Venous Blood Collection / Venipuncture (M) Flashcards
What are the originating Greek words of the term ‘phlebotomy’?
1) phlebo
2) tomia
What is the meaning of the Greek word phlebo?
vein
What is the meaning of the Greek word tomia?
cutting off
What are the principles of phlebotomy?
1) Describes the procedure of inserting a needle into a vein, to be able to collect blood
2) It is one of the most commonly performed procedures w/c, carried out skillfully, carefully, and accurately
3) will provide high quality blood sxs w/out causing discomfort to pt
What is the importance of preanalytical phase?
The ability of a lab to deliver pt results w/ of highest QUALITY and RELIABILITY starts w/ their preanalytical phase
What phase is the most crucial (or most important) in phlebotomy?
Preanalytical phase
What are the types of venipuncture?
1) Syringe method
2) ETS / Vacuette method
What is the other term for syringe method?
Open system
What is the other term for ets / vacuette method?
Closed system
What are the characteristics (or circumstances that may occur) of syringe method?
1) Time and labor intensive
2) Requires manual transfer of specimen to sample tubes
3) Prone to higher risk exposure to sx and accident due to manipulation
4) Inaccurate blood to additive ratio
What are the characteristics (or circumstances that may occur) of vacuette method?
1) Most rapid method to draw multiple sxs
2) It draws blood into the tubes at a safe speed, reducing the risk of direct exposure to blood
3) Dilution of the blood to additive is more accurate
What are the characteristics that makes a vein optimal for venipuncture?
1) Well-supported by muscle and connective tissue
2) Large and prominent
3) Easily visible
4) Easy to palpate
5) Elastic quality or bouncy
6) Soft
What are the stages (or steps) to locate a vein?
1) Visual inspection
2) Palpation
What is the principle of visual inspection of vein?
The scrutiny of the veins in both arms is essential prior to choosing a vein
What are the purposes of palpation?
1) Determines the loc and condition of the veins
2) Determines the size, depth, and direction of veins
3) Distinguishes veins from arteries
What is the preferred area for venipuncture?
Veins of the antecubital fossa
What are the veins in the antecubital fossa?
1) Median cubital vein
2) Cephalic vein
3) Basilic vein
What is the importance (or purpose) of dorsal hand veins?
These veins are used if the antecubital fossa is unavailable
What should be used for venipuncture in dorsal hand veins?
Use of blood collection set (butterfly winged infusion set)
Why is butterfly winged infusion set recommended for use to dorsal hand veins for venipuncture?
Because these veins are small fragile veins
What are the other terms for butterfly winged infusion set (syringe?)?
Safety Blood Collection / Infusion set
What is the purpose (or importance) of veins of the foot?
These veins are the last resort for blood collection after the arm and hand veins have been determined unsuitable
What are the veins present in the foot?
1) Great Saphenous Vein
2) Lesser Saphenous Vein
3) Dorsal Venous Arch
What are the sites to avoid in venipuncture?
1) Feet or ankles
2) IV transfusion line
3) Mastectomy
4) Hematomas or edematous sites
5) Wrists
6) Arteries
7) Fistula or shunt
Why should feet or ankles be avoided (for venipuncture)?
Risk of clot formation, tissue necrosis, or inflammation to bedridden or diabetic pts
Why should IV transfusion line be avoided (for venipuncture)?
Risk of diluting sx w/ IV fluid w/c may cause inaccurate results
Why should mastectomy be avoided (for venipuncture)?
Risk of infection and lymphedema
Why should hematomas or edematous sites be avoided (for venipuncture)?
Risk of contaminating sx w/ tissue fluid
Why should wrists be avoided (for venipuncture)?
Risk of puncturing nerves, tendons, or arteries
Why should arteries be avoided (for venipuncture)?
Risk of prolonged bleeding
Why should fistula or shunt be avoided (for venipuncture)?
Risk of damage and infection to the surgically prepared access point for dialysis
What are the mats needed for venipuncture?
1) Gloves
2) Alcoholic 2 % Chlorhexidine wipes or cotton w/ antiseptic
3) Tourniquet (rubber, latex, and the like)
4) Syringe (w/ barrel and needle)
5) Bandaid
6) Cotton pads
7) Cotton balls
8) Evacuated tubes
9) Marker (preferably sharpie or other smudge free markers)
10) Waste disposal containers (sharps, infectious waste containers, and the like)
What are the parts of a syringe?
1) Cannula (needle)
2) Hub
3) Barrel (calibrated)
4) Plunger tip
5) Plunger
What is the other term for needle?
Cannula
What are the steps in venipuncture?
1) Physician’s instructions
2) Assemble products
3) Hand hygiene
4) Discussion w/ the pt
5) Position the pt
6) Select the puncture site
7) Putting on gloves
8) Disinfect the puncture site
9) Apply the tourniquet again
10) Venipuncture
11) Release the tourniquet
12) Withdraw the needle
13) Order of draw, tube inversion
14) Filling of tubes
15) Label the tube
16) Farewell, disposal, cleaning, and hand disinfection
What is the main event in physician’s instructions step?
