what sites should be avoided when performing venipuncture quizletwhat sites should be avoided when performing venipuncture quizlet

Drawing the patient in a reclined position. Arteries pulsate, are very elastic, and have a thick wall. If multiple blood samples are to be taken, the phlebotomist must be careful to follow the proper order of draw. You may also remove the tube, wait a few seconds for blood flow to resume, and then engage a short drawtube. Because most laboratory specimens contain bacteria, it is not necessary to wash hands before collecting them, The tourniquet applied prior to venipuncture is removed: This article was co-authored by Matt Garcia. Last draw - additive tubes in this order: SST (red-gray or gold top). The antecubital fossa is a collection of veins located within the arm's inner area, opposite of the elbow, where the arm folds in. wikiHow, Inc. is the copyright holder of this image under U.S. and international copyright laws. Mix and label all appropriate tubes at the patient bedside. Avoid bruising the infants heel when obtainingblood. Occupational Safety and Health Administration, United States Department of Labor. If it is then heated, what can you say about: b) how often the molecules hit the walls of the can. While hand veins may be utilized for blood draws and intravenous infusions, veins in the feet and legs should be avoided for adults. If possible, speak with the patient during the process. Dispose of contaminated materials in appropriate waste receptacles. This vein can be found along the upper arm to the thumb, but it is commonly drawn from the forearm or antecubital fossa area. McCall, R. E., & Tankersley, C. M. (2016). Serum iron levels tend to drop during the day. Warning: Make sure you are confident that the structure you're palpitating is indeed a vein. This vein lies close to the surface of the skin and there is not a large nerve supply. In some instances, the legs or feet are required for use, but a physician or doctor should be completing the draw, not a phlebotomist. Asking the patient about their previous blood draw experiences is beneficial, especially if they are a hard stick and know which area works best. Puncture no deeper than 2.4mm (approximately 0.1 inches). What should you do with a CBC or lavender top tube before putting them down? Any attempt to repeat a puncture at the same site increases the risk of complications. Also found in the antecubital fossa, the basilic vein serves as a last resort for blood draws. Never draw blood through a hematoma. The creatine kinase (CK), aspartate aminotransferase (AST), lactate dehydrogenase (LDH), and platelet count may increase. Whole blood specimens may not be able to be analyzed if microscopic clots are present. You should not perform this technique unless you are certain that the needle is in the immediate vicinity of the vein. Ask the patient orcaregiver to state the patients name and date of birth. B. above an IV line This image is not<\/b> licensed under the Creative Commons license applied to text content and some other images posted to the wikiHow website. D. after needle removal, When drawing blood you should always follow universal ______ B. Betadine Back the needle out until the bevel is just below the skin. Avoid the side of the finger where there is less soft tissue, where vessels and nerves are located, and where the bone is closer to the surface. Areas of fingers and heels that are cold, swollen, scarred or covered with a rash, should be avoided. This information must be given when requesting microbiology, cytology, fluid analysis, or other testing where analysis and reporting is site specific. Remember that veins should ideally feel bouncy. Question. Top Vein Sites Used in Phlebotomy | PhlebotomyU | CPT1 Course Observe all applicable isolationprocedures. Position the patient's arm in a comfortable extended position that provides adequate access to the planned venepuncture site. Anxiety that results in hyperventilation may cause acid-base imbalances, and increased lactate. Psychological interventions for needle-related procedural pain and distress in children and adolescents. Proper patient identification MANDATORY. If this is not successful, remove the needle, take care of the puncture site and redraw at another site. If a vein feels hard, it may be scarred or sclerosed. Additionally, blood samples should not be taken on an arm with a fistula used for dialysis treatments. Warm the heel from which blood is to be obtained. Any microtainerscontaining additives should be tapped to dislodge additives from the walls and top. Watch for formation of a hematoma. wikiHow, Inc. is the copyright holder of this image under U.S. and international copyright laws. 9. 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. }, false); obvious areas of skin infections After assembling the appropriate equipment, follow the next steps to perform a proper venipuncture. Adhesive bandages / tape - protects the venipuncture site after collection. C. at a mastectomy site Capillary Specimens may be collected on filter paper and sent to lab for testing for. Extensive scarring or healed burn areas should be avoided Specimens should not be obtained from the arm on the same side as a mastectomy. Lines - Drawing from an intravenous line may avoid a difficult venipuncture, but introduces problems. If the puncture is parallel to the lines of the fingerprint, theblood will not form as a drop but will run down the finger making collection difficult. Fill the microtainer tube(s) as needed. Use a butterfly to compensate for patient movement. Normal reference ranges are often noted according to age. This type of venipuncture procedure is a little different, and sometimes can be a little more involved. Never leave a tourniquet on for more than two minutes. Place labeled specimens in zip lock bag and deliver to the laboratory as soon as possible. D. 70% isopropyl alcohol. doi: 10.1002/14651858.CD005179.pub3. The blood is normally drawn from a vein on the top of the hand or from the inside of the elbow. IF AN INCOMPLETE COLLECTION OR NO BLOOD IS OBTAINED: Change the position of the needle. therapy is usually associated