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\u00a9 2023 wikiHow, Inc. All rights reserved. He holds a Diploma in Medical Laboratory Assistance and is certified under the British Columbia Society of Laboratory Science. What are some of the reasons to draw blood? IV lines are very useful in hospitals because some patients require frequent blood tests. 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. Use a smaller tube with less vacuum. 2019;95(1):15-19. doi: 10.1016/j.diagmicrobio.2019.04.001. What are the complications that can occur when performing a venipuncture? Fill the microtainer tube(s) as needed, adhering to the order of draw. wikiHow, Inc. is the copyright holder of this image under U.S. and international copyright laws. (2017). f.src = 'https://forms.zohopublic.com/healthservicesacademy/form/RequestCourseInformationCPTIAccelerated/formperma/SBGg-3DTNCwt65i9A6n_zU3SneyGD89SSqM_7F_nCas?zf_rszfm=1'; -do not rapidly insert the needle. (a) the electric power required. In most of these cases, the skin on the hand is pierced and a vein is accessed so medications or fluids can be given intravenously. This is more common in humeral and femoral punctures than radial punctures. This information must be given when requesting microbiology, cytology, fluid analysis, or other testing where analysis and reporting is site specific. The median cubital creates less bruising and pain than other draw sites. 7. Be informed of the hospital rules and regulations regarding patient conduct. if( evntData && evntData.constructor == String ){ 70% isopropyl alcohol If possible, speak with the patient during the process. 3. -use correct angle of needle insertion Interruptions and distractions during medical encounters and procedures should be avoided. Avoid excessive probing ("fishing"). -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? The fifth finger tends to have less soft tissue overlying the bone. The performance of routine vascular access procedures by skilled phlebotomists requires, at a minimum, the use of gloves to prevent contact with blood. antecubital fossa What are the best veins for venipuncture? A. in the region of a hematoma Cleanse the heel with alcohol prep, then dry with a sterile 22 as alcohol can influence testresults. -antiseptic swabs (See, The chlorhexidine is a concern for the premature babies in NICU as it can, be absorbed through the skin. It is large and near the skins surface, making it easier for phlebotomists to see before anchoring the vein. outstretched or raised Sanders AM, Agger WA, Gray AM, Fischer CM, Kamprud EA. It brings the entire family wikiHow, Inc. is the copyright holder of this image under U.S. and international copyright laws. 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. Blood clots, and the serum is separated by centrifugation, Chemistries, Immunology and Serology, Blood Bank (Crossmatch), Serum separator tube (SST) contains a gel at the bottom to separate blood from serum on centrifugation, Plasma Separating Tube (PST) with Lithium heparin, Anticoagulates with lithium heparin; Plasma is separated with PST gel at the bottom of the tube, Hematology (CBC) and Blood Bank (Crossmatch); requires. This is especially important when collecting EDTA (lavender top) or heparin (green top) tubes. Hemolysis may occur, with pseudohyperkalemia. 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. The best locations for fingersticks are the 3rd (middle) and 4th (ring) fingers of the non-dominant hand. Place labeled specimens in zip lock bag and deliver to the laboratory as soon as possible. Areas in which two veins join should be avoided where possible, as valves are often present. This is a general guide for troubleshooting a venipuncture scenario in which blood flow is not initially established upon needle insertion. Warm the heel from which blood is to be obtained. When do you release the tourniquet during venipuncture? {"smallUrl":"https:\/\/www.wikihow.com\/images\/thumb\/6\/68\/Troubleshoot-a-Difficult-Venipuncture-Step-1.jpg\/v4-460px-Troubleshoot-a-Difficult-Venipuncture-Step-1.jpg","bigUrl":"\/images\/thumb\/6\/68\/Troubleshoot-a-Difficult-Venipuncture-Step-1.jpg\/aid11732774-v4-728px-Troubleshoot-a-Difficult-Venipuncture-Step-1.jpg","smallWidth":460,"smallHeight":345,"bigWidth":728,"bigHeight":546,"licensing":"
\u00a9 2023 wikiHow, Inc. All rights reserved. Veins sometimes roll away from the point of the needle and puncture site. D. 70% isopropyl alcohol. Guidelines established by the Clinical and Laboratory Standards Institute (CLSI) dictate that a phlebotomist shall not attempt a venipuncture more than two times, and a maximum of three attempts shall be undertaken on a patient. wikiHow is where trusted research and expert knowledge come together. As always, properly fill out appropriate requisition forms, indicating the test(s) ordered. You should not perform this technique unless you are certain that the needle is in the immediate vicinity of the vein. A. the tubes are filled and properly labeled NOTE:Tubes with additives must be thoroughly mixed. Proper patient identification procedures. A scooping motion to collect blood and strong repetitive pressure (milking) MUST be avoided, as both procedures may result in hemolysis or tissue-fluid contamination fo the specimen. The median cubital vein is used the most for its accessibility. What are the gray top containers used for? The Patient's Bill of Rights has been adopted by many hospitals as declared by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). Have the patient position their arm on the armrest. 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. 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. This process is automatic. The infograph below provides a detailed description of the venipuncture steps as found in our how to draw blood resource. Many drugs will have "peak" and "trough" levels that vary according to dosage levels and intervals. Contains a gel separator and clot activator. 