Pt’s requisition slip from his or her doctor to conduct an examination
Where does the requisition slip of the pt (for venipuncture) come from?
From the doctor of the pt
What are the types of requisition form?
This is received in the form of a 1) written; request document or via an 2) LIS (Laboratory Information System)
The physician’s instruction include what?
Specifications from the lab on preanalytics and proper blood collection
What is the main event in assemble products step?
Preparation of all mats needed in performing venipuncture
What are the other events in assemble products step?
Ensure all the required products (in their various versions) and safety equipment are available
What are the mats required for diff pts?
1) Needles
2) Blood collection tubes
3) Accesories
Diff pts require what needles?
Needles of various sizes and lengths
Diff pts require what blood collection tubes?
Blood collection tubes in various versions
What are the various accessories required for diff pts?
1) Sharps container
2) Tourniquets
3) Alcohol
What is the main event in hand hygiene step?
Hand washing to get rid of all visible dirt
What is the importance of handwashing?
It is still the most important step in controlling and preventing the spread of infection
When is hand rubbing accepted?
It is accepted in the event of limited access to H2O or sink
What antiseptic is used in hand rubbing?
Alcohol
What are the 5 moments of hand hygiene?
1) Before touching a pt
2) Before clean or aseptic procedure
3) After body fluid exposure risk
4) After touching a pt
5) After touching pt surroundings
What are the events or principles in discussion w/ the pt step?
1) Introduction to the pt
2) Gather information on diet, allergies (latex), and the pt’s exps
3) Address any fears and exps and respond appropriately
4) Discuss the test that is going to be performed
5) Obtain consent
6) Match lab form w/ identity (of the pt)
What are the essential information that should be gathered from the pt?
Information about:
1) Diet
2) Allergies (latex)
3) Pt’s exps
What are the events or principles in pt identification?
1) The phlebotomist is responsible for correctly identifying the pt using at least 2 unique pt identifiers:
a) Pt’s complete first, middle, and last name
b) Date of birth, age, and sex
2) Every pt must verbalize his / her name to the phlebotomist, if able to do so
What should be done (by the phlebotomist) in terms of pt identification for inpatients?
1) Check the information on the pt’s wristband
2) Confirm that the name and hospital # or medical record number matches the pt information on the test order
What should be done (by the phlebotomist) in terms of pt identification for outpatients?
Ask the pt (or guardian / caregiver) to state the pt’s name and DOB
What are the other information that should be considered (in terms of pt identification?
1) NEVER rely on identification attached to a bed, chart, or door
2) NEVER draw a pt whose identity is not established or is in conflict
What are the events or principles in position the pt step?
Either in a sitting or lying position:
1) Hyperextend the pt’s arm in a downward orientation
- > enlargement of veins
- > tubes fill adequately
What should be the position of the pt?
Either in a sitting / lying position
What are the results if the pt hyperextends his / her arm in a downward position?
1) Enlargement of veins
2) Tubes fill adequately
What is the main event in select the venipuncture site step?
Vein location and selection
What is the order of preferred puncture sites for diff sites of the pt’s body?
1st: veins on the antecubital fossa
2nd: veins on the dorsal hand
3rd: alternative puncture sites (requires expertise and doctor’s consultation)
What are the events for acquiring optimal visibility of the veins?
1) Tourniquet (not necessary for prominent veins)
2) Slightly bent arm
3) Position on arm rest
4) Pull the skin taut
5) Make a fist (w/out pumping the hand)
Is tourniquet necessary for prominent veins?
No (may be)
Is pumping of the hand (by the pt) acceptable?
No
What are the sub steps of select the puncture site step?
1) Tourniquet application
2) Vein location
How should the tourniquet be applied to the pt?
Apply a tourniquet far enough away from the puncture site
What is the purpose of applying the tourniquet far enough away from the puncture site?
So that it will not impede the subsequent steps
What is the proper measurement (in inches) of tourniquet application?
3 - 4 in above the puncture site
What should not be done in tourniquet application?
Do not apply the tourniquet for longer than 1 min
What is event in palpation of the vein?
To localize a vein, the area is palpated w/ the index finger
What finger is used for palpating the vein?
Index finger
What are the information that influences product selection?
1) Course of the vein and localization of the puncture site
2) Vein condition (springy, elastic)
3) Size, depth, and orientation
When should the tourniquet be released?
After successful selection of vein (after palpating the selected vein)
The course of the vein influences what?
The orientation and positioning of the person having the blood sx taken
The size and depth of the vein influences what?
Influences the product selection and the choice of needle size
What should be used (in terms of needle) for large vein?
Thick needle
What should be used (in terms of needle) for small vein?
