Consult a specialist at the patient's own request and expense. 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. D. All of the above, Needles are sterile until: Notify your supervisor or patientsphysician if unsuccessful. Enzymes, proteins, lipids, iron, and calcium are significantly increased with changes in position. Check the requisition form for requested tests, patient information, and any special requirements. This information must match therequisition. Start with the arm closest to you and palpate the antecubital fossa. -18, 20, 22 gauge needles. If there is a concern regarding contamination by tissue fluids or thromboplastins, then one may draw a non-additive tube first, and then the light blue top tube. Phelan MP, Reineks EZ, Berriochoa JP, Schold JD, Hustey FM, Chamberlin J, Kovach A. Refuse treatment to the extent permitted by law. -thrombosis Do not use the tip of the finger or the center of the finger. Use pillows or foam wedges to elevate the arm and help with extension. Tip: Lowering the arm below the level of the heart may help to engorge the vessels. Do not place too tightly or leave on more than 2 minutes (and no more than a minute to avoid increasing risk for hemoconcentration). 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. The sides and the tip of the, Select the proper approved lancet: The BD Microtainer Contact-Activated, Lancet 1.5 mm (lavender) is used for glucometers and the BD Microtainer, Contact-Activated Lancet 2.0 mm (blue) is used any time you need more, Prepare the finger by cleaning it with a Chlorhexadine wipe. Watch for formation of a hematoma. This vein lies close to the surface of the skin and there is not a large nerve supply. Be methodical in your search for a vein. (2017). Avoid bruising the infants heel when obtainingblood. You should always contact your doctor or other qualified healthcare professional before starting, changing, or stopping any kind of health treatment. C. at a mastectomy site D. mandates, The most common antiseptic used in venipuncture is: Erroneous test results may be obtained when the blood is not thoroughly mixed with the additive. 12. Prepare the equipment, the patient and the puncture site. Have the patient position their arm on the armrest. finger should be avoided. Various sizes are available. The service requires full cookie support in order to view this website. If none of these veins work, then the phlebotomists use the hand veins. wikiHow, Inc. is the copyright holder of this image under U.S. and international copyright laws. 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. By signing up you are agreeing to receive emails according to our privacy policy. Last draw - additive tubes in this order: SST (red-gray or gold top). 1. Asking the patient about their previous blood draw experiences is beneficial, especially if they are a hard stick and know which area works best. List several effects of exercise, posture, and tourniquet application
upon laboratory values. Two forms of active identification are required. 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. -infection at site The line must be flushed first. Lightly touch the microtainer capillary collectiondevice (or filter paper) to the LARGE drop of blood. Avoid excessive pressure that may squeeze tissue fluidinto the drop of blood. Most reference ranges are based on normal laboratory test values for: Healthy people in a basal state. Label the specimens before leaving the patients bedside. iframe.style.height = zf_ifrm_ht_nw; Assess the need for sample recollection and/or rejection. Apply the tourniquet 3-4 inches above the selected puncture site. prevent falls, should the patient lose consciousness. 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. Transferring a sample from one collection tube to another or mixing blood from different collection tubes must be avoided. The recommended location for blood collection on a newborn baby or infant is the heel. Extremity is edematous. % of people told us that this article helped them. performing a capillary puncture is as follows: 1. Am J Clin Pathol. Procedures and Devices for the Collection of Diagnostic Capillary Blood. D. Butterfly, Before leaving the patient's bedside, you must make sure that: Second - coagulation tube (light blue top). 9. Because of contacts with sick patients and their specimens, it is important to follow safety and infection control procedures. 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. Unlike the cephalic and basilic veins, the median cubital vein is not near major nerves or arteries. (Partial penetration may allow blood to leak into the soft tissue surrounding the vein by way of the needle bevel). Areas of the body that look infected, scarred, or burned must also be avoided. If just a routine coagulation assay is the only test ordered, then a single light blue top tube may be drawn. 