Blood Collection Prt. 2 Flashcards
Causes of Hemolysis
• Use a needle that is too small
• Pulling syringe plunger back too fast
• Expelling blood strongly into the tube
• Forcing the blood from a syringe into an evacuated tube
• Shaking or mixing the tubes vigorously
• Performing blood collection before the alcohol has dried at the collection site
Causes of Hematoma
• The vein is too fragile or too small for the needle size
• The needle penetrates all the way to the vein
• Needle is partly inserted into the vein
• Needle is removed while tourniquet is still on
• Excessive probing
• Pressure is not adequately applied after venipuncture
Three Types of Blood Collection
• Venipuncture -> venous blood
• Capillary Puncture -> mixture of venous and arterial blood
• Arterial Puncture -› arterial blood
• Most common technique used to obtain blood.
• Requires ample skill to ensure accurate results and preservation of patient vein integrity
• Drawing blood of venous blood for transfusion, apheresis, diagnostic testing, experimental procedures, treatment
Venipuncture
Venipuncture methods
Syringe method
ETS
Butterfly collection
: 1st critical step.
Correct Patient Identification
Selection of the site
median cubital (preferred), median basilic, cephalic veins.
If not veins of the wrist, back of the hand, ankle, or foot (consult if there are circulatory problems).
avoid areas
w/ hematoma
burns
scars
edema
IV line
mastectomy site
Apply the tourniquet-
3-4 inches above the site.
Remove the needle and apply pressure
> do not allow px to_____
- This will reopen the wound and result in hemorrhage.
bend the arm.
LABEL SPECIMEN
-> no_______
- (4)and any information required by the institution
pre-labeling
name
date and time
age/sex
initials of the phlebotomist
Common mistakes during venipuncture procedures are:
> failure to dry site
bevel down
failure to mix blood ASAP
failure to release the tourniquet
excessive pulling of the plunger
IV site/Med lock
> never drawn on the same side -› opposite arm
distal or below IV line (noted)
• Transfusion
> may collect blood
> should be…
indicated and drawn on the opposite arm.
• HD shunt/Fistula
> it is avoided
> ask for the patient’s status
> may draw distal…
at least 4 inches below.
REMEMBER: each phlebotomist is allowed only___ attempts.
two
• The classical way of obtaining venous blood
• Open svstem
• The preferred technique in veins that are easily collapsed
SYRINGE METHOD
• Favored because it can tell if the vein is hit through the backflow which is made visible in the needle hub
SYRINGE METHOD
SYRINGE METHOD ORDER OF DRAW:
- Blood culture
- Coagulation tests
- Plasma tubes (tubes with other additives)
- Serum Tubes
• Multiple tube draw
• Closed system (lesser contamination)
• A faster way of collecting blood
EVACUATED TUBE SYSTEM
EVACUATED TUBE SYSTEM
• ORDER OF DRAW
- Blood culture
- Coagulation tests
- Serum Tubes
- Plasma tubes (tubes with other additives)
NOTE:
- The main advantage of the evacuated tube system is that it allows multiple blood draws
- However, the proper order of draw should be followed to avoid…
cross-contamination or carryover of additives from one tube to another
• Open or closed system
- Closed system
• air will not contaminate the blood
• ETS is used
-> Open system
• blood is exposed to blood
• Syringe is used
WINGED INFUSION METHOD
Winged infusion method
Needle gauge
• 25-gauge needle -> for collapsable veins
For Butterfly with ETS, a_____ is needed
Discard tube
Complications for Venipuncture
• Hematoma (most common)
• Ecchymosis
• Syncope
• Bleeding
• Nerve Damage
• Arterial puncture
• Dizziness
dermal puncture or capillary puncture
Skin puncture
Skin puncture in infants
• Lateral or Medial plantar surface of the heel for infants
NOT ON POSTERIOR CURVATURE
Skin puncture
puncture not more than_____ to prevent hospital induced anemia or osteomyelitis
2.4mm
Skin puncture sites
3rd or 4th finger
big toes
heel
last resort is the earlobe
Skin puncture for adults is done due to
obesity
burns
extremely small veins
Capillary puncture
• Blood is a mixture of
capillary
venous
arterial blood
interstitial and intracellular fluid
Order of Draw for Skin Puncture
• Blood Gases
• Slides/Smears
• EDTA Microtainer Tubes (CBC)
• Plasma/Other Tubes
• Serum tubes
Complications in Skin puncture
• Collapse of vessels
• Osteomyelitis of the heel bone
• Nerve Damage
• Hematoma
• Scarring
• Localized or generalized necrosis
Skin/ capillary puncture
SOURCES OF ERROR
• Hemolysis
• Failure to dry the site
• Failure to wipe the 1st drop of blood
• Vigorous massaging or milking the area
• Accidental capturing of bubbles
• Picture of the proper site of skin puncture (Turgeon)
• Wipe the first drop of blood to avoid…
contamination of tissue juices
Premature neonates (up to 3kg)
Heel
0.85mm
Infants under 6 months
Heel
2.0mm
Child aged 6 months to 8 years
Finger 1.5mm
Child older than 8 years and adults
2.4mm
Mainly done for arterial blood gas
- 02, CO2, pH levels in the blood
- arterial blood reflects true oxygen, carbon dioxide, and pH
eve
Arterial puncture
• Can also be done if venipuncture or capillary puncture is not possible
• the most dangerous type of blood collection
Arterial puncture
•___ leak, while___ spray (high pressure)
• areas (3)
Veins; arteries
Brachial, Radial, Femoral (thigh area)
- Have the patient make a fist and occlude both the ulnar (opposite the thumb site) and radial (close to the thumb site) arteries by compressing with two fingers over each artery
-> Have the patient open his or her and observe for bleaching of blood
-Release the pressure on the ulnar artery only and note if blood return is present
Modified Allen’s Test
Complications in Arterial Puncture
• Arteriospasm
• Hematoma
• Nerve Damage
• Vasovagal response -› faint/syncope
• Drop in blood pressure -› due to psychological distress or excessive blood collected
• Sweating and Pallor
• Lack of consciousness
