PMLS LAB 2 Flashcards
-Is the procedure for removing blood from veins for
analysis
Venipuncture
-first site or choice of location for venipuncture.
Antecubital Fossa
shallow depression and anterior ans below the bend of the elbow
antecubital fossa
2 common patterns
H-pattern ans M-pattern
acceptable for venipuncture
veins on the back of the hands
foot and ankle
femoral vein
veins on the ______ are never acceptable for venipuncture
underside of the wrist
differs somewhat from person to
person, and you may not see the exact textbook
pattern
vein location
•The important thing to remember when locating a vein is to choose
prominent vein
well fixed
does not overlie a pulse (which indicates the presence of an artery and the potential presence of a major nerve.)
Hospital identification bracelet includes:
-Patient’s first and last names
-Hospital numbers (often two sets)
-Birth date
-Physician
-Temporary identification number and bracelet
Unidentified patients
to correctly identify the patient
Requisitions
Organize the necessary equipment
Requisitions
collect the appropriate samples
Requisitions
legal protection
Requisitions
Before leaving the laboratory
REVIEW THE REQUISITION!
Steps to review the requisition
• Verify the tests to be collected
• Check the time and date of collection
• Determine the patient preparation needed.
Contents in the Requisition or Request form
• Patient’s first and last names
• Identification number
• Patient’s date of birth
• Patient’s location
• Ordering health-care provider’s name
• Tests requested
• Requested date and time of sample collection
•Other information that may be present
Status of sample (stat, timed, routine)
(such as fasting
sample or latex sensitivity)
•Special collection information
(such as areas that
should not be used for venipuncture)
Special patient information
•Billing information and ICD-9 codes
Status of sample (stat, timed, routine)
Fasting Blood Sugar (fbs) hours
8-10hrs
Lipid profile fasting hours
10-12hrs
FBS and Lipid profile fasting
10hrs
the most important procedure in phlebotomy
patient identification
a hospitalized patient must always be correctly identified by an _____ that is attached to the patient
ID band
a hospitalized patient must always be correctly identified by an ______ that is attached to the patient
ID band
personnel already familiar with the patient must never become _____ with regard to patient identification
lax
failure to properly identify the patient may result in
patient medication and treatment mismanagement
Has refrained from strenuous exercise and has
not ingested food or beverages except water.
BASAL STATE
verify that the appropriate pretest preparation
such as fasting or abstaining from medications has
occurred
Patient Preparation
• If not, report to the nurse before drawing blood.
• If the sample is still required, note on the
requisition form and the sample
Patient Preparation
Patients should remove any objects such as food,
drink, gum, or a thermometer from their mouths
before performing the venipuncture.
Positioning the patient
Any foreign object in the mouth could cause
choking
Place the tubes in the correct order for sample
collection and have additional tubes readily
available for possible use during the procedure.
equipment selection
mansate that gloves be worn when performing a venipuncture procedure
Occupational safety and health administration
-causes blood to accumulate in the veins making
them more easily located
Tourniquet Application
-provides a larger amount of blood for collection.
Tourniquet Application
Tourniquet Application angle between skin and needle:
<30
tourniquet application must not be more than
1 minute
Effects of prolonged application
-Hemoconcentration
-Hemolysis
-Shortened coagulation time
This requires that the tourniquet be applied twice
during the venipuncture procedure:
- first when vein selection is being made
- immediately before the puncture is performed.
Two routine steps in the venipuncture procedure
aid the phlebotomist in locating a suitable vein
-applying a tourniquet
-asking the patient to clench his or her fist
Site selection
Two routine steps in the venipuncture procedure
-applying a tourniquet
-asking the patient to clench his or her fist
asking the patient to pump his or her fist may cause
elevated potassium levels
Select a vein that is
easily palpated and large
enough to support good blood flow
Select a vein that is easily palpated and large
enough to support good blood flow determine the
direction and depth of the vein to aid the
phlebotomist during needle insertion
find a visual reference for the selected vein to
assist in relocating the vein after cleansing the site.
