VENIPUNCTURE PROCEDURE Flashcards
First step in Venipuncture Procedure
Prepare Request form of the Patient
Second step in Venipuncture Procedure
Greet and Identify the Patient
Out Patient (Conscious)
Ask patient to give their full name and spell their last name, Compare information on identification bracelet and request form
Sleeping Patient
Awaken a sleeping patient before venipuncture
Unidentified Emergency Patient
Use ID number on all tests; cross-reference if patient is already identified with the temporary number
Third step in Venipuncture procedure
Verify diet restriction, latex sensitivity, and other allergies
Sites to be avoided
- Burns, Scars, or tattoos
- Damaged veins
- Edema (high tissue fluid)
- Hematoma
- Mastectomy (lymph node removal)
- IV line, cannula, fistula
Order of Draw
- Blood Culture Bottles
- Coagulation Tubes
- Serum Tubes with or w/o clot activator/ gel serum separator
- Heparin Tubes with or w/o gel plasma separator
- EDTA Tubes
- Oxalate/fluoride, glycolytic inhibitor tubes
PROBLEMS ENCOUNTERED
- Pain
- Nerve Damage
- Nausea
- Syncope
- Diabetic Shock
- Convulsions
- Cardiac Arrest
- Continuous Bleeding
- Skin Allergies
- Hematoma
UNUSUAL BLOOD SPECIMENS
- Icteric
- Lipemic
- Hemolyzed
ICTERIC
px w/ jaundice; large amounts of bilirubin
LIPEMIC
px not fasting; large amounts of lipids/fats
HEMOLYZED
Contaminated w/ RBC Contents
Causes of Hemolysis
- drawing from a hematoma
- Rupturing of RBCs
- Alcohol on the site
- Pulling the plunger too forcibly
- Fast drip/expelling blood vigorously
- Redirecting
- Mixing tubes vigorously
POSSIBLE CAUSES FOR FAILED VENIPUNCTURE
- Vacuum at tube is not working
- Bevel against the vein wall
- Bevel inserted too far
- Needle partially inserted
- Needle slipped beside the vein
- Collapsed the vein
- Undetermined needle position
TECHNIQUES TO ENHANCE VEIN AND RECOVER A FAILED VENIPUNCTURE
- Retie the tourniquet
- Use a blood pressure cuff in place of a tourniquet
- Massage arm/ warm location
- Lower arm
- Reseat tube holder
- Use a different tube
- Place finger below site and stretch the vein slightly
- Pull back/ advance needle slightly
- Rotate the needle one quarter to one half turn
- 2 tries only
MOST COMMON ERRORS IN SPECIMEN COLLECTION
- Misidentification of px
- Mislabeling
- Short draws/wrong AC/blood ratio
- Mixing problems/clots
- Hemolysis/lipemia
- Hemoconcentration from prolonged tourniquet time
- Exposure to light/extreme temperatures
- Improperly timed specimen/ delayed delivery to lab
- Processing errors: incomplete centrifugation, improper storage
SPECIMEN CONSIDERATIONS
- Fasting
- Random
- Post-Prandial
- Basal state
FACTORS CONTRIBUTING TO THE VARIATION OF RESULTS
- Exercise
- Fasting
- Diet
- Position/Posture
- Tourniquet
- Smoking
- Alcohol ingestion
- Stress/anxiety
- Drugs
Exercise can increase
Blood glucose, lactic acid, serum proteins, muscle enzymes
Px did not undergo fasting:
Elevated blood glucose, potassium, lipids
Prolonged fasting:
Elevated serum bilirubin, TAG, glycerol, free FA, and decreased plasma glucose
High protein diet:
increased urea, ammonia, urates
Long time vegetarian
decreased LDL, VLDL, total lipid, phospholipid, cholesterol, TAG