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. Collect drops of blood into the collection device by gently massaging the finger. remove needle C. at a mastectomy site Safely dispose of potentially infectious materials. D. All of the above, Needles are sterile until: Joslin JO. Take enough time to assess the vein before beginning the venipuncture procedure. The area where the blood is to be drawn from is first cleaned with a germ-killing solution. Ernst, Dennis J. Any attempt to repeat a puncture at the same site increases the risk of complications. 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. Use of hair nets and face masks to decrease blood culture contamination rates. Effective communication - both verbal and nonverbal - is essential. var d = document.getElementById("zf_div_SBGg-3DTNCwt65i9A6n_zU3SneyGD89SSqM_7F_nCas"); Label the specimens before leaving the patients bedside. A. given to the patient Have the patient hold a small gauze pad over the puncture site for a couple of minutes to stop the bleeding. 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. Most reference ranges are based on normal laboratory test values for: Healthy people in a basal state. 2. Position the infant with the head slightly elevated. Why? When there is an IV line present, blood can be drawn from this line. 4. The upper extremity on the side of a previous mastectomy - test results may be affected because of lymphedema. Recognize complications associated with the phlebotomy procedure. How many time should you invert them? Warning: Make sure you are confident that the structure you're palpitating is indeed a vein. Also consider adjusting the angle of the needle. 9. Never draw over scars or a new tattoo sites. Wear gloves and a lab coat or gown when handling blood/body fluids. Over time and with several repeated punctures, significant amounts of scar tissue builds up. This makes every subsequent poke harder and harder because scar tissue is more fibrous and tougher to puncture. An outpatient must provide identification other than the verbal statement of a name. Reassure the patient that the minimum amount of blood required for testing will be drawn. 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. 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. B. evacuated tube Try rotating the arm to better expose the cephalic or basilic vein. This image may not be used by other entities without the express written consent of wikiHow, Inc.
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\n<\/p><\/div>"}, 7 Easy Ways to Figure Out Your Blood Type (With or Without a Test). Apply blood to the printed side of the filter paper. 10. prevent falls, should the patient lose consciousness. Give an example of each. Most commonly, venipuncture will be performed on the Antecubital Fossa, or the inside of the elbow. chemistries, serology, immunnology, blood bank. How can you tell if you are palpating a vein? If this is not successful, remove the needle, take care of the puncture site and redraw at another site. wikiHow, Inc. is the copyright holder of this image under U.S. and international copyright laws. Gloves are to be worn during all blood collection procedures, and changed betweenpatient collections. The median cubital vein and the cephalic vein in the wrist area should be avoided when possible. C. Red Diurnal Rhythms: Diurnal rhythms are body fluid and analyte fluctuations during the day. Check for any allergies to antiseptics, adhesives, or latex by observing for armbands and/or by asking the patient. -thrombosis Use pillows or foam wedges to elevate the arm and help with extension. the 3 rd (middle) or 4 th (ring) finger of the hand. C. the needle has penetrated all the way through the vein Deliver specimens promptly to the laboratory. The first attempt is the antecubital fossa area, starting with the median cubital vein, then the cephalic vein, and the basilic vein. The vein may have collapsed; resecure the tourniquet to increase venous
filling. 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. Intravenous therapy (IV) / blood transfusions - fluid may dilute the
specimen, so collect from the opposite arm if possible. Perform the venipuncture. 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. https://www.ncbi.nlm.nih.gov/books/NBK138650/pdf/Bookshelf_NBK138650.pdf (Accessed June 13, 2022). Look at the dorsum of the hand as a last resort. Obtain from the practitioner complete and current information about
diagnosis, treatment, and any known prognosis, in terms the patient can
reasonably be expected to understand. Lines - Drawing from an intravenous line may avoid a difficult venipuncture, but introduces problems. 3. World Health Organization. What equipment is needed for a venipuncture? Tourniquet - Wipe off with alcohol and replace frequently. Giavarina D, Lippi G. Blood venous sample collection: Recommendations overview and a checklist to improve quality. If using a needle and syringe, avoid drawing the plunger back too forcefully. Avoid excessive pressure that may squeeze tissue fluid into the drop of blood. Here phlebotomists will typically choose from three veins: the median cubital vein, the cephalic vein or the basilic vein. Am J Clin Pathol. What are the red top containers used for? By using our site, you agree to our. B. just after needle insertion, but prior to vacutainer activation Capillary Specimens may be collected on filter paper and sent to lab for testing for. window.addEventListener('message', function (){ Fasting, dietary restrictions,