5. Clin Lab Med. 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. Make sure the venipuncture site is dry. Tetracaine is a substance used as a spinal anesthetic. Dispose of items in appropriate containers. (b) How would you prepare tetracaine from p-nitrobenzoic acid? Blood collection tubes must be drawn in a specific order to avoid cross-contamination of additives between tubes. The sides and the tip of the. Giavarina D, Lippi G. Blood venous sample collection: Recommendations overview and a checklist to improve quality. -use correct angle of needle insertion Over time and with several repeated punctures, significant amounts of scar tissue builds up. Make certain that the blood completely saturates all four (4) circles and is visible from bothsides. 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. on patients who are extremely dehydrated or have poor peripheral circulation. -tourniquet Even if several vials of blood have to be drawn it usually amounts to no more than one ounce. Avoid excessive pressure that may squeeze tissue fluid into the, mix the blood. For the CLSI Updated Phlebotomy Procedures please click here. 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. The 2nd (index) finger tends to have thicker, callused skin. Which of the following actions should the technician take? Sign up for wikiHow's weekly email newsletter. 8. 2017;148(4):330-335. D. all of the above, Common causes of hematomas that form during a venipuncture include: (c) the rate of heat transfer. Pediatric Pointers. Center for Phlebotomy Education, Inc. Ernst, Dennis J. and Catherine Ernst. Observe universal (standard) safety precautions. Keep in mind that elderly patients often have fragile veins. 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. 9. containers. What is an Approved Phlebotomy School in California. WHO guidelines on drawing blood: best practices in phlebotomy. Drawing blood for laboratory analysis is most often a routine and uneventful procedure. Is the seating comfortable and has the patient been seated for at least 5 minutes to avoid being rushed or confused? Never draw blood through a hematoma. An outpatient must provide identification other than the verbal statement of a name. This image is not<\/b> licensed under the Creative Commons license applied to text content and some other images posted to the wikiHow website. 10. Label the collection tubes at the bedside or drawing area. 2009 Feb;131(2):195-204. (See Use of Band-Aids in the Post Phlebotomy. 1. Northfield, IL: College of American, NCCLS. Select a vein other than the one with the IV. obvious areas of skin infections The recommended order of draw for plastic collection tubes is: First - blood culture bottle or tube (yellow or yellow-black top). Scan the skin for lines of blue indicating a prominently visible vein. 2013 Oct 10;(10):CD005179. Have the patient make a fist and flex the arm, which helps engorge muscles to fill veins. Safely discard potentially infectious materials. Do not use alcohol for prepping the site when drawing a blood alcohol sample. Expect reasonable safety congruent with the hospital practices and
environment. As a countermeasure, phlebotomists. Inadvertently nicking a nerve causes intense pain. Gloves - can be made of latex, rubber, vinyl, etc. What should you do with a CBC or lavender top tube before putting them down? They are also. B. evacuated tube After the needle selection, phlebotomists begin to look and feel for a viable vein. Impact of Use of Smaller Volume, Smaller Vacuum Blood Collection Tubes on Hemolysis in Emergency Department Blood Samples. Palpate and trace the path of veins with the index finger. Reassure the patient that the minimum amount of blood required for testing will be drawn. 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. 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? Please enable JavaScript on your browser and try again. Similarly, it's quite easy to get lost in a "Wikipedia wormhole." Indeed, Wikipedia's depth is infinite, as you link from subject to subject, never able to stop. Label all appropriate tubes at the patient bedside. HealthStar Press, Inc. 2001, updated 1/08. You will be redirected once the validation is complete. This image is not<\/b> licensed under the Creative Commons license applied to text content and some other images posted to the wikiHow website. What is the most common site for blood sampling? What are the gold top containers used for? McCall, R. E., & Tankersley, C. M. (2016). The performance of routine vascular access procedures by skilled phlebotomists requires, at a minimum, the use of gloves to prevent contact with blood. Factitious biochemical measurements resulting from hematologic conditions. Not making it mobile friendly. Needles - The gauge number indicates the bore size: the larger the gauge number, the smaller the needle bore. -laceration of vein Re-anchor the vein. 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. It is not as close to the skin surface as the median cubital and cephalic veins, which poses a greater risk of damage to the median nerve and brachial artery. Apply only ONE drop of blood per circle. (See picture.) Remove the needle from the patient's arm using a swift backward motion. Therefore, an arm containing an IV should not be used to draw blood specimens if it can be avoided. Which of the following is the most likely mechanism for alteration in protein values in this situation? 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 vein may have collapsed; resecure the tourniquet to increase venous
