what sites should be avoided when performing venipuncture quizlet

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An electric motor draws a current of 10 amp with a voltage of 110V110 \mathrm{~V}110V. The output shaft develops a torque of 10.2Nm10.2 \mathrm{~N} \cdot \mathrm{m}10.2Nm and a rotational speed of 1000 RPM. After assembling the appropriate equipment, follow the next steps to perform a proper venipuncture. When wearing gloves, change them between each patient and wash your hands frequently. Failure to do this results in an unequal blood-to-additive ratio, making the specimen unsuitable for analysis. -Vacutainer barrel 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. Needles should be placed in a proper disposal unit IMMEDIATELY after their use. The hydrostatic pressure causes some water and filterable elements to leave the extracellular space. 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. -keep extremity below heart level for a few minutes. Tip: Lowering the arm below the level of the heart may help to engorge the vessels. Am J Clin Pathol. })(); The cephalic vein is a safe secondary option if the median cubital vein is not working. Factitious biochemical measurements resulting from hematologic conditions. (b) How would you prepare tetracaine from p-nitrobenzoic acid? If the blood flow is diminished, repeat the capillary PUNCTURE to complete the collection. Avoid excessive pressure that may squeeze tissue fluid into the drop of blood. Perform the venipuncture, collecting the sample(s) in the appropriate container(s). 9. C. the seal is broken Contaminated surfaces must be cleaned with freshly prepared 10% bleach solution. Diurnal Rhythms: Diurnal rhythms are body fluid and analyte fluctuations during the day. Document that the venipuncture was performed distal to (below) an infusion site. Stop the procedure if a hematoma occurs. After the third attempt, further medical directions must be sought with the attending physician before proceeding. Procedure for Capillary Puncture of the Finger: The best site for a finger puncture is just off the center of the finger pad of. (Uman et al, 2013). 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. Any attempt to repeat a puncture at the same site increases the risk of complications. Regardless of the source of payment, request and receive an itemized and detailed explanation of the total bill for services rendered in the hospital. Do not use excessive pressure or heavy massaging because the blood may become diluted with tissue fluid. A requisition form must accompany each sample submitted to the laboratory. Warning: Make sure you are confident that the structure you're palpitating is indeed a vein. Make the cut across the heelprint lines so that a drop of blood can well up and not run down along the lines. All rights reserved. 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. Date, time and initials of the phlebotomist must be on the label of EACH tube. 4. Avoid a probing, traumatic venipuncture. If you stick yourself with a contaminated needle: Remove your gloves and dispose of them properly. Patients who are dehydrated, obese, terminally ill, or hard sticks often get their blood drawn in other locations rather than the antecubital fossa. 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. Apply blood to the printed side of the filter paper. To determine the best vein, use both sight and touch. Use a butterfly to compensate for patient movement. if( evntData && evntData.constructor == String ){ 8. Sites to avoid: Extensive scarring from burns or surgery The upper extremity on the side that a mastectomy was performed. Choosing an appropriate site for venipuncture is crucial for a successful . Because most laboratory specimens contain bacteria, it is not necessary to wash hands before collecting them, The tourniquet applied prior to venipuncture is removed: Do not use the central portion of the heel because you might injure the underlying bone, which is close to the skin surface. 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? B. evacuated tube Cleanse in a circular fashion, beginning at the site and working outward. If none of these veins work, then the phlebotomists use the hand veins. Be informed of the hospital rules and regulations regarding patient conduct. Expect that any discussion or consultation involving the patient's case will be conducted discretely and that individuals not directly involved in the case will not be present without patient permission. 1. Wait 2 minutes before reapplying the tourniquet. Apply the tourniquet approximately 4-5 finger-widths above the planned venepuncture site. 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. Hold equipment firmly and place fingers against patient's arm, using the flange for leverage when withdrawing and inserting tubes. -infection at site C. After all specimens have been collected 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. UF Health Pathology Laboratories Nontuberculosis Mycobacteria Laboratory, This page uses Google Analytics (Google Privacy Policy), Capillary puncture may be used for obtaining specimens in infants or in adults where. Which of the following actions should the technician take? Change your approach when dealing with uncooperative patients, such as pediatrics and those with neurodevelopmental or psychiatric disorders. 