Venipuncture

Question 1

IV sites to avoid (8)

Answer 1

1) . areas of infection/cellulitis
2) . skin rashes
3) . new tattoos
4) . extensively scarred areas
5) . same side upper extremity of mastectomy
6) . hematoma present
7) . IV line or fluids
8) . arm with fistula or canula

Question 2

potential complications of IV insertion? (5)

Answer 2

1) . cellulitis
2) . phlebitis
3) . thrombosis
4) . vein laceration
5) . hemorrhage/hematoma
* complications increase with repeated puncture at site

Question 3

what is serum?

Answer 3

substrate that remains when fibrinogen is removed from plasma

Question 4

where is the cubital fossa?

Answer 4

triangular hollow area on anterior aspect of elbow

Question 5

which two veins are most prominent for venipuncture?

Answer 5

cephalic and basilic

Question 6

best vein for vacutainer procedure?

Answer 6

median cubital (then cephalic, then basilic)

Question 7

what happens if tourniquet is too close to venipuncture site?

Answer 7

vein may collapse

Question 8

how to do vacutainer procedure?

Answer 8

stretch skin downward with nondominant hand, insert needle bevel up halfway into vessel, hold needle steady while inserting/replacing tubes, fill tubes 3/4 full, release tourniquet and allow pt to relax when last tube is filling

Question 9

order of draw

Answer 9

1) . cultures (purple and green)
2) . light blue (full draw-coag)
3) . red (chem tests)
4) . gold (chem tests)
5) . green then lavender (requires full draw and inversion 8x- heme test)
6) . gray (full draw- lithium, sodium, heparin, glucose)
7) . dark blue

Question 10

after filling syringe with blood, which size needle do you switch to in order to fill tubes?

Answer 10

18 or 19 gauge

Question 11

what do you do if you stick an artery?

Answer 11

apply firm steady pressure for 10 mins

Question 12

MAX time to leave tourniquet on?

Answer 12

2 minutes (hemoconcentration)

Question 13

what can happen if you draw syringe plunger back too forcefully?

Answer 13

can shear cells and collapse BVs

Question 14

never draw blood above ____ site

Answer 14

IV

Question 15

don’t use what material when drawing blood alcohol level?

Answer 15

alcohol swabs

Question 16

how long are blood cultures incubated for?

Answer 16

7-14 days at 35 degrees celsius

Question 17

indications for blood cultures? (9)

Answer 17

• Suspicion of bacteremia/sepsis
• infective endocarditis
• central line infection
• meningitis
• osteomyelitis
• septic arthritis
• bacterial pneumonia
• fever of unknown origin
• monitor efficacy of tx for blood-borne infections

Question 18

contraindications for blood cultures (3)

Answer 18

1) . coumadin (benefit vs risk)
2) . active skin infections
3) . multiple previous neg BCs for same reason

Question 19

how many sets of blood cultures do you get?

Answer 19

2 sets from 2 different sites

Question 20

blood cultures procedure (7)

Answer 20

1) . apply tourniquet 3 inches above site, locate vein, release tourniquet
2) . clean site with alcohol (2-3 circles inside to out)
3) . clean site with iodine 2-3x in same manner
4) . replace tourniquet and remove iodine with alcohol swab
5) . perform syringe venipuncture or vacuum tube
6) . swab top of culture bottle before blood insertion (alcohol swab)
7) . remove tourniquet after first tube is filled