Phlebotomy Book- Chapter 9 Flashcards
Most common technique to obtain blood specimens-
Venipuncture
Basic blood collection steps- (6)
-Greet and properly identify the patient
-Select and assemble the appropriate equipment
-Use aseptic technique and standard precautions during venipuncture and blood specimen collection
-Provide proper post-puncture patient care
-Adhere to specimen labeling requirements
-Correctly handle and transport specimens
Preparing the equipment steps- (2)
-Line up the equipment near the patient with the tubes assembled in the order of draw
-Attach needle into tube adapter.
Positioning the patient for blood draw- (3)
-Patient should lie supine or sit in a phlebotomy chair
-Straight chair with arm
-Use pillow or towel if necessary
Tourniquet application- (4)
-Position the tourniquet under the arm
-Cross the left end over the right end
-Grasp both ends of the tourniquet close to the patient’s arm between the thumb and forefinger of the left hand
-tuck the left end under the right end. The loose end of the tourniquet will be pointing toward the shoulder and the loop will be pointed toward the hand
Selecting Venipuncture site- (4)
-Position arm at downward angle
-Ask patient to make a fist
-Examine the antecubital area first
-Palpate vein with fingertip
1-2-3-2-1 method- (5)
-1—pair of gloves.
-2—tourniquet and alcohol swab.
-3—needle, holder, and tubes (in draw order).
-2—gauze/cotton swab and bandage.
-1—sharps container.
1-2-3-2-1 method used in-
Locations not typically used for blood collection
Special considerations for children- (6)
-Squat down to child’s height to reduce intimidation
-Never lie
-Ask the child’s caregiver to help
-Use restraining chairs or arm boards if necessary
-Have special bandages or stickers available as rewards
-Always be honest and direct
Special considerations for geriatric patients- (3)
-Allow extra time for communication if sensory impairment exists
-Skin is fragile and veins tend to roll; hold skin taut
-If using a butterfly needle, a shallower angle is required during insertion
Technique used for cleansing Venipuncture site-
Aseptic
Aseptic technique- (2)
-70% alcohol pad
-use concentric circles
Wet alcohol on injection site can-
Hemolyze the specimen & affect lab results
Performing Venipuncture steps- (4)
-Reapply the tourniquet
-Visually confirm the site
-Anchor the vein
-Insert the needle
Causes of unsuccessful Venipuncture- (5)
-Poor site selection (vein hard and sclerosed)
-Patient fails to remain still
-Tourniquet too tight
-Use of expired evacuated tubes
-Use of a tube that has lost vacuum
Causes of unsuccessful Venipuncture with improper technique- (4)
-bevel on lower wall of vein (doesn’t allow blood flow)
-needle rotated 45 deg
-needle inserted too far
-needle partially inserted (blood leaks into tissue)
Collecting the specimen steps- (4)
-Insert the first evacuated tube to start blood flow
-Hold equipment steady during tube changes
-Allow each tube to fill completely
-Mix tubes with additives immediately
Removing the tourniquet steps- (5)
-Release the tourniquet
-Place gauze on puncture site
-Remove needle smoothly
-Engage needle safety mechanism
-Apply gentle pressure to patient’s arm
Use butterfly set only when-
Standard draw isn’t possible
Do not use butterfly set with evacuated tubes if-
Patient has fragile veins
Transferring specimen from syringe to evacuated tube- (4)
-peel off backing from transfer device
-insert syringe tip into hub & rotate syringe clockwise
-Hold the syringe facing down and push the evacuated tube into the holder. Do not depress the plunger of the syringe
-after removing evacuated tube, discard tube holder and syringe in an approved sharps container
Patient complications with allergic reactions- (2)
-latex
-alcohol
Patient complications with syncope- (3)
-Heavy perspiration
-Pale skin
-Shallow or fast breathing
Patient complications with syncope phlebotomist actions- (3)
-Remove tourniquet and needle
-Call for help
-Apply pressure to venipuncture site
Patient Complications: Petechiae- (2)
-Make sure tourniquet is not too tight
-Apply tourniquet for only 1 minute at a time
Patient Complications Bleeding- (3)
-Arm movement may cause bleeding to recur
-Check the arm before leaving the patient
-Apply adhesive bandage over clean piece of gauze
Patient Complications if Hematoma occurs- (4)
-Release the tourniquet
-Pull the needle out
-Apply firm pressure at the site
-If patient complains of discomfort, apply ice
Patient Complications: Iatrogenic Anemia- (2)
-Anemic response to removal of large amount of blood over short time period
-More than 10% blood loss may become life-threatening
Patient complications: Exsanguination- (2)
-Life-threatening amount of blood loss
-Occurs easily in small patients, children, and infants
Avoid puncture site infection- (4)
-Ensure sterility of all equipment used
-Do not touch puncture site after it is cleansed
-Apply pressure until all bleeding has stopped
-Never puncture through a previous puncture site
Patient complications: injury- (2)
-Do not insert the needle too deeply
-NEVER probe for a vein
Patient Complications: Additive Reflux- (3)
-Blood mixed with tube additive flows back into patient’s vein
-May cause adverse reactions
-To avoid, always collect blood with patient’s arm and evacuated tubes in a downward position
Arterial puncture results in-
Bright red blood pulsing into tube
What to do in case of arterial puncture- (3)
-End the procedure immediately
-Apply pressure for at least 5 minutes
-Apply pressure dressing
Hemoconcentration situations that affect situation quality- (2)
-Water leaves the vein and enters the tissues
-Water that remains in the vein contains a falsely higher level of cells and chemicals
Hemoconcentration-
Rapid increase in ratio of blood components to plasma
Hemoconcentration can cause erroneous results in some lab tests- (3)
-Protein levels
-Cell counts
-Coagulation studies
