\u00a9 2023 wikiHow, Inc. All rights reserved. -do not rapidly insert the needle. How to Troubleshoot a Difficult Venipuncture: 14 Steps - wikiHow Refuse treatment to the extent permitted by law. For a detailed breakdown of each step of the venipuncture test scroll down. f.src = 'https://forms.zohopublic.com/healthservicesacademy/form/RequestCourseInformationCPTIAccelerated/formperma/SBGg-3DTNCwt65i9A6n_zU3SneyGD89SSqM_7F_nCas?zf_rszfm=1'; 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. Stress: May cause transient elevation in white blood cells (WBC's) and elevated adrenal hormone values (cortisol and catecholamines). Look for visual clues which may help assess the patient's condition. Wayne, PA: Clinical and Laboratory Standards Institute; 2008. As always, properly fill out appropriate requisition forms, indicating the test(s) ordered. Label collection tubes after identification of the patient. Sites to avoid: Extensive scarring from burns or surgery The upper extremity on the side that a mastectomy was performed. What should you do with a CBC or lavender top tube before putting them down? Last draw - additive tubes in this order: SST (red-gray or gold top). -18, 20, 22 gauge needles. Avoid bruising the infants heel when obtainingblood. Procedures and Devices for the Collection of Diagnostic Capillary Blood. In other words, there is no need for another venipuncture procedure. Perform the venipuncture. Any microtainerscontaining additives should be tapped to dislodge additives from the walls and top. Drawing blood from major vessels (e.g. Lightly touch the microtainer capillary collection device (or filter paper) to the LARGE drop of blood. wikiHow, Inc. is the copyright holder of this image under U.S. and international copyright laws. B. Hematoma Follow institution's guidelines regarding treatment and follow-up. Asking the patient about their previous blood draw experiences is beneficial, especially if they are a hard stick and know which area works best. Tubes with different additives are used for collecting blood specimens for specific types. Airborne precautions may be considered to provide a level of safety against infectious diseases such as tuberculosis, influenza, and COVID-19. f.style.width="100%"; However, do not use too high a temperature warmer, because baby's skin is thin and susceptible to thermal injury. Apply only ONE drop of blood per circle. Which element has the highest ionization energy? Label the specimens before leaving the patients bedside. Pre-warm the region of the vein to reduce vasoconstriction and increase blood flow. PST (light green top). 1. Anxiety that results in hyperventilation may cause acid-base imbalances, and increased lactate. To prevent hemolysis when performing a venipuncture, the phlebotomist should: 1. B. the insertion site has stopped bleeding You will be redirected once the validation is complete. wikiHow, Inc. is the copyright holder of this image under U.S. and international copyright laws. 2017;50(10-11):568-573. 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. together for emotional support and understanding across multiple locations to reach you in the community where you live. Dispose of items in appropriate containers. Stop the procedure if a hematoma occurs. 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. Cap, rotate and invert the collection device to mix the blood collected. 1. previous experience with vomiting or fainting Place blood collection equipment away from patients, especially children and psychiatric patients. The patient should make a fist without pumping the hand. Interruptions and distractions during medical encounters and procedures should be avoided. 7. However, if there is no alternative and an arm with an IV line in place must be used for venipuncture, try to choose a site away from and below the location of the IV. You may also remove the tube, wait a few seconds for blood flow to resume, and then engage a short drawtube. 1. 2017;148(4):330-335. 3. } doi: 10.1002/14651858.CD005179.pub3. With risk for blood spatter a face shield provides protection. Document that the venipuncture was performed distal to (below) an infusion site. 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. Top Vein Sites Used in Phlebotomy | PhlebotomyU | CPT1 Course C. Iodine What is the most common complication of venipuncture? Allow to air dry. f.style.height="352px"; Needles should be placed in a proper disposal unit IMMEDIATELY after their use. Povidone-iodine wipes/swabs - Used if blood culture is to be drawn. Greet the patient and identify yourself and indicate the procedure that will take place. var iframe = document.getElementById("zf_div_SBGg-3DTNCwt65i9A6n_zU3SneyGD89SSqM_7F_nCas").getElementsByTagName("iframe")[0]; If another site is not available, collect the specimen distal to the hematoma. By using our site, you agree to our. Identification errors in pathology and laboratory medicine. Order of draw for multiple tube phlebotomy. www.mlo-online.com is using a security service for protection against online attacks. Diurnal Rhythms: Diurnal rhythms are body fluid and analyte fluctuations during the day. Filter paper should touch only the blood and not the heel or finger. 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. Various sizes are available. Therefore, an arm containing an IV should not be used to draw blood specimens if it can be avoided. A. Preferred venous access sites, and factors to consider in site selection, and ability to differentiate between the feel of a vein, tendon and artery. When multiple vials of blood are collected it can seem like a large amount. -use a smaller gauge needle Tip: Lowering the arm below the level of the heart may help to engorge the vessels. 