Lesson 6 Flashcards
It is not advisable to choose this site because veins in this area may be difficult to examine and blood circulation may be impaired. Blank may be too painful to touch and blank may also be susceptible to infection due to the dyes used that may interfere with the process.
Burns, Scars, and Tattoos
Aside from being difficult to perform, puncturing this may also produce inaccurate results. Veins could be sclerosed or hardened or thrombosed or clotted.
Damaged Veins
also known as oedema, is an abnormal swelling caused by the accumulation of fluid in the tissues. The tissues become fragile, making the task of locating the veins harder. This condition may be due to reactions from medications, pregnancy, infections, and other medical problems.
Edema
is a solid swelling or mass of blood in the tissues caused by the leakage of blood from the vessels during venipuncture. Selecting a venipuncture site with hematoma will be painful for the patient because it will obstruct the blood flow.
It could also lead to the contamination of blood sample.
Hematoma
This procedure, often done to breast cancer patients, refers to the removal of the breast through surgery.
Blood drawing from patients who had undergone this procedure becomes a challenge since the lymph flow is obstructed, and there may be swelling and infection after the surgery. In addition, tourniquet cannot be applied because it can cause injury. It could also change the blood composition.
Mastectomy
This is the condition in which the individual is grossly overweight. Patients who are obese have veins that are deep and difficult to locate. A solution is using a longer tourniquet or locating the cephalic or cubital vein.
Obesity
There are cases when _____ are needed for blood sampling, infusing medication, central venous pressure readings, and blood transfusion of a patient. Choosing vascular access sites is based on the needs of the patient, the purpose, and the length of time the device is to remain in the body. Listed are vascular access sites and devices used in phlebotomy.
VADs (Vascular Access Devices)
Vascular Access Sites and Devices
To obtain samples for arterial blood gas and laboratory studies, critically ill patients require arterial lines where a thin catheter is inserted into an artery. This is also used to monitor blood pressure continuously. Neither tourniquet nor venipuncture is allowed in the arm with an arterial line.
Arterial Line
is a passageway created through surgery, and is usually in the arms with the intention of connecting the artery and a vein directly. This may be created for hemodialysis treatment or pathological process such as erosion of arterial aneurysm.
Arteriovenous Shunt or Fistula
is used to avoid the use of needle-sticks, prevent infections, and reduce wastage from line draws.
The device collects blood from the arterial or central venous catheter where it is connected.
Blood Sampling Device
which is commonly called a
“hep-lock,” is an intravenous (IV) catheter attached to a stopcock or cap with diaphragm. Its basic function is to provide access for administering medicine or drawing blood from the patient. It is threaded in the peripheral vein, which is in the lower arm above the wrist for up to 48 hours. It is usually flushed with heparin or saline (to prevent clogging) and capped for future use.
Heparin or Saline Lock
An IV line is a thin plastic tube or catheter inserted into a vein in the forearm to inject a volume of fluids into the bloodstream. The phlebotomist should avoid collecting blood from the arm with IV because the blood collected could be contaminated with IV fluid. If blood collection is necessary, the collection site should be below the IV. Take note that collection of blood from previously known IV sites should be avoided for 24 to 48 hours.
Intravenous IV Sites
also known as indwelling lines, are any of the tubings inserted to the main vein or artery used for blood collection, monitoring the patient’s pressures, and administering medications and fluids. There are three (3) types of CVADs: the central venous catheter lines, the implanted port, and the peripherally inserted central catheter.
Central Vascular Access Devices
is also known as a central line inserted into the large vein (subclavian) and advanced into the superior vena cava.
Central Venous Catheter
a surgically implanted disk-shaped chamber attached to the indwelling line. This is usually placed on the upper chest just below the collarbone.
Implanted Port
is a flexible tube inserted into the veins of extremities and the central veins.
Peripherally Inserted Central Catheter or PICC
When the patient has adhesive allergy, a gauze should be placed over the site and should be removed after 15 minutes. The alternative is to ask the patient to apply pressure for five minutes. When the patient has antiseptic allergy, simply use a different antiseptic. When the patient has latex allergy, look for a sign to indicate the allergy and use a non-latex alternative for gloves, tourniquet, and bandages.
Allergies to Equipment and Supplies
When a patient is on aspirin or anticoagulant, the bleeding may take a longer time. The pressure should be applied to the site until the bleeding stops. The attention of the authorized personnel should be called when the bleeding continues after five minutes.