with acidic or alkaline solutions or solutions that have a high osmolarity. When finished, clean the site and apply pressure with a clean gauze to stop the bleeding. In fact, many search engines provide the option to avoid dangerous sites by turning on a "safer" search. Of course, the phlebotomist may understand this, however, the patient may not. Hold the baby's foot firmly to avoid sudden movement. He holds a Diploma in Medical Laboratory Assistance and is certified under the British Columbia Society of Laboratory Science. Apply the tourniquet below the IV site. Our students gain a vast amount of experience with phlebotomy vein sites through our hands-on and engaging curriculum and externship program. Holder/Adapter - use with the evacuated collection system. Some images used in this set are licensed under the Creative Commons through Flickr.com.Click to see the original works with their full license. When do you release the tourniquet during venipuncture? Hemolysis may occur, with pseudohyperkalemia. 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. Adjust the height and swivel the chair to ensure your body is in line with the vein. Proper labeling procedures and completion of laboratory requisitions. 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. This image is not<\/b> licensed under the Creative Commons license applied to text content and some other images posted to the wikiHow website. wikiHow, Inc. is the copyright holder of this image under U.S. and international copyright laws. This image is not<\/b> licensed under the Creative Commons license applied to text content and some other images posted to the wikiHow website. Check the requisition form for requested tests, patient information, and any special requirements. This image is not<\/b> licensed under the Creative Commons license applied to text content and some other images posted to the wikiHow website. Collect drops of blood into the . An assortment of needles and syringes of different sizes Tourniquet Alcohol and alcohol swabs Gauze or cotton balls Laboratory forms and blood-specimen labels Transportation bags and sharps container Step 2: Prepping The Patient Once you have the necessary supplies, it's time to ready the patient. What is the best position to perform venipuncture in? Avoid UE on same side of mastectomy (lymphedema) 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} D. all of the above, Common causes of hematomas that form during a venipuncture include: 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. diet, exercise, stress, basal state). Start with the arm closest to you and palpate the antecubital fossa. var zf_ifrm_data = evntData.split("|"); 6. When would you use a butterfly/infustion set? -use a smaller gauge needle Dalal BI, Brigden ML. site. Lightly touch the microtainer capillary collectiondevice (or filter paper) to the LARGE drop of blood. 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 _____. How should you have the patient position their arm after the venipuncture is complete? Puncture only the uppermost wall of the vein, Remove the tourniquet before removing the needle, Make sure the needle fully penetrates the upper most wall of the vein. Drawing blood for laboratory analysis is most often a routine and uneventful procedure. 7. Begin by selecting the proper, approved lancet, such as: BD Microtainer Quikheel Lancet, 2.5 mm for full-term babies (green), BD Microtainer Quickheel Preemie Lancet, 1.75 mm for neonatal, Unistick2 Neonatal 18G, 1.2mm Lancet for neonatal babies less than, Prepare the heel by cleaning it with a Chlorhexadine wipe. If another site is not available, collect the specimen distal to the hematoma. Cleanse the fingertip of the 3rd (middle) or 4th (ring) finger with an alcohol prep. wikiHow, Inc. is the copyright holder of this image under U.S. and international copyright laws. Extremity is edematous. 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. When using a syringe avoid drawing the plunger back too forcefully. Stress: May cause transient elevation in white blood cells (WBC's) and elevated adrenal hormone values (cortisol and catecholamines). Do not add blood to a circle already filled orpartially filled with blood. What equipment is needed for a venipuncture? Specimens from infants under the age of 6 months are typically collected by heelstick. Each phlebotomist generally establishes a routine that is comfortable for her or him. (b) the power developed by the output shaft. 2. Dorsal hand veins are often utilized for intravenous infusions but are viable options for blood draw sites. Let's take a look at the types of websites you and your staff need to be wary of and how to avoid them. Effective communication - both verbal and nonverbal - is essential. 2. Apply firm pressure for more than 5 minutes. The patient should either sit in a chair, lie down or sit up in bed. Diurnal Rhythms: Diurnal rhythms are body fluid and analyte fluctuations during the day. Fill the microtainer tube(s) as needed, adhering to the order of draw. Gloves - can be made of latex, rubber, vinyl, etc. Select the proper approved lancet: The BD Microtainer Contact-Activated. *NEVER BEND THE ARM*. Loosen the tourniquet. 4. This requisition form must contain the proper information in order to process the specimen. Serum red top or amber tube with red top. Contains lithium heparin anticoagulant and a gel separator. })(); The cephalic vein is a safe secondary option if the median cubital vein is not working. These items include: Veins on the underside of the wrist should be avoided. Filter paper should touch only the blood and not the heel or finger. Needles should be placed in a proper disposal unit IMMEDIATELY after their use. (See Use of Band-Aids in the Post Phlebotomy. (b) How would you prepare tetracaine from p-nitrobenzoic acid? Cleanse the heel with alcohol prep, then dry with a sterile 22 as alcohol can influence testresults. d.appendChild(f); This seats the bevel into the lumen of the vein, and is also the technique used to insert an IV catheter. This process is automatic. 4. 