Plebotomy Rotation

Question 1

Describe the anatomy and placement of veins, nerves, and arteries in the arm.

Answer 1

—The median cubital vein is the vein of choice because it is well anchored and not painful to puncture.

—The cephalic vein is the second choice because it is less well anchored

—The basilic vein is the last choice because it is near an artery and nerve, both of which could be damaged by puncture.

Question 2

List the materials or supplies needed for a successful venipuncture using both vacutainer and butterfly needle sets.

Answer 2

—Gloves

—Tourniquet

—Alcohol and gauze

—Needle

—Plastic needle holder

—Tubes with the correct additive

—Tape

—Warming device

—Test order form

—Container for sharps disposal

(ice, foil etc for special tests collection)

Question 3

purple or pink top

Answer 3

EDTA:

◦strongly chelates divalent cations including Ca++

◦strong anticoagulant, prevents platelet clumping

◦purple used for cell counts (hematology)

◦pink used for blood bank (immunohematology)

Question 4

green top

Answer 4

Lithium Heparin :

◦serine protease inhibitor, acts directly on clotting cascade proteins

◦will not alter ion levels in plasma

◦ used for electrolytes, basic chemistry panels

Question 5

light blue top

Answer 5

Sodium Citrate:

◦Weak conjugate base – binds cations

◦Easily reversible

◦Used for coagulation studies

(9:1 ratio)

Question 6

Yellow top

Answer 6

Acid Citrate Dextrose (ACD) :

◦HLA and DNA testing

Question 7

Gray top

Answer 7

Sodium Oxalate

Question 8

Choose the correct order of draw for venipunctures, skin punctures and blood cultures.

Answer 8

◦Blood Cultures/SPS

◦Light blue

◦Red

◦Gold

◦Green

◦Purple/pink

◦Gray

◦There are periodic discussions as to which tube to draw first, the red or the light blue: follow the instructions at your facility.

Question 9

Identify the correct site to use for venipuncture if the patient has an IV, shunt or mastectomy.

Answer 9

—Draw opposite to a mastectomy

—Do not draw above an IV line

Question 10

Venipuncture Procedure

Answer 10

1. Greet the patient and introduce yourself
2. Describe the procedure to be performed
3. Identify outpatients by asking for their name and birth date, and inpatients by checking the name and medical record number on their wristband. Check against the information on the order form or tube labels.
4. Place all the equipment in easy reach, fully assembled (needle in needle holder with loose cap)
5. Apply tourniquet . Tourniquets should not be in place for more than a minute.
6. Palpate for vein. Veins should be pliable and soft.
7. Clean area that will be punctured
8. Insert needle at a 15-30 degree angle
9. Position the needle, bevel up and smoothly insert into the vein
10. Place the first evacuated tube in the needle holder. Push container onto the needle. If the vein has been accessed, blood should flow.
11. Change tubes without disturbing the needle.
12. Gently mix each specimen by inversion.
13. When you are finished with blood collection, remove the tourniquet.
14. Place gauze over the puncture site and remove the needle.
15. Apply pressure
16. Activate the needle safety device
17. Discard the needle into a sharps container
18. Make sure the bleeding has stopped and secure the gauze with tape.
19. Apply tape to keep the gauze in place
20. Label tubes immediately while the patient is present. Do not leave the room until the tubes are labeled.