venipuncture - syringe method & evacuated tube system Flashcards
what are the advantages for ETS and syringe method
ETS: (closed system)
o direct and efficient - not time consuming and no need to transfer unlike syringe system
o allows collection for larger volumes and multiple tubes
syringe system: (needle and syringe)
o allows collection from patients with small, fragile, or weak veins
* Pediatrics = infants and children
* Geriatrics = elderly
what is the disadvantages of syringe system
higher risk of needle stick injury - cos there is many needle manipulations
what are the materials needed for blood collection
ETS:
multisample needle
tube holder
syringe system:
needle and syringe
transfer device
both:
complete ppe (gloves, face mask, lab gown) - N95 mask if patient has an airborne disease
torniquet
alcohol pads
bandages
evacuated tube
sharps container
what is the procedure for ETS method
- Receive, Review, and Accession the Test Request
- Approach, Greet, and Identify the Patient
- Explain Procedure and Obtain Consent (alw ask permission before touching the patient)
- verify collection requirements and identify sensitives and potential problems
- sanitize hands and put on gloves
visibly soiled - hand washing
not - hand disinfectants - position the patient, apply torniquet and ask the patient to make a fist
- place the arm straight downward, relax arm - select vein, release torniquet and ask the patient to open fist
[this is where u prep equipment and check the syringe and tubes] - clean and air-dry the site
- prepare equipment [while waiting for it to dry, double check the equipment, place tube on the rack based on their order of draw]
- select right equipment - reapply the torniquet and uncap and inspect the needle
- ask the patient to make a fist, anchor the vein and insert the needle
- establish blood flow, release the torniquet and open fist
- fill, remove and mix tubes in order of draw
- mix immediately/ invert after removal from hub - withdraw the needle, place gauze, activate the needle safety feature and apply pressure
- remove needle before placing hub - discard blood collection unit
- label and prepare tubes for handling and transport
- check the patient’s arms and apply a bandage
- dispose of used materials and reposition moved items
- items must be returned to their original position
-replenish supplies everyday - thank the patient, remove gloves and sanitize hands
- instructing fasting patients that they may eat - transport specimens to the lab promptly
- transport to the lab so that can process immediately
- pneumatic system
process of recording in the order of received tests wherein a unique number is assigned to identify the specimen or test order number
accession
is like giving each medical test or specimen its own “ID number” when it arrives at the lab
receive, review and accession the test request
complete details (full name, age, biological gender)
date and time of collection
priority
dietary restrictions or special circumstances
- history of fainting
- fasting
- allergy
- arm precautions
status designation
- ASAP, as soon as possible
urgent test need to be done right away
emergency situations
- TIMED
test must be done at specific times
ex: blood sugar test at exactly 2 hours after eating - ROUTINED
regular, non urgent test
can be done during normal lab hours
no specific time requiremnets
test request
ex: cbc
approach, greet and identify the patient
proper bedside manner
ask the patient to state and spell their name and DOB
verify collection requirements and identify sensitives and potential problems
fasting
previous problems during collection
allegies
fainting
what happens when the patient faint during drawing of blood
stop immediately and secure the patient in a reclined or recumbent position
why do you need to open the fist after palpating vein
to restore circulation, 2 minute rest
why do we have to always ask the nurse if the patient has diabetes
because patient w diabetes has viscous blood which travel slow/ slow circulation
what to do/ ensure when you are selecting a vein before puncturing it
to not leave the torniquet for more than a min
palpate veins at median > lateral, cephalic > medial, basilic > other arm
this requires written permission from MD
drawing blood at legs or foot
how do you clean the site
CLSI recommended:
friction scrub - back and forth movement
not recommended:
inward to outward, circulation method
what do you have to do when you want to repalpitate
gloved finger must be cleaned with alcohol
why do we have to airdry the site before drawing blood
to not make it painful
to avoid hemolysis as there might be contamination of alcohol
- dont fan, blow or dry the alcohol w gauze as it is sterile and to prevent from contaminating it
how do u anchor the vein
stretch the skin or “L” hold technique
needle insertion level
bevel up
less than 30 degrees needle insertion
- if shallow, smaller angle
- if deeper, arnd 30
*back flow - wait for a flash of blood to enter the needle hub
how do u insert the evacuated tube in the multisample needle
- Holder flange: middle and index finger
