Venipuncture Procedures Flashcards
- Process of collecting or “drawing” blood from VEIN
- MOST common way to collect blood specimens for laboratory testing
Venipuncture
3 methods of venipuncture
- syringe method
- evacuated tube system
- butterfly
Step 1-5 in blood collection?
1.Review and Accession test Request
2.Approach, Identify, and prepare Patient
3.Verify Diet restrictions and Latex Sensitivity
4.Sanitize hands
5.Position Patient, Apply torniquet, and ask patient to make a fist
Step 6 - 10 in blood collection?
6.Select Vein, Release torniquet, and ask patient to open fist
7.Clean and air-dry the site
8. Prepare equipment and put on gloves
9. Reapply tourniquet, uncap and inspect needle
10. Ask patient to remake a fist, anchor vein, and insert needle
Step 11 - 15 in blood collection?
- Establish blood flow, release the tourniquet, and ask patient to open fist
- Fill, remove, and mix tubes in order of draw or fill syringe
- Place gauze, remove needle, activate safety feature, and apply pressure
- Discard collection unit, syringe needle, or transfer device
- Label tubes
Step 16 - 20 in blood collection?
- Observe special handling instructions
- Check patient’s arm and apply bandage
- Dispose of contaminated materials
- Thank patient, remove gloves, and sanitize hands
- Transport specimen to the lab
What are 3 skills used in phlebotomy?
1.Social Skills (Interpersonal)
2.Administrative/Clerical Skills-most errors in the laboratory
3.Technical Skill
- Ordering physician’s name
- Patient’s firstand last names and middle initial
- Patient’s medical record number (if inpatient)
- Patient’s date of birth or age
- Room number and bed (if inpatient)
- Type of test to be performed
- Date test is to be performed
- Billing information and ICD-9 codes (if outpatient)
- Test status (e.g., timed, fasting, priority)
- Special precautions (e.g., latex sensitivity)
- Accessioning number
- Department or location where to do the test
Information included in Test Request Form/Requisition Form
A number to identify all paperwork and supplies associated with each patient
Accession Order in Test Request form
contain the actual labels that are placed on the specimen tubes immediately after collection
Computerized (test request form)
- Multipart carbon form
- Imprinting plate
Full name, ID #, Rm#, Physician’s name, Request tests (handwritten only) - Can be given to the phlebotomist or the patients
Manual (test request form)
print out at a special computer terminal at the phlebotomist station in the laboratory
Computer requisitions for inpatients (receipt of test request)
- laboratory requisitions or prescription slips with test orders written on them by their physicians
- responsible for taking them to a blood collection site
Outpatients (receipt of test request)
In reviewing the test request, the phlebotomist must?
- Check to see that all required information is present and complete.
- Verify the tests to be collected and time and date of collection.
- Identify diet restrictions or other special circumstances that must be met prior to collection
- Determine test status or collection priority
- Process of recording in the order received
- This means to take steps to unmistakably connect the specimen and the accompanying paperwork with a specific individual
- It ensures prompt and accurate processing from receipt of the order to reporting of test results.
Accesioning of Test Request
- Organized and effective and efficient
- Arrange the requisitions according to priority
- Review the requisitions in order to see what equipment is in cart or tray before going to the patient
- Outpatients, summoned from waiting area according to arriva
Approaching the patient
- Looking for signs-“code”
- Entering a patient’s room
- Physicians and ClergyFamily and Visitors
- Unavailable Patient
- Obtaining Consent-“patient’s consent”
- Bedside manner
- Define as the behavior of thehealthcare provider towards the patient
- Introduce yourself
approaching patients
Define as the behavior of the healthcare provider towards the patient
bedside manner
- Gaining the patient’s trust
- Introduce yourself to the patient
- Give your name, your title and why you are there
- Immediate role in his/her care
- How long the procedure will take
- What you are going to do
- Never give false assurance to the patient
greeting the patient
- Most important step in the collection process
- Results will be wrong if the sample is not identified correctly
- Ask the patient to state his/her full name and DOB
- CLSI recommend to let patient spell the last name
- Check ID Bracelets
Patient identification
What information can be found in an ID band?
Name, ID #, Medical Record Number, DOB, Age, Room, Bed and Physician/s name
What information can be found in a 3-Way ID?
