what sites should be avoided when performing venipuncture quizlet

\u00a9 2023 wikiHow, Inc. All rights reserved. The best locations for fingersticks are the 3rd (middle) and 4th (ring) fingers of the non-dominant hand. An assortment of needles and syringes of different sizes Tourniquet Alcohol and alcohol swabs Gauze or cotton balls Laboratory forms and blood-specimen labels Transportation bags and sharps container Step 2: Prepping The Patient Once you have the necessary supplies, it's time to ready the patient. Observe all applicable isolationprocedures. Hematoma - may cause erroneous test results. In some instances, the legs or feet are required for use, but a physician or doctor should be completing the draw, not a phlebotomist. For children over 6 months and adults, the finger is punctured. 13. Lightly touch the microtainer capillary collectiondevice (or filter paper) to the LARGE drop of blood. are known to vary lab results of some analytes. -cotton sponges 2004;24(4):979-96, vii. Tip: In spite of a difficult draw, remember to invert your tubes. D. 70% isopropyl alcohol. A. standards Sites that should be avoided include areas with extensive scarring, healed burns, inflamed sites, edematous sites, previous puncture sites, earlobes and thumbs. If none of these veins work, then the phlebotomists use the hand veins. 8. and "What is your date of birth?". 3. The antecubital fossa is a collection of veins located within the arms inner area, opposite of the elbow, where the arm folds in. For most clinical examinations the blood is obtained: The vacuum (evacuated) tube system (vacutainer) requires the following components: The healthcare worker needs essential items for either venipuncture or microcollection. Larger tube sizes typically provide for collection of samples from 6 to 10 mL. Phlebitis is inflammation of a vein. Avoid a probing, traumatic venipuncture. 5. This requisition form must contain the proper information in order to process the specimen. wikiHow, Inc. is the copyright holder of this image under U.S. and international copyright laws. B. above an IV line Background: Venipuncture is the most common invasive medical procedure performed by health care providers. (Uman et al, 2013). Obtain from the practitioner complete and current information about diagnosis, treatment, and any known prognosis, in terms the patient can reasonably be expected to understand. Coagulation tests (protime and prothrombin time), Tube is designed to contain no contaminating metals, Trace element testing (zinc, copper, lead, mercury) and toxicology, Antiglycolytic agent preserves glucose up to 5 days, HLA tissue typing, paternity testing, DNA studies, Inactivates thrombin and thromboplastin; contains virtually no lead. Firmly grasp the flanges of the tube holder to avoid advancing the needle further into the vein as you change tubes. -Vacutainer barrel Serum iron levels tend to drop during the day. Position the patient with the arm extended to form a straight-line form shoulder to wrist. B. evacuated tube When using a syringe and needle, avoid drawing the plunger back too forcibly. Extremity is edematous. Clin Lab Med. When working with patients who have undergone a mastectomy, draw from the arm on the opposite side of the mastectomy to avoid edematous tissue. Wikipedia. wikiHow, Inc. is the copyright holder of this image under U.S. and international copyright laws. diet, exercise, stress, basal state). Phlebitis can also occur as a result of vein trauma during insertion, use of an inappropriate I.V. Filter paper should touch only the blood and not the heel or finger. Let's take a look at the types of websites you and your staff need to be wary of and how to avoid them. Identify the additive, additive function, volume, and specimen considerations to be followed for each of the various color coded tubes. Blood Collection Techniques in Exotic Small Mammals. Lippi G, Salvagno GL, Montagnana M, Franchini M, Guidi GC. An outpatient must provide identification other than the verbal statement of a name. For example, serum cortisol levels are highest in early morning but are decreased in the afternoon. Blindly maneuvering the needle within the skin is painful to the patient and you run the risk of hitting a nerve, tendon, or artery. (function() { Avoid excessive pressure that may squeeze tissue fluidinto the drop of blood. Notify your supervisor or patientsphysician if unsuccessful. 2019;95(1):15-19. doi: 10.1016/j.diagmicrobio.2019.04.001. BD Vacutainer), rather than IV catheter insertions. The Patient's Bill of Rights has been adopted by many hospitals as declared by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). 3. 