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 . B. the insertion site has stopped bleeding Do not use the tip of the finger or the center of the finger. D. mandates, The most common antiseptic used in venipuncture is: Most commonly, venipuncture will be performed on the Antecubital Fossa, or the inside of the elbow. if ( (iframe.src).indexOf('formperma') > 0 && (iframe.src).indexOf(zf_perma) > 0 ) { Sometimes you may get initial blood flow, but then it stops when you change tubes. This is a general guide for troubleshooting a venipuncture scenario in which blood flow is not initially established upon needle insertion. The first attempt is the antecubital fossa area, starting with the median cubital vein, then the cephalic vein, and the basilic vein. Identification errors in pathology and laboratory medicine. This seats the bevel into the lumen of the vein, and is also the technique used to insert an IV catheter. wikiHow, Inc. is the copyright holder of this image under U.S. and international copyright laws. 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. (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.). Matt Garcia is an experienced phlebotomist in Vancouver, Canada. The median cubital creates, The dorsal venous network is the next most common vein site for phlebotomists. -use correct angle of needle insertion Last draw - additive tubes in this order: SST (red-gray or gold top). Is the seating comfortable and has the patient been seated for at least 5 minutes to avoid being rushed or confused? Avoid excessive pressure that may squeeze tissue fluidinto the drop of blood. Cleanse the fingertip of the 3rd (middle) or 4th (ring) finger with an alcohol prep. This article was co-authored by Matt Garcia. 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. (a) the electric power required. Cochrane Database Syst Rev. We use cookies to make wikiHow great. Whole blood specimens may not be able to be analyzed if microscopic clots are present. 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. Airborne precautions may be considered to provide a level of safety against infectious diseases such as tuberculosis, influenza, and COVID-19. Serum iron levels tend to drop during the day. D. Both A and B, A sharps container is identified by its bright ____ color Using a sterile lancet, puncture the most medial or lateral portion of the plantar surface of theheel, medial to a line drawn posteriorly from the mid great toe to the heel. Avoid bruising the infant's heel when obtaining blood. Journal of Exotic Pet Medicine. Lightly touch the microtainer capillary collectiondevice (or filter paper) to the LARGE drop of blood. 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. therapy is usually associated with acidic or alkaline solutions or solutions that have a high osmolarity. wikiHow, Inc. is the copyright holder of this image under U.S. and international copyright laws. Loosen the tourniquet. B. sterilized and reused An outpatient must provide identification other than the verbal statement of a name. Diagn Microbiol Infect Dis. Phlebotomy issues and quality improvement in results of laboratory testing. Place blood collection equipment away from patients, especially children and psychiatric patients. -cotton sponges var zf_perma = zf_ifrm_data[0]; What sites should be avoided when drawing blood? 5. Position the patient's arm in a comfortable extended position that provides adequate access to the planned venepuncture site. Phlebitis is inflammation of a vein. B. the needle is only partially in the vein Remove your gloves and wash your hands. C. Scarring Fasting, dietary restrictions, medications, timing, and medical treatment are all of concern and should be noted on the lab requisition. Assess the need for sample recollection and/or rejection. Avoid bruising the infants heel when obtainingblood. Patient care following completion of venipuncture. To prevent hemolysis when performing a venipuncture, the phlebotomist should: 1. The median cubital vein is used the most for its accessibility. outstretched or raised Mix and label all appropriate tubes at the patient bedside. Promptly send the specimens with the requisition to the laboratory. Lippi G, Salvagno GL, Montagnana M, Franchini M, Guidi GC. Tip: When using a butterfly and sodium citrate is the first to be collected in the order of draw, a discard tube must always be filled first to purge the air from the tubing. While most patients veins are compatible with a standard needle gauge, others require a butterfly needle. Arm with fistula or cannula placement For the CLSI Updated Phlebotomy Procedures please click here. While most patients veins are compatible with a standard needle gauge, others require a. . The most commonly used site for a venipuncture is at the bend of the elbow, also called the antecubital fossa 1. www.mlo-online.com is using a security service for protection against online attacks. 2004;24(4):979-96, vii. The performance of routine vascular access procedures by skilled phlebotomists requires, at a minimum, the use of gloves to prevent contact with blood. What is the procedure to draw blood from an arm with an IV in it? The thumb has a pulse and is likely to bleed excessively. ROUTINE CAPILLARY PUNCTURE BLOOD COLLECTION GUIDELINES. Intravenous therapy (IV) / blood transfusions - fluid may dilute the specimen, so collect from the opposite arm if possible. Tip: In spite of a difficult draw, remember to invert your tubes. When using a syringe and needle, avoid drawing the plunger back too forcibly. -hemorrhage/hematoma. Determine the final temperature of the R-134a and the final specific internal energy. Copyright 2023 - PhlebotomyU | Website Design & SEO by, Phlebotomy: 5 Tips on Finding Difficult Veins. 