what sites should be avoided when performing venipuncture quizlet

\u00a9 2023 wikiHow, Inc. All rights reserved. https://www.ncbi.nlm.nih.gov/books/NBK138650/pdf/Bookshelf_NBK138650.pdf (Accessed June 13, 2022). Avoid drawing blood from a hematoma; select another draw site. 2011-2023 Phlebotomy Coach. 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. For an inpatient the nursing staff can be contacted to aid in identification prior to proceeding. Veins on the underside of the wrist should be avoided. The median cubital creates less bruising and pain than other draw sites. Erroneous test results may be obtained when the blood is not thoroughly mixed with the additive. 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. 2009;18(2):117-139. Serum red top or amber tube with red top. Identify the additive, additive function, volume, and specimen considerations to be followed for each of the various color coded tubes. Apply blood to the printed side of the filter paper. window.addEventListener('message', function (){ Warm the heel from which blood is to be obtained. 6. Avoid UE on same side of mastectomy (lymphedema) What two things should you make sure you discuss with your patients prior to venipuncture? How To Draw Blood | Phlebotomy Coach Have the patient make a fist and flex the arm, which helps engorge muscles to fill veins. PROBLEMS OTHER THAN AN INCOMPLETE COLLECTION: A hematoma forms under the skin adjacent to the puncture site - release the tourniquet immediately and withdraw the needle. The best locations for fingersticks are the 3rd (middle) and 4th (ring) fingers of the non-dominant hand. Remember -- the rst vein found is not always the best vein. They are also. The hydrostatic pressure causes some water and filterable elements to leave the extracellular space. wikiHow, Inc. is the copyright holder of this image under U.S. and international copyright laws. 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. Apply an adhesive bandage. prevent falls, should the patient lose consciousness. wikiHow, Inc. is the copyright holder of this image under U.S. and international copyright laws. Each phlebotomist generally establishes a routine that is comfortable for her or him. 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. var zf_perma = zf_ifrm_data[0]; Identify the patient using two different identifiers, asking open ended questions such as, "What is your name?" Avoid previous hematoma (draw distal of hematoma) Precautions include a medical grade face mask. This image is not<\/b> licensed under the Creative Commons license applied to text content and some other images posted to the wikiHow website. 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. Holder/Adapter - use with the evacuated collection system. Intravenous therapy (IV) / blood transfusions - fluid may dilute the specimen, so collect from the opposite arm if possible. Wipe away the first drop of blood with sterile 22 gauze. 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. Wait 2 minutes before reapplying the tourniquet. What are the green/lavender top containers used for? 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. 5. Contains a gel separator and clot activator. This image is not<\/b> licensed under the Creative Commons license applied to text content and some other images posted to the wikiHow website. Lightly touch the microtainer capillary collectiondevice (or filter paper) to the LARGE drop of blood. 6. -use correct angle of needle insertion Hematoma formation is a problem in older patients. Last draw - additive tubes in this order: SST (red-gray or gold top). Recognize complications associated with the phlebotomy procedure. This vein can be found along the upper arm to the thumb, but it is commonly drawn from the forearm or antecubital fossa area. Several essential steps are required for every successful collection procedure: Patient comfort. are known to vary lab results of some analytes. Label all specimens per accepted guidelines. Tubes with different additives are used for collecting blood specimens for specific types. 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. A key element for successful venipuncture is choosing the best vein. Extensive scarring or healed burn areas should be avoided Specimens should not be obtained from the arm on the same side as a mastectomy. 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. This image is not<\/b> licensed under the Creative Commons license applied to text content and some other images posted to the wikiHow website. Select the proper approved lancet: The BD Microtainer Contact-Activated. Certain larger molecules are not filterable into the tissue, therefore they are more concentrated in the blood. (See, The chlorhexidine is a concern for the premature babies in NICU as it can, be absorbed through the skin. Most commonly, venipuncture will be performed on the Antecubital Fossa, or the inside of the elbow. Avoid placing sample onhot surfaces such as bili-lights or monitors. Clin Biochem. Am J Clin Pathol. Regardless of the source of payment, request and receive an itemized and detailed explanation of the total bill for services rendered in the hospital. If an inpatient is able to respond, ask for a full name and always check the armband or bracelet for confirmation. Asking the patient about their previous blood draw experiences is beneficial, especially if they are a hard stick and know which area works best. Procedure for Capillary Puncture of the Heel: A heel puncture is performed on the lateral or medial plantar surface of the, foot. What sites should be avoided when drawing blood? Properly fill out appropriate requisition forms, indicating the test(s) ordered. Watch for formation of a hematoma. 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. 