what sites should be avoided when performing venipuncture quizlet

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Allow it to air, Grasp the finger, and using a sterile lancet, press firmly against the finger. antecubital fossa What are the best veins for venipuncture? Lightly touch the microtainer capillary collectiondevice (or filter paper) to the LARGE drop of blood. hemorrhage or hematoma at site of puncture, remove tourniquet -antiseptic swabs 2. 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. Therefore, an arm containing an IV should not be used to draw blood specimens if it can be avoided. How can you decrease the risk of hematoma formation? What should you do with a CBC or lavender top tube before putting them down? The thumb has a pulse and is likely to bleed excessively. Deliver specimens promptly to the laboratory. Websites that masquerade as the ones you trust. Once you establish blood flow, slightly modify your hand position to stabilize the needle against the arm and prevent further movement. If superficial veins are not readily apparent, you can force blood into the vein by massaging the arm from wrist to elbow, tap the site with index and second finger, apply a warm, damp washcloth to the site for 5 minutes, or lower the extremity over the bedside to allow the veins to fill. He holds a Diploma in Medical Laboratory Assistance and is certified under the British Columbia Society of Laboratory Science. Perform the venipuncture. Label all specimens per accepted guidelines. 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} 4. It is large and near the skins surface, making it easier for phlebotomists to see before anchoring the vein. BD Eclipse green-capped) is used for most routine and uncomplicated venipunctures. C. Scarring The recommended order of draw for plastic collection tubes is: First - blood culture bottle or tube (yellow or yellow-black top). Use pillows or foam wedges to elevate the arm and help with extension. 11. Avoid previous hematoma (draw distal of hematoma) Never draw over scars or a new tattoo sites. Individually packaged 70% isopropyl alcohol wipes. The area where the blood is to be drawn from is first cleaned with a germ-killing solution. When using a syringe and needle, avoid drawing the plunger back too forcibly. By signing up you are agreeing to receive emails according to our privacy policy. Concentrations of fluids and medications could affect baseline test results. wikiHow is where trusted research and expert knowledge come together. Gloves are to be discarded in the appropriate container immediately after the bloodcollection procedure. (See, The chlorhexidine is a concern for the premature babies in NICU as it can, be absorbed through the skin. A. just prior to needle insertion C. at a mastectomy site Veins on the underside of the wrist should be avoided. Check for timing instructions for drawing the appropriate samples. Interruptions and distractions during medical encounters and procedures should be avoided. You should always contact your doctor or other qualified healthcare professional before starting, changing, or stopping any kind of health treatment. As a countermeasure, phlebotomists anchor the vein with their hand to stabilize it for the draw. However, drawing blood from the hand is affiliated with higher levels of pain and less control. When using a syringe inserted into the line, blood must be withdrawn slowly to avoid hemolysis. Hematoma - may cause erroneous test results. apply pressure for at least 10 minutes. 8. (Partial penetration may allow blood to leak into the soft tissue surrounding the vein by way of the needle bevel). Avoid a probing, traumatic venipuncture. 2. Hold a gauze pad over the puncture site for a couple of, minutes to stop the bleeding, and then tie gauze around the foot. https://www.ncbi.nlm.nih.gov/books/NBK138650/pdf/Bookshelf_NBK138650.pdf (Accessed June 13, 2022). For a detailed breakdown of each step of the venipuncture test scroll down. A. the tubes are filled and properly labeled Sharps Disposal Container. Apply the tourniquet 3-4 inches above the selected puncture site. Avoid excessive pressure that may squeeze tissue fluid into the, mix the blood. 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. Follow the same procedure as for performing a finger, Order of Draw for a Capillary Puncture: Proper collection of tubes when. Blood collection tubes must be drawn in a specific order to avoid cross-contamination of additives between tubes. 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. 