LESSON 5 Flashcards
This refers to the process of collecting or “drawing” blood from a vein of the patient for laboratory testing purposes.
venipuncture
They should possess the necessary knowledge and skills to perform venipuncture since they will perform this procedure frequently as part of their duties and responsibilities in the healthcare institution.
Phlebotomists
The first step of the pre-examination phase is the ___ that comes from a physician.
test request
The _______ includes information on the type of test ordered and any special instructions or conditions that should be considered during the pre-examination and examination phases.
request form
This form will be part of the patient’s medical record and can be referred to, should issues regarding the test arise.
Request form
The ___ could be manual, computerized, or bar-coded.
test requisition
These usually have parts for request, report, and billing.
Manual requisition forms
With the advances in technology, the use of the manual method has ___.
declined
These forms still serve as back-up when the computerized system fails.
Manual requisition forms
The___ includes patient information, test status, and other details that are useful for the test.
computerized requisition form
A _____ for the collection tube is made available, with which the phlebotomist must note the time of collection and confirm the information by affixing his/her initials.
computer-generated label
The _____ may contain a barcode, which is scanned into a computer using a special device with a laser.
manual or computerized request
The information in the (the barcode from the manual or computerized request) code is then interpreted and processed. The use of these codes greatly help in minimizing _____.
clerical errors
The required pieces of information in the requisition form are as follows: (10)
•Name of the physician who ordered the test
• Patient’s full name including the middle initial
•The medical record number for inpatients
• Birthday and age of the patient
• Room number and bed number if inpatient
•Type of test ordered
•Date when the test is to be performed
• Billing information (if required)
• Test status
•Special precaution
In which step can you find this?
A review of the test requisition to avoid duplication of request, to ensure proper collection timing, and to identify special instructions or equipment required for the test.
Step 1: Review and Accession the Test Request
The venipuncture procedure begins with a thorough review of the test requisition to: (3)
1) avoid duplication of request
2) to ensure proper collection timing
3) to identify special instructions or equipment required for the test.
In reviewing the request, the phlebotomist must: (4)
1) check the completeness of the required information
2) verify the tests to be collected including information such as the time and date of collection
3) take note of any dietary restrictions or special conditions that should be followed before the actual collection
4) determine the test status or priority of collection
The test request is then ______, which means that the specimen to be collected is assigned a special number that will serve as the reference number for all associated processes and paperwork.
accessioned
This helps improve the documentation, handling and reporting of test results.
Accessioning the test request
What is step 2 in the venipuncture procedure?
Step 2: Approach, Identify, and Prepare the Patient
Phlebotomists should organize the test request according to: (2)
1) priority
2) prepare all the necessary equipment and supplies needed to complete their collection round.
They should check for phlebotomy-related signs and warnings regarding the condition of the patient such as:
“No taking of blood pressure (BP) or venipuncture on the right arm.”
What are these called?
“No taking of blood pressure (BP) or venipuncture on the right arm.”
phlebotomy-related signs and warnings
These signs are usually posted on the door or wall next to the patients room.
phlebotomy-related signs and warnings
This refers to the behavior of a healthcare worker as perceived by the patient which is applicable to both in- and out-patient settings.
“Bedside manner”
These help the phlebotomists gain the trust and confidence of the patient are part of the professional bedside manner. (3)
Proper approach, conduct, and demeanor
The following practices of phlebotomists show proper bedside manner: (7)
• Knock on the door gently before entering the room.
• Make a good impression by greeting the patient warmly.
•Stay organized and have all the supplies available and approach the patient in a professional manner that goes well with having a neat appearance.
• Maintain a calm expression as most patients are afraid of blood collection.
• Introduce yourself and explain the procedure. Obtain the verbal or expressed consent of the patient before proceeding with the test.
•Remain compassionate and professional during the procedure.
•Thank the patient for his/her cooperation before leaving.
If there is a physician or clergy in the room, the phlebotomists may interrupt only if the ordered test is _____.
stat or timed
Phlebotomists have to excuse and ask ____ to proceed with the test.
permission
Family members or visitors ____ in the room, but it would be better if they could ____ of the room until the process is finished.
can stay
step out
If the patient to be tested is not available and the phlebotomists are unable to obtain the specimen, it should be indicated in the form that ____.
no collection has been made.
The form should be submitted to the ____.
nurses’ station
It is an important part of specimen collection.
Positively confirming the identity of the patient
Obtaining a specimen from the wrong person of specimen can have _____ in cases that involve blood transfusion.
serious consequences and can even be fatal
This can be a reason or cause for a phlebotomists dismissal or lawsuit against him/her on the grounds malpractice.