Excessive Bleeding
Fainting is a temporary loss of consciousness which is caused by the insufficient flow of blood to the brain. Patients prone to fainting during venipuncture are asked to lie down during the procedure.
Fainting
When the patient feels nauseous and has the tendency to vomit, the phlebotomist has to discontinue the procedure until the patient feels better or until the feeling subsides. An emesis basin or wastebasket should be provided, and a cold damp washcloth should be applied to the forehead.
Nausea and Vomiting
The patient should be warned before the needle insertion, and the phlebotomist should avoid redirection of the needle. If the patient complains of extreme pain or numbness, remove the needle and apply ice to the site because this could indicate nerve involvement.
The phlebotomist needs to document the incident if the condition persists.
Pain
This condition involves the appearance of small red or purple spots that look like rashes, which appear on the arm when tourniquet is applied.
Petechiae
When this occur, the blood draw should be discontinued quickly. There must be pressure held over the site but it must be made certain that movement is not restricted; the mouth is free from any obstruction and the patient is protected from
Seizures or Convulsions
The phlebotomist should hold pressure over the site immediately after discontinuing the draw. A cold compress or ice pack may be offered to help address the swelling. The following are conditions that trigger hematoma:
• There is excessive or blind probing.
• There is inadvertent arterial puncture.
• The size of the vein is too small.
• The needle penetration has gone all through the vein.
• Needle is not completely inserted.
• Tourniquet is still on when the needle was removed.
• The pressure is not adequate.
Hematoma Formation
This results from blood loss due to blood draw. It is important to ensure that only the required specimen volume is collected because if 10% of the blood volume is removed at once from the body, the patient could face a threat.
Iatrogenic Anemia
This happens when blood is filling up the tube rapidly and there is a rapid formation of hematoma on the site.
Inadvertent Arterial Puncture
Infection can be avoided by making sure that tapes or bandages are not opened ahead of time; needles are not preloaded into the tube holders; insertion site of the needle is not touched after sterilization; cap is removed just before venipuncture; and patients are advised to keep the bandage on the site for at least 15 minutes.
Infection
Nerve injuries happen when there is improper site selection, rapid needle insertion, excessive redirection of the needle, and blind probing.
If the initial attempt is unsuccessful, the phlebotomist should try to redirect the needle by using a slightly forward or backward movement.
The next step is to remove the needle and look for an alternative site.
Nerve Injury
Blood that has already been drawn flowing back into the vein from the collection tube may cause adverse reaction because of the presence of tube additives. To avoid this, make sure that the arm of the patient is in a downward position and the tube is just below the venipuncture site.
Reflux of Anticoagulant
Damaging the vein could be avoided by following the proper technique and avoiding blind probing.
Vein Damage
is a decrease in the fluid content or plasma volume which is usually caused by tourniquet that stagnates the normal flow of blood leading to the increase in concentration of red blood cells and other non-filterable large molecules.
Hemoconcentration
refers to the rupture of the red blood cells. The hemoglobin is then released into the surrounding fluid.
Hemolysis
happens when the phlebotomist pulls a tube before reaching the required volume. This may lead to the incorrect blood-to-additive ratio.
Partially filled tube or short draw
means that the specimen is compromised due to incorrect handling, which involves allowing alcohol, powder or other materials into the sample. Getting glove powder or perspiration into films and specimens; using the wrong antiseptic; or simply not following the proper antiseptic procedure could interfere with the results.
Specimen Contamination
should not be used because the manufacturer could not warrant the quality of the seal and pressure after the expiration date indicated in the tube.
Wrong or expired collection tube
Venipuncture attempts could fail due to improper seating of the tube and failure of the needle to go through the stopper. The phlebotomist must be aware and must take measures to ensure that the proper procedures are followed.
The needle position is critical to the success of the venipuncture. The phlebotomist should ensure that the following do not happen:
1. Needle not inserted far enough
2. Bevel partially out of skin
3. Bevel partially into vein
4. Bevel partially through vein
5. Bevel completely through vein
6. Bevel against vein wall
7. Needle beside vein
8. Undetermined position
Troubleshooting Failed Venipuncture
usually occur when conditions are less than ideal, which leads to the veins being blocked, resulting in insufficient blood flow. This happens when there is a strong pressure in the vacuum of the tube or plunger; the tourniquet is too close to the site or it is too tight; or when the tourniquet has been removed during the draw.
Collapsed Veins
the phlebotomist should make sure that the bevel is not partially out of skin and the tube itself is not damaged.
Tube Vacuum