Thin needle
What is the other event that should be done w/ putting on gloves step?
Hand hygiene
When is wearing well-fitting gloves recommended?
It is recommended during any procedure that involves handling of blood and body fluids, particularly w/ venipuncture
What is the purpose of wearing well-fitted gloves in any procedure that involves handling of blood and body fluids, particularly w/ venipuncture?
This is to prevent contamination of the practitioner from potential blood spills
When is disinfection done?
Before inserting the needle
How is disinfection of the site should be done?
Cleanse in an outward concentric spiral motion
What are the mats that can be used for disinfection of the site?
1) 2 % Chlorhexidine swabs w/ 70 % Isopropyl alcohol
2) Alcohol swabs
3) Alcohol-iodine preparation
What should be done after disinfection of the site?
1) Allow the site to air dry for about 30 - 60 secs
2) Refrain from touching the cleansed site
What is the time duration for air drying the disinfected site?
30 - 60 secs
What event should be done during venipuncture?
The skin and the vein are held in place by pulling them taut w/ the thumb
What should be the shape (of the grip) during venipuncture?
L-shaped grip
What is the proper insertion angle of needle to the vein?
15 - 30 degrees
What should be observed to the bevel of the needle prior to insertion of needle?
The bevel of the needle should be pointing upwards
What should be the insertion depth of the needle to the vein?
The insertion depth varies depending on the pt and vein selected
Is it important to follow the adopted position (or the course of the vein) during insertion of the needle to the vein?
Yes, the adopted position now helps you follow the course of the vein
How is the vein punctured?
It is punctured in one forward motion
What is the indication that the puncture done is successful?
When penetrating the vein wall, you will feel decreasing resistance
What is the main event in release the tourniquet step?
Release the tourniquet as soon as blood flows into the collection tube
What is the main event in withdraw the needle step?
Secure and dispose the needle
What should be done when withdrawing the needle?
Apply a swab and remove the puncture needle w/out applying pressure to the puncture site under the swab
What are the results if pressure is applied to the puncture site when taking blood or withdrawing the needle?
1) The vein or skin may be slashed
2) Pain is inflicted
What are the ways on how to recap the used needle?
1) One hand scoop technique
2) Using scissors
3) Using syringe cutter
What should be done after withdrawal of needle?
Immediately after withdrawing the needle, apply light pressure to the wound for 3 - 5 mins
What is the time duration of application of light pressure after withdrawal of needle?
3 - 5 mins
Why is the site applied w/ light pressure after needle withdrawal?
To prevent a hematoma forming
Can pts themselves apply the pressure needed after needle withdrawal?
Yes, as long as they are able to ensure that the pressure is sufficient
What are the events in order of draw (in syringe and mostly in ETS)?
1) Fill, remove, and mix tubes based on the correct order of draw
2) Mix tubes immediately upon removal from the holder using gentle inversions (depending on type) to prevent clot formation
Why should tubes be mixed immediately?
To prevent clot formation
How to perform a tube inversion correctly?
A correct inversion is one complete turn of the wrist, back and forth
What is the recommended order of draw?
1) Blood culture tube
2) Coagulation tube
3) Serum
4) Heparin
5) EDTA
6) Glucose
7) All others
How many times should blood culture tube be inverted?
Multiple times
How many times should coagulation tube be inverted?
4 times
How many times should serum tube be inverted?
5 - 10 times
How many times should heparin tube be inverted?
5 - 10 times
How many times should EDTA tube be inverted?
5 - 10 times
How many times should glucose tube be inverted?
5 - 10 times
How should the tubes be labeled?
Label all collection tubes accurately w/ the relevant pt information after blood is drawn and mixed
When should labelling of tubes always be done?
Always label tubes before leaving the bedside or dismissing pt
What should be properly observed for handwritten labels?
Make sure it is legibly written using a permanent marker / pen
What should be done (or events that causes hematoma) to avoid hematoma?
1) Make sure the needle fully penetrates the uppermost wall of the vein
2) Needle angle is too steep or too shallow
3) Remove the tourniquet before removing the needle
4) Use the major superficial veins
5) Hold the venous blood collection assembly still while collecting the sx
6) Pressure must not be applied to the puncture site when taking blood or withdrawing the needle
What should be done (or events that causes hemolysis) to avoid hemolysis?
1) Avoid direct puncture of syringe to the tube
2) Allowing the venipuncture site to air dry
3) Never draw blood through a hematoma
4) Make sure the needle is fitted securely on a syringe to avoid frothing
5) Avoid drawing the plunger of syringe too forcibly
6) Use blood collection sets for small fragile veins
7) Avoid vigorous shaking of tubes
What should be done (or events that causes hemoconcentration) to avoid hemoconcentration?
1) Do not leave tourniquet on the pt’s arm for 1 min >
2) Avoid pumping of fist during blood collection
3) Avoid sudden change in position prior to blood collection
4) Avoid site probing
