Venipuncture Procedure Flashcards
Venipuncture
What are the contraindications? — 8
— skin infection, rash, tattoo
— scarring
— phebitis, sclerosed veins
— lymphoedema
— hematoma
— IV infusion catheter distal to the site of v.p
— arm with cannula in place
— fistula an abnormal connection between two body parts, such as an organ or blood vessel and another structure
Venipuncture
What are some complications — 6
— vasovagal syncope
— cellulitis, phlebitis
— bruising
— laceration of the vein
— haemorrhage/hematoma
— patients with coagulopathies may have prolonged bleeding after
A hematoma is defined as a solid swelling of clotted blood within the body’s tissues. Ecchymosis is a skin discoloration that results from bleeding underneath the skin and usually larger than 1 cm or . 4 inches
Blood is how much % of total body weight?
6-8%
What is serum?
Substrate remaining when the fibrinogen has been removed from the plasma
What is plasma?
Blood plasma is a light amber-colored liquid component of blood in which blood cells are absent, but contains proteins and other constituents of whole blood in suspension.
What are the three types of blood cells?
Erythrocytes (RBCs)
Lymphocytes (wbcs)
Thrombocytes (platelets)
Describe steps in patient prep 7
— review procedure w/ patient
— ask about prior surgeries
— ask about prior experiences with v.p
— ask about anticoagulant use
— inform pt about stinging and bruising
— instruct to remain still
— answer all qs
What materials are required? 13
— gloves x 2
— tourniquet 3/4 inch to 1 for adults 1/8 inch for kids
— gauze pads
— isopropyl alcohol pads 70%
— povidone iodine
— evacuated tubes
— labels
— adhesive strips
— sharps container
— biohazard waste
— single draw needle (18-23 gauge) or butterfly (21, 23, 25)
— vacutainer holder
— bandaid
After you’ve gathered supplies, palpated vasculature and placed the tourniquet, what’s the next step?
Ask the pt to make a fist with their hand
How large an area should you sanitize and how long do you wait to dry?
2 inches
5 seconds
How do you anchor the vein?
How do you insert the needle? 2
How full ?
— anchor distal to the site
— bevel up
— 15-30 degrees
— 3/4 full
When do you release the tourniquet?
After you’ve let the tube fill 3/4 full
What are the best veins in order of preference?
MCB
— median cubital
— cephalic
— basilic
Tips for finding difficult vein 4
— keep extremity low
— apply a warm towel < 42 degrees for 2 minutes
— use a blood pressure cuff
— rub/tap the vein
Where do you place the tourniquet?
3-4 inches above site
Never leave the tourniquet on for?
More than 2 mins
Why do you need to let alcohol dry?
Alcohol lyses RBCs and will sting
What prevents occurrence of haemorrhage and hematoma at puncture site?
Slower insertion and correct angle
If hematoma develops, what do you do?
Remove tourniquet, need and maintain pressure for 10 mins
Or 15 for pts on anticoagulants
With syringe blood collection, what should you not do?
Do not use the plunger to fill the tubes
How long should pressure be applied after procedure?
3-4 minutes or until bleeding stops
5 mins for pts on anticoagulants
What should be on the vacutainer label? 6
— name
— pt number
— date drawn
— time drawn
— amount drawn
— initials of person drawing blood
If you have to use the ipsilateral IV arm, what do you do? 3
— turn off IV for 2 mins, if possible
— draw blood from another vein
— discard first 5ml
When should you not use alcohol wipes for cleansing?
When drawing blood for alcohol specimen
What is a sign the vein has collapsed?
Blood stops flowing
What can happen if you leave the tourniquet on for more than 2 minutes?
The hydrostatic pressure causes some water and filterable elements to leave the Extracellular space
After how many unsuccessful attempts do you stop and ask for assistance?
Three
In the skills check off, which five things do you have to verbalise?
— ask pt to make a fist
— performing: I am inserting the needing into the vein with the bevel up and at a 15-30 degree angle directly over and parallel to the vein
— I am letting the tube fill 3/4 full
— (release the tourniquet) you can relax your hand now
— (to the patient) could you please hold pressure on the gauze
fist — performing — 3/4 — relax — pressure
Red top is for? — 4
— chemistry
— immunology
— serology panels
— blood bank
Gold top is for?
— chemistry
— immunology
— serology
Light blue top is for?
Draw amount?
Coagulation (thrombin and prothrombin times)
full draw
Green or lavender top is for?
Draw amount?
Haematology or blood bank
full draw
Gray top is for?
Draw amount?
Lithium level
Sodium heparin level
Glucose
full draw
Syringe is for?
Blood cultures
