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HEMA 1: LAB > Proper Blood Collection: Venipuncture and Capillary Puncture > Flashcards

Proper Blood Collection: Venipuncture and Capillary Puncture Flashcards

1
Q

VENIPUNCTURE PROCEDURES

A
  1. Prepare request form of the patient
  2. Greet and identify the patient
  3. Verify diet restriction, latex sensitivity, and other allergies
  4. Sanitize hands and vosition the patient
  5. Assemble equipment and supplies
  6. Apply TOURNIQUET. Ask the patient to make a fist without vigorous pumping. Select a suitable vein for puncture
  7. Put on gloves. Cleanse the venipuncture site with 70% isopropyl alcohol. Allow the area to dry.
  8. Anchor the vein firmly.
  9. Enter the skin with a needle at approx. 30-degree angle. bevel up.
  10. Release the tourniquet. NEVER WITHDRAW THE NEEDLE WITHOUT REMOVING THE TOURNIQUET.
  11. Place gauze, withdraw needle and apply pressure
  12. Properly recap the needle using “fishing out” technique.
  13. Check the condition of the patient.
  14. Dispose contaminated material (needle and holder, and syringe) in designated containers using Universal Precautions.
  15. Label tubes at the patient’s side.
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2
Q

Test request form should contain:

PPPADDDTC

A

Patient identification number

Physicians name

Patient’s complete name

Age

Date of birth

Date and time the sample is to be obtained

Department or location of the patient

Type of test to be collected

Clinical impression/ diagnosis

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3
Q

How to greet

Conscious patients (Out-patient)

A

Ask patients to give their FULL NAME and spell their last name.

Compare the information on the request form

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4
Q

How to greet

Conscious patients (In-patient)

A

Ask patients to give their FULL NAME and spell their last name.

Compare the information on their identification bracelet and request form

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5
Q

How to greet

Sleeping patient

A

Awaken a sleeping patient before attempting venipuncture

If the patient is already awake, do the same steps as conscious patients

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6
Q

How to greet

Semi-conscious or Comatose Patients

A

Ask the watcher (or nurse, if no watcher is around) to identify the patient.

Compare the information on their identification bracelet and request form

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7
Q

How to greet

Too young. mentally incompetent or do not speak the lanquage of a phlebotomist

A

Ask the watcher (or nurse, if no watcher is around) to identify the patient.

Compare the information on their identification bracelet and request form

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8
Q

How to greet

Unidentified Emergency Patient

A

Upon admission, a temporary identification number will be assigned to the patient.

Use this ID number on all tests.
When a permanent number or when the patient has already been identified, cross-reference it with the temporary number.

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9
Q

SITES TO BE AVOIDED:

BED HIM

A

Burns, scars or tattoos
Edema
Damaged veins
Hematoma
IV line, cannula, fistulas
Mastectomy

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10
Q

Avoid due to compromised blood flow and potential contamination from ink or scars.

A

Burns, scars or tattoos

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11
Q

Avoid pain, complications, and difficulty in obtaining a proper blood sample.

A

Damaged veins

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12
Q

Avoiding swollen tissue can obscure veins and increase the likelihood of unsuccessful attempts.

A

Edema

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13
Q

Avoid pain and further tissue damage from puncturing near a hematoma.

A

Hematoma

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14
Q

Mastectomy

Avoid on the side of mastectomy to prevent potential complications and_____.

A

lymphedema

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15
Q

Avoid drawing from these sites to prevent contamination and vessel damage; opt for a different vein if possible.

A

IV line, cannula, fistula

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16
Q

Cleanse the venipuncture site with______. Allow the area to dry.

A

70% isopropyl alcohol

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17
Q

ORDER OF DRAW

BCSHEO

A
  1. Blood culture bottles (sterile procedure)
  2. Coagulation tubes
  3. Serum tubes w/ or w/o clot activator or gel serum separator
  4. Heparin tubes w/ or w/o del plasma separator
  5. EDTA tubes
  6. Oxalate/fluoride, glycolytic inhibitor tubes
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18
Q

Yellow Top

A

Blood culture bottles (sterile procedure)

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19
Q
  • Light Blue Top
A

Coagulation tubes

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20
Q

Red/ Gold Tan

A

Serum tubes w/ or w/o clot activator or gel serum separator

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21
Q

Green Top

A

Heparin tubes w/ or w/o gel plasma separator

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22
Q

Lavender Top

A

EDTA tubes

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23
Q

Black Top

A

Oxalate/fluoride - glycolytic inhibitor tubes

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24
Q

Properly recap the needle using “____” technique.

