children and adolescents. therapy is usually associated with acidic or alkaline solutions or solutions that have a high osmolarity. 11. Do not use the central portion of the heel because you might injure the underlying bone, which is close to the skin surface. The patient has the right to refuse
participation in such activity. 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. Most reference ranges are based on normal laboratory test values for: Healthy people in a basal state. 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. How to Troubleshoot a Difficult Venipuncture. Asking the patient about their previous blood draw experiences is beneficial, especially if they are a hard stick and know which area works best. PDF Selecting The Venipuncture Site - Yola Previous puncture sites should be avoided. Approach the patient in a friendly, calm manner. antecubital fossa What are the best veins for venipuncture? Please enable JavaScript on your browser and try again. Fill the microtainer tube(s) as needed. If blood stops flowing into the vacuum tube, the vein may have collapsed. This image is not<\/b> licensed under the Creative Commons license applied to text content and some other images posted to the wikiHow website. Hemolysis may occur, with pseudohyperkalemia. What is the procedure to draw blood from an arm with an IV in it? A. EMLA 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. The blood is normally drawn from a vein on the top of the hand or from the inside of the elbow. 2. Avoid excessive pressure that may squeeze tissue fluid into the drop of blood. 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. Mix and label all appropriate tubes at the patient bedside. Otherwise, satisfactory samples may be drawn below the IV by following these procedures: Turn off the IV for at least 2 minutes before venipuncture. C. Red Stress: May cause transient elevation in white blood cells (WBC's)
and elevated adrenal hormone values (cortisol and catecholamines). Too tight of a tourniquet may cause the vein to collapse upon needle insertion. Cleanse the heel with alcohol prep, then dry with a sterile 22 as alcohol can influence testresults. 5. Compare and contrast the two major types of neuronal pathways. NHA Exam Questions Flashcards | Chegg.com Use of hair nets and face masks to decrease blood culture contamination rates. Blood Collection Techniques in Exotic Small Mammals. Back the needle out until the bevel is just below the skin. In the case of an accidental stick, immediately wash the area with an antibacterial soap,express blood from the wound, and contact your supervisor. In some cases, a phlebotomist may have to switch sites if they find the blood is not properly flowing from the vein. Question. (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.). 4. f.src = 'https://forms.zohopublic.com/healthservicesacademy/form/RequestCourseInformationCPTIAccelerated/formperma/SBGg-3DTNCwt65i9A6n_zU3SneyGD89SSqM_7F_nCas?zf_rszfm=1'; 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. 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. 2. Label all appropriate tubes at the patient bedside. Draw 5 ml of blood and discard before drawing the specimen tubes for testing. Contains acid citrate dextrose. Refuse treatment to the extent permitted by law. Patient care following completion of venipuncture. Avoid excessive pressure that may squeeze tissue fluid into the, mix the blood. You must check the timing of these variations for the desired collection point. Grasp the patient's arm firmly using your thumb to draw the skin taut and anchor the vein. Occupational Safety and Health Administration, United States Department of Labor. 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. 4. INR for patients on warfarin) are often knowledgeable on the veins that are most likely to work. 7. 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. 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. 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. -tourniquet 3. What Is Venipuncture? (Uman et al, 2013). *NEVER BEND THE ARM*. The maximum number of times an individual should attempt a venipuncture on a patient is two, True or False? All of the following are common types of equipment used for venipuncture EXCEPT: He holds a Diploma in Medical Laboratory Assistance and is certified under the British Columbia Society of Laboratory Science. Order of draw for multiple tube phlebotomy. So You're Going to Collect a Blood Specimen: An Introduction to Phlebotomy, 13th Edition (2010), College of American Pathologists, Northfield, IL. Apply firm
pressure for more than 5 minutes. Alcohol not dry in the required amount of time B. Veins less prominent and less filling C. Veins more prominent and easier to puncture D. Blood stop flowing to arteries but not veins A The most common site (s) for the venipuncture procedure is/are the following: This image is not<\/b> licensed under the Creative Commons license applied to text content and some other images posted to the wikiHow website. Sites to avoid: Extensive scarring from burns or surgery The upper extremity on the side that a mastectomy was performed. -cotton sponges 8. What are the red top containers used for? Wipe away the first drop of blood with sterile 22 gauze. (See, The chlorhexidine is a concern for the premature babies in NICU as it can, be absorbed through the skin. (c) the rate of heat transfer. Identify the patient. 2017;50(10-11):568-573. Expect reasonable safety congruent with the hospital practices and
