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Phlebotomy > venipuncture > Flashcards

venipuncture Flashcards

1
Q

equipment for routine venipuncture

A

● Gloves
● Tourniquet
● Alcohol prep pads
● Gauze pads
● Needle
● Evacuated tube holder or syringe
● Appropriate evacuated tubes
● Needle disposal (sharps) container
● Adhesive bandage or tape
● Permanent marker or pen
● Computerized or requisition label

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2
Q

how to check needle tube adapter compatible?

A
  • attach needle to tube adapter and make sure needle is screwed all the way up to the tube adapter
  • dont remove needle cap
  • place first tube loosely in tube holder/ adapter
  • push tube up to adapter guidelien or indention but dont push tube in bc will loos vacuum
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3
Q

how should the patient be position for venipuncture?

A
  • pt should be other lying down or reclining backward or in phleb chair (has movable arm to support pt arm) (NEVER STANDING OR IN A STOOL)
  • def in chair with arm or if no arm place arm on thigh
  • can place arm on top of pillow or towel
  • keep arm straight
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4
Q

what to do if pt faints

A
  • phlebotomist could push pt against wall to keep from falling out of chair
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5
Q

phlebotomy for in patient

A
  • supine position
  • extend arm in straight line from shoulder
  • rolled towel or pillow to support arm and aid in position
  • if you lower a bed rail to draw blood raise it before you leave
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6
Q

WHat to do if one has to draw blood in an area not designed for blood collection

A

1—pair of gloves
2—tourniquet and alcohol swab
3—needle, holder, and tubes (in the order to be drawn)
2—gauze/cotton swab and bandage
1—sharps container

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7
Q

how to apply a tourniquet

A
  • make vein more visible by stoing flow o venous blood and increase pessure in veins, making palpation easier
  • place 3-4 in above venipuncture site
  • not pinch but slightly tight (not so tight numb or turns colors nor should you twist it - keep flat)
  • place hand towel or washcloth over skin for pt with fragile skin
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8
Q

tourniquet application steps

A
  1. Position the tourniquet under the arm while grasping the ends above the arm and
    venipuncture area.
  2. Cross the left end over the right end and apply a small amount of tension to the
    tourniquet by pulling on each half of the tourniquet.
  3. Grasp both ends of the tourniquet close to the patient’s arm between the thumb
    and forefinger of the left hand.
  4. Using the right middle finger or index finger, tuck the left end under the right end.
    The loose end of the tourniquet will be pointing toward the shoulder and the loop
    will be pointing toward the hand (see Figure 9-5).
  5. When tugged after the venipuncture procedure, the loose end will easily release
    the tourniquet from the arm.
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9
Q

how to select the venipuncture site?

A
  • antecubital area
  • locate median cubital vein (largest and best anchored)
  • also can use cephalic or basilic vein
  • usually more prominent veins on dominent arm
  • instruct pt to make fist but dont pump bc it will cause hemoconcentration
  • can appyl moist compress at body temp for 3-5min
  • palpate vein with tip of index finger (large and does not roll)
  • feel for valley instead of bulge
  • pick vein without sclerosis and instead one that is soft
  • no paralzyed limbs and sites with shunts and fistulas
  • can use bp cuff
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10
Q

how to differntiate btwn tendonds and veins

A
  • have pt rotate their wrist (tendon will move, vein wont)
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11
Q

what to do if drawing from hand?

A
  • use winged infusion set with smaller needle
  • ask pt to position hand downward and place thumb of nonsticking hand abt 1-2 in below insertion area
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12
Q

how to cleans venipuncture area

A
  • use 70% isopropyl
    alcohol (alc pads) in concentric circles
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13
Q

how to verify venipuncture?

A
  • make pt make fist
  • use dominant hand and pick up venipuncture assembly with thumb on top of tube adapter and finger underneath
  • visually inspect needle
  • position needle bevel area up- 15-30 degree angle to vein
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14
Q

how to insert needle

A
  • use thumb of nondominant hand to pull skin taut 1-2 in below needle insertion while grasping arm
  • line needl with vein
  • you will feel a pop when needle enters vein
  • push in tube while holding assembly still (first sign of successful venipuncure is bood in the evacuated tube)
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15
Q

What to do if venipuncture is not successful

A
  • could be insufficient vacuum in tube
  • bad needle posiiotn (needle against wall of vein - rotate needle, pull it back, slightly forward)
  • release tourniquet
  • if vein collapse remove tube or syringe perssure and wait for vein to fill then reapply
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16
Q

why should you never probe the site?