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. Arteries pulsate, are very elastic, and have a thick wall. Document that the venipuncture was performed distal to (below) an infusion site. Perform the venipuncture, collecting the sample(s) in the appropriate container(s). remove needle It may be, necessary, on occasion, to perform a capillary puncture on the toe of a patient, who is severely burned. 70% isopropyl alcohol NOTE:Tubes with additives must be thoroughly mixed. An outpatient must provide identification other than the verbal statement of a name. Not making it mobile friendly. 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. outstretched or raised 1. Focus on what you do best, and find someone who can help you communicate that with your target market. Promptly send the specimens with the requisition to the laboratory. Northfield, IL: College of American, NCCLS. Summarize the problems that may be encountered in accessing a vein, including the procedure to follow when a specimen is not obtained. Have an assistant stabilize the arm by firmly locking the elbow joint. Determine the final temperature of the R-134a and the final specific internal energy. Tetracaine is a substance used as a spinal anesthetic. Diurnal Rhythms: Diurnal rhythms are body fluid and analyte fluctuations during the day. (b) How would you prepare tetracaine from p-nitrobenzoic acid? Over time and with several repeated punctures, significant amounts of scar tissue builds up. Capillary Specimens may be collected on filter paper and sent to lab for testing for. Background: Venipuncture is the most common invasive medical procedure performed by health care providers. PDF Selecting The Venipuncture Site - Yola Each time a vein is accessed with a needle, scar tissue forms as part of the body's healing process. Be methodical in your search for a vein. The recommended location for blood collection on a newborn baby or infant is the heel. Second - coagulation tube (light blue top). Apply the tourniquet 3-4 inches above the selected puncture site. 7. Do not add blood to a circle already filled orpartially filled with blood. This image is not<\/b> licensed under the Creative Commons license applied to text content and some other images posted to the wikiHow website. drawing from hand or foot In fact, many search engines provide the option to avoid dangerous sites by turning on a "safer" search. Label all appropriate tubes at the patient bedside. True or False? 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} This guide follows the steps as outlined in the World Health Organizations Guidelines on Drawing Blood: Best Practices in Phlebotomy. Keep in mind that elderly patients often have fragile veins. Hematoma - A venipuncture should not be performed on a hematoma, regardless of how small it may be. Observe all applicable isolationprocedures. Lightly touch the microtainer capillary collection device (or filter paper) to the LARGE drop of blood. When using a syringe and needle, avoid drawing the plunger back too forcibly. If a vein feels hard, it may be scarred or sclerosed. Hyperextend the patient's arm. wikiHow, Inc. is the copyright holder of this image under U.S. and international copyright laws. 9. Observe universal (standard) safety precautions. Dispose of needles immediately upon removal from the patient's vein. 7. He holds a Diploma in Medical Laboratory Assistance and is certified under the British Columbia Society of Laboratory Science. C. at a mastectomy site Within the antecubital fossa, this vein poses the least amount of risk. Follow the same procedure as for performing a finger, Order of Draw for a Capillary Puncture: Proper collection of tubes when. Make sure the venipuncture site is dry. 2. Take enough time to assess the vein before beginning the venipuncture procedure. The antecubital fossa is a collection of veins located within the arm's inner area, opposite of the elbow, where the arm folds in. Two forms of active identification are required. Identification errors in pathology and laboratory medicine. wikiHow, Inc. is the copyright holder of this image under U.S. and international copyright laws. The basic patient rights endorsed by the JCAHO follow in condensed form are given below. B. just after needle insertion, but prior to vacutainer activation Question. Povidone-iodine wipes/swabs - Used if blood culture is to be drawn. Order of draw for multiple tube phlebotomy. The 6 Mistakes to Avoid When Building a Business Website (and - Medium 2019;95(1):15-19. doi: 10.1016/j.diagmicrobio.2019.04.001. Never draw blood through a hematoma. -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? Gas tubes (must warm the site before collecting the specimen), 4. 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. A. Best practices in capillary blood collection - Medical Laboratory Observer C. the needle has penetrated all the way through the vein The upper extremity on the side of a previous mastectomy - test results may be affected because of lymphedema. 6. Carry out hand hygiene before and after each patient procedure, before putting on and after removing gloves. 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. 9. A requisition form must accompany each sample submitted to the laboratory. Avoid prolonged tourniquet application or fist clenching. When using a syringe inserted into the line, blood must be withdrawn slowly to avoid hemolysis. -do not rapidly insert the needle. Position the patient so that the hand is easily accessible. 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. Dalal BI, Brigden ML. Place labeled specimens in zip lock bag and deliver to the laboratory as soon as possible. This image may not be used by other entities without the express written consent of wikiHow, Inc.
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