8. The best locations for fingersticks are the 3rd (middle) and 4th (ring) fingers of the non-dominant hand. Impact of Use of Smaller Volume, Smaller Vacuum Blood Collection Tubes on Hemolysis in Emergency Department Blood Samples. Position the patient with the arm extended to form a straight-line form shoulder to wrist. Re-anchor the vein. Intravenous therapy (IV) / blood transfusions - fluid may dilute the specimen, so collect from the opposite arm if possible. NOTE:Tubes with additives must be thoroughly mixed. Collection tubes can vary in size for volume of blood drawn, appropriate to the tests ordered with sample size required, and vary in the kind of additive for anticoagulation, separation of plasma, or preservation of analyte. (c) How would you prepare tetracaine from benzene? Compare and contrast the two major types of neuronal pathways. Ernst, Dennis J. Capillary specimens are collected in microtainers with colored caps that are used to. Edematous extremities - tissue fluid accumulation alters test results. Expect reasonable safety congruent with the hospital practices and environment. Previous puncture sites should be avoided. Phelan MP, Reineks EZ, Berriochoa JP, Schold JD, Hustey FM, Chamberlin J, Kovach A. Do not use a previous puncture site. Over time and with several repeated punctures, significant amounts of scar tissue builds up. if ( (iframe.src).indexOf('formperma') > 0 && (iframe.src).indexOf(zf_perma) > 0 ) { Collect drops of blood into the collectiondevice by gently massaging the finger. Kiechle FL. Be methodical in your search for a vein. For example, serum cortisol levels are highest in early morning but are decreased in the afternoon. 7. Document that the venipuncture was performed distal to (below) an infusion site. This is very painful, risks damage to underlying structures, and widens the needle hole to prolong bleeding time. The first drop contains excess tissue fluid and must be wiped away. Clin Chem Lab Med. Why? 9. Include your email address to get a message when this question is answered. After the needle selection, phlebotomists begin to look and feel for a viable vein. This is especially important when collecting EDTA (lavender top) or heparin (green top) tubes. Such terms as "needs to," "must," "require" and "should" are used to explain how medical professionals should perform capillary blood collection procedures. wikiHow, Inc. is the copyright holder of this image under U.S. and international copyright laws. The median cubital vein is used the most for its accessibility. It brings the entire family There may be no vacuum in the tube being used. 2004;24(4):979-96, vii. 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. -keep extremity below heart level for a few minutes. After cleansing, allow the venipuncture site to air dry. Also consider adjusting the angle of the needle. The hydrostatic pressure causes some water and filterable elements to leave the extracellular space. This image is not<\/b> licensed under the Creative Commons license applied to text content and some other images posted to the wikiHow website. Areas in which two veins join should be avoided where possible, as valves are often present. Journal of Exotic Pet Medicine. This is a general guide for troubleshooting a venipuncture scenario in which blood flow is not initially established upon needle insertion. Greet the patient and identify yourself and indicate the procedure that will take place. Because most laboratory specimens contain bacteria, it is not necessary to wash hands before collecting them, The tourniquet applied prior to venipuncture is removed: BD Vacutainer), rather than IV catheter insertions. Giavarina D, Lippi G. Blood venous sample collection: Recommendations overview and a checklist to improve quality. Patches of purple or yellow may suggest bruising after a recent venipuncture. Remember that veins should ideally feel bouncy. Blood samples drawn from an IV line should be documented and analyzed with care. In some instances, the legs or feet are required for use, but a physician or doctor should be completing the draw, not a phlebotomist. This image is not<\/b> licensed under the Creative Commons license applied to text content and some other images posted to the wikiHow website. Wipe away the first drop of blood with a sterile 22 gauze. Summarize the problems that may be encountered in accessing a vein, including the procedure to follow when a specimen is not obtained. Arm with fistula or cannula placement These may include listening to music or a story, watching a video, playing with a toy, having a parent provide distraction with talk or touch, using flash cards, and squeezing a rubber ball. Fill the microtainer tube(s) as needed. Povidone-iodine wipes/swabs - Used if blood culture is to be drawn. Green Choosing an appropriate site for venipuncture is crucial for a successful . Tip: In spite of a difficult draw, remember to invert your tubes. Basilic vein. Asking the patient about their previous blood draw experiences is beneficial, especially if they are a hard stick and know which area works best. 2009;47(2):143-53. Observe all applicable isolationprocedures. This is more common in humeral and femoral punctures than radial punctures. 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. 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. and "What is your date of birth?". Using the smallest acceptable needle size can help reduce the risk of bleeding or hematoma . Joslin JO. What are some of the reasons to draw blood? Give an example of each. Avoid excessive pressure that may squeeze tissue fluidinto the drop of blood. All other items used for the procedure must be disposed of according to properbiohazardous waste disposal policy. Grasp the patient's arm firmly using your thumb to draw the skin taut and anchor the vein. A. Syringe What can happen if you vigorously shake the tubes? Since newborns do not often bleed immediately, use gentle pressure to produce a rounded drop of blood. Because of contacts with sick patients and their specimens, it is important to follow safety and infection control procedures. Avoid excessive pressure that may squeeze tissue fluid into the drop of blood. The puncture should be made perpendicular to the ridges of the fingerprint so that the drop of blood does not run down the ridges. All rights reserved. 