Venipuncture Flashcards
What are some contraindications for blood draw?
- Signs of skin infections (cellulitis, abscess)
- Areas of scarring
- Venous fibrosis on palpation
- Presence of a hematoma
- Presence of a vascular shunt or graft
- Presence of a vascular access device
- IV in extremity
- Ipsilateral mastectomy
- Edematous extremities
What are some possible complications with blood draws?
- Cellulitis
- Phlebitis
- Thrombosis
- Vein laceration
- Hematoma/hemorrhage
- Nerve damage
Which veins are most commonly selected for phlebotomy?
Why?
The superficial veins of the upper extremities (particularly those in the antecubital fossa)
Because they are usually readily available and palpable
What four veins are located in the antecubital fossa?
- Cephalic
- Accessory cephalic
- Median cubital
- Basillic
Are the metacarpal veins preferred for blood draws?
No, it is an easy stick but is more painful. The metacarpal veins are more likely to roll and collapse on vacuum application than antecubital veins.
More bifercations
If there is an incomplete collection or no blood is returned what are the troubleshooting steps?
- Move it forward, as it may not be in the lumen
- Or move it backwards, as it may have penetrated too far
- Adjust the angle (the bevel may be against the wall)
If a hematoma starts to form, what measures can be taken to limit the growth?
- Release tourniquet immediately
- Withdraw the needle
- Apply firm pressure
If you puncture an artery the needle should be withdrawn and presure should be applied for how many minutes?
At least 5 minutes, closer to 10 minutes ideally
The tourniquet should be placed how high above the draw site?
At least 3 inches above the site
The needle should be inserted bevel up at what degree angle?
10-30
What is the order of blood draws?
First, blood culture (yellow or yellow-black top)
Second, coagulation studies (light blue top)
Third, non-additive tube (red top)
Last draw, additive tubes
What are the effects of exercise on lab values?
Muscular activity has both transient and longer lasting effects. The creatine kinase (CK), aspartate aminotransferase (AST), lactate dehydrogenase (LDH), and platelet count may increase.
What lab values are sensitive to postural changes?
- Enzymes
- Proteins
- Lipids
- Iron
- Calcium
What degree angle is an intramuscular injection inserted?
90 Degrees
What degree angle is a subcutaneous injection given?
45 Degrees