- Bottom of the tube: thumb
true or false:
release torniquet when there is a backflow of blood in the needle hub
false - Release tourniquet: after blood flow is established and not left >1 min
how long do u have to apply pressure at the site after blood collection
3 to 5 min
discard blood collection unit
Black Bin:
Yellow Bin:
Sharps Container:
Black Bin:
packaging of the syringe
Yellow Bin:
used cotton balls
gauze
prep pads
used tubes
Sharps Container:
needles
broken tubes
where do u place the tube during transportation
in an upright position in biohazard specimen bag during transport
* label (Full Name, Age/Gender, Date and Time of Collection, Date of Birth, Initials)
how long do u have to observe the site to check for signs of bleeding
5 - 10 sec
why should we tell the patient to limit exertion and pressure
prevent bruising and reopening the site
avoid:
Heavy lifting
Strenuous exercise
Excessive arm movement
what happens if the bleeding still occurs more than 5 minutes
notify the medical doctors
how long do u have to leave the bandage on for
15 - 30 min so that it is fully clotted
more than 30 min = skin irritation
Works like a bank drive-through tube system
Uses air pressure to move containers through tubes
Connects different parts of hospital/facility
Much faster than walking
pneumatic system
what is the procedure for syringe system
steps 1 - 12 are the same
- fill syringe
- slowly pull back the plunger - withdraw needle, place gauze, activate needle safety feature and apply pressure
- remove syringe needle and discard it in a sharps container
- attach the syringe hub to transfer device, rotating it to ensure secure attachment
- avoid leakage upon transfer
- reduce the risk of accidental needle stick injury and confines the aerosol or spraying that may e generated as the tube is removed - hold the syringe vertically w the tip down and transfer device at the bottom
- ensures tht tube fills from bottom to top
- do not push plunger as it may cause hemolysis
-upright position to avoid crossover contamination - place ETS tube in the transfer device, push it all the way to the end
- let the tubes fill the vacuum draw of the tube
- do not push the syringe plunger - when finished, discard the syringe and transfer device unit in a sharps container
step 16 - 20 are the same
why is bending of arms is not allowed after drawing blood
prone to hematoma
if hematoma occurs = instruct the patient to apply ice on the puncture site
what do u have to do in a procedural risk
stop, assess and correct
o two unsuccessful try = ask another phlebotomist
o whatever the reason of the inability to obtain specimen, notify the MD or RN
o arterial is not an alternative
o if patient refuses, try to convince up to two times if not make them sign the request form
REFUSED:
Patient’s Signature over
Printed Full Name
Phlebotomist’s Signature
over Printed Full
Name/Initials
Date and Time
what do u have to do in a procedural error and failure
▪ Failure to mix tubes immediately
▪ Pulling plunger too quickly
▪ Syringe was filled too slowly
▪ Failure to apply pressure on puncture site
▪ Failure to mix tubes immediately
clot formation (micro clots)
▪ Pulling plunger too quickly
hemolysis (hemolyzed sample)
▪ Syringe was filled too slowly
may form clots
▪ Failure to apply pressure on puncture site
hematoma
what are the procedural risk in pediatric collection
▪ Check the tests and the volume required
▪ Not more than 10% of the total blood volume
(hospitals do have their own policy)
o may lead to shock or cardiac arrest
▪ Risks to iatrogenic anemia
o increased risk for children due to repeated blood collection’
o may cause a drop in hemoglobin and hematocrit
▪ Ask parents or guardians about history of blood collection
o behavior and approach that will work
▪ Option should be given: Stay or Wait outside the room
▪ Lower yourself to the patient’s level
▪ Never tell a child that it will not hurt
▪ Approaches
o videos
o games
o songs
o counting
▪ EMLA/12 to 24% sucrose solution
o EMLA – topical anesthetic (lidocaine)
o Sucrose solution – heighten pain tolerance
▪ Methods of Restraining
EMLA vs Sucrose soln
EMLA:
It’s a numbing cream
Contains lidocaine (local anesthetic)
Put on skin 30-60 minutes before procedure
Makes needles hurt less
Works like temporary numbing of the skin
Common use: before blood draws or IV insertion
sucrose soln:
12-24% sugar water solution
Given to babies during painful procedures
Works as natural pain reliever
Both are used to:
Reduce pain
Make procedures more comfortable
Decrease anxiety
Especially helpful for:
Children
Patients afraid of needles
Sensitive patients
what are the challenges in geriatric collection
o skin discoloration
o hearing and vision problems
o mobility issues
o diabetics
o mental and emotional problems
what happens if the skin loses elasticity and lack of hydration in elderly patients
o harder to anchor the vein
o prone to rolling and collapsing vein
o increased bruising
what are some of the procedural risk in geriatric collection
▪ Skin loses elasticity and lack of hydration