1. 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. Butterflies are incredibly valuable tools for tackling difficult draws, owing to their precision, shorter shaft length, and maneuverability. Too tight of a tourniquet may cause the vein to collapse upon needle insertion. 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. Do not obtain specimens from an arm having a cannula, fistula, or vascular graft. 8. Most reference ranges are based on normal laboratory test values for: Healthy people in a basal state. Heparin light or dark green top tube, 5. Perform the venipuncture, collecting the sample(s) in the appropriate container(s). World Health Organization. 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. Follow institution's guidelines regarding treatment and follow-up. This vein can be found along the upper arm to the thumb, but it is commonly drawn from the forearm or antecubital fossa area. var iframe = document.getElementById("zf_div_SBGg-3DTNCwt65i9A6n_zU3SneyGD89SSqM_7F_nCas").getElementsByTagName("iframe")[0]; 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. Look for visual clues which may help assess the patient's condition. 10. outstretched or raised 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. Using the requisition for reference, ask a patient to provide additional information such as a birthdate. Serum red top or amber tube with red top. Clin Biochem. Extensive scarring or healed burn areas should be avoided Specimens should not be obtained from the arm on the same side as a mastectomy. Fill the capillary tube(s) or micro collection device(s) as needed. Have an assistant stabilize the arm by firmly locking the elbow joint. 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. List several effects of exercise, posture, and tourniquet application upon laboratory values. All approved lancets utilized at Akron Childrens are for single use and feature, Heel punctures are performed on infants less than 6 months of age, or on, older premature infants who are the approximate size of a full-term 6 month, old. 3. A 21-gauge needle (e.g. Foot veins are a last resort because of the higher probability of complications. If just a routine coagulation assay is the only test ordered, then a single light blue top tube may be drawn. 8. 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. C. all disposable equipment has been discarded properly Dispose of contaminated materials in appropriate waste receptacles. f.style.border="none"; Of course, the phlebotomist may understand this, however, the patient may not. Needle disposal unit - needles should NEVER be broken, bent, or recapped. Tip: BD Vacutainer tubes use a translucent stopper to identify short draw variants. Promptly send the specimens with the requisition to the laboratory. If you stick yourself with a contaminated needle: Remove your gloves and dispose of them properly. Occupational Safety and Health Administration, United States Department of Labor. A lab coat or gown must be worn during blood collection procedures. Contains a gel separator and clot activator. 2. Ask the patient to lie on their back. It may be, necessary, on occasion, to perform a capillary puncture on the toe of a patient, who is severely burned. 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. Adjust the angle (the bevel may be against the vein wall). Allow to air dry. 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. Other Factors: Age, gender, and pregnancy have an influence on laboratory testing. Filter paper should touch only the blood and not the heel or finger. 7. the 3 rd (middle) or 4 th (ring) finger of the hand. window.addEventListener('message', function (){ Apply firm pressure. iframe.style.height = zf_ifrm_ht_nw; Stabilize the needle as you're inserting your tubes. 2. followed pre-lab instructions. 2. This image is not<\/b> licensed under the Creative Commons license applied to text content and some other images posted to the wikiHow website. Blood is collected into an attached vial or tube that is airtight and the flexible band is then removed from the arm. A tin can containing air is sealed. Ask the patient orcaregiver to state the patients name and date of birth. 9. (See Use of Band-Aids in the Post Phlebotomy. This process is automatic. advantageous in certain adult populations, such as: those with severe burns, obese patients, those with thrombotic tendencies, and for point-of-care testing, when a small volume of blood is needed. Source of specimen. Swiftly insert the needle through the skin and into the lumen of the vein. This vein lies close to the surface of the skin and there is not a large nerve supply. Select the appropriate microtainers for the specimens to be collected. Warning: Make sure you are confident that the structure you're palpitating is indeed a vein. While hand veins may be utilized for blood draws and intravenous infusions, veins in the feet and legs should be avoided for adults. Wipe away the first drop of blood, which tends to contain excess tissue