A
  • extr painful
  • tissue damage
  • hemolyzed specimen
  • probing is moving needle back and forth or side to side to hit a vein
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17
Q

what is a venoscope

A
  • uses LED to illuminate subcuaneous tissue (veins r darker so easier to see)
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18
Q

How to collect specimen

A
  • hold venipuncture steady
  • grab flange (short wings) of tube with index and middle finger and use thumb to push tube to end of adapter
  • can release tourniquet once collection starts or wait till draw is fnished to ensure no venous erflex (many practicing phlebotomist suggest releasing tourniquet when last tube is one half full)
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19
Q

how to change tubes during collection?

A
  • brace thumb against flange of holder and use pulling motion to remove tube
  • place new tube in holder and getly push tube all the way into holder and onto needle
  • dont move needle
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20
Q

how to remove needle?

A
  • remove lat tuve from hoder and fold gauze with other hand in half or in quartersd then gently place over area with needle (dont apply pressure)
  • withraw needle with 15-30 degree angle
  • engage safety mechanism
  • apply pressure
  • keep arm straight to avoid ecchymosis and hematom
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21
Q

what to do after venipuncture is over?

A
  • ask pt to hold pressure on gauze
  • dispose of needle and label specimen
  • apply bandage to wound
22
Q

how to dispose of equipment?

A
  • dispose needle and adapter as one unit
  • never reach into sharps container
  • seal and dispose sharps container when 2/3 to 3/4 full
23
Q

how to apply bandage?

A
  • discard old gauze pad and apply new gauze pad by folding in half or quarters, place on site, apply adhesive bandage or tape
24
Q

what is a butterfyl neddle set?

A
  • winged infusion set
  • less painful to pt
  • can result in more accidental needlesticks
  • only when standard venipuncture cant be performed
  • 21-25 gauge
  • 1/2 to 3/4 in in length
25
Q

how to use butterfy needle set

A
  • bend wings together (wings up)
  • insert needle into skin and wait till flash of blood in needle hub
  • mostly evacuated tubes, can use syringe (infants, children, and some adults)
  • could hcreate a collapsed vein if vein is tiny with evacuated tubes
26
Q

differences in performing venipuncture with butterfly needle?

A
  • sekecting evacuated tubes needed for specimen transfer from a syringe
  • remove syringe from sterile pacakging and push plunger in and out to ensure free movement (not doing this almost always results in teh inabiltiy to perform a draw)
  • make sure plunger is pushed completely in
  • attach syringe to safety needle/ butterfly set up
  • never push plunger while in vein
  • after venupuncture pull back plunger so u do not withdraw needle
  • barrel of syringe will fill with blood as you pull the plunger out
27
Q

lab tests severely affected by hemolysis

A
  • APTT
  • AST
  • CBC
  • K
  • LD
  • PT
28
Q

lab tests considerably affected by hemolysis

A
  • ALT
  • ANA
  • Fe
  • Folate
  • TSH
  • B12
29
Q

what lab tests r barely affected by hemolysis

A
  • acid phopshates
  • albumin
  • Ca
  • Mg
  • P
  • TP
30
Q

how to transfer specimen to tubes?

A
  • remove needle from arm
  • transfer blood into evacuated tubes using blood transfer safety device (fill tubes in blood draw order)
  • when usign blood transfer device you must first remove the needle the syringe
  • attach device ot syringe and then insert the evacuated blood collection tube into transfer device
  • allow blood to transfer using vacuum in tube
  • dont depress plunger as it may result in hemolysis
31
Q

butterfyky with evacuated tubes

A
  • 2 types of evacuated tub adapters (pediatrcis and regular)
  • butterfly needle has tubing that attaches needle to evacuated tube adapter
32
Q

what are some examples of patient complications

A

fainting, nausea, vomiting, seizures, postprocedure bleeding, formation of petechiae or hematomas, accidental arterial
puncture, infection or injury, additive reflux, and choking

33
Q

where to record pt complications?