filling. This preliminary action allows you to safely adjust the needle's position. What two things should you make sure you discuss with your patients prior to venipuncture? This guide follows the steps as outlined in the World Health Organizations Guidelines on Drawing Blood: Best Practices in Phlebotomy. Posture: Postural changes (supine to sitting etc.) But since each patient's medical condition varies, so does their veins. B. Hematoma Hold the baby's foot firmly to avoid sudden movement. wikiHow, Inc. is the copyright holder of this image under U.S. and international copyright laws. In this elbow pit, phlebotomists have easy access to the top three vein sites used in phlebotomy: The median cubital vein, also known as the antecubital vein, is the most common vein for phlebotomy. diet, exercise, stress, basal state). The fluid may dilute the specimen, so collect from the opposite arm. The venipuncture procedure is complex, requiring both knowledge and skill to perform. Dry the cleaned area with a dry cotton sponge. 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. A. Place a pillow under the patient's arm if additional support is needed. 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. A face mask reduces risk for blood culture specimen contamination. As always, properly fill out appropriate requisition forms, indicating the test(s) ordered. This seats the bevel into the lumen of the vein, and is also the technique used to insert an IV catheter. f.style.border="none"; Hemolysis may occur, with pseudohyperkalemia. Verify the patient's condition. Dispose of contaminated materials in appropriate waste receptacles. Povidone-iodine wipes/swabs - Used if blood culture is to be drawn. 3. 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. if( evntData && evntData.constructor == String ){ Anxiety that results in hyperventilation may cause acid-base imbalances, and increased lactate. Antiseptic. Avoid puncturing a finger that is cold or cyanotic, swollen, scarred, or covered with a rash. 8. The use of a tourniquet during a venipuncture procedure makes: A. Check for timing instructions for drawing the appropriate samples. Areas of fingers and heels that are cold, swollen, scarred or covered with a rash, should be avoided. Hyperextend the patient's arm. Assess the patient's physical disposition (i.e. Do not attempt a capillary puncture more than twice. 2006;52(5-6):217-30. Source of specimen. Use of hair nets and face masks to decrease blood culture contamination rates. C. the seal is broken It is observed that if the tourniquet is left on longer than 2 minutes, changes in the value of a total protein test occur. Venipuncture can also happen when patients have intravenous (IV) lines started. To prevent hemolysis when performing a venipuncture, the phlebotomist should: 1. A. standards Check for any allergies to antiseptics, adhesives, or latex by observing for armbands and/or by asking the patient. Stress: May cause transient elevation in white blood cells (WBC's) and elevated adrenal hormone values (cortisol and catecholamines). D. it is wiped with alcohol, Venipuncture at sites with each of the following could effect the results EXCEPT: The rubber stoppers are color coded according to the additive that the tube contains. Blood samples drawn from an IV line should be documented and analyzed with care. The median cubital vein is used the most for its accessibility. wikiHow, Inc. is the copyright holder of this image under U.S. and international copyright laws. True or False? It is not uncommon for adults and children to feel some fear when having blood drawn, which is why any discussion of venipuncture should at least bring this topic to focus. Swiftly insert the needle through the skin and into the lumen of the vein. Focus on what you do best, and find someone who can help you communicate that with your target market. f.src = 'https://forms.zohopublic.com/healthservicesacademy/form/RequestCourseInformationCPTIAccelerated/formperma/SBGg-3DTNCwt65i9A6n_zU3SneyGD89SSqM_7F_nCas?zf_rszfm=1'; The blood is normally drawn from a vein on the top of the hand or from the inside of the elbow. Change gloves after each patient or when contaminated. Blood is collected into an attached vial or tube that is airtight and the flexible band is then removed from the arm. When there is an IV line present, blood can be drawn from this line. Label all specimens per accepted guidelines. Areas in which two veins join should be avoided where possible, as valves are often present. Located in the antecubital fossa, the median cubital vein is a well anchored, stable vein that rarely rolls during venipuncture. Drawing the patient in a reclined position. A. excessive probing with the needle f.style.transition="all 0.5s ease"; C. Lancet Remember that veins should ideally feel bouncy. 