Venipuncture Procedure

Question 1

Venipuncture
What are the contraindications? — 8

Answer 1

— 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

Question 2

Venipuncture
What are some complications — 6

Answer 2

— 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

Question 3

Blood is how much % of total body weight?

Answer 3

6-8%

Question 4

What is serum?

Answer 4

Substrate remaining when the fibrinogen has been removed from the plasma

Question 5

What is plasma?

Answer 5

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.

Question 6

What are the three types of blood cells?

Answer 6

Erythrocytes (RBCs)
Lymphocytes (wbcs)
Thrombocytes (platelets)

Question 7

Describe steps in patient prep 7

Answer 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

Question 8

What materials are required? 13

Answer 8

— 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

Question 9

After you’ve gathered supplies, palpated vasculature and placed the tourniquet, what’s the next step?

Answer 9

Ask the pt to make a fist with their hand

Question 10

How large an area should you sanitize and how long do you wait to dry?

Answer 10

2 inches
5 seconds

Question 11

How do you anchor the vein?
How do you insert the needle? 2
How full ?

Answer 11

— anchor distal to the site
— bevel up
— 15-30 degrees
— 3/4 full

Question 12

When do you release the tourniquet?

Answer 12

After you’ve let the tube fill 3/4 full

Question 13

What are the best veins in order of preference?

Answer 13

MCB
— median cubital
— cephalic
— basilic

Question 14

Tips for finding difficult vein 4

Answer 14

— keep extremity low
— apply a warm towel < 42 degrees for 2 minutes
— use a blood pressure cuff
— rub/tap the vein

Question 15

Where do you place the tourniquet?

Answer 15

3-4 inches above site

Question 16

Never leave the tourniquet on for?

Answer 16

More than 2 mins

Question 17

Why do you need to let alcohol dry?

Answer 17

Alcohol lyses RBCs and will sting

Question 18

What prevents occurrence of haemorrhage and hematoma at puncture site?

Answer 18

Slower insertion and correct angle

Question 19

If hematoma develops, what do you do?

Answer 19

Remove tourniquet, need and maintain pressure for 10 mins
Or 15 for pts on anticoagulants

Question 20

With syringe blood collection, what should you not do?

Answer 20

Do not use the plunger to fill the tubes

Question 21

How long should pressure be applied after procedure?

Answer 21

3-4 minutes or until bleeding stops
5 mins for pts on anticoagulants

Question 22

What should be on the vacutainer label? 6

Answer 22

— name
— pt number
— date drawn
— time drawn
— amount drawn
— initials of person drawing blood

Question 23

If you have to use the ipsilateral IV arm, what do you do? 3

Answer 23

— turn off IV for 2 mins, if possible
— draw blood from another vein
— discard first 5ml

Question 24

When should you not use alcohol wipes for cleansing?

Answer 24

When drawing blood for alcohol specimen

Question 25

What is a sign the vein has collapsed?

Answer 25

Blood stops flowing

Question 26

What can happen if you leave the tourniquet on for more than 2 minutes?

Answer 26

The hydrostatic pressure causes some water and filterable elements to leave the Extracellular space

Question 27

After how many unsuccessful attempts do you stop and ask for assistance?

Answer 27

Three

Question 28

In the skills check off, which five things do you have to verbalise?

Answer 28

— 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

Question 29

Red top is for? — 4

Answer 29

— chemistry
— immunology
— serology panels
— blood bank

Question 30

Gold top is for?

Answer 30

— chemistry
— immunology
— serology

Question 31

Light blue top is for?
Draw amount?

Answer 31

Coagulation (thrombin and prothrombin times)

full draw

Question 32

Green or lavender top is for?
Draw amount?

Answer 32

Haematology or blood bank

full draw

Question 33

Gray top is for?
Draw amount?

Answer 33

Lithium level
Sodium heparin level
Glucose

full draw

Question 34

Syringe is for?

Answer 34

Blood cultures