PMLS LAB 2 Flashcards by eureka juneille

-Is the procedure for removing blood from veins for
analysis

Venipuncture

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-first site or choice of location for venipuncture.

Antecubital Fossa

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shallow depression and anterior ans below the bend of the elbow

antecubital fossa

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2 common patterns

H-pattern ans M-pattern

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acceptable for venipuncture

veins on the back of the hands
foot and ankle
femoral vein

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veins on the ______ are never acceptable for venipuncture

underside of the wrist

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differs somewhat from person to
person, and you may not see the exact textbook
pattern

vein location

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•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.)

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Hospital identification bracelet includes:

-Patient’s first and last names
-Hospital numbers (often two sets)
-Birth date
-Physician

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-Temporary identification number and bracelet

Unidentified patients

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to correctly identify the patient

Requisitions

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Organize the necessary equipment

Requisitions

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collect the appropriate samples

Requisitions

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legal protection

Requisitions

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Before leaving the laboratory

REVIEW THE REQUISITION!

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Steps to review the requisition

• Verify the tests to be collected
• Check the time and date of collection
• Determine the patient preparation needed.

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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

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•Other information that may be present

Status of sample (stat, timed, routine)

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(such as fasting
sample or latex sensitivity)

•Special collection information

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(such as areas that
should not be used for venipuncture)

Special patient information

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•Billing information and ICD-9 codes

Status of sample (stat, timed, routine)

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Fasting Blood Sugar (fbs) hours

8-10hrs

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Lipid profile fasting hours

10-12hrs

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FBS and Lipid profile fasting

10hrs

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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:

1. first when vein selection is being made 2. 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