w7 safe blood collection Flashcards
are bacteria present in blood
yes but usually they are quickly eliminated by white blood cells, liver and spleen.
-bacteremia, septicaemia develop when infection occurs from multiplication of bacteria in blood stream faster than they can be eliminated
when are blood cultures ordered
-to aid in diagnosis when there is a fever of unknown origin FUO or pyrexia of unknown origin PUO
what do blood cultures help to determine
- presence and extent of infection
- identity of organisms
- antibiotic to which bacteria will be susceptible
when to collect cultures
- just before anticipated fever spike
- immediately following a fever spike
- before antibiotic therapy
- from more than one site
collection set of blood vials
one aerobic and one anaerobic O2 and AnO2. to detect all types of bacteria present.
-ordered at intervals 2x or 3x to increase the chance of isolation- collected from second collection sites
consecutive collection technique
collect both vials from one arm and then the other arm right away -indicate on bottle which arm was used RA or LA- common with patients experiencing acute conditions where administration of antibiotics are immediately required
Time interval technique
collect the second site at a given time following the collection of the first set. 20 to 30 minutes are usual time intervals
limitations to vials
it is a large volume
10ml taken from each vail, 4 vials taken total 40ml of blood taken
where is blood culture taken
performed at bedside
what volume are blood vials filled to
10ml mark down on bottle, they will fill more than that - for adults
kid volumes based on weight
what to remember
clean with alcohol as usual
clean for 30 seconds with iodine then let dry
dont repalpate unless you clean your finger with iodine and dont touch anything
clean tops of vials and leave alcohol swabs on
in total 3 alcohol swabs, 1 iodine swab
what to do if insufficient volume
note it on req
split between the two vials if more than 2ml
if less that two ml inoculate aerobic vial only
do not inoculate paediatric vial in place of adult vial
what to clean with for blood culture
70% isopropyl alcohol
povidone iodine then chlorhexidine gluconate do a friction scrub for 30 seconds then allow t0 dry for one to two minutes
-use gauze after because the iodine is sticky
what is blood culture done with
butterfly need
*since air is present in tube use aerobic one first
order of draw
aerobic, anaerobic, blood tubes in order of draw
what to use for blood culture with bad veins
syringe is okay to use, 20ml syringe would be used for fill both - its not recommended because it could contaminate vials.
make sure to use safety transfer device.
why avoid taking blood from scarred areas
- difficult to palpate in penetrate
- impaired circulation resulting in erroneous results
- repeated phlebotomy or IV drug therapy
healed burns can create scarred areas
why avoid taking blood from abrasions, lesions, fresh tattoos
more susceptible to infection
Mastectomy patients
phlebotomy should not be performed in the same side as a radical mastectomy (total breast and adjacent lymph node removal) can cause disruption of lymph circulation and erroneous test results and injury form tourniquet may lead to injury of arm
what is a hardened, or sclerosed vein caused from, what to do?
- feel hard lack resistance.
- disease, inflammation, irritation from intravenous drugs or scaring
- hard to penetrate
- NARROW interior diameter – impaired blood flow
- take from other arm or another vein of the same arm, or same vein but farther from damaged area
intravenous therapy and blood draw
do not take blood from arm with IV
-blood specimen may be diluted especially if drawn above IV line
you can draw from this arm if you get permission from doctor or nurse if
- iv off for two mins
- tourniquet distal to IV site before venous blood gets to iv site
- on a different vein
- first 5ml discarded
- first 10ml discarded for coag
- note added to req
what to do if collecting blood and there is pain or nerve damage
- pain tolerance differs person to person
- differentiate between discomfort and pain
- if patient expresses pain, remove needle
- if patients asks you to remove needle you must remove needle
- remove needle immediately if patient feels shooting or electric like pain toward shoulder or hand, nerve has been provoked.
reason for hematoma 6
(accumulation of blood thats raised) blue green to purple bruise- blood escapes vein
- needle penetrated completely through vein, venous fluid leaking out bottom
- bevel only partially penetrated vein- venous blood leaks out to top of hole in vein wall
- vein too small for gauge
- needle removed from arm before tourniquet off
- tourniquet reapplied above recent venipuncture site.