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. For an inpatient DO NOT DRAW BLOOD IF THE ARMBAND OR BRACELET IS MISSING. 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). How far above a venipuncture sight should you place a tourniquet? Drawing the patient in a reclined position. For all NICU babies, once you have, collected the blood, wipe off the area with a sterile saline wipe, to remove. Contains a gel separator and clot activator. Never draw above an IV site. Capillary punctures are not suitable for blood culture testing and most coagulation tests. Place labeled specimens in zip lock bag and deliver to the laboratory as soon as possible. 4. A. standards B. Yellow When finished, clean the site and apply pressure with clean gauze to stop the bleeding. C. sterile gauze pads Previous puncture sites should be avoided. If using a needle and syringe, avoid drawing the plunger back too forcefully. 6. Other draw sites, particularly below the waist, are rarely used. hemorrhage or hematoma at site of puncture, remove tourniquet IF AN INCOMPLETE COLLECTION OR NO BLOOD IS OBTAINED: Change the position of the needle. If this is not successful, remove the needle, take care of the puncture site, and redraw. Start with the arm closest to you and palpate the antecubital fossa. Stress: May cause transient elevation in white blood cells (WBC's) and elevated adrenal hormone values (cortisol and catecholamines). What are the contraindications to venipuncture? The fluid may dilute the specimen, so collect from the opposite arm. The venipuncture procedure is complex, requiring both knowledge and skill to perform. Drawing blood for laboratory analysis is most often a routine and uneventful procedure. Tip: Patients who need regular bloodwork (e.g. After cleansing, allow the venipuncture site to air dry. Email is the #1 attack vector cybercriminals use to lure you into a malicious website. (See Use of Band-Aids in the Post Phlebotomy. You may also remove the tube, wait a few seconds for blood flow to resume, and then engage a short drawtube. var zf_ifrm_ht_nw = ( parseInt(zf_ifrm_data[1], 10) + 15 ) + "px"; 4. Try rotating the arm to better expose the cephalic or basilic vein. Several veins in the antecubital fossa provide excellent access. 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. This vein can be found along the upper arm to the thumb, but it is commonly drawn from the forearm or antecubital fossa area. Avoid drawing blood from a hematoma; select another draw site. The recommended order of draw for plastic collection tubes is: First - blood culture bottle or tube (yellow or yellow-black top). 1. previous experience with vomiting or fainting The essential elements of the requisition form are: Patient's surname, first name, and middle initial. Larger tube sizes typically provide for collection of samples from 6 to 10 mL. D. Blue, Which of the following conditions should prevent a site from being selected for venipuncture? 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. var evntData = event.data; Position the infant with the head slightly elevated. Re-secure the tourniquet to increase venous filling. 3. What should you do with a CBC or lavender top tube before putting them down? The patient should make a fist without pumping the hand. C. 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. -thrombosis For an inpatient the nursing staff can be contacted to aid in identification prior to proceeding. When there is an IV line present, blood can be drawn from this line. A lab coat or gown must be worn during blood collection procedures. (c) How would you prepare tetracaine from benzene? f.style.height="352px"; Predict a possible value of the thickness of the soap bubble. 3. 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). Try another tube. A. Apply the tourniquet below the IV site. How should you have the patient position their arm after the venipuncture is complete? obvious areas of skin infections The best locations for fingersticks are the 3rd (middle) and 4th (ring) fingers of the non-dominant hand. A typical single vial contains about five milliliters, which is about one teaspoon. }, false); Clin Chem Lab Med. Therefore, an arm containing an IV should not be used to draw blood specimens if it can be avoided. Give an example of each. However, drawing blood from the hand is affiliated with higher levels of pain and less control. 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. 12. Expect reasonable safety congruent with the hospital practices and environment. The patient shall be informed if the hospital proposes to engage in or perform human experimentation or other research/educational profits affecting his or her care or treatment. If this is not successful, remove the needle, take care of the puncture site and redraw at another site. A. the tubes are filled and properly labeled In fact, many search engines provide the option to avoid dangerous sites by turning on a "safer" search. A. EMLA Hard and dense structures may be nerves or tendons. If just a routine coagulation assay is the only test ordered, then a single light blue top tube may be drawn. are known to vary lab results of some analytes. var f = document.createElement("iframe"); (a) How would you prepare tetracaine from the corresponding aniline derivative, ArNH2_22? The blood is bright red (arterial) rather than venous. Patients in these populations are often nervous and may flail their limbs. By signing up you are agreeing to receive emails according to our privacy policy. Allow another large drop of blood to form. Serum red top or amber tube with red top. Observe all applicable isolationprocedures. Precautions include a medical grade face mask. 