chapter 14/section 2-making difficult draws easier

Question 1

Bariatric Patients

Answer 1

Obese patients often have veins that are hard to feel. Try the cephalic vein.

Question 2

Geriatric patients

Answer 2

Older patients generally have paper-thin skin resulting in skin tears.

Question 3

Needle Phobic patients

Answer 3

Use smaller needles for these patients and lay them down for the procedure.
You can conceal the needle and limit extended observation but never cover the needle.
Place a cover over the tubes with blood.

Question 4

Combative, Impaired, or psychologically Unstable patients

Answer 4

With these patients, be prepared to react by releasing the tourniquet, safely shielding the needle, applying pressure, and protecting yourself.

Question 5

Pediatric patients

Answer 5

With children use the APE- Approach, Positioning, Equipment.
“Dry run” or “rehearse” with kids. Distractions and the human touch work well.
Try to reduce cues of counting down
more than one person, which may be needed.
perform heel sticks on peds
if obtaining a heel stick is unsuccessful, try the median cubital veins.

Question 6

Intravenous drugs

Answer 6

when dealing with intravenous drug users, you may find that scarred veins from extended IV drug use can inhibit normal palpations as the veins may feel like hard cords.

Question 7

Allergic Reactions

Answer 7

There are many types of allergic reactions. Generalized anaphylaxis can have dramatic results on the airway causing the patient to be unable to breathe. A localized allergic reaction can present on the skin. An example is urticaria (hives), which comes from a patient’s exposure to allergens and can present raised welts.

Question 8

Severe Edema

Answer 8

Often veins in these patients require deep palpation. Always ask where other phlebotomists have had success in drawing their blood. Nine times out of ten, the patient will already know where their veins are.

Question 9

Post cancer patients

Answer 9

After a patient has completed chemotherapy, radiation treatment, or both. Their veins are often smaller and harder to palpate. Again it’s OK to ask which veins successfully drawn their blood.

Question 10

Mastectomy patients

Answer 10

A cancer survivor who has received a mastectomy cannot have blood drawn or even have a restricting band placed on the arm of the same side as the procedure. The lymph and return blood flow is severely altered and will cause many issues for the patient.
BE AWARE OF LIMNB ALERT BRACELETS ON MASTECTOMY PATIENTS. THIS BRACELET ALERTS PHLEBOMOISTS TO AVOID CERTAIN LIMBS.

Question 11

Tattoed patients

Answer 11

Skin art that is newly completed are an infection hazard and is best to be avoided.
Tattooed areas will obscure bruising and other complications that may occur pre- or post-venipuncture.
People are told to wait over a year or more before blood draws from the area. if not go to a place with no dye.

Question 12

Sleeping patients

Answer 12

Drawing blood from a sleeping patient might startle the patient and change the testing results. Also, you or the patient could be injured due to the patient being startled. Appropriate action would be to talk to them gently and say the patient’s name.

Question 13

Burned and Scarred areas

Answer 13

Healed burns and scars will have restricted perfusion and result in a failed blood collection attempt. The integumentary tissues will be very tough in this area. Excessive venipuncture pressure may result in excessive damage to the tissues.

Question 14

I.V therapy

Answer 14

Always draw blood BELOW a patient’s IV site. NEVER turn off an IV to draw blood above the IV site as this is beyond the scope of practice.
For example: If the IV is in the arm, only draw from the hand. If the IV is in the hand, draw from the other arm.