5. Label the specimens before leaving the patients bedside. Blood samples drawn from an IV line should be documented and analyzed with care. 1. What angle should you insert the needle at? 11. Provide for their comfort as much as possible, and gain the patient's cooperation. Pediatric Pointers. Center for Phlebotomy Education, Inc. Ernst, Dennis J. and Catherine Ernst. An OSHA acceptable, puncture proof container markedBiohazardous. Edematous extremities - tissue fluid accumulation alters test results. 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. Erroneous test results may be obtained when the blood is not thoroughly mixed with the additive. Avoid excessive pressure that may squeeze tissue fluid into the, mix the blood. Websites that masquerade as the ones you trust. Consult a specialist at the patient's own request and expense. In other words, there is no need for another venipuncture procedure. For children over 6 months and adults, the finger is punctured. 1. -Vacutainer barrel 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. Describe and perform the venipuncture process including: Appropriate clothing and protective equipment. Apply firm pressure. Label collection tubes after identification of the patient. 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). Be informed of the hospital rules and regulations regarding patient conduct. 2. Let's take a quick, high-level look at the venipuncture procedure. Which element has the highest ionization energy? Safely dispose of potentially infectious materials. Apply the tourniquet 3-4 inches above the selected puncture site. D. it is wiped with alcohol, Venipuncture at sites with each of the following could effect the results EXCEPT: Have the patient drink fluids if dehydrated. var d = document.getElementById("zf_div_SBGg-3DTNCwt65i9A6n_zU3SneyGD89SSqM_7F_nCas"); Over 52 percent of all web traffic is from mobile devices . Step 3: Venipuncture. What are the light blue top containers used for? Choosing an appropriate site for venipuncture is crucial for a successful . Arteries pulsate, are most elastic, and have a thick wall. Keep in mind that elderly patients often have fragile veins. Recognize complications associated with the phlebotomy procedure. Which of the following is the most likely mechanism for alteration in protein values in this situation? Pre-warm the region of the vein to reduce vasoconstriction and increase blood flow. Date, time and initials of the phlebotomist must be on the label of EACH tube. The first drop contains excess tissue fluid and must be wiped away. You must check the timing of these variations for the desired collection point. However, drawing blood from the hand is affiliated with higher levels of pain and less control. Follow the same procedure as for performing a finger, Order of Draw for a Capillary Puncture: Proper collection of tubes when. Compared to the standard blood donation which is about sixteen ounces, one ounce is really small. Calculate H\Delta \mathrm { H }H of this reaction. Approach the patient in a friendly, calm manner. 6. D. Both A and B, A sharps container is identified by its bright ____ color B. the needle is only partially in the vein Label the collection tubes at the bedside or drawing area. Areas of the body that look infected, scarred, or burned must also be avoided. Lippi G, Salvagno GL, Montagnana M, Franchini M, Guidi GC. Several veins in the antecubital fossa provide excellent access. increase the circulation of blood to the area. Capillary punctures are not suitable for blood culture testing and most coagulation tests. The patient has the right to refuse participation in such activity. Specimens; Approved StandardSixth Edition. Here phlebotomists will typically choose from three veins: the median cubital vein, the cephalic vein or the basilic vein. Recommended order of collection for microtainer specimens: 7. -infection at site For all NICU babies, once you have, collected the blood, wipe off the area with a sterile saline wipe, to remove. Perform the venipuncture, collecting the sample(s) in the appropriate container(s). Capillary puncture should not be used. Fill the capillary tube(s) or micro collection device(s) as needed. C. placed in the sharps container (c) How would you prepare tetracaine from benzene? Gloves are to be discarded in the appropriate container immediately after the bloodcollection procedure. This enables the bloodto form as a drop on the fingertip. 2009 Feb;131(2):195-204. This image is not<\/b> licensed under the Creative Commons license applied to text content and some other images posted to the wikiHow website. 3. Position the infant with the head slightly elevated. Dorsal hand veins are often utilized for intravenous infusions but are viable options for blood draw sites. https://www.osha.gov/laws-regs/standardinterpretations/2007-10-26 and https://www.osha.gov/OshDoc/data_BloodborneFacts/bbfact03.pdf (Accessed June 13, 2022). 7. By signing up you are agreeing to receive emails according to our privacy policy. The upper extremity on the side of a previous mastectomy - test results may be affected because of lymphedema. What is the procedure to draw blood from an arm with an IV in it? Include your email address to get a message when this question is answered. If an inpatient is able to respond, ask for a full name and always check the armband or bracelet for confirmation. Cephalic vein. 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? Am J Clin Pathol. outstretched or raised By using our site, you agree to our. 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. NHA Exam Questions Flashcards | Chegg.com PDF Venipuncture - Central Zone - Alberta Health Services Also consider adjusting the angle of the needle. After cleansing, allow the venipuncture site to air dry. However, blood samples that are normally taken are actually very small. To request course information, contact PhlebotomyU today. The recommended location for blood collection on a newborn baby or infant is the heel. HealthStar Press, Inc. 2001, updated 1/08. Avoid trauma and excessive probing. This image may not be used by other entities without the express written consent of wikiHow, Inc.
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