what sites should be avoided when performing venipuncture quizlet

\u00a9 2023 wikiHow, Inc. All rights reserved. Keep in mind that elderly patients often have fragile veins. If another site is not available, collect the specimen distal to the hematoma. 4. Uman LS, Birnie KA, Noel M, et al. Stop the procedure and remove the needle if: Thanks to all authors for creating a page that has been read 43,712 times. By holding the needle either by the plastic wings or the hub, phlebotomists can achieve a shallower angle, typically 10-15 degrees. Within the antecubital fossa, this vein poses the least amount of risk. Change gloves after each patient or when contaminated. Asking the patient about their previous blood draw experiences is beneficial, especially if they are a hard stick and know which area works best. In this elbow pit, phlebotomists have easy access to the top three vein sites used in phlebotomy: Median cubital vein. Why? The fluid may dilute the specimen, so collect from the opposite arm. How can you tell if you are palpating a vein? This enables the bloodto form as a drop on the fingertip. Capillary specimens are collected in microtainers with colored caps that are used to. Verify the patient's condition. To request course information, contact PhlebotomyU today. Do not use the central portion of the heel because you might injure the underlying bone, which is close to the skin surface. 8. Preanalytical phase of the testing process begins for the laboratory when a: Test is ordered by a patient's physician. NOTE: The use of post-exposure prophylaxis following blood exposure to HIV has shown effectiveness (about 79%) in preventing seroconversion. This article was co-authored by Matt Garcia. The essential elements of the requisition form are: Patient's surname, first name, and middle initial. Wipe away the first drop of blood with sterile 22 gauze. This complication of peripheral I.V. Using the requisition for reference, ask a patient to provide additional information such as a birthdate. Most commonly, venipuncture will be performed on the Antecubital Fossa, or the inside of the elbow. What are the complications that can occur when performing a venipuncture? When wearing gloves, change them between each patient and wash your hands frequently. True or False? This image is not<\/b> licensed under the Creative Commons license applied to text content and some other images posted to the wikiHow website. Please enable cookies on your browser and try again. If you are using a butterfly, try to retie the tourniquet around the patient's arm to increase pressure and re-establish blood flow. 2. followed pre-lab instructions. } 2. Ask the patient orcaregiver to state the patients name and date of birth. Elderly patients often have fragile skin and veins that roll quite easily, When a vein rolls, the needle tends to push the vein aside rather than penetrating through. What sites should be avoided when drawing blood? Back the needle out until the bevel is just below the skin. All rights reserved. wikiHow, Inc. is the copyright holder of this image under U.S. and international copyright laws. Our students gain a vast amount of experience with phlebotomy vein sites through our hands-on and engaging curriculum and externship program. Have the patient make a fist and flex the arm, which helps engorge muscles to fill veins. try{ If the blood flow is diminished, repeat the capillary PUNCTURE to complete the collection. Some individuals are afraid of needles, while others are frightened at the sight of blood. -antiseptic swabs Avoid excessive pressure that may squeeze tissue fluid into the, mix the blood. Phelan MP, Reineks EZ, Berriochoa JP, Schold JD, Hustey FM, Chamberlin J, Kovach A. Hold a gauze pad over the puncture site for a couple of, minutes to stop the bleeding, and then tie gauze around the foot. Re-anchor the vein. the 3 rd (middle) or 4 th (ring) finger of the hand. How can you decrease the risk of hematoma formation? PST (light green top). Wait 2 minutes before reapplying the tourniquet. A. Edema This is especially important when collecting EDTA (lavender top) or heparin (green top) tubes. 3. In fact, many search engines provide the option to avoid dangerous sites by turning on a "safer" search. Check for timing instructions for drawing the appropriate samples. It is observed that if the tourniquet is left on longer than 2 minutes, changes in the value of a total protein test occur. Since newborns do not often bleed immediately, use gentle pressure to produce a rounded drop of blood. wikiHow, Inc. is the copyright holder of this image under U.S. and international copyright laws. Needles should be placed in a proper disposal unit IMMEDIATELY after their use. Never leave a tourniquet on for more than two minutes. Identify the patient using two different identifiers, asking open ended questions such as, "What is your name?" Using a sterile lancet, puncture the most medial or lateral portion of the plantar surface of theheel, medial to a line drawn posteriorly from the mid great toe to the heel. var evntData = event.data; wikiHow, Inc. is the copyright holder of this image under U.S. and international copyright laws. Let's take a quick, high-level look at the venipuncture procedure. Hematoma - A venipuncture should not be performed on a hematoma, regardless of how small it may be. Butterflies are incredibly valuable tools for tackling difficult draws, owing to their precision, shorter shaft length, and maneuverability. Swiftly insert the needle through the skin and into the lumen of the vein. Proper patient identification procedures. Veins on the underside of the wrist should be avoided. Guidelines established by the Clinical and Laboratory Standards Institute (CLSI) dictate that a phlebotomist shall not attempt a venipuncture more than two times, and a maximum of three attempts shall be undertaken on a patient. 