what sites should be avoided when performing venipuncture quizlet

\u00a9 2023 wikiHow, Inc. All rights reserved. 3. Tip: Lowering the arm below the level of the heart may help to engorge the vessels. Fill the microtainer tube(s) as needed. However, drawing blood from the hand is affiliated with higher levels of pain and less control. Hemolysis may occur, with pseudohyperkalemia. 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. -obvious skin infection (including newly tattooed areas) -extensive scarring -don't use same side as mastectomy -avoid previous hematoma -avoid arm w/ fistula/cannula -edamtous extremity What is the most common site for blood sampling? Examples of labeled collection tubes are shown below: THE FOLLOWING ARE NEEDED FOR ROUTINE VENIPUNCTURE: Evacuated Collection Tubes - The tubes are designed to fill with a predetermined volume of blood by vacuum. Allow to air dry. 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. 5. B. Yellow This guide follows the steps as outlined in the World Health Organizations Guidelines on Drawing Blood: Best Practices in Phlebotomy. Press down on the gauze once the needle is out of the arm, applying adequate pressure to avoid formation of a hematoma. 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. Hematoma - may cause erroneous test results. Proper patient identification procedures. In fact, many search engines provide the option to avoid dangerous sites by turning on a "safer" search. Stabilize the needle as you're inserting your tubes. Position the infant with the head slightly elevated. A tin can containing air is sealed. What is the best position to perform venipuncture in? Diurnal variations associated with some blood components are: When the last tube to be drawn is filling, remove the tourniquet. 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. 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. 2. Therefore, an arm containing an IV should not be used to draw blood specimens if it can be avoided. Approach the patient in a friendly, calm manner. 5. Tubes with different additives are used for collecting blood specimens for specific types. Phlebotomy Essentials 5th Edition Chapter 9. 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. You may also remove the tube, wait a few seconds for blood flow to resume, and then engage a short drawtube. Butterflies are incredibly valuable tools for tackling difficult draws, owing to their precision, shorter shaft length, and maneuverability. B. evacuated tube Assess the need for sample recollection and/or rejection. 2004;24(4):979-96, vii. Posture: Postural changes (supine to sitting etc.) Fill the microtainer tube(s) as needed, adhering to the order of draw. Document that the venipuncture was performed distal to (below) an infusion site. Do not add blood to a circle already filled orpartially filled with blood. Order of draw for multiple tube phlebotomy. Kiechle FL. f.src = 'https://forms.zohopublic.com/healthservicesacademy/form/RequestCourseInformationCPTIAccelerated/formperma/SBGg-3DTNCwt65i9A6n_zU3SneyGD89SSqM_7F_nCas?zf_rszfm=1'; 8. 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. Make the cut across the heelprint lines so that a drop of blood can well up and not run down along the lines. prevent falls, should the patient lose consciousness. You should not perform this technique unless you are certain that the needle is in the immediate vicinity of the vein. Several essential steps are required for every successful collection procedure: Patient comfort. When finished, clean the site and apply pressure with clean gauze to stop the bleeding. wikiHow, Inc. is the copyright holder of this image under U.S. and international copyright laws. However, blood samples that are normally taken are actually very small. Avoid bruising the infants heel when obtainingblood. This image is not<\/b> licensed under the Creative Commons license applied to text content and some other images posted to the wikiHow website. This vein lies close to the surface of the skin and there is not a large nerve supply. Do not use a previous puncture site. 3. Northfield, IL: College of American, NCCLS. Thrombosed veins lack resilience, feel cord-like, and roll easily. Extensive scarring or healed burn areas should be avoided Specimens should not be obtained from the arm on the same side as a mastectomy. This seats the bevel into the lumen of the vein, and is also the technique used to insert an IV catheter. The vein may have collapsed; resecure the tourniquet to increase venous filling. (function() { Blood is commonly obtained from the median cubital vein on the anterior forearm. -keep extremity below heart level for a few minutes. on patients who are extremely dehydrated or have poor peripheral circulation. Remember -- the rst vein found is not always the best vein. Cap, rotate and invert the microtainer to mix the blood collected. While venipuncture is considered to be reasonably safe, the present study investigated the incidence of serious complications occurring in an outpatient setting. 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. B. the insertion site has stopped bleeding 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. World Health Organization. f.style.transition="all 0.5s ease"; B. Betadine Sometimes you may get initial blood flow, but then it stops when you change tubes. Drawing the patient in a reclined position. Verify the patient's condition. Firmly grasp the flanges of the tube holder to avoid advancing the needle further into the vein as you change tubes. 6. 1. If an inpatient is able to respond, ask for a full name and always check the armband or bracelet for confirmation. -use correct angle of needle insertion The performance of routine vascular access procedures by skilled phlebotomists requires, at a minimum, the use of gloves to prevent contact with blood. Each time a vein is accessed with a needle, scar tissue forms as part of the body's healing process. Identify the additive, additive function, volume, and specimen considerations to be followed for each of the various color coded tubes. -thrombosis Apply only ONE drop of blood per circle. When there is an IV line present, blood can be drawn from this line. This information must be given when requesting microbiology, cytology, fluid analysis, or other testing where analysis and reporting is site specific. Mastering Pediatric Phlebotomy. Center, for Phlebotomy Education, Inc. 5. Which of the following actions should the technician take? It doesn't matter . Check for any allergies to antiseptics, adhesives, or latex by observing for armbands and/or by asking the patient. Avoid excessive probing ("fishing"). Valenstein PN, Sirota RL. Have the patient hold a small gauze pad over the puncture site for a couple of minutes to stop the bleeding. What sites should be avoided when drawing blood? f.style.width="100%"; A. given to the patient Question. chemistries, serology, immunnology, blood bank. Websites that masquerade as the ones you trust. 