site selection
palpating for a vein using the _____ not the ______
fingers, thumb
According to the ________, an attempt must have been made to locate the __________ before considering other veins
CLSI standard, median cubital vein on both arms
patient veins are more prominent in the
dominant arm
sites to avoid during a venipuncture
edematous area
arms in cast
IV line/Cannula
aretriovenous Fistula
side of masectomy
burned skin/skinnwith scars
hematoma
cleansed using a 70 percent isopropyl alcohol
prep pad
Cleansing the Site
Cleansing the Site performed with a
circular motion
-starting at the inside of the venipuncture site and
working outward in
widening concentric circles
about 2 to 3 inches
alcohol should be allowed to dry for
30 to 60
seconds on the patient’s arm
Performing a venipuncture before the alcohol has
dried will cause a
stinging sensation for the patient
and may hemolyze the sample
Do not reintroduce microbial contaminants by
blowing on the site, fanning the area, or drying the
area with nonsterile gauze.
Sample Labeling and Identification
• The following minimum information is required:
-Patient’s FULL NAME
-Date of Birth / Hospital Code
-Date and Time the sample was collected
-Initials or name of person collecting sample
Complications in venipuncture
Ecchymosis
Fainting
IV line/IV cannula
Obesity
excessive bleeding
neurological problems such as seizure and nerve damage
rejected specimens
hemolysis
failure to ibtain blood
Aka “bruise”
Ecchymosis
Most common complication encountered
Ecchymosis
Leakage of small amounts of blood
Ecchymosis
• Flat, purplish skin discoloration
ecchymosis
Leakage of large amounts of blood
Hematoma
Swollen / bulging, purplish skin discoloration
Hematoma
syncope
Fainting
Short lapse in consciousness
Fainting
Increase concentration of cells, larger nolecules
and analyts in the blood because of a shift in water
balance.
Hemoconcentration
Can be caused by prolong tourniquet application.
hemoconcentration
After prolonged application, allow
2 minutes
before reapplying the tourniquet.
Extract blood from the opposite IV side.
IV Line / IV Cannula
Ask the charge nurse and stop infusion for
2-5 minutes
Draw _____ the catheter
below
Discard _____ of blood.
first 5ml
Mastectomy Patients
Draw on the opposite mastectomy side.
obesity Can use ____ in locating the vein
BP Cuff
BP Cuff must not be
> 40 mmHg; not more than 1
minute.
•latrogenic Anemia is also called as
“nosocomial anemia”
• “physician-induced anemia”
blood loss due to venipuncture.
•latrogenic Anemia
-Patient usually stops bleeding in
2-6 minutes
-Some medications may prolong the bleeding time
• Blood thinners (Ex Heparin, Warfarin)
• Arthritis medication
• Aspirins
• Coagulation abnormalities (Petechiae present)
-Physician must be notified if bleeding does not
Neurological Problems
seizure and nerve damage
If this occurs during a procedure;
immediately remove the tourniquet, then needle
from arm (engage the safety device); call for help
and do not attempt to give patient anything by
mouth
seizure
Patient will experience a tingling
sensation radiating down the affected nerve.
• Immediately remove the tourniquet and needle
and apply pressure to the site.
• Notify an authorized person and file an incident
report.
-Nerve damage:
Rejected Specimens:
Reasons
-Unlabeled or mislabeled specimen
-Insufficient quantity
-Defective-tube
-Incorrect-tube used for the test ordered
-Hemolysis
-Clotted blood in an anti-coagulated specimen
the major cause of specimen
rejection because it cannot be detected until the
blood cells separate from the plasma or serum.
Hemolysis
-Failure to obtain blood
-Reasons may help with second attempt
• Remain calm as you asses the problem.
Failure to obtain blood.
-Common causes:
• Bevel is against the wall of the vein
• The needle pierced all the way through the vein.
Insertion of the needle at an angle greater than 15
degrees is a likely cause.
• The needle is only partially inserted into the vein,
possibly because the needle is inserted at less
than a 15 degree angle.
• The needle has missed the vein entirely.
patient should never be stuck
more than ______ by the same phlebotomist.
two times
There is now an instrument that transilluminates
the surface of the skin with infrared light to assist
in locating difficult-to-find veins.
vein locator
