Chapter 11 Venipuncture Complications Flashcards
____ is the most important procedure in phlebotomy.
Positive ID
If patient not in their room always verify with the ____ the location.
Nursing station
List 4 situations that can make positively identifying a patient difficult.
- Emergency requisitions
- ER collections
- Orders telephoned in to lab
- Requisitions picked up at site
Any discrepancies determining the info on the requisition and on the patient ID band must be resolved ____ collection.
Before
ID band missing contact the ____.
Nursing station
If patient ID band is detached but in the room you ____.
Cannot draw blood
A ____ has the ID band come with matching labels for the specimens.
Commercial ID system
A sleeping patient cannot give ____ so ____ should happen to get them oriented.
Informed consent
One or two attempts to wake the patient
Drawing from a patient without consent may ____.
Lead to assault charges
Treat an unconscious patient as you would a ____. Including ____ and ____, because unconscious patients may ____.
Conscious patient
Identifying yourself
Describing the procedure
Be able to hear you
If physician or clergyman is in the room ____, unless it’s a ____ or ____.
Return at another time
Stat
Timed collection
If a physician enters as you are preparing to draw, you should ____.
Leave until they are finished with the patient
If a patient has visitors you should ____.
Politely ask them to leave the room
If a patient cannot understand you, ____ to try and obtain consent. If not, then seek a ____.
Show them what you’re going to do
Translator
If patient refuses with you and after you have attended with the nurse to try and draw blood, ____ along with ____ and notify the ____.
Document this on the request
Nurse’s name
Health care provider
The ____ is the most common site for routine venipuncture.
Antecubital fossa
Veins that are ____ (____) or ____ (____) feel hard or cordlike and lack resiliency.
Occluded, blocked
Sclerosed, hardened
Occlusion and sclerosis can be caused by 5 things, list them. These types of veins are susceptible to ____, and may produce ____.
- Inflammation
- Disease
- Chemotherapy
- Prolonged IV therapy
- Repeated venipunctures
Infection
Erroneous results
A hematoma (____) can be caused by 4 things, list them. This makes the blood ____ and can ____ the vein slowing blood flow. All of which can ____.
Collection of blood out of the vessel
- Needle going through vein
- Bevel opening partially in vein
- Not applying pressure after withdrawal
- Repeated punctures
No longer fresh from the vein
Obstruct
Alter test results
____ appears swollen from the collection of fluid.
Edematous tissue
Areas with ____, ____, or ____ have impaired ____, are susceptible to ____, and may be painful or difficult to penetrate.
Burns, scars, tattoos
Circulation
Infection
____ is a surgical operation to remove a breast.
Mastectomy
____ is the lack of lymph fluid movement such as in the removal of lymph tissue on the side of a mastectomy.
Lymphostasis
Lymphostasis ____ test results and can be painful to the patient as well as increase ____.
Can affect
Risk of infection
Blood ____ be drawn from an arm if there is an IV device in place. If no other sites are available you must draw from a site ____ (____) the IV site.
Should not
Distal (away from)
Any condition resulting in disruption of ____ means that the site should be avoided. Give 4 examples.
Skin integrity
- Open lesions
- Skin rashes
- Recent tattoos
- Stitches not fully healed
Name 4 techniques to use when having difficulty finding a vein.
- Check the other arm
- Enhance vein prominence
- Use a blood pressure cuff (sphygmomanometer)
- Use alternative arm
When checking for veins it’s ok to ____.
Ask patient about sites of previous successful phlebotomy
List 4 ways a phlebotomist could enhance vein prominence.
- Massage upward from wrist to elbow
- Dangle arm downward to increase blood
- Apply heat but not moist heat
- Rotate wrist to increase cephalic vein prominence
You can use a ____ instead of a tourniquet for hard-to-find veins. It should be placed ____ the venipuncture site, and inflated ____ but ____.
Blood pressure cuff
3-4 inches above
Above the diastolic
Below the systolic
When a suitable vein cannot be found in the ____, you will have to collect from the ____, ____, or ____.
Antecubital fossa
Hand, foot, leg
The ____ and ____ are more susceptible to ____ and ____, and they are not recommended sites for patients with ____ or patients on ____ (____ or ____).
Leg, Foot Clot, Infection Diabetes Anticoagulant therapy Warfarin, heparin
Collection from the leg or foot usually requires ____.
Physician permission
Hand veins are small and fragile so if drawing from them use a ____ (____) with a smaller gauge needle and tube or a ____.
WIS (winged infusion set), butterfly
Syringe
A butterfly is ideal for hand drawing because tubing allows for ____.
Lower angle of insertion
A ____ allows for suction control, pulling the blood slowly which is important for elderly and pediatric patients.
Syringe
____ cannot be used for cleaning when drawing a ____. It is also not a strong enough antiseptic for drawing ____, ____, or ____. Instead use ____, and for patients allergic to this, use ____.
Alcohol Blood alcohol test Blood cultures, blood gases, blood donations Povidone-iodine Chlorhexidine gluconate
When you use an alternative antiseptic ____.
Note it on the requisition
____ is not recommended for dermal punctures, because it may elevate test results for ____, ____, ____, and ____ (____).
Povidone-iodine
Bilirubin, uric acid, phosphorus, potassium, BURPP
A tourniquet should not remain in place for more than ____. This is to prevent ____, or alteration in the ____ in the blood.
1 minute
Hemoconcentration
Ratio of elements
When a tourniquet is on too long, the ____ portion of the blood filters into the tissue, increasing the ____ left in the vein. This affects determinations of large molecules, such as ____, ____, and ____. It also increases ____ and ____.
Plasma
Proportion of cells
Plasma proteins, enzymes, lipids
RBC, iron and calcium levels
Leaving a tourniquet on too long can alter ____ and ____ levels by a different mechanism.
Potassium, lactic acid
The tourniquet should be released ____.
As soon as blood flow starts
Hemoconcentration can also be caused by ____, ____ or ____, ____, or ____.
Pumping the fist
Sclerosed, occluded veins
Long-term IV therapy
Dehydration
____ are small, nonraised red spots that appear on the skin when the tourniquet is applied to a patient with a ____ or ____ disorder.
Petechiae
capillary wall, platelet
Petechiae indicates that ____ will occur after the procedure and ____ is required.
Excessive bleeding
Extended gauze pressure
If there is no ____, or the patient complains of pinching or arm numbing, the tourniquet is ____.
Arterial pulse
Too tight
____ is becoming more common therefor all patients must be asked if they have a ____. Alternate forms of this material can be substituted in phlebotomist’s ____, ____, and ____.
Latex allergies
Latex allergy
Gloves, tourniquets, bandages