1-kg of R-134a initially at 600 kPa and 25C25^{\circ} \mathrm{C}25C undergoes a process during which the entropy is kept constant until the pressure drops to 100 kPa. CLSI document H04-A6. This image is not<\/b> licensed under the Creative Commons license applied to text content and some other images posted to the wikiHow website. Do not add blood to a circle already filled orpartially filled with blood. Identification errors in pathology and laboratory medicine. Occupational Safety and Health Administration, United States Department of Labor. X=[Ar]4s23d5Y=[Ar]4s23d104p1Z=[Ar]4s23d104p6. This image is not<\/b> licensed under the Creative Commons license applied to text content and some other images posted to the wikiHow website. Pre-warm the region of the vein to reduce vasoconstriction and increase blood flow. Green Using a sterile lancet, puncture the fingertip in the fleshy part of the finger, slightly to the sideof the center and across (perpendicular to) the grooves of the fingertip. He previously worked in a high-volume outpatient lab and is currently employed in an acute care hospital and Level III trauma center in downtown Vancouver. Additionally, a hematoma may compress the nerve and lead to long-term damage. There are some slight risks associated with venipuncture which may include excessive bleeding, feeling light-headed, fainting, nerve damage, hematoma (accumulation of blood under the skin), and infection. Cochrane Database Syst Rev. if ( prevIframeHeight != zf_ifrm_ht_nw ) { If this is not successful, remove the needle, take care of the puncture site and redraw at another site. Observe universal (standard) safety precautions. Collection tubes can vary in size for volume of blood drawn, appropriate to the tests ordered with sample size required, and vary in the kind of additive for anticoagulation, separation of plasma, or preservation of analyte. What can happen if you vigorously shake the tubes? Apply the tourniquet below the IV site. Do not use alcohol for prepping the site when drawing a blood alcohol sample. After the needle selection, phlebotomists begin to look and feel for a viable vein. Tubes with different additives are used for collecting blood specimens for specific types. If none of these veins work, then the phlebotomists use the hand veins. Allow filter paper to air dry for two (2) hours at room temperature. Allow the blood to soak through and completely fill the pre-printed circle on the filter paper. -Vacutainer barrel Label the specimens before leaving the patients bedside. If multiple blood samples are to be taken, the phlebotomist must be careful to follow the proper order of draw. Adjust the angle (the bevel may be against the vein wall). A test that has been ordered may be cancelled due to problems unrelated to drawing the specimen, and these are the most common causes for cancellations: A test may be cancelled due to a technical problem in the specimen collection process: Identification of the specimen is suspect. C. the needle has penetrated all the way through the vein f.style.border="none"; Websites that masquerade as the ones you trust. PROBLEMS OTHER THAN AN INCOMPLETE COLLECTION: A hematoma forms under the skin adjacent to the puncture site - release the tourniquet immediately and withdraw the needle. Discarding the first set minimizes the effects of any potential additive contamination. })(); The cephalic vein is a safe secondary option if the median cubital vein is not working. The Patient's Bill of Rights has been adopted by many hospitals as declared by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). Apply the tourniquet 3-4 inches above the selected puncture site. The blood is normally drawn from a vein on the top of the hand or from the inside of the elbow. When finished, clean the site and apply pressure with clean gauze to stop the bleeding. If an IV is in place, samples may be obtained below but NEVER above the IV site. Phlebitis is inflammation of a vein. What sites should be avoided when drawing blood? The median cubital creates less bruising and pain than other draw sites. var f = document.createElement("iframe"); Move it forward (it may not be in the lumen). (Uman et al, 2013). After assembling the appropriate equipment, follow the next steps to perform a proper venipuncture. var zf_ifrm_ht_nw = ( parseInt(zf_ifrm_data[1], 10) + 15 ) + "px"; Know the identity and professional status of individuals providing service and to know which physician or other practitioner is primarily responsible for his or her care. 12. Wipe away the first drop of blood with sterile 22 gauze. This image is not<\/b> licensed under the Creative Commons license applied to text content and some other images posted to the wikiHow website. Allsurfaces are cleaned daily with bleach. Unlike the cephalic and basilic veins, the median cubital vein is not near major nerves or arteries. Hard and dense structures may be nerves or tendons. D. mandates, The most common antiseptic used in venipuncture is: A 21-gauge needle (e.g. Label all specimens per accepted guidelines. (See, The chlorhexidine is a concern for the premature babies in NICU as it can, be absorbed through the skin. Reasonable informed participation in decisions involving the patient's health care. if ( zf_ifrm_data.length == 2 ) { (c) How would you prepare tetracaine from benzene? Allow another large drop of blood to form. Fill the capillary tube(s) or micro collection device(s) as needed. (a) How would you prepare tetracaine from the corresponding aniline derivative, ArNH2_22? The equipment used during the venipuncture test can vary, but the following are most commonly used for routine venipuncture: Phlebotomists may choose to draw blood from several different sites of the body. It is large and near the skins surface, making it easier for phlebotomists to see before anchoring the vein. When multiple vials of blood are collected it can seem like a large amount. (See picture.) This image may not be used by other entities without the express written consent of wikiHow, Inc.
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