Patient’s verbal ID statement, check of ID band, comparison of labeled specimen and patient’s ID before leaving the bedside
Patient identification procedures (state of patient): Ask full name (verbally), confirm using ID bracelets
Conscious Inpatients/Hospitalized patients
Patient identification procedures (state of patient): Same as conscious, awakened before collection
Sleeping patients
Patient identification procedures (state of patient): Ask relative or nurse or physician and record name of person, ID bracelets
Unconscious
Patient identification procedures (state of patient): Ask relative or nurse and record name of person, ID bracelets
Infants and Children and Mentally Incompetent
Patient identification procedures (state of patient):
* Receptionist verifies the ID of the patient
* Patient may show ID
* Clinic issued ID CARD
* State full name, date of birth and spell the last name
outpatient/ambulatory patients
Patient identification procedures (state of patient):
* Assign a temporary number to patient and record it on test forms
* Fill out labels by hand or computer and apply them to the test request and specimens after collection
* When a permanent number is issued, it must be cross referenced to the temporary number
* Attach an ID band or device to the patient that has name and temporary number on it.
-> 3 part identification band
Emergency room patients
What to do in case of ID discrepancies?
- Notify the nurse
- Do not obtain until discrepancy is addressed and the ID has been verified
If there are no (ID) band on wrist, where should we check?
ankle
In the case of missing ID, what does IV pole and night table bed mean?
may not belong to patient
What to do when a burn patient has missing ID?
verbal statement of ID, confirm ID by a nurse or relative then ask for their name
“Ask the nurse to put ID band before collecting specimen” this is done when?
there is missing ID
What is that thing we should never do in the case of a missing ID?
NEVER verify information from an ID band not attached to the patient or collect a specimen from an inpatient who is not wearing an ID band
What to do to prepare patient for blood collection?
- Explaining the procedure
- Addressing Patient Inquiries
- Handling Patient Objections
- Addressing Needle Phobia
- Addressing Objects in the Patient’s Mouth
Most common diet/fasting for blood collection?
Most common is fasting (8-12 hrs
- Can be life threatening
- If with allergy, use equipment/materials with no latex or latex free
Latex sensitivity
- Proper hand hygiene
- Preferably done in the presence of the patient
- Sanitize or decontaminate hands
- Observe infection control and isolation policies
- Prevent spread of disease and to protect the patient
- Gloves are usually put on at this point
- Other prefers to wait until after vein selection
sanitize hands
Position of the patient?
- Arm in a downward and comfortable manner not bent on the elbow
- Out patients-Seated or reclined
- Inpatients-lying down in their beds
- NOT STANDING nor SITTING in a TALL STOOL
- Chair with adequate arm support
purpose of tourniquet?
- Obstruct the venous blood flow
- Make the veins prominent
What is the distance from the site in which the tourniquet will be placed?
3 - 4 inch above the site
How long should a tourniquet be applied on?
applied not longer than 1 minute
Blood pressure cuff?
60 mmHg (between systolic and diastolic pressure)
after applying the tourniquet, what should we ask of the patient?
Make a fist or clench
When locating a vein, what does it feel?
- Soft and bouncy to touch
- Determine roundness, direction and depth of vein
- Felt the vein using the tip of the ____ or ____ fingers
- ____ has different angles or cross the arm going side to side
- If there is pulse when you pulsates, that is an ____
- Avoid puncturing ____ and ____
- index or middle
- Veins
- artery
- tendons and nerves
In vein selection:
* Select the most _____ vein
* Always choose the ___vein
* Enhance vein _____
- prominent
- best
- prominence
Order of checking for the best available site (vein)?
(1) Upper arm, (2) hand, (3) wrist, (4) foot or ankle
Appropriate sites
Sites:
Newborns a.Scalp
b.Popliteal
c.Jugular
d.Dorsal of the hand
Sites to be avoided?
a.IV lines in both arms
b.Areas with Hematoma
c.Burned or scarred areas
d.Thrombosed veins
e.Edematous arms
f.Partial/Radial mastectomy
g.With AV shunt or fistula
h.Cast (s) on arm (s)
If a suitable vein is not felt on the first arm, remove the tourniquet and try the ______
other arm or other sites.
What to do if a suitable vein cannot be found?
- Massage the arm from wrist to elbow
- Wrap a warm, wet towel around the arm or hand for a few minutes
If an appropriate site is found, you can mark the vein’s location by???
- Do not use pen
- Use alcohol pads
When a tourniquet is used for preliminary vein selection, it should be released and reapplied after ____ (time)
two minutes
If a vein has already been chosen, decontaminate the patient’s skin with an ________
alcohol pad or cotton with alcohol.