- pressure not applied after needle is removed.
what to do if hematoma starts to form, and a sign its going to form
swelling forms around needle, unless absolutely necessary ( STAT) take tourniquet off and and venipuncture discontinued
-elevate arm while applying direct pressure later ice the site , cover with pressure bandage (pad folded gauze taped securely in place)
**be extra careful with coagulation patients, make sure no bleeding occurs before bandage
elderly patients often are more prone to hematomas
warn patient there will be a bruise if you think that you may have given them a hematoma and that it will go away in a couple of days
why does Syncope or fainting occurs
dizzy and faint, patient usually appears apprehensive, strong and healthy patients sometimes do at thought or sight of needle
- decrease in blood volume
- cardiac arrhythmia
- hyperglycemia
- hyperventilation
- psychological stress ( most common)
what is is syncope
affected individual undergoes a reaction that results from inadequate blood supply to vein. = loss of consciousness
fainting symptoms 9
- stop talking
- waver in their voice
- become vague or disorientated
- pale
- beads of perspiration on their forehead
- warn phlebotomist of dizzy feeling
- waver back and forth with their head or upper body
- roll eyes back into their head
- slump suddenly without warning
what to do if patient fainting
if they have any symptoms, tourniquet off immediately remove needle and apply pressure to site, position yourself to prevent patient from falling onto floor.
- have patient put head between legs, hold them then lower them to floor if they faint call for help
- outpatients who previously get faint should lie recumbent on while getting blood drawn, this allows for more blood to brain. plus hazard risk is decreased, can’t fall on floor
what to do if patient is feeling ill
may feel nauseous, direct them to breath slowly and deeply, venipuncture discontinued of phlebotomist thinks they will throw up emesis ( kidney) basin supplied and cold compress supplied for forehead
seizures and convulsions symptoms and what to do
- triggered by physical and emotional stress.
- can be due to venipuncture
- loss of colour to complexion
- eye rolling
- arching or stiffening is a sign of seizure, in fainting the body would go slack
- discontinue venipuncture immediately and call for help. stay with patient and make sure they don’t hurt themselves.
- with assistance lower patient to floor, remove glasses, loosen clothing remove sharp objects - call in nurse , outpatient call paramedics, or physician
what to do if arterial puncture occurs
-apparent- the blood is bright red.
would fill tube or syringe in spurts- evacuated tube forced backward and out of system.
** immediately discontinue venipuncture and PHLEBOTOMIST must apply very firm pressure to site for 5 minutes to ensure needle hole injury has close.
this injury must be reported to supervisor
two main risks to patient when artery entered
higher blood pressure present and increases risk of significant hematoma
when entered with a needle arteries spasm affecting blood supply to area
most common complication after venipuncture is?
infection, because hands and feet are more exposed, must disinfect area very well beforehand
complication with infant heal puncture
- osteomyelitis or osteochondritis can occur, insufficient skin disinfection and penetration of the calcaneus heal bone with lancet blade
- if site is too medial ( arch of foot) disruption of longitudinal fat pad that supports nerves and blood vessels can occur
- laceration of the posterior tibial nerve or posterior tibial after can result in denervation of the plantar aspect of the footing results in a painful neuroma and negative intrinsic claw toes
what is a vascular access device
VAD device inserted into patient to facilitate the removal of blood specimen and the administration of IV fluids and meds. drawing blood from these devices requires special training, techniques and experience, NOT PERFORMED BY LAB
CVC
Central venous line
(catheter)
usually inserted into subclavian vein which is located in chest area below clavicle and covered with a dressing that covers tubing extending from the skin
PICC
peripherally inserted central catheter- line inserted into the peripheral venous system with a lead into the central venous system- inserted in arm basilica or cephalic
implanted port
small chamber is surgically inserted beneath skin, attached to an indwelling line
Heparin lock
device inserted into VAD to enable access for administration of medication and blood collection, device flushed regularly with heparin to ensure clots dont form
Cannula
renal dialysis patient VADs
tubular device inserted into kidney patients arm or hand and left there, blood samples drawn with syringe and iv fluids can be delivered
fistula
renal dialysis patient VADs
artificial shunt whereby vein and arty of renal patients arm have been fused together through surgery, may be called vascular graft and used for hemdialysis. not used for blood collection
dialysis shunt arm
renal dialysis patient VADs
currently or recently had a shunt for hemodialysis and should not be used for blood collection, scarring and blood vessels will be enlarged and noticeable select other arm
