CS2 - Venipuncture and Blood cultures Flashcards
What is venipuncture and who is specially trained in it?
A procedure in which a needle is inserted into a vein to remove venous blood; Phlebotomists
When is venipuncture indicated?
- Obtain venous blood sample for laboratory testing
- Therapeutic (polycythemia/hemachromatosis)
When is venipuncture contraindicated?
- thrombosed vein or phlebitis
- lymphedema or hx of mastectomy
- scars
- recent tattoos
- rash/cellulitis
- hematoma
- artery
- proximal to IV site
- vascular anomaly
- cannula placement
What are the potential complications with venipuncture?
- Hematoma
- discomfort
- vasovagal syncope
- cellulitis
- phlebitis
- thrombosis
- bleeding
What are the best and second best sites for venipuncture?
1 - median cubital vein
#2 - Cephalic vein
Which vein is not ideal and why?
Basilic vein; median nerve and brachial artery complications
What is the provider’s role in venipuncture?
Educate whether labs are fasting vs non-fasting and medication instructions
Review any previous complications, contraindications, gather all materials, and gain verbal consent
Instructions for tourniquet?
Apply 3 inches above the venipuncture site and have patient make a fist
Do not leave it on longer than 1-2 minutes
How should the needle be inserted?
at a 15-30 degree angle, parallel to the vein with the needle bevel facing up
What should be considered if there is no blood return?
May have missed the vein or the needle is against the wall
Can slightly move needle but should stop if you see a hematoma forming
What should be done once all the tubes are filled?
Always remove the tourniquet first before removing the needle
How long should pressure be applied after removing the needle and why?
3 minutes to prevent a hematoma
What patient education should be given?
- Minor discomfort
- Care instructions: clean and dry
- Potential complications
What does clean up consist of ?
All sharps in sharps container
Blood contaminated material in biohazard waste container
Dispose of gloves and wash hands
What should be done if there is difficulty locating a vein for venipuncture?
- extremity below heart x few minutes
- apply warm towel
- blood pressure cuff inflation
- rub or tap veins
- vein imaging
What is a blood culture + sensitivity
A test to identify microorganisms in the bloodstream; sensitivity identifies effectiveness of antimicrobial agents to offending microorganism
What is important to remember about blood cultures as a provider?
- Obtain them BEFORE AB initiation
- must obtain from at least 2 sites
- be mindful of false positives
When are blood cultures indicated?
- diagnosing sepsis
- identifying microorganism causing septicemia
- treatment monitoring
- fever of unknown origin or concerns of systemic infection
When are blood cultures contraindicated?
- site of skin infection like cellulitis or abscess
- Be cautious in those that are anticoagulated
What are some potential complications of blood cultures?
- hematoma
- discomfort
- vasovagal syncope
- cellulitis/phlebitis
- bleeding
- contaminated sample
What are some signs of a contaminated blood culture?
- non-pathogenic skin flora microorganisms are reported
- multiple different microorganisms are noted on report
- negative blood culture results in the presence of a positive result
What sites are preferred for a blood culture?
- antecubital fossa
- median cubital veins
What vein is not preferred but can be used, and why?
cephalic veins; may roll
What vein should not be used and why?
basilic vein; close to brachial nerve and artery
What may be used when a suitable arm vein cannot be located?
hand or wrist veins
How should an area be cleaned before a blood culture?
- 70% isopropyl alcohol wipes x 3
- Chlorhexidine x 3
What must be done if site needs touched after cleaning?
must have sterile gloves on
In what order should blood be drawn for a blood culture?
- aerobic blood culture
- anaerobic blood culture
- additional tubes
What should be done prior to completion of the blood cultures?
wipe the opening of culture with alcohol
What are the correct blood collection volumes?
10 mL for adults
1-5mL for infants
What should the culture tube be labeled with?
patient info, site location, date and time, and initials
Blood cultures should always be done _____
First
