Venipuncture Flashcards
Use the thumb of the nondominant hand to anchor the selected vein while inserting the needle. Place the thumb 1 or 2 inches below and slightly to the left of the insertion site and
the four fingers on the back of the arm and pull the skin taut.
Anchoring the vein
Return of blood into the hub of the needle
Flash of blood
Lateral aspect; located on the thumb side of the arm; second choice; hard to palpate but fairly well anchored & the only vein can be felt in large patients
Cephalic Vein
Impeding venous blood flow that causes blood to accumulate in the veins making them more easily located and provides a larger amount of blood for collection.
Tourniquet Application
Needles used for the evacuated tube system are also known
Multi-sample needles
made up of a beveled needle that is attached to a length of tubing with a luer adapter on the opposite end. Just below the needle on the butterfly system are two “wings” that are made of hard plastic.
Winged infusion sets or Butterfly system
May be used if antecubital fossa veins are
unsuitable or unavailable.
Site Selection in Hand
Inversion per tube
Culture tubes - 8 to 10
Sodium Citrate (Light blue) - 3 to 4
Red (Plain) - 5
SST (Yellow) - 5
Heparin (Green) - 8 to 10
EDTA (Purple) - 8 to 10
Sodium Flouride (Gray) - 8 to 10
Return the bed and bed rails to the original position if they have been moved. Failure to replace bed rails that results in patient injury can result in legal action
Leaving the patient
Dispose of the contaminated needle and holder in an acceptable sharps container conveniently located near the patient.
Dispose the needle
When a tourniquet is used during preliminary vein selection, it should be released and reapplied after 2 minutes.
Failure to remove the tourniquet before removing the needle may produce a bruise
Hematoma
Maximum time for tourniquet application: 1 minute
The phlebotomist disposes of all contaminated supplies such as alcohol pads and gauze in a biohazard container and needle caps and paper in the regular waste container, removes gloves and disposes of them in the biohazard container, and washes his or her hands.
Disposing the used supplies
Needle must be bevel up
Examine the needle
Patient Identification
Identify the patient verbally by having him or her state both the first name and last name and compare the information on the patient’s ID band with the requisition form.
The most important procedure in phlebotomy is correct identification of the patient.
Medial side; not well anchored & rolls easily, ↑ risk of puncturing median cutaneous nerve or the brachial artery
Basilic Vein
When the vein is securely anchored, align the needle with the vein and insert it, bevel up, at an angle of 15 to 30 degrees depending on the depth of the vein.
Inserting the needle
Most frequently used solution
povidone-iodine and tincture of iodine or chlorohexidine gluconate
The most common and most efficient method of performing venipuncture is the use of the evacuated tube system.
Evacuated Tube System
Required Information in Requisition Forms
- Patient’s name and last name
- Identification number
- Patient’s date of birth
- Patient’s location
- Ordering healthcare provider/ physician
- Test requested
- Date and time that is requested
- Date and time of extraction
- Status of sample
The last resort for blood collection is from the foot veins after the arm veins have been determined unsuitable.
Site Selection in Foot
Site Selection
Preferred site for venipuncture: antecubital fossa (located anterior and below the bend of the elbow)
Bleeding at the venipuncture site should stop within 5 minutes. Before applying the adhesive bandage, the phlebotomist should examine the patient’s arm to be sure the bleeding has stopped.
Bandaging the patient’s arm
Located near the center; preferred vein for venipuncture because it is large and stationary
Median Cubital Vein
Made of a hollow plastic barrel with graduated measurements in cubic centimeters (cc) or milliliters (mL) printed on the side.
Syringe
Patient Tube Labels
Patient’s name and identification number
Date and time of collection
Phlebotomist’s initials
Post-Venipuncture
The patient’s arm is examined to see if bleeding has stopped. An adhesive bandage or tape is applied on the site (following institutional policies).
The patient is instructed to leave the bandage on for a minimum of 15 minutes.
Out patients should be advised not to carry a purse or other heavy object or lift heavy objects with that arm for 1 hour.
The patient should be thanked for his or her cooperation –this helps leave the patient with a positive feeling.
Contaminated materials should be disposed of in approved biohazard containers following the institutional policies before attending to the next patient.
RELEASE TOURNIQUET BEFORE NEEDLE
What finger is used to palpate a vein?
Tip of the index finger
Angle of bevel for puncture
15 - 30 degrees
Prolonged time of tourniquet can cause
Hemoconcentration
Maximum time for tourniquet application
1 minute
Reapplication of tourniquet
After 2 minutes
Tourniquet be applied twice, first when vein selection is made, second when puncture is performed.
Apply the tourniquet 3 to 4 inches above the antecubital fossa.
HAI means
Health-care acquired infections
Assembly of Puncture Equipment
Check equipment for defects
Check needle and syringe if properly screwed
Extra tubes should be near at hand
Do not place collection tray on patient’s bed
