Proper Blood Collection: Venipuncture and Capillary Puncture Flashcards
VENIPUNCTURE PROCEDURES
- Prepare request form of the patient
- Greet and identify the patient
- Verify diet restriction, latex sensitivity, and other allergies
- Sanitize hands and vosition the patient
- Assemble equipment and supplies
- Apply TOURNIQUET. Ask the patient to make a fist without vigorous pumping. Select a suitable vein for puncture
- Put on gloves. Cleanse the venipuncture site with 70% isopropyl alcohol. Allow the area to dry.
- Anchor the vein firmly.
- Enter the skin with a needle at approx. 30-degree angle. bevel up.
- Release the tourniquet. NEVER WITHDRAW THE NEEDLE WITHOUT REMOVING THE TOURNIQUET.
- Place gauze, withdraw needle and apply pressure
- Properly recap the needle using “fishing out” technique.
- Check the condition of the patient.
- Dispose contaminated material (needle and holder, and syringe) in designated containers using Universal Precautions.
- Label tubes at the patient’s side.
Test request form should contain:
PPPADDDTC
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
How to greet
Conscious patients (Out-patient)
Ask patients to give their FULL NAME and spell their last name.
Compare the information on the request form
How to greet
Conscious patients (In-patient)
Ask patients to give their FULL NAME and spell their last name.
Compare the information on their identification bracelet and request form
How to greet
Sleeping patient
Awaken a sleeping patient before attempting venipuncture
If the patient is already awake, do the same steps as conscious patients
How to greet
Semi-conscious or Comatose Patients
Ask the watcher (or nurse, if no watcher is around) to identify the patient.
Compare the information on their identification bracelet and request form
How to greet
Too young. mentally incompetent or do not speak the lanquage of a phlebotomist
Ask the watcher (or nurse, if no watcher is around) to identify the patient.
Compare the information on their identification bracelet and request form
How to greet
Unidentified Emergency Patient
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.
SITES TO BE AVOIDED:
BED HIM
Burns, scars or tattoos
Edema
Damaged veins
Hematoma
IV line, cannula, fistulas
Mastectomy
Avoid due to compromised blood flow and potential contamination from ink or scars.
Burns, scars or tattoos
Avoid pain, complications, and difficulty in obtaining a proper blood sample.
Damaged veins
Avoiding swollen tissue can obscure veins and increase the likelihood of unsuccessful attempts.
Edema
Avoid pain and further tissue damage from puncturing near a hematoma.
Hematoma
Mastectomy
Avoid on the side of mastectomy to prevent potential complications and_____.
lymphedema
Avoid drawing from these sites to prevent contamination and vessel damage; opt for a different vein if possible.
IV line, cannula, fistula
Cleanse the venipuncture site with______. Allow the area to dry.
70% isopropyl alcohol
ORDER OF DRAW
BCSHEO
- Blood culture bottles (sterile procedure)
- Coagulation tubes
- Serum tubes w/ or w/o clot activator or gel serum separator
- Heparin tubes w/ or w/o del plasma separator
- EDTA tubes
- Oxalate/fluoride, glycolytic inhibitor tubes
Yellow Top
Blood culture bottles (sterile procedure)
- Light Blue Top
Coagulation tubes
Red/ Gold Tan
Serum tubes w/ or w/o clot activator or gel serum separator
Green Top
Heparin tubes w/ or w/o gel plasma separator
Lavender Top
EDTA tubes
Black Top
Oxalate/fluoride - glycolytic inhibitor tubes
Properly recap the needle using “____” technique.
fishing out
Problems encountered in Venipuncture
PANNTS CCD
Pain
Allergy
Nerve damage
Nausea
Trembling
Syncope/ fainting
Cardiac arrest
Continuous bleeding
Diabetic shock
PAIN
Reposition the needle
Release the tourniquet
Discontinue venipuncture
Avoid deep, probing venipunctures
NERVE DAMAGE
• If the nerve is ONLY TOUCHED, not damaged, it may be gone in a____
• If damaged, numbness could be___.
•_____ venipuncture
few hours or days
PERMANENT
Discontinue
NAUSEA
• 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
SYNCOPE/FAINTING
• Warning signs:
Perspiration beads on the forehead
Hyperventilation
Loss of color
- fainting due to abrupt pain or trauma
Vasovagal syncope
What to do when patient faints
• Lower the head and arms
• Discontinue venipuncture
DIABETIC SHOCK
• Experience______ because they fasted
hypoglycemia
What to do during diabetic shock
If conscious, let them drink a glass of ORANGE JUICE or COLA will temporarily help
If unconscious, call a PHYSICIAN
• Patient become unconscious and exhibit mild to violent uncontrollable movements
TREMBLING
What to do when patient is trembling
DO NOT RESTRAIN the patient
Move object out of the way; PROTECT THE HEAD
Patients will usually recover after a few minutes.