How to decontaminate patient’s skin with alcohol pad or cotton with alcohol?
- Disinfection of the site for puncture
- Circular motion from in to outside.
- Must remove excess alcohol with dry cotton not by blowing on it.
- No traces of alcohol should remain (Cause hemolysis and contaminate glucose testing)
4 disinfectant used to clean and air-dry the site
- 70% isopropyl alcohol
- Iodine
- Chlorhexidinegluconate/isopropyl alcohol
- BenzalkoniumChloride (ZephiranChloride)
- Positioning equipment for use:
- Place ______ and other supplies such as gauze and alcohol pads and extra supplies within easy reach
- Caution: Do not place the _____ on patient’s bed or any other place that could be contaminated by it.
- collection equipment
- phlebotomy tray
Perform the venipuncture:
* Re-apply the tourniquet. Ask the patient to _____ to make veins more prominent.
* Anchor the ___
* Avoid fist _______ (Can cause ________)
* Pull the skin gently with the thumb, and position the needle _______ or running in the same direction as the vein.
- close his fist
- vein
- clenching or vigorous hand exercise (Hemoconcentration)
- parallel
- Insert the needle quickly, bevel side up.
- Align the needle (_____ up)
- ___ angle with the skin
- The more superficial the vein the ____ the angle
- Slight “pop” should be felt as the needle ____
- bevel
- 15-30 degree
- lower
- enters the vein
- Needle specifications
- Small bore can cause ____
hemolysis
- For Syringe Method:
Using _____ hand
Held the syringe in a manner that the ___ is facing upward
Grasp the arm with the ______ hand
Do not enter the vein at _______
Feeling the ____ as you enter the vein
____ is used to pull the plunger
Pulling the plunger ___
dominant
bevel
non dominant
exact point you felt the vein
“pop”
Non-dominant hand
slowly
For syringe method, when should we remove the tourniquet?
- As soon as blood flow is established
- May move the needle or vein
- ALWAYS remove before withdrawing the needle on the arm.
Two methods of transferring blood in syringe method?
- Using transfer device
- puncturing the stopper of the tube
Blood transfer method in syringe method in which: Removed the used needle then change it with the transfer device, then slipped the tube inside
Using transfer device
Blood transfer method in syringe method in which:
* Used when there’s no transfer device available
* Used needle is removed and used a new needle
* Place the evacuated tubes in a tube holder then puncture the stopper of the tube
Puncturing the stopper of the tube
- For Evacuated Tube System
Follow the same steps as the syringe with slight variation
_____ created is on the tube
Advantage: For multiple sample, do not need to change syringe, only ______
Holder and needle are held the same manner as the ____
Non-dominant hand is used to _____
- Vacuum
- tubes
- syringe
- change tubes
For Evacuated Tube System
When to remove the tourniquet?
Tourniquet can be left on until after tubes have filled if blood flow is slow
ALWAYS remove torniquet before withdrawing needle
For Evacuated Tube System:
* For multiple draw?
Carefully remove each tube from the holder with a gentle twist and pull motion. Follow the order of draw
- Can use either evacuated tubes or connected to a syringe
- Uses Luer adapter
Butterfly (Winged Infusion Set)
At what degree angle is a butterfly needle inserted?
5 - 10 degrees angle
When to use butterfly (winged infusion set)?
Small veins in the antecubital area or access veins in the back of the hand [Same steps as the evacuated tube system]
Order of Draw:
1.Sterile blood culture tubes-Yellow
2.Coagulation tubes-Light blue
3.Serum tube/ Plain tube-Red
4.Heparin tube-Green
5.EDTA tube-Lavander/Purple
6.Anti-glycolytictube/ Fluoride-Gray
After blood collection:
Withdraw needle with a quick motion, Hold a dry cotton or gauze pad over the ______.
MUST and ALWAYS: Recap needle but _______. Just Fish out
Apply _____on the site
site
DO NOT RECAP with BOTH HANDS
pressure
How long should pressure be applied in the site after blood collection?
3 - 5 mins, max of 15 mins
What is the purpose of applying pressure on the site after blood collection?
To stop the bleeding
___ and _____ is discarded as single unit
_______ may be removed and discarded separately
- Needle and tube holder
- Syringe safety needle
Syringe connected to a transfer device for transfer of blood, after that, dispose as single unit (syringe attached on the transfer device)
safety syringe
CAUTION: ______ regulations prohibit cutting, bending, breaking or recapping blood collection needles or removing them from tube holders after use.
