Module 3: Patient Preparation Flashcards
what should you do before beginning blood collection procedure
- review lab requisition form
- identify pt
- explain procedure
- obtain pt consent
who is authorized to order lab tests
- physicians
- physician assistants
- nurse practitioners
- chiropractors in some states
info lab requisition form has
- specific tests the provider wants to be completed
- provider information
- pt full name
- pt date of birth
- pt sex
- specific identification numbers (medical record number)
- specific precautions (allergy, sites to avoid)
- space to document date and time of collection, billing info, and diagnostic coding
what should you review the requisition form for
- any discrepancies
- duplicate test orders
- missing info
what to write on tubes after collection
- date and time of collection
- your initials
- pt full name and date of birth
- other specific identifiers
what agency mandates using two pt identifiers
The Joint Commission
what to do if pt is unable to state their identifying info
- view pt wristband
- ask family member to confirm pt identity
deliberately touching pt without their consent
battery
informed consent
- pt received full info about procedure
- form required for high risk, invasive, and surgical procedures
expressed consent
- pt gives explicit consent to procedure orally or in writing on a consent form
implied consent
- pt actions indicate they are giving consent
- most common for phlebotomy
- pt extends arm
- low risk procedures
- emergency medical situations
consent for minors
- child’s parent or guardian must give consent
- exceptions for teens who are married, in the military, emancipated by court order, or otherwise self-supporting and independent
does the pt have to offer an explanation for refusing to give consent
no
what to do when pt refuses consent
obtain written proof of refusal
what to do if pt comes to get blood drawn without adhering to testing requirements
- consult with provider
- may need to reschedule tests
fasting pretesting preparation
- not each or drink anything other than water
- typically 8 to 12 hr before test
- encourage pt to drink water
medication pretesting preparation
- tests may determine the effectiveness of medications
- pt takes medications at specific time and has specific time for specimen collection
basal state pretesting preparation
- based on pt lifestyle and overall condition
- after refraining from eating or exercising for 12 hr, typically first thing in the morning
- necessary when provider establishes reference ranges
things to ask about during pt interview
- allergies to latex or adhesives
- previous reactions to blood draws (feeling faint, nauseous)
what to do if pt feel faint
- stop procedure
- pt lower head and take deep breaths
- loosen tight clothing
- apply cold compress on forehead or back of neck
- observe pt for 15 minutes
- document the incident
what happens when applying a tourniquet to the arm on the side of a mastectomy
- affect lymph nodes
- swelling, injury, infection
collection site for pt with double mastectomy
back of hand
things that are contraindications for a blood draw on that arm
- mastectomy
- central venous access device
- arteriovenous fistula
- IV
- cast
- scarring
- burns
- thrombosed vein
what do thrombosed veins feel like when palpating
- rope cord
- easily roll
how does alcohol affect blood
- coagulation activation
- platelet reactivity
how does smoking affect blood
- elevates coagulation factors
how does exercise affect blood
- coagulation activation
- pt rest for 15-30 minutes after exercising
how to explain venipuncture
- discuss steps: preparing site, tourniquet, inserting needle, filling tubes
- inform of slight pain, never promise it won’t hurt
- tell pt to say something if they feel sick or have severe pain
- explain complications and what to do if they occur, most are relatively rare
excessive bleeding or bruising phlebotomy complication
- little bleeding and bruising is common
- bruise bigger than 2x2 gauze
- bleeding saturates 2x2 gauze
- apply pressure and ice
- evaluation by provider
severe pain or lack of sensation phlebotomy complication
- severe pain, numbness, tingling
- indicates nerve damage
- if electric shock pain or pain radiating down arm is felt during procedure, stop procedure and apply pressure and ice
infection phlebotomy complication
- area around site becomes red, swollen, and painful
- hematomas can become infections
- contact provider
pt positioning for venipuncture
- comfortable position in bed for inpatient settings
- venipuncture chair
can you perform venipuncture on pt who is standing or sitting on the edge of the exam table
no
arm positioning for venipuncture
- full extension of arm
- palm facing upward
- slight rotation depending on which vein you are accessing
- pillow or armrest can improve pt comfort
- support arm under the elbow with free hand
types of blood vessels
- arteries
- veins
- capillaries
three accessible veins in antecubital fossa
- median cubital vein (center)
- cephalic vein (lateral, thumb side)
- basilic vein (medial, pinky side)
first choice vein in antecubital fossa and why
- median cubital vein
- large
- less prone to injury
- less painful
second choice vein in antecubital fossa and why
- cephalic vein
- large
- may not be easy to see
- tends to roll
- difficult to stabilize
third choice vein in antecubital fossa and why
- basilic vein
- large
- close to brachial artery
- close to median nerve
- don’t readjust needle
fingers used for capillary puncture
- middle or ring finger
- little finger is too small, close to bone
- index finger and thumb are usually sensitive
where on the finger should you perform capillary puncture
- side of the finger
- tip is too sensitive, fewer capillaries
capillary puncture site for infants under 12 months
side of heel
hand veins
- next choice after antecubital fossa
- more fragile
- often roll
- smaller
- tends to be more painful than antecubital area
- best to use a butterfly needle
places you should never collect blood from for venipuncture
- inside of wrist: tendons and nerves close to surface
- ankle or foot veins without provider approval
ankle and foot veins
- last choice for venipuncture
- difficult to access
- easy to injure
- painful
- never from pt with diabetes or peripheral vascular disease due to poor circulation
- increase risk of infection, phlebitis, hematoma
palpation of vein suitable for venipuncture
