Challenges of Phlebotomy Flashcards by Do Re Mi

What challenge of phlebotomy is this?

needle not inserted far enough
bevel partially out of the skin
bevel partially into the vein
bevel against a vein wall
needle beside the vein

failed venipuncture

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What challenge of phlebotomy is this?

allergy
excessive bleeding
nausea and vomiting
pain
seizures/convulsions
petechiae
fainting/vasovagal syncope
hematoma

Complications of venipuncture

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What to do in case of hematoma?

First 24 hrs: apply ace (20-30 mins)
After 24 hrs: apply warm compress

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What challenge of phlebotomy is this?

Iatrogenic anemia
infection
vein damage
nerve damage

complications of venipuncture

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Relating to a result of a medical procedure

Iatrogenic

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What does these symptoms suggest?

Extreme pain
burning/electric shock sensation
numbness of arm
radiating pain

nerve injury

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3 things to do in case of multiple venipuncture attempts

try again on the other hand
ask someone (superior) to collect blood
let the patient rest and try again

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What to do when you still can’t draw blood from patient even after multiple attempts (and letting another try)?

inform nurse or physician

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Pediatric venipuncture

2 tests that require large amount of blood

cross-matching
blood cultures

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Pediatric venipuncture

2 tests that cannot normally be performed by skin puncture

Ammonia levels
Most coagulation studies

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Pediatric venipuncture

What is the location of the vein?

antecubital fossa
forearm

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Pediatric venipuncture

Aside from antecubital fossa and forearm, what are the other 4 possible venipuncture sites?

medial wrist
dorsum of the foot
scalp
medial ankle

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Pediatric venipuncture

Who is allowed to draw blood from a pediatric patient’s media wrist, dorsum of the foot, scalp, and medial ankle?

Physician or personnel with special training (with permission of patient’s physician)

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Pediatric venipuncture

Removing more than ________% of an infant’s blood volume at one time can lead to shock and cardiac arrest

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Pediatric venipuncture: method of restraint

Wrapped in a blanket

newborn or young infant

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Pediatric venipuncture: method of restraint

have them sit upright on a parent’s lap

toddlers

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Pediatric venipuncture: method of restraint

sit by themselved in the blood-drawing chair, but a parent or another phlebotomist should help steady the child’s arm

older children

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Pediatric venipuncture

Used to move the child’s attention from the procedure to something else
bubbles, spinning lights, large picture books, anything that will block the view of the puncture from the child

distraction

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Pediatric venipuncture

What is the gauge of the butterfly needle attached to an ETS holder or syringe?

23-gauge

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Pediatric venipuncture

What size of ETS tube should be used?

Smallest

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Pediatric venipuncture

Small amount of blood can be drawn into a syringe and the blood placed in ________ rather than ETS tubes

microcollection tubes (microtubes “bullets)

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Pediatric venipuncture

If venous blood is placed in a microtube, label the spx as ____________

venous blood

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Geriatric venipuncture

Term which refers to old age

Geriatric

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Geriatric venipuncture

4 challenges in Geriatric venipuncture

skin changes
hearing and vision problems
mobility issues related to arthritis and osteoporosis
mental and emotional conditions

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# Geriatric venipuncture What should you not do if a patient has a hearing impairment?

Never shout

# Geriatric venipuncture What does these refer to? * farsightedness, cataract formation resulting in dim vision * light intolerance and poor night vision

Visual impairment

# Geriatric venipuncture For this problem, phlebotomy area should have adequate lighting without glare

Visual impairment

# Geriatric venipuncture For this impairment, you may need to repeat your statement or question more than once

mental impairment

# Geriatric venipuncture What should you remember to do for patients in wheelchairs?

Lock the wheels

# Geriatric venipuncture Equipment selection

butterfly needles; for extremely fragile veins, collect bysyringe or finger puncture

# Geriatric venipuncture Tourniquet application

Apply the tourniquet snugly but loose enough to avoid damaging the patient‟s skin

# Geriatric venipuncture Site selection

* antecubital * gently massage the arm from wrist to elbow to force blood into the area * wrap a warm, wet towel around the arm or hand for a few minutes to increase blood flow

# Geriatric venipuncture Patients that are susceptible to bleeding and hematomas

patient on anticoagulant therapy

# Geriatric venipuncture For how long should you apply pressure on the site of a patient on anticoagulant therapy

5 mins

# Geriatric venipuncture For patients on anticoagulant therapy, when should you check the arm?

In 15 mins

# Geriatric venipuncture What to do if the patient refuses blood collection?

Do not collect blood, then inform the doctor | Patient has the right to refuse to have a sample drawn

# Geriatric venipuncture What can result from drawing blood from patient without their consent?

Can result in charges of assault and battery

# Geriatric venipuncture For cognitively impared or combative patients, who should explain the procedure to the patient or to help hold the patient?