9. A requisition form must accompany each sample submitted to the laboratory. This preliminary action allows you to safely adjust the needle's position. Sites that should be avoided include areas with extensive scarring, healed burns, inflamed sites, edematous sites, previous puncture sites, earlobes and thumbs. Let's take a look at the types of websites you and your staff need to be wary of and how to avoid them. The line must be flushed first. Using a sterile blood lancet, puncture the side of the heel in the appropriate regions shown above in green. Apply the tourniquet below the IV site. Potassium A phlebotomy technician is removing his gloves after a venipuncture procedure. Impartial access to treatment or accommodations that are available or medically indicated, regardless of race, creed, sex, national origin, or sources of payment for care. Performing a venipuncture on a child under one year of age . At least two patient identifiers, such as name and date of birth, are needed. What should you never do to a site you just cleansed with alcohol? Venipuncture can also happen when patients have intravenous (IV) lines started. If using a syringe, make sure the needle is fitted securely on a syringe to avoid frothing. For operation at steady state, determine for the motor, each in kW\mathrm{kW}kW The Patient's Bill of Rights has been adopted by many hospitals as declared by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). Over time and with several repeated punctures, significant amounts of scar tissue builds up. Penetrate the skin at a 30 to 45 angle at first (even less with a butterfly), then once you get a flash, reduce the angle by bringing the needle assembly down closer to the arm and advance the needle a tiny bit further into the vein. })(); The cephalic vein is a safe secondary option if the median cubital vein is not working. For example, serum cortisol levels are highest in early morning but are decreased in the afternoon. if ( (iframe.src).indexOf('formperma') > 0 && (iframe.src).indexOf(zf_perma) > 0 ) { Serum iron levels tend to drop during the day. Hard and dense structures may be nerves or tendons. If a vein feels hard, it may be scarred or sclerosed. Failure to do this results in an unequal blood-to-additive ratio, making the specimen unsuitable for analysis. Avoid a probing, traumatic venipuncture. Collect drops of blood into the collection device by gently massaging the finger. For an inpatient DO NOT DRAW BLOOD IF THE ARMBAND OR BRACELET IS MISSING. The infograph below provides a detailed description of the venipuncture steps as found in our how to draw blood resource. Copyright 2023 - PhlebotomyU | Website Design & SEO by, Phlebotomy: 5 Tips on Finding Difficult Veins. Tip: In spite of a difficult draw, remember to invert your tubes. Get instant access to our latest tools and our must-read site updates: What Certifications Are Used For Higher Pay For Phlebotomists? B. the needle is only partially in the vein Place labeled specimens in zip lock bag and deliver to the laboratory as soon as possible. 1. (Uman et al, 2013). You should always contact your doctor or other qualified healthcare professional before starting, changing, or stopping any kind of health treatment. Avoid excessive pressure that may squeeze tissue fluidinto the drop of blood. Even if several vials of blood have to be drawn it usually amounts to no more than one ounce. 4. Apply firm pressure. By holding the needle either by the plastic wings or the hub, phlebotomists can achieve a shallower angle, typically 10-15 degrees. Journal of Exotic Pet Medicine. When 25.0 mL of 0.500 M H2S04 is added to 25.0 mL of 1.00 M KOH in a coffee-cup calorimeter at 23.50C23.50 ^ { \circ } \mathrm { C }23.50C the temperature rises to 30.17C30.17 ^ { \circ } \mathrm { C }30.17C . X=[Ar]4s23d5Y=[Ar]4s23d104p1Z=[Ar]4s23d104p6. 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. Draw 5 ml of blood and discard before drawing the specimen tubes for testing. A. the plastic sleeve is removed 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. Background: Venipuncture is the most common invasive medical procedure performed by health care providers. 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. 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. Phlebitis can also occur as a result of vein trauma during insertion, use of an inappropriate I.V. 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. Adjust the height and swivel the chair to ensure your body is in line with the vein. This image is not<\/b> licensed under the Creative Commons license applied to text content and some other images posted to the wikiHow website. All of the following are common types of equipment used for venipuncture EXCEPT: 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. A. 7. It is large and near the skins surface, making it easier for phlebotomists to see before anchoring the vein. 4. The fifth finger tends to have less soft tissue overlying the bone. Psychological interventions for needle-related procedural pain and distress in children and adolescents. Fasting, dietary restrictions, medications, timing, and medical treatment are all of concern and should be noted on the lab requisition. (See, The chlorhexidine is a concern for the premature babies in NICU as it can, be absorbed through the skin. puncture site downward and gently applying intermittent pressure to the surrounding tissue (or proximal to the puncture site when the blood is obtained from a finger). Ask the patient orcaregiver to state the patients name and date of birth. What sites should be avoided when drawing blood? Hematoma - may cause erroneous test results. If this is not successful, remove the needle, take care of the puncture site and redraw at another site. 3. https://www.osha.gov/laws-regs/standardinterpretations/2007-10-26 and https://www.osha.gov/OshDoc/data_BloodborneFacts/bbfact03.pdf (Accessed June 13, 2022). Ernst, Dennis J. (b) the power developed by the output shaft. Whole blood specimens may not be able to be analyzed if microscopic clots are present. By using our site, you agree to our. Re-secure the tourniquet to increase venous filling. If just a routine coagulation assay is the only test ordered, then a single light blue top tube may be drawn. This image may not be used by other entities without the express written consent of wikiHow, Inc.
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