OSHA
All samples should be labeled after ______ and before ____
- the blood is drawn
- the phlebotomist leaves the patient
DO NOT label the tubes before _______
the blood sample is drawn.
Data labeled by computers?
collection date, Time of collection, Phlebotomist’s initials
Hand-labelled information?
The patient’s first and last names
An identification number such as date of birth
The collection date
The time the sample was collected
The initials or name of the person collecting the sample
What is computer labelling showed/represented by?
Bar code
In computer labelling, what does the bar codes show?
What test to run, What patient the test is on
Results automatically enter the patient’s record
Speed up computer entry of results and eliminate clerical errors
why are labels adhesive?
Adhesive so they are directly attached to the tube
What to do after collecting/labelling sample?
Observe special handling instructions.
Check the condition of the patient before leaving.
Dispose the used materials.
Needle, cottons, syringe
Thank the patient. Remove gloves and sanitize the hand.
Transport the specimen to the laboratory.
Complications of venipuncture:
Excessive pull of plunger
Piercing the other pole of the vein
Transfixation of vein
Incorrect bevel position
Absence of vacuum
Failure of blood to enter syringe
complications of venipuncture:
Increase in the number of formed elements in the blood
Hemoconcentration
Complications of venipuncture: Product of blood escaping from the punctured vein and goes to the surrounding tissue
hematoma
Complications of venipuncture:
Causes:
Fragile vein
Needle pentrated through the vein
Needle is partially inserted
Excessive or blind probing
Needle is removed while the tourniquet is still on
Pressure is not adequately applied after venipuncture
hematoma
Remedy for hematoma?
- Ice applied in the first 24 hours (After 24 hours, apply warm compress)
4 immediate local complications of venipuncture
- hemoconcentration
- failure of blood to enter syringe
- hematoma
- bleeding
2 late local complications of venipuncture?
- thrombosis
- thrombophlebitis
Late local complication of venipuncture:
Abnormal vascular condition
Thrombus development within the blood vessel
thrombosis
late local complication of venipuncture:
Inflammation of the vein accompanied by a clot
Result of trauma to the vessel wall
thrombophlebitis
Intermediate general complication of venipuncture: Due to blood extraction
circulatory failure
Intermediate general complication:
Transient loss of conscience due to lack of Oxygen in the brain
Inability to stay in an upright position
Anxiety or worriednessof the patient because of the procedure
Remedy: Ammonia, enhance circulation of blood supply to the brain
Seated patient feels faint, withdraw needle, head lowered between legs and patient breath deeply
syncope (fainting)
2 intermediate general complication?
- circulatory failure
- syncope (fainting)
late general complications of venipuncture (4)
- hepatitis
- AIDS
- Anemia: IDA, latrogenic anemia
- nerve injury
late general complications of venipuncture:
Nerves contacted by needle
Improper vein selection
nerve injury
Pain
Nausea
Diabetic shock
Convulsions
Skin Allergies
other patient’s possible reaction
breaking or rupturing of the membrane of the red blood cells
hemolysis
Drawing from a hematoma
Rupturing of red blood cells using small needle bore
Excess alcohol on puncture site
Leakage of air due to not attached syringe to needle
Pulling back the plunger too fast
Temperature extremes
(causes of) hemolysis
Yellowish or orange color of the serum due to high bilirubin level in the blood
Jaundice
White and milky color due to large amount of fats and lipid
Lipemia
Techniques to enhance vein and recover a failed venipuncture?
- Retie the tourniquet.
- Use a blood pressure cuff in place of the tourniquet.
- Massage the arm. Do not slap the arm.
- Lower the patient’s arm.
- Warm the venipuncture location.
- Reseat the tube in the holder.
- Use a different tube.
- Place your finger below the venipuncture site and stretch the vein slightly.
- Rotate the needle one-quarter to one-half a turn.
- Pull back or advance the needle slightly.
If the first try of venipuncture fails, what should be the next step?
If the first try fails, evaluate the problem and try on the other site
Try below the first site, opposite arm, hand or wrist vein
If veins are small or fragile, _______ on 2nd attempt
use a butterfly or syringe method
If 2nd attempt at venipuncture is unsuccessful, what should we do?
ask another phlebotomist to take over, if still unsuccessful, let the patient rest then try again later
After 3 failed venipuncture attempts, If still cannot obtain blood, what should we do?
Notify the patient’s nurse and/or physician
