Pre-Analytical Consideration Part B Flashcards
avoid these areas since it’s difficult to palpate or penetrate in burned
and scarred areas.
o painful
o susceptible to infection
→ healed sites with extensive scarring may have impaired circulation that
could lead to erroneous (invalid or false) test results
Burns, Scars and Tattoos
may feel hard and cordlike and lack of resiliency since they are partially or completely occluded (obstructed)
Damaged Veins
Veins may be:
- Sclerosed (hardened)
- Thrombosed (clotted)
Effects of inflammation, disease, or chemotherapy drugs
Thrombosed (clotted)
Swelling caused by abdominal accumulation of fluid in tissue
Edema
What is the common problem after mastectomy
Edema
yield inaccurate test results owing to contamination by swelling
▪ harder to locate
▪ fragile
▪ easily injured by tourniquet & antiseptic
▪ healing may be prolonged
Edema
Swelling or mass of blood (often clotted)
Hematoma
o can be caused by blood leaking from a blood vessel
o large bruise spread around the area
o Hemolyzed blood will occur when puncturing to hematoma
site
▪ painful
▪ can coagulation and lead to inaccurate test
Hematoma
Surgical Breast Removal
Mastectomy
- never drawn blood from an arm on the same side
o Lymph node removal
▪ part of the procedure
Mastectomy
May case Lymphocytosis
Mastectomy
o Obstruction or stoppage of normal lymph flow
o could change blood composition
o lead to inaccurate test results
Lymphocytosis
it’s an impaired lymph flow makes the arm susceptible to
swelling
Lymphedema
- Extremely Overweight
Obesity
18 inch long
Strap Tourniquet
Designed for obese
Bariatric Tourniquets
used and just below the patient’s diastolic pressure
Bariatric or XL size blood pressure cuff
What are the steps to locate obese vain
–> 1st check antecubital area
→ next palpable is median cubital vein
→ then ask the patient where or what sites have been successful for past blood draws
→ next option: cephalic vein
o to locate: rotate the patient’s arm medially
- Loss of muscle function
- Can be temporary or permanent
- Can be localized in one area or widespread
Paralysis
What is the meaning of ALS
Amyotrophic lateral sclerosis
What is the meaning of VADS
Vascular Access Devices and Sites
→ tubing devices that are designed to allow entry to veins or arteries
→ for patients who require frequent venous or arterial access
→ commonly used for administration of meds, fluids, blood products & sometimes blood collection
→ General Rule: do not performed in extremity with VAD
Vascular Access Devices and Sites (VADS)
What is the meaning of IV?
Intravenous Line
→ “Pertaining to or within the vein”
→ quick way to deliver fluids, meds, blood transfusion products and other substances
Intravenous Line (IV)
o catheter inserted in peripheral vein
▪ its typically connected to a line that is used to administer fluid
o line is attached to a bag containing the substance being
administered
Intravenous Line (IV)
Line is usually having a special drip chamber that prevents air from entering the tubing allows the flow rate to be estimated and controlled
IV Drip
If the patient has an IV in both arms, draw ____ the IV
distal (below)
If both are not free ____ must be taken
Capillary puncture
needle connection device in the form of a stopcock or a cap that is
connected to a hub of catheter or cannula by short length of IV tubing
o cap or stopcock has a diaphragm
▪ thin, rubberlike cover
▪ for administering meds or drawing blood
o lock, often places in vein in the lower arm above the back of
the wrist and can be left in place for 48 hours
IV Catheter Lock
Device filled with saline known as SAline Lock
Lock
One filled with Heparin known as ___ or Heplock
Heparin Lock
- A-line or Art-line
- Catheter placed in an artery
- located in radial artery of the wrist
Arterial Line
Permanent surgical connection of an artery and vein
Arteriovenous AV shunt
bypasses the capillaries and forces
arterial blood directly into a vein
AV shunt
to move or force
shunt
dialysis shunt created by direct permanent fusion of the
artery and vein
AV fistula
Most common type of shunt for dialysis
AV Fistula
piece of vein or tubing form a loop from the artery to vein that can be seen under the skin
AV Graft
Distinctive buzzing sensation of shunt
Thrill
Needle closed blood sampling sometime connected to an arterial or central venous catheter
Blood Sampling Device
Also known as indwelling line
Central Vascular Access Devices (CVAD)
