\u00a9 2023 wikiHow, Inc. All rights reserved. ACDA or ACDB (pale yellow top). Confidentiality of all communications and other records pertaining to the patient's care. By signing up you are agreeing to receive emails according to our privacy policy. Do not attempt a capillary puncture more than twice. (c) the rate of heat transfer. Cleanse in a circular fashion, beginning at the site and working outward. Allow to air dry. If an IV is in place, samples may be obtained below but NEVER above the IV site. B. above an IV line (c) How would you prepare tetracaine from benzene? The median cubital vein is used the most for its accessibility. 2. A. C. Iodine 6. Phlebotomy NHA flashcards Flashcards | Chegg.com The most common complications are bleeding at the puncture site or hematoma formation. Edematous extremities with swollen tissue alter the results. Hematoma - may cause erroneous test results. Some individuals are afraid of needles, while others are frightened at the sight of blood. D. all of the above, Julie S Snyder, Linda Lilley, Shelly Collins, Zoology Chapter 16 & 17: Invertebrate Deutero. Background: Venipuncture is the most common invasive medical procedure performed by health care providers. This image is not<\/b> licensed under the Creative Commons license applied to text content and some other images posted to the wikiHow website. In some cases, a phlebotomist may have to switch sites if they find the blood is not properly flowing from the vein. f.src = 'https://forms.zohopublic.com/healthservicesacademy/form/RequestCourseInformationCPTIAccelerated/formperma/SBGg-3DTNCwt65i9A6n_zU3SneyGD89SSqM_7F_nCas?zf_rszfm=1'; 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. 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. This requisition form must contain the proper information in order to process the specimen. Puncture no deeper than 2.4mm (approximately 0.1 inches). What can happen if you vigorously shake the tubes? The fifth finger tends to have less soft tissue overlying the bone. Hard and dense structures may be nerves or tendons. Answer. 9. At least two patient identifiers, such as name and date of birth, are needed. Check the requisition form for requested tests, patient information, and any special requirements. Cleanse the heel with alcohol prep, then dry with a sterile 22 as alcohol can influence testresults. Two forms of active identification are required. 2. Free Flashcards about Phlebotomy Chapter 9 - StudyStack A. standards 5. It is large and near the skins surface, making it easier for phlebotomists to see before anchoring the vein. Joslin JO. The service requires full cookie support in order to view this website. Punctures to the posterior curvature of the heel cab cause damage to the bones. Also found in the antecubital fossa, the basilic vein serves as a last resort for blood draws. Patches of purple or yellow may suggest bruising after a recent venipuncture. Have an assistant stabilize the arm by firmly locking the elbow joint. are known to vary lab results of some analytes. Potential source of test error, particularly from hemolysis, Most lines are flushed with a solution of heparin to reduce the risk of thrombosis, Discard a sample at least three times the volume of the line before a specimen is obtained for analysis. var zf_ifrm_ht_nw = ( parseInt(zf_ifrm_data[1], 10) + 15 ) + "px"; The thumb has a pulse and is likely to bleed excessively. (a) the electric power required. Do not use excessive pressure or heavy massaging because the blood may become diluted with tissue fluid. Scan the skin for lines of blue indicating a prominently visible vein. 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. The patient should make a fist without pumping the hand. Apply an adhesive bandage. This is a general guide for troubleshooting a venipuncture scenario in which blood flow is not initially established upon needle insertion. Which of the following is the most likely mechanism for alteration in protein values in this situation? Drawing blood from major vessels (e.g. the 3 rd (middle) or 4 th (ring) finger of the hand. var zf_perma = zf_ifrm_data[0]; Properly fill out appropriate requisition forms, indicating the test(s) ordered. Because of contacts with sick patients and their specimens, it is important to follow safety and infection control procedures. 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. The blood is normally drawn from a vein on the top of the hand or from the inside of the elbow. Regardless of the source of payment, request and receive an itemized and detailed explanation of the total bill for services rendered in the hospital. Please enable JavaScript on your browser and try again. Compared to the standard blood donation which is about sixteen ounces, one ounce is really small. Most reference ranges are based on normal laboratory test values for: Healthy people in a basal state. wikiHow, Inc. is the copyright holder of this image under U.S. and international copyright laws. -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? Lightly touch the microtainer capillary collectiondevice (or filter paper) to the LARGE drop of blood. Additionally, a hematoma may compress the nerve and lead to long-term damage. Collect drops of blood into the collection device by gently massaging the finger. Step 3: Venipuncture. -do not rapidly insert the needle. Place labeled specimens in zip lock bag and deliver to the laboratory as soon as possible. 