1. previous experience with vomiting or fainting Feel for the median cubital first, the cephalic vein second, and the basilic vein third. Areas of the body that look infected, scarred, or burned must also be avoided. Label all specimens per accepted guidelines. Asking the patient about their previous blood draw experiences is beneficial, especially if they are a hard stick and know which area works best. Check the requisition form for requested tests, patient information, and any special requirements. The median cubital creates, The dorsal venous network is the next most common vein site for phlebotomists. Certain other sites should also be avoided. What angle should you insert the needle at? 2009;47(2):143-53. The median cubital vein and the cephalic vein in the wrist area should be avoided when possible. When finished, clean the site and apply pressure with a clean gauze to stop the bleeding. Squeeze puncture site to promote bleeding. -obvious skin infection (including newly tattooed areas). By signing up you are agreeing to receive emails according to our privacy policy. Although the skill set and procedures may apply to both instances, this content is primarily aimed towards venous blood collection using evacuated tube systems (e.g. Avoid areas of hematoma. Identify the patient using two different identifiers, asking open ended questions such as, "What is your name?" All approved lancets utilized at Akron Childrens are for single use and feature, Heel punctures are performed on infants less than 6 months of age, or on, older premature infants who are the approximate size of a full-term 6 month, old. 2. Select a vein other than the one with the IV. Why? While most patients veins are compatible with a standard needle gauge, others require a. . Sign up for wikiHow's weekly email newsletter. Blood should NEVER be poured from one tube to another since the tubes can have different additives or coatings (see illustrations at end). 5. It is observed that if the tourniquet is left on longer than 2 minutes, changes in the value of a total protein test occur. 7. Regardless of the source of payment, request and receive an itemized and detailed explanation of the total bill for services rendered in the hospital. These may include listening to music or a story, watching a video, playing with a toy, having a parent provide distraction with talk or touch, using flash cards, and squeezing a rubber ball. Make certain that the blood completely saturates all four (4) circles and is visible from bothsides. Serum red top or amber tube with red top. A lab coat or gown must be worn during blood collection procedures. Sometimes you may get initial blood flow, but then it stops when you change tubes. Make the cut across the heelprint lines so that a drop of blood can well up and not run down along the lines. 2009 Feb;131(2):195-204. In some cases, a phlebotomist may have to switch sites if they find the blood is not properly flowing from the vein. For example, Google offers SafeSearch that can block explicit search results like porn, and it works for all image and video searches, as well as news and general search content. 3. Start with the arm closest to you and palpate the antecubital fossa. Uman LS, Birnie KA, Noel M, et al. Summarize the problems that may be encountered in accessing a vein, including the procedure to follow when a specimen is not obtained. 4. They are also. www.mlo-online.com is using a security service for protection against online attacks. Each phlebotomist generally establishes a routine that is comfortable for her or him. The area of the arch should be avoided, as should the posterior, curvature of the heel; a puncture in these areas could cause injury to the, All babies in the neonatal unit must be warmed before performing a. puncture. For the CLSI Updated Phlebotomy Procedures please click here. 8. To determine the best vein, use both sight and touch. This image is not<\/b> licensed under the Creative Commons license applied to text content and some other images posted to the wikiHow website. Veins sometimes roll away from the point of the needle and puncture site. Avoid excessive pressure that may squeeze tissue fluidinto the drop of blood. There are three phlebotomy vein sites located in the arm most utilized by medical professionals and three additional draw sites that are last resorts. Reassure the patient that the minimum amount of blood required for testing will be drawn. Diurnal Rhythms: Diurnal rhythms are body fluid and analyte fluctuations during the day. If using a needle and syringe, avoid drawing the plunger back too forcefully. This image is not<\/b> licensed under the Creative Commons license applied to text content and some other images posted to the wikiHow website. Proper patient identification procedures. } The fluid may dilute the specimen, so collect from the opposite arm. Do not use a previous puncture site. Clean the site to be punctured with an alcohol sponge. Hemolysis may occur, with pseudohyperkalemia. Change your approach when dealing with uncooperative patients, such as pediatrics and those with neurodevelopmental or psychiatric disorders. Last draw - additive tubes in this order: SST (red-gray or gold top). Never draw over scars or a new tattoo sites. Even if several vials of blood have to be drawn it usually amounts to no more than one ounce. 