Special Situations in Phlebotomy

Question 1

What should be done if the patient has an IV?

Answer 1

Use opposite arm or perform fingerstick, if possible. Or, have nurse turn off IV for two minutes, apply tourniquet below IV, and different vein if possible. Document location of IV, venipuncture, and type of fluid

Question 2

What should be done if the patient has a fistula?

Answer 2

draw from opposite arm

Question 3

What should be done if the patient has an indwelling line, catheter, heparin lock, or cannulas?

Answer 3

usually not drawn by lab. first 5 mL drawn should be discarded. Lab may draw below heparin lock if nothing is being infused

Question 4

What should be done if the patient has sclerosed veins?

Answer 4

select another site

Question 5

What should be done if the patient has a hematoma?

Answer 5

draw below

Question 6

What should be done if the patient has a streptokinase/tissue plasminogen activator (TPA)?

Answer 6

minimize venipuncture. hold pressure until bleeding has stopped

Question 7

what should be done if the patient has edema?

Answer 7

select another site

Question 8

what should be done if the patient has scars, burns, and tattoos?

Answer 8

select another site

Question 9

What should be done if the patient has had a mastectomy?

Answer 9

draw from opposite arm

Question 10

what should be done if the patient refuses venipuncture?

Answer 10

try to persuade, if unsuccessful, notify nurse. never draw without consent; could lead to charges of assault and battery

Question 11

what should be done with an unidentified patient?

Answer 11

ask nurse to ID before drawing