Misidentifying patients
When identifying patients, confirm the _____ (2)
name and date of birth of the patient.
The patient’s response should match the information on the is request form. Otherwise, the difference or error should be _____ before collection.
resolved and rectified
The ______ should also match and the phlebotomist should inform the nurse on duty if there are any discrepancies or missing IDs.
identification bracelets
Who should the phlebotomist inform if there are any discrepancies or missing IDs?
the nurse on duty
If the patient is fast asleep, the phlebotomist should:
wake up the patient gently for proper identification.
A patient in the emergency room or intensive care unit may be ____ during the time of the collection.
unconscious
Ask for the help of a ______ in identifying the patient. (3)
relative, nurse, or physician
What should you do after asking the person who confirmed the identity of the patient?
Make sure to note the name of the person
If the patient is young, mentally-incapacitated, or there is a language barrier, the phlebotomist should ask a ____ to identify the patient.
relative, an attendant, or the nurse
The ID bands for inpatient newborns or babies under 2 years old are placed in _____.
the lower leg
The _____ must confirm the identity of the child. The identity of the person who confirmed the identity must be noted on the request form.
nurse, guardian, or relative
The phlebotomist should ___ the test procedure to the patient and confirm that the patient understood what has been discussed.
explain
As part of the informed consent advocacy, a ____ should be obtained before proceeding with the collection.
verbal or expressed consent
It is best to direct a patient’s inquiries on the purpose or result of the test to the patient’s _____ to avoid any miscommunication.
If the patient objects to the collection, respect the right of the patient to refuse testing.
nurse or physician
The refusal should be noted in the ____ and the authorized personnel should be informed about the refusal
test request
A patient must be treated with care under all circumstances, and the phlebotomist must remain calm and professional even if the patient is being ____.
difficult or is exhibiting needle-phobia
_____ should be given to minimize the trauma.
Special attention
What is the step 3?
Step 3: Verify the Patient’s Diet Restrictions and Latex Sensitivity
Phlebotomists should verify if there are special instructions on the diet of the patient that need to be followed such as fasting for about ____.
8 to 10 hours
During fasting, the patient may be allowed to drink water to avoid ____.
dehydration
It is best to advise the ____ if the patient has not been able to follow the fasting requirement so a decision could be made if the collection will proceed as scheduled.
doctor
A patient with allergic reaction to latex can have _____ upon exposure, so it is important to check if all pieces of equipment used on the patient are latex-free, and there are no latex items in the room.
life-threatening reactions
What is the step 4?
Step 4: Sanitize Hands
This should be observed to prevent the spread of infection.
Proper hand hygiene
What is the step 5?
Step 5: Position the Patient, Apply the Tourniquet, and Ask Patient to Make a Fist
During the venipuncture procedure, an inpatient is usually _____, while an outpatient is seated on a blood-drawing chair, except when the patient is prone to fainting in which case he/she is placed in a reclining chair, sofa, or bed.
lying down in bed
During the venipuncture procedure, an outpatient is ____, except when the patient is prone to fainting in which case he/she is placed in a reclining chair, sofa, or bed.
seated on a blood-drawing chair
Be sure that the hand or arm for venipuncture procedure is ___
well supported
The tourniquet should be placed ____ from the intended site.
3 to 4 inches
Apply over a ____ if the patient has sensitive skin
gauze
Never apply a tourniquet over an ____.
open sore
When the tourniquet is in place, ask the patient to ____.
clench his/her fist
What is the step 6?
Step 6: Select Vein, Release Tourniquet, and Ask Patient to Open Fist
The ____ of the arm is the preferred venipuncture site.
antecubital area
When leu pileboromist has found a vein, he/she should ___ to gauge its size.
roll his finger from one side to the other
Using the fingers, the phlebotomist should trace the path to determine a _____
possible entry point
The ____ are checked by pressing on the site a couple times.
depth and patency
If the vein is not suitable, the phlebotomist should look for a ____ or ____ could be an option.
alternative site
or a capillary puncture
TOURNIQUET APPLICATION:
Place the tourniquet ____ or ____ from the intended puncture site.