A

fishing out

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25
Q

Problems encountered in Venipuncture

PANNTS CCD

A

Pain
Allergy
Nerve damage
Nausea
Trembling
Syncope/ fainting

Cardiac arrest
Continuous bleeding
Diabetic shock

26
Q

PAIN

A

Reposition the needle
Release the tourniquet
Discontinue venipuncture
Avoid deep, probing venipunctures

27
Q

NERVE DAMAGE

• If the nerve is ONLY TOUCHED, not damaged, it may be gone in a____
• If damaged, numbness could be___.
•_____ venipuncture

A

few hours or days

PERMANENT

Discontinue

28
Q

NAUSEA

A

• Make the patient as comfy as possible
• Instruct him/her to breathe slowly
• Apply COLD COMPRESS if necessary
• Give waste basket or container and have tissues and water ready

29
Q

SYNCOPE/FAINTING
• Warning signs:

A

Perspiration beads on the forehead

Hyperventilation

Loss of color

30
Q
  • fainting due to abrupt pain or trauma
A

Vasovagal syncope

31
Q

What to do when patient faints

A

• Lower the head and arms
• Discontinue venipuncture

32
Q

DIABETIC SHOCK
• Experience______ because they fasted

A

hypoglycemia

33
Q

What to do during diabetic shock

A

If conscious, let them drink a glass of ORANGE JUICE or COLA will temporarily help

If unconscious, call a PHYSICIAN

34
Q

• Patient become unconscious and exhibit mild to violent uncontrollable movements

A

TREMBLING

35
Q

What to do when patient is trembling

A

DO NOT RESTRAIN the patient

Move object out of the way; PROTECT THE HEAD

Patients will usually recover after a few minutes.

36
Q

Patient falls into unconsciousness, no pulse or respiration, dilated eyes and pale skin

A

CARDIAC ARREST

37
Q

What to do when patient undergoes cardiac arrest

A

IMMEDIATE CPR

38
Q

CONTINUOUS BLEEDING
• Some patients take more than___ MINUTES for the site to stop bleeding
• Continue to wrap an elastic gauze around the arm with a pad
• Leave it on for___ MINUTES or until the bleeding stops.

A

5

15

39
Q

ALLERGY
Some patient are allergic to latex, tape or iodine

What to do?

A

use hypoallergenic tape and non-latex elastic wrap

40
Q

What to do when there is
НЕМАТОМА

A

Discontinue venipuncture and apply pressure

41
Q

UNUSUAL BLOOD SPECIMENS

A

Icteric samples

Lipemic samples

Hemolyzed samples

42
Q

• Serum/plasma that contains large amounts of BILIRUBIN
• Patient presents with jaundice

A

ICTERIC SAMPLES

43
Q

• Serum/plasma contains large amounts of FATS and LIPIDS.
• May be due to the patient NOT FASTING.

A

LIPEMIC SAMPLES

44
Q

• Serum/plasma contaminated with RBC contents.

A

HEMOLYZED SAMPLES

45
Q

CAUSES OF HEMOLYSIS

DR PFRM

A

Drawing from a hematoma

Rupturing of RBCs by using needle that is too small

ALCOHOL on the site of venipuncture that entered the blood sample

Pulling the plunger too forcibly

Fast drip/ expelling blood vigorously as it is transferred to the tube

Redirecting

Mixing tubes vigorously

46
Q

POSSIBLE CAUSES FOR FAILED VENIPUNCTURE

VC BBUNN

A
  1. Vacuum in tube is not working
  2. Collapsed vein
  3. Bevel against the vein wall
  4. Bevel inserted too far
  5. Undetermined needle position
  6. Needle partially inserted
  7. Needle slipped beside the vein
47
Q