fluid. Proper Handling of an Uncooperative Patient in an Outpatient Setting Akron. When the last tube to be drawn is filling, remove the tourniquet. D. Both A and B, A sharps container is identified by its bright ____ color Dispose of items in appropriate containers. This seats the bevel into the lumen of the vein, and is also the technique used to insert an IV catheter. You must check the timing of these variations for the desired collection point. -Vacutainer barrel Allow another large drop of blood to form. -obvious skin infection (including newly tattooed areas). with their hand to stabilize it for the draw. A. Edema Anxiety that results in hyperventilation may cause acid-base imbalances, and increased lactate. This image is not<\/b> licensed under the Creative Commons license applied to text content and some other images posted to the wikiHow website. f.style.width="100%"; The most common complications are bleeding at the puncture site or hematoma formation. When do you release the tourniquet during venipuncture? prevent falls, should the patient lose consciousness. 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. Dispose of needles immediately upon removal from the patient's vein. Some examples of these include notices from banks, online retailers such as Amazon or eBay, and even . If this is not successful, remove the needle, take care of the puncture site and redraw at another site. The blood is normally drawn from a vein on the top of the hand or from the inside of the elbow. Never draw above an IV site. At least two patient identifiers, such as name and date of birth, are needed. (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.). 6. Mastering Pediatric Phlebotomy. Center, for Phlebotomy Education, Inc. It is not as close to the skin surface as the median cubital and cephalic veins, which poses a greater risk of damage to the median nerve and brachial artery. It doesn't matter . Holder/Adapter - use with the evacuated collection system. Drawing blood for laboratory analysis is most often a routine and uneventful procedure. While we are ranked among the best children's hospitals in the country, it's our compassionate approach to treatment that makes us truly exceptional. Significant increases can be found in total protein, aspartate aminotransferase (AST), total lipids, cholesterol, iron, Affects packed cell volume and other cellular elements. 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. Lightly touch the microtainer capillary collectiondevice (or filter paper) to the LARGE drop of blood. 11. Which of the following is the most likely mechanism for alteration in protein values in this situation? (Uman et al, 2013). Adhesive bandages / tape - protects the venipuncture site after collection. B. evacuated tube }catch(e){} What equipment is needed for a venipuncture? 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. Posture: Postural changes (supine to sitting etc.) -thrombosis Have the patient position their arm on the armrest. But since each patient's medical condition varies, so does their veins. Clean the site to be punctured with an alcohol sponge. -laceration of vein 13. The dorsal venous network is the next most common vein site for phlebotomists. diet, exercise, stress, basal state). wikiHow, Inc. is the copyright holder of this image under U.S. and international copyright laws. 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. 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. 2. https://www.osha.gov/laws-regs/standardinterpretations/2007-10-26 and https://www.osha.gov/OshDoc/data_BloodborneFacts/bbfact03.pdf (Accessed June 13, 2022). Blood should NEVER be poured from one tube to another since the tubes can have different additives or coatings (see illustrations at end). Allow filter paper to air dry for two (2) hours at room temperature. Feel for the median cubital first, the cephalic vein second, and the basilic vein third. Try rotating the arm to better expose the cephalic or basilic vein. Warm the heel from which blood is to be obtained. C. the seal is broken This image is not<\/b> licensed under the Creative Commons license applied to text content and some other images posted to the wikiHow website. (b) the power developed by the output shaft. Select the proper approved lancet: The BD Microtainer Contact-Activated. Lines - Drawing from an intravenous line may avoid a difficult venipuncture, but introduces problems. Step 3: Venipuncture. Approach the patient in a friendly, calm manner. The use of a tourniquet during a venipuncture procedure makes: A. drawing from hand or foot B. above an IV line Tip: Patients who need regular bloodwork (e.g. 6. 2. When finished, clean the site and apply pressure with clean gauze to stop the bleeding. When there is an IV line present, blood can be drawn from this line. Any attempt to repeat a puncture at the same site increases the risk of complications. var f = document.createElement("iframe"); 2017;148(4):330-335. Last draw - additive tubes in this order: SST (red-gray or gold top). -cotton sponges Drawing the patient in a reclined position. This image may not be used by other entities without the express written consent of wikiHow, Inc.
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what sites should be avoided when performing venipuncture quizlet 2023