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. Start with the arm closest to you and palpate the antecubital fossa. D. all of the above, Common causes of hematomas that form during a venipuncture include: 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. 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. It doesn't matter . wikiHow, Inc. is the copyright holder of this image under U.S. and international copyright laws. EDTA and sodium citrate tubes should still be filled to the marked fill line to ensure a correct blood-to-additive ratio. 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 image is not<\/b> licensed under the Creative Commons license applied to text content and some other images posted to the wikiHow website. Adjust the height and swivel the chair to ensure your body is in line with the vein. B. just after needle insertion, but prior to vacutainer activation chemistries, serology, immunnology, blood bank. Never draw above an IV site. 6. 70% isopropyl alcohol Perform the venipuncture. For the CLSI Updated Phlebotomy Procedures please click here. The equipment used during the venipuncture test can vary, but the following are most commonly used for routine venipuncture: Phlebotomists may choose to draw blood from several different sites of the body. (See Use of Band-Aids in the Post Phlebotomy. Firmly grasp the flanges of the tube holder to avoid advancing the needle further into the vein as you change tubes. Patient care following completion of venipuncture. Consult a specialist at the patient's own request and expense. A. given to the patient The basic patient rights endorsed by the JCAHO follow in condensed form are given below. *NEVER BEND THE ARM*. A. Syringe PhlebotomyU offers Certified Phlebotomy Technician (CPT I) courses for aspiring phlebotomists. A lab coat or gown must be worn during blood collection procedures. wikiHow, Inc. is the copyright holder of this image under U.S. and international copyright laws. There are three phlebotomy vein sites located in the arm most utilized by medical professionals and three additional draw sites that are last resorts. Within the antecubital fossa, this vein poses the least amount of risk. The puncture should be made perpendicular to the ridges of the fingerprint so that the drop of blood does not run down the ridges. The essential elements of the requisition form are: Patient's surname, first name, and middle initial. try{ Apply only ONE drop of blood per circle. wikiHow, Inc. is the copyright holder of this image under U.S. and international copyright laws. IF AN INCOMPLETE COLLECTION OR NO BLOOD IS OBTAINED: Change the position of the needle. (2017). Tip: Lowering the arm below the level of the heart may help to engorge the vessels. The line must be flushed first. Have the patient hold a small gauze pad over the puncture site for a couple of minutes to stop the bleeding. This guide follows the steps as outlined in the World Health Organizations Guidelines on Drawing Blood: Best Practices in Phlebotomy. Position the patient's arm in a comfortable extended position that provides adequate access to the planned venepuncture site. Antiseptic. Certain larger molecules are not filterable into the tissue, therefore they are more concentrated in the blood. 23-gauge needles (e.g. Cap, rotate and invert the microtainer to mix the blood collected. Adjust the angle (the bevel may be against the vein wall). Whole blood specimens may not be able to be analyzed if microscopic clots are present. Do not use a previous puncture site. What Is Venipuncture? This image is not<\/b> licensed under the Creative Commons license applied to text content and some other images posted to the wikiHow website. Avoid puncturing a finger that is cold or cyanotic, swollen, scarred, or covered with a rash. Do not use alcohol for prepping the site when drawing a blood alcohol sample. Areas in which two veins join should be avoided where possible, as valves are often present. NOTE: The use of post-exposure prophylaxis following blood exposure to HIV has shown effectiveness (about 79%) in preventing seroconversion. Top Vein Sites Used in Phlebotomy | PhlebotomyU | CPT1 Course 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. Apply the tourniquet approximately 4-5 finger-widths above the planned venepuncture site. wikiHow, Inc. is the copyright holder of this image under U.S. and international copyright laws. Tetracaine is a substance used as a spinal anesthetic. Apply the tourniquet below the IV site. Apply blood to the printed side of the filter paper. Consult the nursing unit or your facility's resources prior to drawing from an IV or PICC line or performing venipuncture on an arm with an IV line in place. 