medications, timing, and medical treatment are all of concern and should be noted on the lab requisition. Palpate and trace the path of veins with the index finger. Regardless of the source of payment, request and receive an itemized and detailed explanation of the total bill for services rendered in the hospital. Extensive scarring or healed burn areas should be avoided Specimens should not be obtained from the arm on the same side as a mastectomy. All other items used for the procedure must be disposed of according to properbiohazardous waste disposal policy. A commercial heel warmer may be used. PST (light green top). 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. (function() { Phlebotomists are considered to have occupational exposure to blood borne pathogens. Capillary specimens are collected in microtainers with colored caps that are used to. Re-secure the tourniquet to increase venous filling. Certain areas are to be avoided when choosing a site: Extensive scars from burns and surgery - it is difficult to puncture the scar tissue and obtain a specimen. 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. Refuse treatment to the extent permitted by law. Avoid excessive pressure that may squeeze tissue fluidinto the drop of blood. Some individuals are afraid of needles, while others are frightened at the sight of blood. A tin can containing air is sealed. For most clinical examinations the blood is obtained: The vacuum (evacuated) tube system (vacutainer) requires the following components: The healthcare worker needs essential items for either venipuncture or microcollection. d.appendChild(f); 8. 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. Be methodical in your search for a vein. 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. Apply firm pressure. site. Wipe away the first drop of blood with sterile 22 gauze. The maximum number of times an individual should attempt a venipuncture on a patient is two, True or False? D. Near a tattoo, Needles are used once and then: increase the circulation of blood to the area. This image is not<\/b> licensed under the Creative Commons license applied to text content and some other images posted to the wikiHow website. The phlebotomist's role requires a professional, courteous, and understanding manner in all contacts with the patient. Hematoma - may cause erroneous test results. For example, serum cortisol levels are highest in early morning but are decreased in the afternoon. Areas of fingers and heels that are cold, swollen, scarred or covered with a rash, should be avoided. Asking the patient about their previous blood draw experiences is beneficial, especially if they are a hard stick and know which area works best. Carry out hand hygiene before and after each patient procedure, before putting on and after removing gloves. Place labeled specimens in zip lock bag and deliver to the laboratory as soon as possible. Never draw blood through a hematoma. Re-anchor the vein. Procedures and Devices for the Collection of Diagnostic Capillary Blood. This article has been viewed 43,712 times. Avoid UE on same side of mastectomy (lymphedema) Potassium A phlebotomy technician is removing his gloves after a venipuncture procedure. They are also. Websites that masquerade as the ones you trust. -18, 20, 22 gauge needles. These items include: Holder/Adapter - use with the evacuated collection system. Do not attempt a capillary puncture more than twice. After the needle selection, phlebotomists begin to look and feel for a viable vein. In general, blood should not be drawn from an arm with a fistula
or cannula without consulting the attending physician. By signing up you are agreeing to receive emails according to our privacy policy. There are some slight risks associated with venipuncture which may include excessive bleeding, feeling light-headed, fainting, nerve damage, hematoma (accumulation of blood under the skin), and infection. When using a syringe avoid drawing the plunger back too forcefully. Filter paper should touch only the blood and not the heel or finger. var iframe = document.getElementById("zf_div_SBGg-3DTNCwt65i9A6n_zU3SneyGD89SSqM_7F_nCas").getElementsByTagName("iframe")[0]; X=[Ar]4s23d5Y=[Ar]4s23d104p1Z=[Ar]4s23d104p6. Be sure to dispose of the lancet in the appropriate sharps container. Dispose of needles immediately upon removal from the patient's vein. Previous puncture sites should be avoided. 2004;24(4):979-96, vii. B. above an IV line Proper patient identification MANDATORY. -obvious skin infection (including newly tattooed areas). 1. https://www.osha.gov/laws-regs/standardinterpretations/2007-10-26 and https://www.osha.gov/OshDoc/data_BloodborneFacts/bbfact03.pdf (Accessed June 13, 2022). This image is not<\/b> licensed under the Creative Commons license applied to text content and some other images posted to the wikiHow website. Wayne, PA: Clinical and Laboratory Standards Institute; 2008. wikiHow, Inc. is the copyright holder of this image under U.S. and international copyright laws. A variety of techniques can be employed to reduce pain and anxiety. Larger tube sizes typically provide for collection of samples from 6 to 10 mL. Contains acid citrate dextrose. Notify your supervisor or patientsphysician if unsuccessful. Summarize the problems that may be encountered in accessing a vein,
including the procedure to follow when a specimen is not obtained. Cap, rotate and invert the collection device to mix the blood collected. Place a pillow under the patient's arm if additional support is needed. -keep extremity below heart level for a few minutes. obvious areas of skin infections Psychological interventions for needle-related procedural pain and distress in children and adolescents. Dispose of items in appropriate containers. 2. followed pre-lab instructions. While this may be effective in some difficult draws, the risk of a needlestick injury is higher if the patient has a withdrawal reflex and the needle recoils back into your finger. Ask the patient orcaregiver to state the patients name and date of birth. C. placed in the sharps container