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. Provide for their comfort as much as possible, and gain the patient's cooperation. Place labeled specimens in zip lock bag and deliver to the laboratory as soon as possible. The service requires full JavaScript support in order to view this website. Kiechle, Frederick L. So Youre Going to Collect a Blood Specimen: An, Introduction to Phlebotomy, 11th Edition. The content of this article is not intended to be a substitute for professional medical advice, examination, diagnosis, or treatment. Place labeled specimens in zip lock bag and deliver to the laboratory as soon as possible. therapy is usually associated with acidic or alkaline solutions or solutions that have a high osmolarity. C. at a mastectomy site Position the patient. How can you decrease the risk of hematoma formation? Here phlebotomists will typically choose from three veins: the median cubital vein, the cephalic vein or the basilic vein. What is the procedure to draw blood from an arm with an IV in it? Lippi G, Blanckaert N, Bonini P, Green S, Kitchen S, Palicka V, Vassault AJ, Mattiuzzi C, Plebani M. Causes, consequences, detection, and prevention of identification errors in laboratory diagnostics. However, drawing blood from the hand is affiliated with higher levels of pain and less control. wikiHow, Inc. is the copyright holder of this image under U.S. and international copyright laws. 3. Avoid drawing blood from a hematoma; select another draw site. Transferring a sample from one collection tube to another or mixing blood from different collection tubes must be avoided. Intravenous therapy (IV) / blood transfusions - fluid may dilute the specimen, so collect from the opposite arm if possible. Not making it mobile friendly. Avoid excessive pressure that may squeeze tissue fluid into the, mix the blood. This information must be given when requesting microbiology, cytology, fluid analysis, or other testing where analysis and reporting is site specific. In some cases, a phlebotomist may have to switch sites if they find the blood is not properly flowing from the vein. Veins on the underside of the wrist should be avoided. Avoid prolonged tourniquet application or fist clenching. Preanalytical phase of the testing process begins for the laboratory when a: Test is ordered by a patient's physician. 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. 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). Thrombosed veins lack resilience, feel cord-like, and roll easily. Cleanse the fingertip of the 3rd (middle) or 4th (ring) finger with an alcohol prep. (a) How would you prepare tetracaine from the corresponding aniline derivative, ArNH2_22? Gloves - can be made of latex, rubber, vinyl, etc. When working with patients who have undergone a mastectomy, draw from the arm on the opposite side of the mastectomy to avoid edematous tissue. Step 3: Venipuncture. 1. Am J Clin Pathol. You should always contact your doctor or other qualified healthcare professional before starting, changing, or stopping any kind of health treatment. Hard and dense structures may be nerves or tendons. Diagn Microbiol Infect Dis. Phlebotomists are considered to have occupational exposure to blood borne pathogens. Inadvertently nicking a nerve causes intense pain. The median cubital vein is used the most for its accessibility. The fluid may dilute the specimen, so collect from the opposite arm. wikiHow, Inc. is the copyright holder of this image under U.S. and international copyright laws. 3. 6. Date, time and initials of the phlebotomist must be on the label of EACH tube. When there is an IV line present, blood can be drawn from this line. The use of a tourniquet during a venipuncture procedure makes: A. 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 caution should you observe when using a Vacutainer? In some instances, the legs or feet are required for use, but a physician or doctor should be completing the draw, not a phlebotomist. The hydrostatic pressure causes some water and filterable elements to leave the extracellular space. The line must be flushed first. 2. Avoid excessive probing ("fishing"). Subcutaneous tissue feels squishy and muscle feels hard. Capillary Specimens may be used immediately for point-of-care testing. Clin Lab. D. discarded in the trash, True or False? Capillary punctures are not suitable for blood culture testing and most coagulation tests. They are also. 4. Venipuncture Quiz Flashcards | Quizlet Adhesive bandages / tape - protects the venipuncture site after collection. Dispose of needles immediately upon removal from the patient's vein. Gauze sponges - for application on the site from which the needle is withdrawn. -test tubes Precautions include a medical grade face mask. So You're Going to Collect a Blood Specimen: An Introduction to Phlebotomy, 13th Edition (2010), College of American Pathologists, Northfield, IL. It doesn't matter . If the patient is sitting in a phlebotomy chair, make sure they are sitting upright with their back against the chair. ROUTINE CAPILLARY PUNCTURE BLOOD COLLECTION GUIDELINES. Place a pillow under the patient's arm if additional support is needed. As a countermeasure, phlebotomists anchor the vein with their hand to stabilize it for the draw. Change your approach when dealing with uncooperative patients, such as pediatrics and those with neurodevelopmental or psychiatric disorders. 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. 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. Sanders AM, Agger WA, Gray AM, Fischer CM, Kamprud EA. Label all specimens per accepted guidelines. Compared to the standard blood donation which is about sixteen ounces, one ounce is really small. The puncture should be made perpendicular to the ridges of the fingerprint so that the drop of blood does not run down the ridges. Choosing an appropriate site for venipuncture is crucial for a successful . D. all of the above, Common causes of hematomas that form during a venipuncture include: 6. wikiHow, Inc. is the copyright holder of this image under U.S. and international copyright laws. Significant increases can be found in total protein, aspartate aminotransferase (AST), total lipids, cholesterol, iron, Affects packed cell volume and other cellular elements. Position the patient so that the hand is easily accessible. Prepare the patient's arm using an alcohol prep. Venipuncture (sometimes referred to as venapuncture, venepuncture or even venu puncture) is the collection of blood from a vein which is usually done for laboratory testing. This image may not be used by other entities without the express written consent of wikiHow, Inc.
\n<\/p>

\n<\/p><\/div>"}, {"smallUrl":"https:\/\/www.wikihow.com\/images\/thumb\/1\/15\/Troubleshoot-a-Difficult-Venipuncture-Step-4.jpg\/v4-460px-Troubleshoot-a-Difficult-Venipuncture-Step-4.jpg","bigUrl":"\/images\/thumb\/1\/15\/Troubleshoot-a-Difficult-Venipuncture-Step-4.jpg\/aid11732774-v4-728px-Troubleshoot-a-Difficult-Venipuncture-Step-4.jpg","smallWidth":460,"smallHeight":345,"bigWidth":728,"bigHeight":546,"licensing":"