Nurse or patient's relatives

# Geriatric venipuncture How to handle "difficult" patients

* remain calm and professional * treat the patient in a caring manner under all circumstances

# Geriatric venipuncture Vein are often difficult to feel in obese patients. What are the two veins that are best to locate and use?

* median cubital vein - most prominent vein to feel * cephalic vein - also prominent | may use hand vein

# Geriatric venipuncture What should you wear for patients in isolation

Proper PPE

Scarred, burned, or tattoed areas should be what?

Avoided

Veins that are obstructed, hard and cordlike, lacking resiliency

Sclerosed (hardened)

# Vein has a tendency to collapse Best way to collect blood?

syringe method

# Vein has a tendency to collapse You can use ETS but?

use small tubes only

Refers to persistent irrational fear of pins and needles

belonephobia | Belone - needle Phobos - fear

Who should perform venipuncture on patient with needle phobia?

Most experienced and skilled phlebotomist

# For patients with needle phobia What should you do to the site to numb it before venipuncture?

Apply an ice pack for 10 - 15 mins

What is the recommended location to perform venipuncture when the patient has needle phobia?

Performed at sites where personnel are trained in cpr and a defibrillator is readily accessible

# Legal Issues Most legal actions against healthcare workers are ________ in which the alleged injured party sues for __________

* civil actions * monetary damages

# Legal Issues Willful actions by healthcare workers with the intent to produce harm or death can results in what?

Criminal charges

# Legal Issues The most common civil actions in healthcare are based on what law?

Tort law

# Legal Issues * A wrongful act other than breach of contract committed against someone's person, property, reputation, or other legally protected right, for which the individual is entitled to damages awarded by the court. * wrongdoing done by one part against another party.

Tort

# Legal Issues An act or threat causing another to be in fear of immediate battery (harmful touching).

Assault

# Legal Issues An intentional harmful or offensive touching of, or use of force on, another person without consent or legal justification

Battery

# Legal Issues What type of offense is battery?

Both tort and a criminal offense

# Legal Issues A phlebotomist who attempts to collect a blood specimen without the patient’s consent can face a charge of ____________

assault and battery

# Legal Issues The violation of one‟s right to be left alone

Invasion of privacy

# Legal Issues What issue does these describe? * opening the door and walking into a patient's room without asking permission to enter. * the unauthorized publishing or release of private information, which can also be considered a breach of confidentiality.

Invasion of privacy

# Legal Issues failure to keep privileged medical information private

Breach of confidentiality

# Legal Issues failure to exercise due care, the level of care that a person of ordinary intelligence and good sense would exercise under the given circumstances.

Negligence

# Legal Issues doing something that a reasonable person would not do; not doing something that a reasonable person would do

Negligence

# Legal Issues A type of negligence committed by a professional

Malpractice

# Legal Issues Latin for “*the thing speaks for itself*,” which applies to the rule of evidence in a case of negligence.

Res ipsa loquitur

# Legal Issues When a breach of duty is so obvious that it does not need further explanation, it is said that the situation speaks for itself

Res ipsa loquitur

# Legal Issues * Latin for “*let the master respond*” * An employer is liable (legally responsible) for the actions of an employee, even though the employee is the one at fault.

Respondeat superior

# Legal Issues * Compensates the insured in the event of malpractice liability * Individual workers are not typically targets of lawsuits because of respondeat superior * Can be named as codefendant

Malpractice insurance

# Legal Issues Best insurance against lawsuits?

Take steps to avoid them

# Guidelines to avoid lawsuit * Acquire ________ before collecting specimens. * Respect a patient‟s ________. * Strictly adhere to accepted ________. * Use proper ________ and devices. * Listen and ________ appropriately to the patient's requests.

* informed consent * right to confidentiality * procedures and practices * safety containers * respond

# Communication skills Types of communication skills

* verbal * non-verbal

# Communication skills * Level that the patient will understand * Use terms that can be understood by the patient

Verbal

# Communication skills * Body language * Postures, gestures, eye contact, facial expressions

Non-verbal

# Communication skills What skill does this require the listener to do? 1. Focus on the customer. 2. Limit your talking 3. Do not interrupt. 4. Manage your own thoughts 5. Listen for feeling, not just words.

Active listening

# Communication skills: What to say instead of... I don't know

I'll find out

# Communication skills: What to say instead of... No

What I can do is...

# Communication skills: What to say instead of... That's not my job

This is who can help you

# Communication skills: What to say instead of... You're right, this stinks

I understand your frustration

# Communication skills: What to say instead of... That's not my fault

Let's see what we can do about it

# Communication skills: What to say instead of... I'm busy right now

I'll be with you in just a moment

4 reasons for dissatisfaction?

* Previous negative experience * Personality characteristics * High expectations * Waiting Time

4 Reasons of patients in choosing a phlebotomy area (draw site)

1. Insurance company 2. Physician‟s order 3. Convenient location 4. Image of draw site

In dealing with "difficult" customers, what should you do?

Understandthe fears and concerns of the customers.