A
  • record at nurses staton, in pt EHR,lab computer, phlebotomy deparment log books, variance forms, and risk managemetn forms
34
Q

what to do to avoid allergic reactions

A
  • some pt have allergies to latex and/or alc
  • use warm water on gauze to cleanse puncture site if pt is allergic to antiseptic
35
Q

what happens when pt faints (syncope)

A
  • heavy perspirations
    pale skin, and shallow or fast breathing. Following this, the patient experiences drooping eyelids, rapid and weak pulse,
    and finally unconsciousness
  • remove tourniquet and needke, activate safety degvie
  • call for help and apply pressure
  • dont leave pt
    = position yourslef in front of the phleb chair or next to bedside
  • lay pt flat or lower their head
  • lower pt head and arms by placing both head and arms btwn pt knee
  • loosen tight clothing
  • dont use ammonia inhalant
  • wiupe pt forehead and back of neck
36
Q

what to do in case of seizure

A
  • remove tourniquet and needle
  • protectp t from injury by supporting head if tehy follapse and move sharp objects and furnituy away from them
  • dont restrain
  • law pt on floor
  • remain with pt and calm
37
Q

what to do with petechia

A
  • minute hemorrhage, can result if tourniquet on too long
  • in nromal or pt with coagulation dosirders
  • leaves pt with negative lasting impression
  • make sure to remove tourqniet in timely manner
38
Q

what to do if bleeding does not stop/

A
  • if pt says bleeding stops but comes back after removing arm gauze with blood dripping movement of arm cuased wound to reopen
  • must check puncutre wound to determine if bleeding has stopped before letting pt leave
39
Q

what to do if hematoma

A
    • mass of bloood caused by leakage of blood into tissue
  • occur if tourniquet is left on arm too long after needle has been taken out
  • remove tourniquet before needle
  • also can occur if needle has gone thorugh vein or if bevel of needle is not inserted fully into vein
40
Q

what to do if iatrogenic anemia and exsanguination

A
  • repeated blood collection can = iatrogenic anemia (anemia from removal of large amt of blood)
  • if amt of blodo removed for testing exceeds 10% of total blood volumne could become life threatening
  • called exsanguination
41
Q

what to do to avoid infecion

A
  • ensure sterility of equipment (dont remove cap from needle until insertion, dont remove needle and rest on another surface, dont touch puncture site till cleansed, dont perform venipuncture on previosly used wound)
42
Q

potential injure to pt

A
  • poor selection of venipuncture spot
  • if vei feels tight and stringy its a tendon
  • could puncutre nerve if insret needle too deep
  • probing can reust in nerve or tendon damage
  • nerve hit = jerk or shocking
  • if nerve hit elevate arm and use ice and light pressure on site
43
Q

what is additive reflux

A
  • flwoign of blood mixed with tube additive back into pt vein
  • should always have pt arm adn evacuated tube downard
44
Q

what to do if choking

A
  • ppl should not be drinking eating or chewing
45
Q

what to do if accidental arterial puncture

A
  • vein is bouncy
  • artery feels firmer and pulsates
  • artery is bright red and will flow with greater force and may even pulsate
  • if artery stick remove tourniquet and withdraw needle and apply pressure + gauze
46
Q

how to avoid hemoconcenntration

A
  • rapid increase in ratio of blood components in plasma
  • water leave vein, concentration of cells and chemicals increase
  • can be caused by tight tourniqurt, too long touriniquet, and pumping fist
  • pain if hemoconcentration
47
Q

EMLA

A

EMLA - eutectiv (easily melted) mixture of local anesthetic
- topic anesthetics with lidocain and prilocaine
- takes about 1 hr to anesthetise 5 mm dep
- cant be used on those allergic, infants < 37 weeks, infants under 12 recieving methemoglovin iinducing agents

48
Q

What is oral sucrose

A

12-24% solution of oral sucrose reduce pain of prcuedre for infants up to 6 months
- administreted by dropped, nipple, oral syringe, or on a pacifer
- 2 min before procuedres
- 5 min long

49
Q

dialysis patients

A
  • pt with ESRD may do hemodialysis where pt blood is filtered through special machine
  • dont through AV shunt/ fistula which is a permanent fused artery and vein
50
Q

petechiae and blood draw

A

petechia could be caused by capillary wall defects, coag abn (platelet defect and thrombocytopenia), aspirin, disease
- could indicate venipuncutre site may bleed excessibley

51
Q
A

Phlebotomy (17 decks)

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