Phlebotomy Complications

Question 1

Sleeping patients should be gently

Answer 1

awakened

Question 2

Unavailable Patient

Answer 2

-Seek assistance from attending nurse/ nurse station to locate patient

Question 3

Young and Cognitively Impaired Patients

Answer 3

-Ask the patient’s nurse, relative, or a friend to identify the patient

Question 4

Patient Preparation

Pre-examination variables associated with the patient’s activities before sample collection can affect the quality of the sample.

Variables include:

Answer 4

• Diet
• Posture
• Exercise
• Stress
• Alcohol
• Smoking
• Time of the Day
• Medication

Question 5

Patient Preparation

Physiological variables include:

Answer 5

• Age
• Altitude
• Gender affect normal values

Question 6

Patient Preparation

• patient has refrained from strenuous exercise and has not ingested food or beverages except water for 12 hours fasting.
• The ideal time to collect blood from a patient

Answer 6

BASAL STATE

Question 7

Patient Complication

• those who are anxious or fearful must be calm down.
• Assistance from a nurse or parent is frequently required

Answer 7

APPREHENSIVE PATIENTS

Question 8

Patient Complication

• spontaneous loss of consciousness caused by insufficient blood flow to the brain.
  Remedy: Patient’s head is lowered between legs & instructed to breath deeply; Give spirit of ammonia

Answer 8

Syncope (Fainting)

Question 9

Patient Complication SEIZURES (what to do)

Answer 9

• Tourniquet and needle should be removed, pressure applied to the site, and summon help.
• Restrain the patient only to the extent that injury is prevented.
• Document the time the seizure started and stopped according to institutional policy.

Question 10

Patient Complication

• Small, nonraised red hemorrhagic spots
• May have prolonged bleeding following venipuncture.
• Additional pressure should be applied to the puncture site following needle removal.

Answer 10

PETECHIAE

Question 11

If the patient is nauseated,

Answer 11

instruct the patient to breathe deeply and slowly apply cold compresses to the patient’s forehead.

Question 12

If the patient vomits,

Answer 12

stop the blood collection and provide an emesis basin or wastebasket and tissues

Question 13

Areas to be avoided (phlebotomy)

Answer 13

• Damaged Veins
• Hematoma
• Edema
• Burns, Scars, and Tattoos
• Mastectomy
• Obesity
• IV Therapy
• Cannulas and Fistulas

Question 14

Technical Complication (Failure To Obtain Blood)

Answer 14

• Needle Position
• Bevel Against the Wall of the Vein
• Needle Too Deep
• Needle Too Shallow
• Collapsed Vein
• Faulty Evacuated Tubes

Question 15

Technical Complication
NERVE INJURY
SIGNS

Answer 15

• Shooting pain
• Electric-like tingling/numbness running up or down the arm or in the fingers of the arm

Question 16

can be caused by incorrect vein selection or improper venipuncture technique and may result in loss of movement to the arm or hand and the possibility of a lawsuit.

Answer 16

Temporary or permanent nerve damage

Question 17

Permanent injury in the venipuncture procedure is damage to the

Answer 17

median antebrachial cutaneous nerve.

Question 18

Phlebotomy Errors in technique:

Answer 18

Blind probing,
electing high-risk venipuncture sites, Employing an excessive angle of needle,
Lateral redirection of the needle, Excessive manipulation

Question 19

Technical Complication

may be detected by the presence of pink or red plasma or serum.
- Rupture of the red blood cell membrane releases cellular contents into the serum or plasma and produces interference with many test results so that the sample may need to be redrawn.

Answer 19

HEMOLYZED SAMPLES - Hemolysis

Question 20

Causes of Hemolysis

Answer 20

1. Using a needle with too small a diameter (above 23 gauge)
2. Using a small needle with a large evacuated tube
3. Using an improperly attached needle on a syringe so that frothing occurs as the blood enters the syringe
4. Pulling the plunger of a syringe back too fast
5. Drawing blood from a site containing a hematoma
6. Vigorously mixing tubes
7. Forcing blood from a syringe into an evacuated tube
8. Collecting samples from IV lines when not recommended by the manufacturer
9. Applying the tourniquet too close to the puncture site or for too long 10. Using fragile hand veins
10. Performing venipuncture before the alcohol is allowed to dry
11. Collecting blood through different internal diameters of catheter and connectors
12. Partially filling sodium fluoride tubes
13. Readjusting the needle in the vein (probing) or using occluded veins

Question 21

Technical Complication

• This is caused by transient rise in chylomicrons following a meal containing fat
• It causes interference with large number of chemical analyses because of turbidity.
  It disturbs the following investigations particularly strongly:
  –Amylase –Bilirubin –Protein –SGOT –SGPT

Answer 21

LIPEMIA OR LACTANESE

Question 22

Technical Complication

• Blue or black skin discoloration commonly due to repeated trauma or puncture of the veins

Answer 22

Hematoma Formation

Question 23

Causes of Hematoma

Answer 23

1. Vein is too fragile
2. Needle penetrates all the way to vein
3. Needle is partly inserted to vein
4. Needle is removed while torniquet is on
5. Excessive probing
   6.Pressure not adequately applied after venipuncture

Question 24

Phlebotomy

Major reasons for sample rejection are the following:

Answer 24

1. Unlabeled or mislabeled samples 2. Inadequate volume
2. Collection in the wrong tube
3. Hemolysis
4. Lipemia
5. Clotted blood in an anticoagulant tube
6. Improper handling during transport, such as not chilling the sample
7. Samples without a requisition form
8. Contaminated sample containers 10. Delays in processing the sample 11. Use of outdated blood collection tubes