Venipuncture Flashcards
Defined as the process of collecting or “Drawing” blood from a vein. It is the most
common way to collect blood in the laboratory.
VENIPUNCTURE
There are two ways of collection,
open system and the closed system
There are two ways of collection,
the open system and the closed system, as follows:
•BY SYRINGE
•BY EVACUATED TUBE SYSTEM
•BY CAPILLARY
Pre-analytical procedures
- PATIENT REGISTRATION
- REQUESTS FOR TESTING
is a routine process during which data are collected that creates a patient record
for the specific individual who is being admitted to the facility, or has arrived for testing at the
specimen collection center.
Registration
Patient’s Identity includes:
-Full name
-Address
-Date of Birth
-Proof of ID
-Sex
The process typically involves assignment of a ____________ which will appear on
all test requests and specimen labels for that patient.
patient-specific identifier
Typically, a physician or other qualified healthcare professional requests laboratory
testing; the exceptions are certain
rapid tests that can be purchased and performed at
home by consumers and blood specimens requested by law enforcement officials that
are used for evidence.
Test requests may be
manual, computerized or barcoded
Required Requisition Information
Ordering healthcare provider or another
authorized person’s name
• Patient’s full name (first, last, and middle
name or initial if applicable or available)
• Patient-specific identifier (e.g., inpatient
medical record number)
• Patient’s sex
• Patient’s date of birth or age (per facility
policy)
• Room number and bed (if inpatient)
• Test(s) that are to be performed
• Collection site, if appropriate
• Date test is to be performed (and time if
applicable)
• Test status (e.g., timed, fasting, priority)
•Other relevant information and
instructions (e.g., special
precautions like latex sensitivity)
• Billing information and ICD-10 codes (if
outpatient)
allow for fast, accurate processing, and their use has been shown to decrease laboratory errors associated with clerical mistakes
Barcode systems
The most important venipuncture step is
patient identification
Venipuncture step 1
eceive, Review, and Accession Test Request
venipuncture Step 2
Approach, Greet, and Identify the Patient
The behavior of a healthcare provider toward
or as perceived by a patient
bedside manner
It is the process of verifying a patient’s identity; it is the most crucial step in specimen
collection. It should not be rushed, or any part skipped to save time.
Patient identification
venipuncture Step 3
Explain the Procedure and Obtain Consent
Step 4:
Verify Collection Requirements, and Identify Sensitivities and Potential
Problems
Step 5:
Sanitize Hands and Put on Gloves
Step 6:
Position Patient, Apply Tourniquet, and Ask the
Patient to Make a Fist
first pumping most notably affects
level of potassium and ionized calcium
Step 7:
Select a Vein, Release the Tourniquet,
and Ask the Patient to Open the Fist
Step 8
Clean and Air-Dry the Site
a number such as a medical record number or other set of characters that is unique to the patient. This type of identifier helps eliminate mistakes caused by confusing patients with the same or similar
names or even the same name and date of birth.
patient-specific identifier
The form on which test orders are entered is called a
requisition
become part of a patient’s medical record and require specific information to ensure that the right patient is tested, the physician’s orders are met, the correct tests are performed at the proper time under the required conditions, and the patient is billed properly.
Test requisitions
are sometimes used in emergencies; however, the request is usually documented on standard request forms or entered in the computer by the time the phlebotomist arrives to collect the specimen.
Verbal test requests
are sometimes used in emergencies; however, the request is usually documented on standard request forms or entered in the computer by the time the phlebotomist arrives to collect the specimen.
Verbal test requests
come in different styles and types as simple as a test request written on a prescription pad by a physician, or a special form (Fig. 8-1) issued by a reference laboratory.
Manual requisitions
typically contain the actual labels that are placed on the specimen tubes immediately after collection. In addition to patient identification and test status information, many indicate the type of tube needed for the specimen and some indicate additional patient information such as “potential bleeder” or “no venipuncture right arm.”
Computer-Generated Requisitions
Either type of requisition may contain a one-dimensional or two- dimensional
barcode
has a series of black stripes and white spaces of varying widths that correspond to letters and numbers that represent patient information.
one-dimensional barcode
use rectangles, dots, and other geometric patterns in two dimensions to represent patient information.
Two-dimensional barcodes
normally contain copies of the barcode that can be peeled off and placed on the specimens.