11. 2017;50(10-11):568-573. Wayne, PA: Clinical and Laboratory Standards Institute; 2008. All of the following are common types of equipment used for venipuncture EXCEPT: This image is not<\/b> licensed under the Creative Commons license applied to text content and some other images posted to the wikiHow website. Clin Biochem. Label the specimens before leaving the patients bedside. Switch to the other arm if you can't find anything. Some DNS services support web filtering, too. This image is not<\/b> licensed under the Creative Commons license applied to text content and some other images posted to the wikiHow website. Here phlebotomists will typically choose from three veins: the median cubital vein, the cephalic vein or the basilic vein. Ask the patient orcaregiver to state the patients name and date of birth. 1. C. After all specimens have been collected Effective communication - both verbal and nonverbal - is essential. Veins sometimes roll away from the point of the needle and puncture site. Step 3: Venipuncture. Wear gloves and a lab coat or gown when handling blood/body fluids. Several essential steps are required for every successful collection procedure: Patient comfort. Patient identification is critical for safety. Have the patient drink fluids if dehydrated. 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. These may include listening to music or a story, watching a video, playing with a toy, having a parent provide distraction with talk or touch, using flash cards, and squeezing a rubber ball. Recognize complications associated with the phlebotomy procedure. Label all specimens per accepted guidelines. How to Troubleshoot a Difficult Venipuncture. Avoid excessive pressure that may squeeze tissue fluidinto the drop of blood. As a phlebotomist, it is critical to know which vein sites offer stable flows for blood draws. and "What is your date of birth?". While venipuncture is considered to be reasonably safe, the present study investigated the incidence of serious complications occurring in an outpatient setting. If blood stops flowing into the vacuum tube, the vein may have collapsed. The median cubital creates less bruising and pain than other draw sites. After the third attempt, further medical directions must be sought with the attending physician before proceeding. })(); The cephalic vein is a safe secondary option if the median cubital vein is not working. Loosen the tourniquet. Normal reference ranges are often noted according to age. Proper Handling of an Uncooperative Patient in an Outpatient Setting Akron. 10. Additionally, a hematoma may compress the nerve and lead to long-term damage. 4. Edematous extremities - tissue fluid accumulation alters test results. If a vein feels hard, it may be scarred or sclerosed. 2. (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.). Some examples of these include notices from banks, online retailers such as Amazon or eBay, and even . The median cubital vein and the cephalic vein in the wrist area should be avoided when possible. Calculate H\Delta \mathrm { H }H of this reaction. 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. } Adhesive bandages / tape - protects the venipuncture site after collection. Apply the tourniquet below the IV site. Greet the patient and identify yourself and indicate the procedure that will take place. Syringes - may be used in place of the evacuated collection tube for special circumstances. 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. Dalal BI, Brigden ML. 4. -obvious skin infection (including newly tattooed areas). Do not use excessive pressure or heavy massaging because the blood may become diluted with tissue fluid. B. collection device A clinical study is performed to determine the optimal time for application of the tourniquet during phlebotomy. C. Scarring Prepare the patient's arm using an alcohol prep. (Uman et al, 2013). When would you use a butterfly/infustion set? Such terms as "needs to," "must," "require" and "should" are used to explain how medical professionals should perform capillary blood collection procedures. A tin can containing air is sealed. Green When finished, clean the site and apply pressure with a clean gauze to stop the bleeding.