3 to 4 inches
Or
about 4 to 5 finger widths
TOURNIQUET APPLICATION:
Hold one side of the tourniquet in each hand. It should be a few ____.
inches from the end
TOURNIQUET APPLICATION:
Apply a _____ so that it will be snug when tied.
little tension
TOURNIQUET APPLICATION:
Bring the two sides together. Hold both ends between the ____ of the right hand.
thumb and forefinger
TOURNIQUET APPLICATION:
Reach over the ____ between the thumb and forefinger of the left hand and release it from the grip of the right hand.
right hand and grasp the right side of the tourniquet
TOURNIQUET APPLICATION:
Near the _____. Hold both sides together between the thumb and forefinger of the left hand, close to the patients arm.
left index finger, cross the left end over the right
TOURNIQUET APPLICATION:
While securely holding both sides, use either the _____ to tuck a portion of the left side under the right side and pull into a loop.
left middle finger or the right index finger
TOURNIQUET APPLICATION:
Tie the tourniquet properly with its ends pointing toward the ___.
shoulder
If the tourniquet is applied, release it and the patient should be asked to ____.
open his fist
What is step 7?
Step 7: Clean and Air-Dry the Site
The venipuncture site should be cleaned using an ___, such as 70% isopropyl alcohol, to prevent infection or contamination.
antiseptic
The area should cover about ____ using a circular motion, and moving outward in ____.
2 to 3 inches diameter
concentric circular motion
Allow the area to dry for about a ___, but do not use ____, and never ___. Avoid ___ the site after cleaning.
minute
unsterilized gauze
fan or blow the site
touching
What is step 8?
Step 8: Prepare the Equipment and Put on Gloves
The ______ are factors to be considered when choosing the system, needle size, and volume of the tube that will be used. (3)
age of the patient
volume of blood for collection
the size and location of the vein
Make sure that you are wearing a ____.
clean pair of gloves
Which step do you wear a clean pair of gloves?
Step 8: Prepare the Equipment and Put on Gloves
What are the steps for ETS equipment preparation? (6)
- Select the appropriate tube for ET’S and tap to dislodge any additives in the stopper.
- Select and inspect the needle for defects.
- Twist needle to expose the back of the needle.
- Screw this end to the threaded hub of the tube holder.
- Place the first tube in the holder.
- Position the tube in the holder.
What are the Winged Infusion Set (Butterfly) equipment preparation steps? (4)
- Use a 23-gauge butterfly gauge with a safety feature.
- Inspect the package before aseptically opening and removing the butterfly.
- Attach the butterfly to an ETS holder or syringe.
- Select the appropriate small-volume tube for the test.
What are the steps to syringe system equipment preparation? (4)
- Select the appropriate syringe and needle.
- Test the plunger before opening the sterile package.
- Open the package aseptically.
- Securely attach the needle to the syringe.
What is the step 9?
Step 9; Reapply the Tourniquet, Uncap, and Inspect the Needle
Reapply the tourniquet ____ the cleaned area.
without touching
Get the collection equipment using your ____ hand.
dominant
Remove the needle cover and inspect the needle. The needle _____ with anything prior to venipuncture.
should not come into contact
What if the needle came into contact before venipuncture?
Remove and replace it with a new one
What is step 10?
Step 10: Ask the Patient to Remake a Fist, Anchor to Vein, and Insert Needle
Which step can this be found?
Ask the patient to make a fist. Anchor the antecubital vein b, holding the patients arm with your free hand.
Step 10: Ask the Patient to Remake a Fist, Anchor to Vein, and Insert Needle
(STEP 10)
The fingers should support the ____ just below the elbow.
back of the arm
When anchoring, Place the thumb at least ____ inches below, but slightly on the side of the site of venipuncture, pulling the skin toward the wrist.
1 to 2
When inserting the needle, the phlebotomist should hold the collection device or butterfly needle with his/her ____ hand.
dominant
He/she should position the needle above the insertion site with the bevel ____, then insert it using a smooth forward motion in a _____ angle.
facing up
30-degree
What is step 11?
Step 11: Establish the Blood Flow, Release the Tourniquet, and Ask the Patient to Open Fist
(STEP 11) Press on the collection tube into the _____. Make sure that the needle has completely penetrated the stopper.
tube holder
(STEP 11) Push the tube with the thumb while the _____ fingers straddle and grasp the flanges of the tube holder slightly pulling it back. Let the blood flow into the tube. Release the tourniquet and ask the patient to release his/her fist.
middle and index
What is step 12?
Step 12: Fill, Remove, and Mix the Tubes in Order of Draw or Fill the Syringe
The ____ should make sure that the required volume has been collected.
Phlebotomist
Tubes that contain additives must be _____ gently several times to mix the content.
inverted
The tourniquet must be released _____ removing the needle.
before
What is step 13?
Step 13: Place Gauze, Remove the Needle, Activate the Safety Feature, and Apply Pressure
(STEP 13) Fold a gauze square into fourths and place it lightly over the site where the needle is inserted. Should you apply pressure or not?
Do not apply pressure
(STEP 13) Remove the needle and activate the safety feature (if applicable) while simultaneously applying pressure with your free hand. Should the arms be extended/raised or no?
