Skills - Module 4 Flashcards
Which site should you avoid in Peripheral Vascular disease patients when obtaining peripheral phlebotomy patients
Avoid the foot
Which AC veins are preferred for venipuncture blood draw?
1st choice - Median cubital
2nd choice - Cephalic
3rd choice - Basilic
How long should a tourniquet be applied during a blood draw?
No longer than 1 min due to increased risk of hemolysis. If accidently applied longer than 1 min, you must remove the tourniquet and wait 2min before you reapply and do the blood draw.
How do you label peripheral venipuncture?
Pt name, DOB, AHC #, date & time sample taken, who took sample, site sample taken
What is the first sample type drawn FIRST from a peripheral venous blood draw
cultures
At what angle do you perform a peripheral IV cannulation?
15-30 degrees
What is the first sample type drawn FIRST from a peripheral venous blood draw
cultures
What is the last sample drawn from a peripheral venous blood draw
Paxgene tubes
What is the most COMMON complication with peripheral IV cannulation
failure to extract blood
How do you prep a vein for venipuncture?
Prep the vein as you would when starting an IV, use alcohol or iodine pad and cleanse the area in a circular motion, starting from the inside and working your way out.
What are the primary influencing factors that negatively impact your reading of a peripheral venous blood draw (5)
- Under/overfilled containment
- tourniquet on for too long (greater than 1 minute)
- improper mixing mixing of tubes
- Hemolysis
- specimen contamination
Why would the venous blood sample be rejected by the lab
no label, inadequate volume, hemolysis, coagulated blood, delay, contaminated
How do you measure the probe for Invasive Core Temperature Monitoring?
Oral insertion: Measure from corner of mouth to the earlobe to 2 cm above the xyphoid process.
Nasal Insertion: Measure from the nose to the earlobe to 2 cm above the xyphoid process.
After the Invasive Core Temperature Monitoring probe has been inserted, what are the next steps?
Secure the probe, attach to temperature cable and monitor, reassess and document. Monitor patient for complications.
what are the indications for radial artery puncture/blood draw
evaluation of acid/base status, respiratory distress, 02/c02 exchange, assessment of interventions
Absolute contraindications for arterial puncture
Failed Allen’s test, previous surgery, shunts, grafts and fistulas
relative contraindications for arterial punctures
burns, trauma, infections to the area
Complications of arterial puncture
Nerve damage, bleeding, hematoma, thrombosis, and inaccurate test results.
What gauge of catheter is used for arterial puncture?
23 gauge
How many mL are you expected to draw from arterial blood sampling
1-2 mL
What is the angle of insertion for arterial blood sampling
45 degree angle
how much time must you put direct pressure over the puncture to avoid bleed out after an arterial puncture
5 minutes is the magic number
How do you label an arterial blood sample?
Name, date, time, ID number and practitioner name.
How much time must you roll syringe after arterial blood draw is obtained
15 seconds
If the arterial sample will be read over 10 minutes after the draw you must do what?
You must place the container in an ice slurry.
Long term storage of arterial blood sample requires what temperature and what time frame
0-4 degrees Celsius for a maximum time of 30 minutes
how do you ensure an accurate read when obtaining arterial blood directly from the line
ensure 10 mL wastage is obtained
What do you do after a arterial blood draw off of an arterial line?
Turn the stop cock off to the cap, perform a fast flush using the flushing device located on the art line transducer line. Flush until all blood is removed from the line. Re-Zero transducer.
Arterial pressure monitoring procedure.
Spike 1000ml saline bag with transducer line and flush each section of the line through vented caps. Place saline bag into pressure infusion device, inflate to 300mmHg. Attach primed line to arterial catheter. Level to the phlebostatic axis and zero the pressure transducer. Repeat the leveling and zeroing each time a patient is moved.
Where is the phlebostatic axis?
Land marked at the intersection of the midaxillary line with the fourth intercostal space when Pt is supine at 30° elevation.
What is considered over damping?
Less than 1.5 oscillations after square wave test
What is considered under damping?
More than 1.5 oscillations after square wave test
What does the anacrotic notch indicate on arterial waveforms?
Represents the end of systole and the beginning of the volume displacement curve
What does the dicrotic notch indicate on arterial pressure waveforms
Closing of the aortic valve and BEGINING of diastole
Define Arterial Pressure
The input pressure for organ perfusion and is a function of PVR and blood flow.
How to calculate mean arterial pressure?
diastolic x 2 + systolic/3
What are the sites for arterial puncture in order of preference
- radial
- brachial
- femoral
- dorsalis pedis
