Peripheral and CVAD Blood Draw Flashcards
1
Q
note
A
- if have IV in left AC, use right AC
- if can’t use right and left has IV, see if stop IV and wait 2-3 minutes then draw in left
- don’t use peripheral IV for blood draw bc low integrity in needle could hemolyze, so want new stick
(only time to draw blood from IV is when first insert IV before running anything) - can take blood from CVAD (but not from port bc need specific certification or training)
- use distal lumen for CVAD blood draw
- for blood cultures, new stick preferred over CVAD (unless specifically to test for infection for CVAD)
- don’t stick on same arm as PICC line
2
Q
equipment
A
- gloves
- tourniquet
- chlorhexidine
- needle holder
- needles
- blood tubes
- syringes
- cotton balls
- band-aid and coban
- patient labels
- computer requisitions
3
Q
tourniquet
A
- always take off tourniquet
- allows blood to pool
4
Q
needles
A
(more what these are for, not really colors)
- smaller numbers = bigger needle
- bigger number= smaller needle
- 23 gauge: pediatric and infant
- 14 or 16 - traumas and emergencies
- 20 or 21: general blood draw
5
Q
syringe
A
- bevel: angles down and goes to a point at the tip of the needle
- always want bevel facing up for venipunctures
- syringe and needle method best for fragile veins so you can do it more gently and not collapse tiny, fragile veins
(think syringe is what would have to keep unscrewing it if needed multiple samples)
6
Q
vacu-holder aka vacu-tainer
A
- vacu-holder is the clear piece holding the lab tube
- least possibility of risk for person drawing blood
- disadvantage bc you don’t get to see the flash
- easy to pop tube off and on if wanting multiple tubes of blood
7
Q
butterfly
A
- highest risk of personal injury, flimsier and a lot of room for error
- can attach butterfly to syringe or vacu-holder
- good for fragile, harder to find veins bc needles are shorter
- less likely to hemolyze (destroy blood vessels) bc needles are smaller
- hemolysis: trauma or damage to red blood cells so RBC popped and leaked out so labs can’t be run
- to avoid hemolysis, do a bigger needle within reason, avoid tiny needles
8
Q
tips for success
A
- tourniquets need to be tight
- phlebotomy is an art: it takes practice
- phlebotomy is more about feel than sight (palpating veins to see if they’re bouncy, and straight enough to put needle in)
- hot packs can help make veins more accessible
- position the patient in a fashion that makes for easier access (arm not higher than body)
- anchor the vein before accessing (vein isn’t moving around)
9
Q
options for venipuncture
A
- median cubital = 1st choice for venipuncture bc run the lowest risk of hitting anything below the surface that’s not that vein
- cephalic vein = 2nd choice, has cutaneous nerves around that area that you run the risk of sticking
- basilic vein = 3rd choice, most risk to patient bc brachial artery is near (which has force of the heart). bicep tendon, and nerves there too, more stuff to hit than other vein
- if can’t get one of those veins, work your way down the arm, look at forearm, wrist, hand
(want to keep the smaller veins for IVs so that’s why do this in arm)
10
Q
angle of entry
A
- 15-20 degree angle
- want to use as shallow as possible to minimize the risk of hitting something else, higher angle = higher risk of injuring patient
11
Q
IV considerations
A
- only collect blood from an arm with a continuous infusion if there are no other options
- stop the infusion prior to collection for 2-3 minutes
- infusions with heparin need to be stopped for 10 minutes prior to blood collection (can mess w/lab values)
(don’t want to use arm with continuous infusion through IV, check with nurse or orders to see if can stop infusion,
if can’t be stopped, would just want to get as far away from the IV, and document blood draw is from left AC, same extremity as whatever IV)
12
Q
venipuncture procedure
A
- review lab req/levels
- AIDET
- hand hygiene and gloves
- fasting and/or diet restrictions
- assemble supplies
- position patient
- apply tourniquet
- cleanse site and allow to dry
- assess sites and select supplies
- inform patient
- insert needle
- collect blood specimen(s)
- order of draw
- release tourniquet, apply gauze, remove needle, pressure
- sharps and label
- evaluate site and bandage
- thank you
(when apply gauze, don’t apply pressure until remove needle,
apply pressure until hemostasis (bleeding has stopped),
syringes, vacu-holders would go in sharps container, not just needle)
13
Q
order of draw
A
- stop, sterile, yellow
- light, lt. blue
- red
- stay, SST
- put, PST
- green
- light, lavender
- go, gray
(if have different orders, this is the order in which you would draw them,
order of draw needs to be followed bc each color has a different additive and don’t want additive from blue tube on green tube.
blood draw goes first, that’s the sterile top - using exam gloves, but the specimen, the inside of the container is sterile)
14
Q
CVAD blood draw considerations
A
- stop any infusions beforehand
- aspirate to verify blood return (pull back)
- flush with 9 mL (using push pause motion, out of 10 mL so stop at 1)
- waste 3-5 mL and discard
- collect sample
- flush with 19 mL
(CVAD dressing change is sterile, CVAD blood draw is not sterile, but clean or modified sterile, wearing exam gloves,
wouldn’t use more than 10 mL tubes bc bigger means more pressure on the area, would use 2 tubes for the 19 mL,
anything that you’re twisting on or off, use alcohol wipe to clean it,
some have alcohol permeated caps so don’t have to clean it but not going to hurt anything,
caps are made for 1 time use,
flushes go in sharps container bc came in contact with patient,
3 saline flushes for CVAD blood draw,
alcohol swabs, 2 10mL tubes (say needing 13 mL of blood), 3 saline flushes (2 flushes (once with 9 and once with 19) but the 19 is 2 tubes)
15
Q
central line
A
- max zero keeps blood from backflowing
- need a max zero on every lumen