3. Place labeled specimens in zip lock bag and deliver to the laboratory as soon as possible. Look at the dorsum of the hand as a last resort. Effects of Exercise: Muscular activity has both transient and longer lasting effects. This image is not<\/b> licensed under the Creative Commons license applied to text content and some other images posted to the wikiHow website. 2. The first drop contains excess tissue fluid and must be wiped away. Thrombosed veins lack resilience, feel cord-like, and roll easily. Journal of Exotic Pet Medicine. Diurnal variations associated with some blood components are: Proper patient identification MANDATORY. To prevent hemolysis (which can interfere with many tests): Mix tubes with anticoagulant additives gently 4-6 times, Avoid drawing the plunger back too forcefully, if using a needle and syringe, or too small a needle, and avoid frothing of the sample. Children, particularly under the age of 10, may experience pain and anxiety during the phlebotomy procedure. var evntData = event.data; -hemorrhage/hematoma. The index finger can be calloused or sensitive and the little finger does not have enough tissue to prevent hitting the bone with the lancet. (a) How would you prepare tetracaine from the corresponding aniline derivative, ArNH2_22? Cleanse the heel with alcohol prep, then dry with a sterile 22 as alcohol can influence testresults. Wayne, PA: Clinical and Laboratory Standards Institute; 2008. Our students gain a vast amount of experience with phlebotomy vein sites through our hands-on and engaging curriculum and externship program. 6. Do not use the tip of the finger or the center of the finger. Use a smaller tube with less vacuum. Get instant access to our latest tools and our must-read site updates: What Certifications Are Used For Higher Pay For Phlebotomists? -18, 20, 22 gauge needles. Fasting, dietary restrictions, medications, timing, and medical treatment are all of concern and should be noted on the lab requisition. Additionally, blood samples should not be taken on an arm with a fistula used for dialysis treatments. Allow another large drop of blood to form. Tip: Lowering the arm below the level of the heart may help to engorge the vessels. An example of a simple requisition form with the essential elements is shown below: A properly labeled sample is essential so that the results of the test match the patient. This preliminary action allows you to safely adjust the needle's position. The 2nd (index) finger tends to have thicker, callused skin. wikiHow, Inc. is the copyright holder of this image under U.S. and international copyright laws. Certain larger molecules are not filterable into the tissue, therefore they are more concentrated in the blood. -test tubes A. in the region of a hematoma Take enough time to assess the vein before beginning the venipuncture procedure. Once again, please be aware that these are only guidelines for blood draws and nurses should consult with the appropriate hospital personnel regarding performing this procedure on patients. Never draw above an IV site. www.mlo-online.com is using a security service for protection against online attacks. Allow to air dry. Refuse treatment to the extent permitted by law. Heparin light or dark green top tube, 5. Remove the first glove so that it turns inside out during removal A phlebotomy technician is preparing to dispose of contaminated sharps. The performance of routine vascular access procedures by skilled phlebotomists requires, at a minimum, the use of gloves to prevent contact with blood. Using the requisition for reference, ask a patient to provide additional information such as a birthdate. Allow the blood to soak through and completely fill the pre-printed circle on the filter paper. A commercial heel warmer may be used. Which of the following actions should the technician take? 2017;50(10-11):568-573. The essential elements of the requisition form are: Patient's surname, first name, and middle initial. All of the following are common types of equipment used for venipuncture EXCEPT: Always thank the patient and excuse yourself courteously when finished. {"smallUrl":"https:\/\/www.wikihow.com\/images\/thumb\/6\/68\/Troubleshoot-a-Difficult-Venipuncture-Step-1.jpg\/v4-460px-Troubleshoot-a-Difficult-Venipuncture-Step-1.jpg","bigUrl":"\/images\/thumb\/6\/68\/Troubleshoot-a-Difficult-Venipuncture-Step-1.jpg\/aid11732774-v4-728px-Troubleshoot-a-Difficult-Venipuncture-Step-1.jpg","smallWidth":460,"smallHeight":345,"bigWidth":728,"bigHeight":546,"licensing":"