▪ Hearing problems may have a hard time in
answering questions
▪ Guide or escort those who are visually impaired
▪ Speak clearly and slowly and expect to repeat
statements or questions
▪ Never force arms of patients with arthritis
▪ Blood thinners
o expect bleeding (coagulation problems)
▪ Diabetes mat cause scarring of skin punctures
o warm the site to avoid this
▪ Help patients who experience tremors (Parkinson’s disease)
true or false:
we can rely on patient’s nodding as a response
false - do not rely
* ask the patient’s companion for help
how do you avoid scarring of skin punctures in diabetes
warm the site
how do you help patient with tremors
(parkinson’s disease)
Position:
Support the shaking arm/hand
Use pillows or arm rests
Help stabilize their arm
Have them sit in a comfortable position
Timing:
Ask when tremors are usually less severe
Some patients have better times of day
Work around their medication schedule
Be patient and wait for calmer moments
Techniques:
Hold their arm gently but firmly
Use your hands to stabilize the area
Draw from larger, more visible veins
Work quickly but carefully when tremors lessen
Support:
Stay calm and reassuring
Don’t rush the process
Let them know it’s okay to take time
Ask if they need a break
Remember: Safety first - if tremors are too severe, consider rescheduling or getting help from another staff member.
how do you perform collection in elderlies on wheelchair
while being seated in wheelchair
use pillow or padded boards
this should not be used in dialysis patients when taking bp or venipuncture
AV (arteriovenous) shunt or fistula
what should u consider when drawing blood from hospice patients
Terminally ill patients should be approached with
care, kindness, and respect
they are elderly or disabled patients who can’t take care of themselves
long-term care patients
procedural risk in home care patients
▪ Bedridden patients who are staying at home
▪ Mobile blood collection
o phlebotomist should have exceptional skills
o all necessary equipment should be brought
o protect samples during transport
techniques to enhance the vein and recover a failed venipuncture
- Retie the tourniquet
- Use a blood pressure cuff in place of the
tourniquet - Massage the arm
o 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 sightly
- Rotate the needle
- Pull back or advance the needle slightly
true or false:
labelling of evacuated tube should be done in presence of the patient and right after blood collection
True
true or false:
it is okay to pre-label
false
what are the minimum information required when labelling
o patient’s full name
o patient-specific identifier
o date of birth
o age and biological gender
o date and time of collection
o phlebotomist’s initials
o additional information = “fasting” or “STAT”
what to do after labelling the evacuated tubes
compare with the request form and patient’s ID band or ask the patient to verify
why is the torniquet placed 3 - 4 inches abv the intended venipuncture site
to ensure adequate dilation of the vein without interfering with the actual puncture area
allows space for proper cleaning of site
what happens if too much tension is applied in fastening a torniquet
it can cause discomfort to the patient
blocking arterial flow = inaccurate test result
cause bruising or damage to the surrounding tissue
what is the purpose of the loop created during the tourniquet application
ez and rapid removal of tourniquet
why is it important to release the torniquet within 1 min
prevent prolonged blood statis
hemoconcentration
what happens if you push the syringe plunger while transferring into an evacuated tube
it can be hemolyze the specimen
cause the tube stopper to pop off - splashing the tube content
it is the dialysis patient’s lifeline
Arteriovenous fistula
- phlebotomist must be able to recognize it
true or false:
laboratory personnel will assume that blood in the microtubules is capillary blood. if venous blood is placed in a microtubule, it is important to label the specimens
true
STAT requests takes priority over all others for
ER STAT take over
- inpatients and outpatients
- inpatient STAT requests
why is it required to follow a series of steps that must be performed to ensure that the specimen is collected from
the correct patient in a timely manner
under the required conditions
in a professional manner that is safe for both the patient and phlebotomist
who has begun using the terms “pre-examination”, “examination” and “pot examination” in place of “preanalytical”, “analytical” and “postanalytical”
international standards organization
clinical and laboratory standards institute
DNR:
DNAR:
DNR: do not resuscitate
DNAR: do not attempt resuscitation
the behavior of a healthcare provider towards or as perceived by a patient
bedside manner
the process of verifying a patient’s identity is the most crucial step in specimen collection
patient identification
- shld not be rushed or any part skipped to save time
what are the 3 way ID
- the patient’s verbal statement
- a check on the ID band
- a visual comparison of the labeled comparison