TECHNIQUES TO ENHANCE VEIN AND RECOVER A FAILED VENIPUNCTURE

A

• Retie the tourniquet
• use a blood pressure cuff in place of a tourniquet
• Massage the arm or warm the location
• Lower the patient’s arm
• Reseat the tube holder
• Use a different tube
• Place your finger below the venipuncture site and stretch the vein slightly
• Pull back or advance the needle slightly
• Rotate the needle ONE QUARTER to ONE HALF TURN. make sure to pull a little backward before redirecting
• Venipuncture attempts should be upto 2 tries only. Ask someone else to do it (endorse to another staff)

48
Q

MOST COMMON ERRORS IN SPECIMEN COLLECTION

MMMESHHIP

A

• Misidentification of patient
• Mislabeling of specimen
• Mixing problems/ clots

• Exposure to light/ extreme temperatures
• Short draws/wrong Anticoagulant-Blood ratio
• Hemolysis/ lipemia
• Hemoconcentration from prolonged tourniquet time
• Improperly timed specimen/ delayed delivery to the laboratory
• Processing errors:

49
Q

Processing errors

A

Incomplete centrifugation
Improper storage

50
Q

LANCET/INCISION DEVICES

A

• Finger puncture
• Heel puncture
• Laser lancet

51
Q

COLLECTION CONTAINERS

A

• Capillary tubes (w/ different anticoagulants)

• Microtainers (w/ different anticoagulants)

52
Q

COMPOSITION OF CAPILLARY BLOOD

A

• Arterial Blood
• Venous Blood
• Interstitial Fluid
• Intracellular Fluid

53
Q

INDICATIONS FOR PERFORMING CAPILLARY PUNCTURE

ADULTS

A

• No accessible veins
• To save veins for chemotherapy
• Clotting tendencies
• POCT procedures such as glucose monitoring

54
Q

INDICATIONS FOR PERFORMING CAPILLARY PUNCTURE

CHILDREN AND INFANTS

A

• To prevent anemia
• To prevent cardiac arrest from removal of large quantities of blood
• Venipuncture injury
• When capillary blood is preferred

55
Q

STEPS IN CAPILLARY PUNCTURE

A
  1. Prepare request form of the patient
  2. Greet and identify the patient
  3. Verify diet restriction, latex sensitivity, and other allergies
  4. Sanitize hands and position the patient
  5. Select puncture/ incision site
  6. Warm site if applicable
  7. Cleanse and air-dry site
  8. Prepare equipment
  9. Puncture the site and discard the lancet
  10. Wipe away the first blood drop
  11. Fill and mix tubes/ containers in order of draw
  12. Place gauze and apply pressure
  13. Label specimen and observe special handling instructions
  14. Check the site and apply bandage
  15. Dispose of used and contaminated materials
  16. Thank patient, remove gloves and sanitize hands
  17. Transport specimen to the laboratory
56
Q

Capillary Puncture

Adults and older children (Over 1 year old)

A

Use the palmar surface of the distal or end segment of the middle or ring finger of the nondominant hand.

Fleshy area, slightly off center, perpendicular to whorls of fingerprint.

57
Q

Capillary puncture

Infants (Less than 1 year old)

A

use the medial or lateral plantar surface of the heel

58
Q

Capillary puncture

For both finger and heel punctures

A

• place lancet firmly against site
• Warn the patient
• Depress lancet trigger
• Discard lancet in sharps container

59
Q

Capillary puncture

Fill and mix tubes/ containers in order of draw

A

• Gentle intermittent pressure, do not milk, position site downward to enhance flow
• SLIDE FIRST, then EDTA, other
ADDITIVES, SERUM

60
Q

Capillary puncture

_______: use capillary action

_______: touch blood drop, do not “scoop” or touch site

Mix gently.

A

Microhematocrit tube

Microcollection containers

61
Q

Capillary puncture

Label specimen and observe special handling instructions

Label with appropriate information

• Apply label directly to______
• Place_______ in a nonadditive tube then label that tube.
• Ice, body temperature, protection from light, etc.

A

microcollection container

microhematocrit tubes

62
Q

TEST THAT CANNOT BE PERFORMED BY CAPILLARY PUNCTURE

A

• Erythrocyte sedimentation rate
• Coagulation studies that requires plasma
• Blood cultures
• Tests that require large volumes of blood

HEMA 1: LAB (12 decks)

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