environment. 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. Sanders AM, Agger WA, Gray AM, Fischer CM, Kamprud EA. What caution should you observe when using a Vacutainer? apply pressure for at least 10 minutes. C. the needle has penetrated all the way through the vein 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. 10. What are the light blue top containers used for? 70% isopropyl alcohol Ask the patient orcaregiver to state the patients name and date of birth. Specimen Collection Procedure - PERFORMING A VENIPUNCTURE | Akron It is large and near the skins surface, making it easier for phlebotomists to see before anchoring the vein. What sites should be avoided when drawing blood? What are the contraindications to venipuncture? Perform the venipuncture, collecting the sample(s) in the appropriate container(s). If a vein feels hard, it may be scarred or sclerosed. f.style.height="352px"; Loosen the tourniquet. Follow institution's guidelines regarding treatment and follow-up. Fill the microtainer tube(s) as needed, adhering to the order of draw. f.style.transition="all 0.5s ease"; Assess the patient's physical disposition (i.e. The blood is bright red (arterial) rather than venous. This complication of peripheral I.V. There may be no vacuum in the tube being used. When multiple vials of blood are collected it can seem like a large amount. Apply blood to the printed side of the filter paper. The content of this article is not intended to be a substitute for professional medical advice, examination, diagnosis, or treatment. Do not add blood to a circle already filled orpartially filled with blood. Gauze sponges - for application on the site from which the needle is
withdrawn. After the needle selection, phlebotomists begin to look and feel for a viable vein. By signing up you are agreeing to receive emails according to our privacy policy. Do not attempt a capillary puncture more than twice. When there is an IV line present, blood can be drawn from this line. We use cookies to make wikiHow great. When working with patients who have undergone a mastectomy, draw from the arm on the opposite side of the mastectomy to avoid edematous tissue. (b) the power developed by the output shaft. 6. Erroneous test results may be obtained when the blood is not thoroughly mixed with the additive. How can you decrease the risk of hematoma formation? Select a vein other than the one with the IV. If using a needle and syringe, avoid drawing the plunger back too forcefully. 1. previous experience with vomiting or fainting The service requires full JavaScript support in order to view this website. This article has been viewed 43,712 times. For an inpatient DO NOT DRAW BLOOD IF THE ARMBAND OR BRACELET IS MISSING. Stop the procedure and remove the needle if: Thanks to all authors for creating a page that has been read 43,712 times. Reasonable informed participation in decisions involving the patient's
health care. Remember that veins should ideally feel bouncy. Subcutaneous tissue feels squishy and muscle feels hard. If this is not successful, remove the needle, take care of the
puncture site, and redraw. Label all specimens per accepted guidelines. 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? Have an assistant stabilize the arm by firmly locking the elbow joint. Drawing from these sites can cause blood clotting and hemostasis. var f = document.createElement("iframe"); C. all disposable equipment has been discarded properly -use a smaller gauge needle (a) the electric power required. A commercial heel warmer may be used. Extensive scarring or healed burn areas should be avoided Specimens should not be obtained from the arm on the same side as a mastectomy. Avoid excessive probing ("fishing"). Apply the tourniquet 3-4 inches above the selected puncture site. For a detailed breakdown of each step of the venipuncture test scroll down. How should you have the patient position their arm after the venipuncture is complete? What are the helpful hints for finding veins? if ( (iframe.src).indexOf('formperma') > 0 && (iframe.src).indexOf(zf_perma) > 0 ) { Drawing blood from major vessels (e.g. Basilic vein. Therefore, an arm containing an IV should not be used to draw blood specimens if it can be avoided. 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. Switch to the other arm if you can't find anything. Avoid previous hematoma (draw distal of hematoma) This image is not<\/b> licensed under the Creative Commons license applied to text content and some other images posted to the wikiHow website. Blood samples drawn from an IV line should be documented and analyzed with care. This is very painful, risks damage to underlying structures, and widens the needle hole to prolong bleeding time. Hemoconcentration: An increased concentration of larger molecules and formed elements in the blood may be due to several factors: Prolonged tourniquet application (no more than 1 minute). The rubber stoppers are color coded according to the additive that the tube contains. Make sure the venipuncture site is dry. Look for visual clues which may help assess the patient's condition. Sign up for wikiHow's weekly email newsletter. 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. C. After all specimens have been collected Deliver specimens promptly to the laboratory. Gloves are to be discarded in the appropriate container immediately after the bloodcollection procedure. Avoid bruising the infants heel when obtainingblood. Blindly maneuvering the needle within the skin is painful to the patient and you run the risk of hitting a nerve, tendon, or artery. This is especially important when collecting EDTA (lavender top) or heparin (green top) tubes.
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