8. INR for patients on warfarin) are often knowledgeable on the veins that are most likely to work. The first drop contains excess tissue fluid and must be wiped away. If you stick yourself with a contaminated needle: Remove your gloves and dispose of them properly. What should you do with a CBC or lavender top tube before putting them down? But since each patient's medical condition varies, so does their veins. The venipuncture procedure is complex, requiring both knowledge and skill to perform. 6. 10. Swiftly insert the needle through the skin and into the lumen of the vein. Adhesive bandages / tape - protects the venipuncture site after collection. A. EMLA A key element for successful venipuncture is choosing the best vein. Remove the needle from the patient's arm using a swift backward motion. Prepare the patient's arm using an alcohol prep. 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. Then the medical technician or phlebotomist will wrap a flexible band on the upper part of the arm to apply some pressure to that area making the vein enlarge with blood. 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. The needle should form a 15 to 30 degree angle with the surface of the arm. Dispose of contaminated materials in appropriate waste receptacles. Sites that should be avoided include areas with extensive scarring, healed burns, inflamed sites, edematous sites, previous puncture sites, earlobes and thumbs. Procedure for Capillary Puncture of the Finger: The best site for a finger puncture is just off the center of the finger pad of. C. the seal is broken If the tech is not comfortable with any of the veins in the inside elbow area, they may choose a dorsal vein in the hand or, as a last resort, choose a vein in the foot. Patients who are dehydrated, obese, terminally ill, or hard sticks often get their blood drawn in other locations rather than the antecubital fossa. DOC Blood Collection by Venipuncture - Michigan Do not add blood to a circle already filled orpartially filled with blood. 2. The patient who is at ease will be less focused on the procedure. This enables the bloodto form as a drop on the fingertip. C. Lancet Laboratory coats or work smocks are not typically needed as personal protective equipment during routine venipuncture, but an employer must assess the workplace to determine whether certain tasks, workplace situations, or employee skill levels may result in an employee's need for laboratory coats or other personal protective equipment to prevent contact with blood. The upper extremity on the side of a previous mastectomy - test results may be affected because of lymphedema. f.style.width="100%"; Blood Specimen Collection and Processing Needle disposal unit - needles should NEVER be broken, bent, or recapped. Apply firm pressure for more than 5 minutes. Northfield, IL: College of American, NCCLS. A. Edema Effective methods use distraction. A tin can containing air is sealed. Change your approach when dealing with uncooperative patients, such as pediatrics and those with neurodevelopmental or psychiatric disorders. The median cubital vein is used the most for its accessibility. Dispose of contaminated materials/supplies in designated containers. Stop the procedure if a hematoma occurs. Let's take a look at the types of websites you and your staff need to be wary of and how to avoid them. (function() { Be methodical in your search for a vein. 3. -18, 20, 22 gauge needles. 4. Allow another large drop of blood to form. 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. This is especially important when collecting EDTA (lavender top) or heparin (green top) tubes. Remember that veins should ideally feel bouncy. The area where the blood is to be drawn from is first cleaned with a germ-killing solution. 9. A government issued photo identification card such as a driver's license can aid in resolving identification issues. Warning: Some phlebotomists use a method of anchoring called the "C-hold", in which the index finger pulls upwards superiorly while the thumb pulls downwards inferiorly. Journal of Exotic Pet Medicine. 2013 Oct 10;(10):CD005179. https://www.osha.gov/laws-regs/standardinterpretations/2007-10-26 and https://www.osha.gov/OshDoc/data_BloodborneFacts/bbfact03.pdf (Accessed June 13, 2022). obvious areas of skin infections Larger tube sizes typically provide for collection of samples from 6 to 10 mL. Safely dispose of potentially infectious materials. Wear gloves and a lab coat or gown when handling blood/body fluids. 2009 Feb;131(2):195-204. Which of the following actions should the technician take? Of course, the phlebotomist may understand this, however, the patient may not. 9. 3. Capillary Specimens may be used immediately for point-of-care testing. 5. 10. Do not use the central portion of the heel because you might injure the underlying bone, which is close to the skin surface. The 2nd (index) finger tends to have thicker, callused skin. X=[Ar]4s23d5Y=[Ar]4s23d104p1Z=[Ar]4s23d104p6. Since newborns do not often bleed immediately, use gentle pressure to produce a rounded drop of blood. When using a syringe inserted into the line, blood must be withdrawn slowly to avoid hemolysis. on patients who are extremely dehydrated or have poor peripheral circulation. 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