Patient falls into unconsciousness, no pulse or respiration, dilated eyes and pale skin
CARDIAC ARREST
What to do when patient undergoes cardiac arrest
IMMEDIATE CPR
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.
5
15
ALLERGY
Some patient are allergic to latex, tape or iodine
What to do?
use hypoallergenic tape and non-latex elastic wrap
What to do when there is
НЕМАТОМА
Discontinue venipuncture and apply pressure
UNUSUAL BLOOD SPECIMENS
Icteric samples
Lipemic samples
Hemolyzed samples
• Serum/plasma that contains large amounts of BILIRUBIN
• Patient presents with jaundice
ICTERIC SAMPLES
• Serum/plasma contains large amounts of FATS and LIPIDS.
• May be due to the patient NOT FASTING.
LIPEMIC SAMPLES
• Serum/plasma contaminated with RBC contents.
HEMOLYZED SAMPLES
CAUSES OF HEMOLYSIS
DR PFRM
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
POSSIBLE CAUSES FOR FAILED VENIPUNCTURE
VC BBUNN
- Vacuum in tube is not working
- Collapsed vein
- Bevel against the vein wall
- Bevel inserted too far
- Undetermined needle position
- Needle partially inserted
- Needle slipped beside the vein
TECHNIQUES TO ENHANCE VEIN AND RECOVER A FAILED VENIPUNCTURE
• 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)
MOST COMMON ERRORS IN SPECIMEN COLLECTION
MMMESHHIP
• 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:
Processing errors
Incomplete centrifugation
Improper storage
LANCET/INCISION DEVICES
• Finger puncture
• Heel puncture
• Laser lancet
COLLECTION CONTAINERS
• Capillary tubes (w/ different anticoagulants)
• Microtainers (w/ different anticoagulants)
COMPOSITION OF CAPILLARY BLOOD
• Arterial Blood
• Venous Blood
• Interstitial Fluid
• Intracellular Fluid
INDICATIONS FOR PERFORMING CAPILLARY PUNCTURE
ADULTS
• No accessible veins
• To save veins for chemotherapy
• Clotting tendencies
• POCT procedures such as glucose monitoring
INDICATIONS FOR PERFORMING CAPILLARY PUNCTURE
CHILDREN AND INFANTS
• To prevent anemia
• To prevent cardiac arrest from removal of large quantities of blood
• Venipuncture injury
• When capillary blood is preferred
STEPS IN CAPILLARY PUNCTURE
- Prepare request form of the patient
- Greet and identify the patient
- Verify diet restriction, latex sensitivity, and other allergies
- Sanitize hands and position the patient
- Select puncture/ incision site
- Warm site if applicable
- Cleanse and air-dry site
- Prepare equipment
- Puncture the site and discard the lancet
- Wipe away the first blood drop
- Fill and mix tubes/ containers in order of draw
- Place gauze and apply pressure
- Label specimen and observe special handling instructions
- Check the site and apply bandage
- Dispose of used and contaminated materials
- Thank patient, remove gloves and sanitize hands
- Transport specimen to the laboratory
Capillary Puncture
Adults and older children (Over 1 year old)
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.
Capillary puncture
Infants (Less than 1 year old)
use the medial or lateral plantar surface of the heel
Capillary puncture
For both finger and heel punctures
• place lancet firmly against site
• Warn the patient
• Depress lancet trigger
• Discard lancet in sharps container
Capillary puncture
Fill and mix tubes/ containers in order of draw
• Gentle intermittent pressure, do not milk, position site downward to enhance flow
• SLIDE FIRST, then EDTA, other
ADDITIVES, SERUM
Capillary puncture
_______: use capillary action
_______: touch blood drop, do not “scoop” or touch site
Mix gently.
Microhematocrit tube
Microcollection containers
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.
microcollection container
microhematocrit tubes
TEST THAT CANNOT BE PERFORMED BY CAPILLARY PUNCTURE
• Erythrocyte sedimentation rate
• Coagulation studies that requires plasma
• Blood cultures
• Tests that require large volumes of blood