o consists of tubing inserted into main vein or artery
o primarily used for administering fluids and meds
o monitoring pressures and drawing blood
Central vascular Acess devices
Mostly; povidone-iodine
Antiseptic Allergy
→ place a clean, folded gauze square over the
site & wrap it with self-adherent elastic bandage
→ instruct to remove after 15 mins
→ hold press the site for 5 mins
Adhesive Allergy
- Involves irritation or rashes
- can be; life-threatening reaction
Latex Allergy
→ aspirin or anticoagulant therapy (may take longer to stop bleeding)
→ if continuous in 5mins, notify personnel’s
Excessive Bleeding
→ loss of consciousness and postural tone
→ contributing factors: anemia,
dehydration, emotional problems, fatigue, hypoglycemia, hyperventilation, medications, nausea, needle phobia and poor or compromised breathing
Fainting [Syncope]
→ not usual to experience
→ do not attempt until it subsides
→ give an emesis basin or wastebasket to hold as precaution
→ ask to breath slowly & deeply
→ apply cold, damp washcloth or cold compress to forehead
Nausea and Vomiting
→ usually in routine venipuncture & capillary puncture
Pain
→ Tiny, non-raised red, purple or brownish spots when tourniquet is applied
→ spots are mins drops of blood that escape capillaries and come to surface
→ Thrombocytopenia – low platelet count
Petechiae
→ discontinue the draw
→ call for help to ease patient
Seizures / Convulsions
→ common complication
→ if hematoma forms while blood drawing; discontinue
→ hold for 3 to 5 mins
→ the arm should be elevated and put cold compress
Hematoma Formation and Bruising
adjective used to describe an adverse condition brought
the effect of treatment
Iatrogenic
Blood loss though blood removed for testing
Iatrogenic blood loss
o blood loss to a point at which life cannot be sustained
o life may be threatened if more than 10% (infant) 14% (adult) volume is removed
Exsanguination
→ rare when proper venipuncture is followed
→ most often associated with deep or blind probing
o especially in basilic vein close to brachial artery
Inadvertent Arterial Puncture
–> rare occurrence but does happen
o don’t open adhesive tape or bandages ahead of time or
temporarily tape them to lab-coat cuffs or other contaminated objects
o don’t pre-load (attach) needles onto tube holders to have a
supply for many draws ahead of time. sterility of needle is
breached once seal is broken
o allow alcohol to dry prior to needle insertion
o before/during don’t touch the site with finger, glove, gauze
or any nonsterile after it has been cleaned
o try to minimize the time between removing the needle cap
o remind patient to keep bandage atleast 15 mins
Infection
→ flow back
→ to avoid reflux; place patient’s arm downward position
→ will cause buildup of scar tissue and increase difficulty to performing subsequent venipunctures
→ Blind probing and improper technique can damage veins and impair vein patency
Reflux of Additive
→ localized venous stasis or stagnation of normal venous blood flow
Hemoconcentration
Ways to prevent Hemoconcentration
o ask to release fist upon blood flow
o choose appropriate patent vein
o don’t allow to pump the fist
o don’t excessively massage the area in locating vein
o don’t probe or redirect the needle multiple times in search of
a vein
o release tourniquet within 1 min
→ results when RBC are damaged or destroyed
Hemolysis
Slightly hemolysis
Pink
Moderate hemolysis
Dark Pink to light Red
Gross hemolysis
Dark red
→ Hemolyzed specimen can result in conditions such as
o hemolytic anemia
o liver disease
o transfusion reaction
→ Must fill ETS tubes until normal amount of vacuum is exhausted
Partially Filled Tubes
→ Short Draws
o failure to partially filled tubes
o acceptable only in: Red tops & SSTs
Partially Filled Tubes
→ improper technique or carelessness
Specimen Contamination
→ Affect test results and jeopardized patient safety
Wrong or Expired Collection Tube
→ not inserted far enough
→ bevel partially out of the skin
→ bevel partially into the skin
→ bevel partially through the vein
→ bevel completely through the vein
→ bevel against vein wall
→ bevel in valve
→ needle beside the vein
→ undetermined needle position
Needle Positions
What are some needle positions
→ not inserted far enough
→ bevel partially out of the skin
→ bevel partially into the skin
→ bevel partially through the vein
→ bevel completely through the vein
→ bevel against vein wall
→ bevel in valve
→ needle beside the vein
→ undetermined needle position
