VENIPUNCTURE (NEEDLE AND SYRINGE) Flashcards
The most frequently performed procedure in
phlebotomy
Venipuncture
is the general term for the blood collection
Phlebotomy
types of phlebotomy
- Venipuncture
- Capillary Puncture
- Arterial Puncture
All phlebotomy (specimen collection) procedures begin with the receipt of a___________
test requisition form
must contain certain basic information
to ensure that the sample drawn and the test
results are correlated with the appropriate patient
Requisition form
states which ward is the
patient and the floor, with the room number
(pediatrics, surgical, etc.)
Patient’s location
(t/f)
In the Philippines, the number of requisition
form can be more than 1 for each patient
(chemistry tests, blood-relates [hematology],
urinalysis, fecalysis, etc.)
TRUE
(TRUE OR FALSE)
Some specimens will be requested immediately
or upon receipt of the requisition form, and
some requests will have a specific time
[Example: A patient has malaria, which have
certain periods of activity during the day, so for
the doctor to have an accurate diagnosis, he will request a CBC or a differential smear in a
certain date or time, more specifically, time.]
true
if it is ASAP, immediate collection, etc.
Status of sample
usually found in barcode systems wherein this
information is found
Number and type of collection tubes
T OR F
If the test requested by the physician includes
that a patient should be fasted, it could be
indicated in the form [ask the patient when is
his last meal, if over fasted or under fasted, do
not collect]
true
TRUE OR FALSE
Ask the patient if he is allergic to latex [non-
latex tourniquet and gloves should be readied]
true
(true or false)
To ensure that the blood is drawn from the right patient, identification is made by comparing information obtained verbally and from the patient’s wrist ID band with the information on the requisition form. (CLSI)
true
(true or false)
When confined, you will be given a wrist ID
band that will be barcoded (for some) or
handwritten. Nevertheless, you, as a
phlebotomist, should confirm the identification
of the patient.
true
preferred site for venipuncture is the _______ located anterior and below the bend of the elbow
antecubital fossa
tourniquet should last
in only 1 minute) If exceeded, you are forming something called
hemoconcentration
two functions:
- Impedes venous blood flow, causing blood to
accumulate in the veins making them more
easily located
- Provides a larger amount of blood for collection
tourniquet
should be worn when performing a
venipuncture procedure! (OSHA Mandate)
Gloves
Located near the center; preferred vein for
venipuncture because it is large, stationary, least painful due to less nociceptor and bruises less easily
MEDIAN CEPHALIC VEIN
Lateral aspect; second choice; hard to palpate but fairly well anchored and the only vein can be felt in obese
CEPHALIC VEIN
Medial side; not well anchored and rolls easily, high risk of puncturing median cutaneous nerve or the brachial artery
BASILIC VEIN
have 2 choices of the median vein
M pattern
1 choice of median vein
H pattern
• 70% Isopropyl alcohol
• Concentric circles (2-3 inches in diameter)
CLEANSING THE SITE
• Check equipment for defects
- Experimentation dates
• Check needle and syringe if properly screwed
• Extra tubes should be near at hand
• Do not place collection tray on patient’s bed
- Use the bedside table
ASSEMBLY OF EQUIPMENT
IMPORTANT: RE-APPLY TOURNIQUET FIRST
- Examine needle – BEVEL UP (butas ng needle;
should be pointed upwards) - Anchoring Vein
- Insertion of Needle (30-40 degrees)
- Filling Tubes
- Removal of Needle
PERFORMING THE VENIPUNCTURE
- Disposal of Needle
- Labelling Tubes (full name, age, sex, date and
time of collection, initials of the phlebotomist
[include the time of the last meal of the patient,
if fasting]) - Bandaging Patient’s Arm
- Disposing Used Supplies
- Leaving Patient (check the patient if the patient
is fine [numbing, signs of nausea, pain]
REMOVE TOURNIQUET BEFORE NEEDLE
Seek assistance form attending nurse/nurse station to locate patient
UNAVAILABLE PATIENT
The ideal time to collect blood from a patient:
- Refrained from strenuous exercise
- Has not ingested food or beverages except
water for 12 hours
- The patient did not change position for 10-15
mins.
BASAL STATE
Increase in the number formed elements in blood
due to decrease plasma volume
• Happens on prolonged tourniquet application!
- Follow the 1 minute during the first tourniquet
application
- The second tourniquet application, you can go
as far as 2 minutes
HEMOCONCENTRATION OR VENOUS STASIS
• Tourniquet and needle should be removed,
pressure applied to the site, and summon help
- If the needle is first removed because of
seizure, recap then detach the tourniquet
- If seizure is controlled, follow the procedure
[tourniquet is removed first, before the needle]
• Restrain the patient only to the extent that injury is prevented
• Document the time that the seizure started and stopped according to institutional policy
• Make sure that the patient do not further harm himself
SEIZURES
• Small, nonraised red hemorrhagic spots
- Will appear immediately
• May have prolonged bleeding following
venipuncture
- Expect bruising later on; avoid hematoma
- Patients that have platelet disorders are
common to this
• Additional pressure should be applied to the
puncture site following needle removal
PETECHIAE
• If the patient is nauseated, instruct the patient to breathe deeply and slowly; apply cold compresses to the patient’s forehead
• If the patient vomits, stop the blood collection and provide an emesis basin or wastebasket and tissues
• Notify the patient’s nurse or designated first aid personnel
VOMITTING
• May result in loss of movement to the arm or hand
• Permanent injury in the venipuncture procedure is
damage to the median antebrachial cutaneous
nerve
NERVE INJURY
Shooting pain, electric-like tingling or numbness, running up or down the arm or in the fingers of the
arm
SIGNS
DELAYED LOCAL COMPLICATIONS
Formation of blood clots inside the lumen of the vein due to trauma
THROMBOSIS OF VEINS
DELAYED LOCAL COMPLICATIONS
Inflammation of the vein caused by thrombus
THROMBOPHLEBITIS
DELAYED LOCAL COMPLICATIONS
• Blue or black skin discoloration commonly due to repeated trauma or puncture of the veins
• Most common one (pagpapasa)
- If the needle penetrates through the vein
- The vein is fragile
- Fishing through the patient’s vein
HEMATOMAS
AREAS TO AVOID
• Damaged veins
• Hematoma
• Edema Burns
Arm on the same side of a mastectomy
IV Therapy
COMMON DIFFICULTIES ENCOUNTERED DURING COLLECTION AND PROCESSING OF BLOOD
HEMOLYSIS and LIPEMIA OR LACTESCENSE
This is caused by transient rise
in chylomicrons following a meal containing fat
- Can be used after doing more
procedures in the specimen
• It causes interference with large
number of chemical analyses because
of turbidity
• It disturbs the following
investigations particularly strongly: - Amylase
LIPEMIA OR LACTESCENSE