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 first step to choosing the right vein is to select the appropriate needle gauge. 9. diet, exercise, stress, basal state). Background: Venipuncture is the most common invasive medical procedure performed by health care providers. D. 70% isopropyl alcohol. In other words, there is no need for another venipuncture procedure. Because of contacts with sick patients and their specimens, it is important to follow safety and infection control procedures. The infograph below provides a detailed description of the venipuncture steps as found in our how to draw blood resource. The area of the arch should be avoided, as should the posterior, curvature of the heel; a puncture in these areas could cause injury to the, All babies in the neonatal unit must be warmed before performing a. puncture. Apply firm pressure. 1. 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. Impact of Use of Smaller Volume, Smaller Vacuum Blood Collection Tubes on Hemolysis in Emergency Department Blood Samples. How to Troubleshoot a Difficult Venipuncture. C. Red C. at a mastectomy site Answer. Check for timing instructions for drawing the appropriate samples. 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. What is the most common complication of venipuncture? 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. Hematoma - may cause erroneous test results. Adjust the angle (the bevel may be against the vein wall). PST (light green top). Needle disposal unit - needles should NEVER be broken, bent, or recapped. Back the needle out until the bevel is just below the skin. So You're Going to Collect a Blood Specimen: An Introduction to Phlebotomy, 13th Edition (2010), College of American Pathologists, Northfield, IL. Subcutaneous tissue feels squishy and muscle feels hard. -tourniquet Make certain that the blood completely saturates all four (4) circles and is visible from bothsides. The patient has the right to refuse participation in such activity. If an inpatient is able to respond, ask for a full name and always check the armband or bracelet for confirmation. Summarize the problems that may be encountered in accessing a vein, including the procedure to follow when a specimen is not obtained. Always wear a clean lab coat or gown. D. it is wiped with alcohol, Venipuncture at sites with each of the following could effect the results EXCEPT: Carry out hand hygiene before and after each patient procedure, before putting on and after removing gloves. 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. Basilic vein. 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. Clin Lab Med. Include your email address to get a message when this question is answered. Lines - Drawing from an intravenous line may avoid a difficult venipuncture, but introduces problems. Allsurfaces are cleaned daily with bleach. Although the skill set and procedures may apply to both instances, this content is primarily aimed towards venous blood collection using evacuated tube systems (e.g. 2013 Oct 10;(10):CD005179. While venipuncture is considered to be reasonably safe, the present study investigated the incidence of serious complications occurring in an outpatient setting. If blood is not obtained, change the position of the needle carefully by moving it forward or backward. 12. Blood should NEVER be poured from one tube to another since the tubes can have different additives or coatings (see illustrations at end). Do not add blood to a circle already filled orpartially filled with blood. 5. Dispose of items in appropriate containers. The patient should either sit in a chair, lie down or sit up in bed. Allow the blood to soak through and completely fill the pre-printed circle on the filter paper. Clean the site to be punctured with an alcohol sponge. B. Betadine When using a syringe inserted into the line, blood must be withdrawn slowly to avoid hemolysis. Follow the same procedure as for performing a finger, Order of Draw for a Capillary Puncture: Proper collection of tubes when. Punctures to the posterior curvature of the heel cab cause damage to the bones. 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. 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. Place a pillow under the patient's arm if additional support is needed. 8. Anxiety that results in hyperventilation may cause acid-base imbalances, and increased lactate. Allow it to air, Grasp the finger, and using a sterile lancet, press firmly against the finger. 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. Nursing Personnel. Make sure the venipuncture site is dry. Inadvertently nicking a nerve causes intense pain. Avoid previous hematoma (draw distal of hematoma) McCall, R. E., & Tankersley, C. M. (2016). Switch to the other arm if you can't find anything.

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