Manual requisitions
Barcode information can be scanned into a computer using a
special light or laser
allow for fast, accurate processing, and their use has been shown to decrease laboratory errors associated with clerical mistakes.
Barcode systems
requires a series of steps that must be performed to assure that the specimen is collected from the correct patient in a timely manner under the required conditions and in a professional manner that is safe for both the patient and the phlebotomist.
Blood specimen collection by venipuncture
Blood collection procedures legally begin with
test request
This is the first step for the laboratory in the preexamination or preanalytical (before analysis) phase of the testing process.
test request
is the highest priority. must be collected immediately and delivered to the laboratory immediately
STAT, which means immediately
are the next priority and must be collected as close to the specified time as possible.
Timed specimens
is a second or third priority depending upon the test
ASAP, which means as soon as possible
are the last priority.
Routine specimens
are second or third priority depending on the test like ASAP
Preop (before an operation) and postop (after an operation)
is the fourth priority
Fasting (no food or drink except water)
has no special priority but is something the phlebotomist should know,
NPO (no food or drink including water)
has no special priority but is something the phlebotomist should know
NPO (no food or drink including water)
also have no priority
Routine specimens
take priority over all others for both inpatients and outpatients.
STAT requests
the process of recording in the order received.”
accession
take steps to unmistakably connect the specimen and the accompanying paperwork with a specific individual.
accession a specimen
When a test request is accessioned, it is assigned a _______ used to identify the specimen
unique number
is different from the patient ID number or the healthcare facility number assigned to that patient at admission
accession number
Fall-colored leaf symbolizing
fall precautions
Falling leaf with a teardrop symbolizing
loss of a newborn.
is a way to transmit a
message, normally understood by healthcare personnel only, over the facility’s public address system.
code
uses numbers or words to convey information needed by healthcare personnel to respond to certain situations.
code
collection rounds scheduled at regular intervals throughout the day
sweep
the process of verifying a patient’s identity, is the most crucial step in specimen collection. It should not be rushed or any part skipped to save time.
Patient identification (ID),
To avoid identification and mislabeling errors, some inpatient facilities require what is referred to as ____ in which the patient is identified by three means:
Three-Way ID
three-way ID, in which the patient is identified by three means:
patient’s verbal ID statements, a check of the ID band, and a visual comparison of the labeled specimen
involves trouble concentrating, learning, remembering, and making decisions. It can be caused, for example, by depression, medication side effects, and dementia.
Cognitive impairment
is a state that is significantly different from the normal waking state of a conscious person.
altered mental state
needle phobia Symptoms
pallor (paleness), profuse sweating, light-headedness, nausea, and fainting. In severe cases, patients have been known to suffer arrhythmia and even cardiac arrest.
persistent irrational fear of pins and needles is called
belonephobia It is derived from the Greek word belone, meaning needle, and phobos, which means fear
The total time required fasting is usually
8 to 12 hours.
Inpatients normally have blood drawn while ______ in their beds.
Recumbent Patients
A tourniquet is applied
3 to 4 in above
tourniquet is applied 3 to 4 in above (i.e., proximal to) the intended venipuncture site to
restrict venous blood flow and make the veins more prominent
tourniquet closer to the site, the vein may
collapse
it is too far above the site
ineffective
When drawing blood from a hand vein, the tourniquet is applied ______ to the wrist bone.
proximal
When drawing blood from a hand vein, the tourniquet is applied _______ to the wrist bone.
proximal
tourniquet should be tight enough to
slow venous flow without affecting arterial flow
tourniquet that is too tight may
prevent arterial blood flow
are the last-choice veins because they are near the median nerve and brachial artery, which could be nicked or punctured accidentally.
basilic and median basilic veins
state of being freely open
patency
distended from being filled with blood)
turgid
Do not select a vein that feels hard and cord-like or lacks resilience, as it is probably
sclerosed or thrombosed
are also hard and lack resilience
tendons
helps locate veins and differentiate them from other structures.
Rotating the patient’s arm slightly
If no suitable AC vein can be found in either arm, check for veins on the
back of the hand or wrist.
Do not use veins on the
palmar (underside) of the
wrist or the lateral wrist above the thumb to mid-forearm
Allow the cleaned area to dry naturally for
30 seconds to one minute.