The arms should be extended or raised.
What is step 14?
Step 14; Discard the Collection Unit, Syringe Needle, or Transfer Device
What is step 15?
Step 15: Label the Tubes
What are the necessary information on the specimen tube? (6)
a. Patient’s complete name (first and last names)
b. Date of birth
c. ID number (if applicable)
d. Date and time of collection
e. Initials of the phlebotomist
f. Additional information such as “fasting”
What is step 16?
Step 16: Observe Special Handling Instructions
What is step 17?
Step 17: Check Patient’s Arm and Apply Bandage
What is step 18?
Step 18: Dispose of Contaminated Materials
What is step 19?
Step 19: Thank the Patient, Remove Gloves, and Sanitize Hands
What is step 20?
Step 20: Transport the Specimens to the Lab
This is necessary when performing pediatric venipuncture involving children below two years old.
Special attention
To minimize pain and trauma of the patients, pediatric procedure should be limited to _____ only.
superficial veins
The challenges faced when dealing with pediatric patients include veins that are usually _____ making it difficult to draw blood.
small and underdeveloped
A considerable risk of damage could be permanent if?
proper procedure is not followed
In pediatric puncture, there is also the risk of ___ since the volume of blood in the body is smaller.
anemia
In pediatric puncture, dealing with the parents or guardians could also be a challenge. The phlebotomist should exhibit a _____ and it would be good to ask the parents or guardians about the child’s ______. They should be allowed to stay in the room with the child if they want to. (2)
(1) warm and caring approach
(2) past blood collection experience
The phlebotomist should take a ___ approach and determine, the ____ of the patient to gain the latter’s trust. (2)
slow
level of anxiety
When explaining the procedure in pediatric puncture, the phlebotomist should— (3)
(1) use terms that the child can understand
(2) emphasize that the young patient should stay still
Also useful to—
(3) offer reward for patient’s cooperation
This Is used for pain interventions. This comes in cream and oral forms and takes about an hour to take effect and anesthetize the area.
Eutectic mixture of local anesthetics (EMLA)
How do you restrain the movement of an infant patient in pediatric puncture?
an infant is wrapped in the blanket
How do you restrain the movement of a toddler patient in pediatric puncture?
a toddler is usually seated on his/her parent’s lap
How do you restrain the movement of a child patient in pediatric puncture?
for children, a second person commonly leans over the child who is in a lying position.
They need special attention because they may have special conditions such as arthritis, diabetes, Parkinsors disease, stroke, atherosclerosis, and dementia, which make blood drawing a challenge. Another problem is their hearing, visual, or mental impairment.
Geriatric or elderly patients
The elderly also have __ which cause the veins to roll easily.
thinner skin and smaller muscles
Note that as a person ages, his/her veins lose their ___, making them prone to collapse during this kind of procedure.
elasticity
The healthcare institution also has to consider safety issues like the space requirement for _____ for the elderly. The wheels of a patients wheelchair must be locked during the procedure. (3)
walkers
wheelchairs
maintenance of nonslip clutter-free floors
The following procedure should be followed when doing venipuncture on an elderly patient.
a. Identify the patient properly and confirm the patient information. Ask the attendant or relative if necessary.
b. Carefully select which needle to use (short draw or butterly needle).
c. Apply the tourniquet carefully to make sure that the skin will not be damaged.
d. Make sure that the present site is not the site from a previous venipuncture,
e. Avold rubbing the site vigorously during cleaning.
f. Prevent the vein from rolling by anchoring it firmly during the venipuncture
g. Hold the pressure over the site and take note that the bleeding in the elderly patients can take a longer time to stop than in
younger patients.
Which patients is this done to?
Use the dorsum of the hand of patients undergoing hemodialysis to preserve the veins of the arms for hemodialysis access. The phlebotomist should comply and select another site other than the arm used with an arteriovenous (AV) fistula.
Dialysis patients
These are provided to patients who cannot perform regular daily activities due to their health condition. These can be assisted-living with the help of relatives or friends, which could be in their private homes or in community-based rehabilitation facilities such as an adult day-care center.
Long-term care services
These are for patients who need medical attention and assistance from health professionals from time to time.
Home health services
They are independent, flexible, with exceptional interpersonal and organizational skills, and can carry all the necessary equipment with them during house calls.
Home care phlebotomists
This is for patients who need end-of-life care, and mostly have a prognosis of six months or less. The phlebotomist should work with extra care with these patients, treating them kindly and with respect, giving these dying patients comfort and dignity.
Hospice care
Hospice care is for patients who need end-of-life care, and mostly have a prognosis of:
six months or less