- soft
- flexible
- bouncy
what does pulsation while palpating indicate
the vessel is an artery and should not be used
what should you palpate a vein for
- depth for angle insertion
- direction of vessel for needle placement
- dimension for choosing right needle size
how to make veins easier to palpate
- place pt arm below heart level
- warm compress to dilate veins
locations not suitable for venipuncture
- above IV insertion
- arm with fistula, CVAD
- arm on same side as mastectomy
- site with edema, scarring, hematoma
sclerotic veins
- not suitable for venipuncture
- hard, inflexible, narrow
- as people age
- difficult to puncture and painful
- from repeated blood draws
tortuous veins
- not suitable for venipuncture
- varicose veins
- twisted, dilated, lack elasticity
- not in straight line
thrombotic veins
- not suitable for venipuncture
- vein with thrombus (blood clot)
- hard, inflexible
- tender when touched
fragile veins
- not suitable for venipuncture
- older adults, newborns, pediatric pts
- thin, weak, difficult to puncture
- collapse easily
- do not refill quickly
- painful
- multiple sticks to get enough blood
phlebitic veins
- not suitable for venipuncture
- tender, warm, red area around them
- can have clots
- difficult to puncture
- painful
how far should lancet puncture on an infant needle stick
no deeper than 2 mm
one of most common lab test
routine urinalysis
urinalysis
- exam of pt urine for variety of factors
- appearance, odor, color, pH, specific gravity, presence or absence of protein/glucose/hemoglobin
usual fasting time for urinalysis
6 to 12 hr
urine culture
- preparing urine for growth and identification of microbes
- often followed by sensitivity testing
- specimen must be from clean-catch sample or from catheter
random urine specimen
- clean, disposable container
- label on side on container
- no preparation needed
- 30 to 60 mL
- specimens at home stored in fridge and brought to lab asap
fasting (first morning) urine specimen
- same supplies and instructions as random urine
- collect specimen immediately after waking up
- more concentrated
- pregnancy, glucose
- refrigerate and get to lab asap
how long after collection does urine start to deteriorate
30 min
clean-catch (midstream) urine specimen
- sterile urine container
- nothing other than urine can come in contact with the inside of the container
- used to detect bacteria
- wash hands before and after collection
- clean genitals
- urinate a bit in the toilet and then urinate in the container
- collect until the container is 1/4 to 1/2 full
- final stream deposited in the toilet
timed urine specimen (24 hr)
- container with preservative
- usually 3000 mL
- 24 hr collection
- record start time
- begin with 2nd void of the day
- collect all urine
- container kept in ice or in fridge
urine reagent testing
- CLIA waived test
- visual or physical observation of strip
- wear clean gloves, dip strip into urine, observe squares for color changes
urine pH
- 4.6/5.5 to 8
- important for bacterial growth
what happens if urine is left unrefrigerated for a long time
- becomes more alkaline (higher pH)
- higher bacteria counts
urine specific gravity
- concentration of urine
- expected range from 1.003 to 1.030
- usually 1.010 to 1.025
- below 1.010 is diluted
- above 1.010 is concentrated
urine white blood cells and nitrites
indicate infection
urine hemoglobin
indicates bleeding, infection, cancer, kidney disease, chemical poisoning
urine ketones
- products of fat metabolism
- presence results from diabetes, starvation, vomiting
urine bilirubin
indicates liver disease or RBC destruction
urine protein
indicates inflammation, infection, kidney disease, chemical poisoning
urine glucose
indicates diabetes
fecal occult blood test
- identifies blood in stool
- diagnose GI lesions and colorectal cancers
instructions for stool collection
- sterile container
- defecate directly into a container or into a clean container and transfer to the specimen container
- avoid getting urine or water in container
- does not require a large amount of stool
- do not refrigerate if testing for parasites
- return to lab immediately
preparation instructions for FOBT
- don’t eat red meat, citrus fruits, or raw vegetables for 3 days before collection
- don’t take vitamin C or aspirin for 3 days before collection
sputum
material coughed from lungs
why would a provider order a sputum test
- testing what microorganism is causing respiratory infection
- determine if treatment is effective
when should you collect the sputum for testing to be most accurate
- morning
- before eating or drinking
- more concentrated
instructions for sputum collection
- sterile container
- collect first thing in the morning
- cough forcefully into container and expectorate
- don’t spit saliva into container
- 1-2 teaspoons
- close lid and label
- deliver to lab asap
why do labs analyze semen
- fertility testing
- assessing effectiveness of sterilization procedure (vasectomy)
- criminal investigation
pretesting instructions for some semen tests
abstain from sexual activity and alcohol several days before collection
instructions for semen collection
- clean container, free of chemicals
- ejaculate into container
- secure lid and label
- protect from extreme heat and cold
- get to lab within 1 hr of collection
neutral pH for urine specimen
7
what to ask if pt seems distracted while you’re explaining a procedure
would you like me to repeat the directions
do you need verbal or written consent in emergency situations
no
should you explain test names or reasons tests are being run to a pt
- no
- provider should
is the provider’s license number required on a lab requisition form
no
pt preparation for cholesterol test
- sit for 5 minutes
- lowers test results
how to cleanse skin for blood culture
- twice
- once with isopropyl alcohol
- allow to dry for 60 sec
- once with chlorhexidine gluconate swab
- allow to dry for 30 sec
accession number
specific to specimen not the pt
identification in an outpatient facility
- one visual, two verbal
- picture ID, full name, DOB
how does a lipemic specimen appear
cloudy
collection method for coagulation test on 3 y/o
winged safety butterfly
who should you verify time of medication administration with
nurse
what to do if pt has IVs in both arms
ask nurse to turn IVs off for 2 mins
how long after medication administration should you draw blood for peak level test
15 to 30 mins
