Avoid a probing, traumatic venipuncture. Venipuncture (sometimes referred to as venapuncture, venepuncture or even venu puncture) is the collection of blood from a vein which is usually done for laboratory testing. 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. What two things should you make sure you discuss with your patients prior to venipuncture? At least two patient identifiers, such as name and date of birth, are needed. What are the gold top containers used for? Capillary Specimens may be collected on filter paper and sent to lab for testing for. 4. wikiHow, Inc. is the copyright holder of this image under U.S. and international copyright laws. Fasting, dietary restrictions, medications, timing, and medical treatment are all of concern and should be noted on the lab requisition. Consider three elements with the following abbreviated electron configurations: X=[Ar]4s23d5Y=[Ar]4s23d104p1Z=[Ar]4s23d104p6\mathrm{X} = \mathrm{[Ar]4s^23d^5}~~~\mathrm{Y}=\mathrm{[Ar]4s^23d^{10}4p^1}~~~\mathrm{Z}=\mathrm{[Ar]4s^23d^{10}4p^6} Track marks are not only found on IV drug users, but also on chronically ill patients requiring repeated vascular access and blood draws and may be a sign of an anticipated difficult draw. Identify the patient. Contains a gel separator and clot activator. The infograph below provides a detailed description of the venipuncture steps as found in our how to draw blood resource. Squeeze puncture site to promote bleeding. A variety of techniques can be employed to reduce pain and anxiety. A. the plastic sleeve is removed If this is not successful, remove the needle, take care of the puncture site and redraw at another site. How many time should you invert them? 6. Dorsal hand veins are often utilized for intravenous infusions but are viable options for blood draw sites. Diurnal variations associated with some blood components are: To determine the best vein, use both sight and touch. Be informed of the hospital rules and regulations regarding patient conduct. A. standards Proper Handling of an Uncooperative Patient in an Outpatient Setting Akron. Lancets are disposed of in an appropriate sharps container as one unit. What caution should you observe when using a Vacutainer? When wearing gloves, change them between each patient and wash your hands frequently. Document that the venipuncture was performed distal to (below) an infusion site. } Which of the following is the most likely mechanism for alteration in protein values in this situation? 5. The hydrostatic pressure causes some water and filterable elements to leave the extracellular space. Certain other sites should also be avoided. Valenstein PN, Sirota RL. Safely discard potentially infectious materials. Blood should NEVER be poured from one tube to another since the tubes can have different additives or coatings (see illustrations at end). Gloves - can be made of latex, rubber, vinyl, etc. Specimens from infants under the age of 6 months are typically collected by heelstick. Phlebotomy issues and quality improvement in results of laboratory testing. Follow institution's guidelines regarding treatment and follow-up. What is the procedure to draw blood from an arm with an IV in it? Look at the dorsum of the hand as a last resort. 1. World Health Organization. A requisition form must accompany each sample submitted to the laboratory. Switch to the other arm if you can't find anything. 4. Diurnal Rhythms: Diurnal rhythms are body fluid and analyte fluctuations during the day. Date, time and initials of the phlebotomist must be on the label of EACH tube. C. Lancet Hematoma - may cause erroneous test results. How can you decrease the risk of hematoma formation? Interruptions and distractions during medical encounters and procedures should be avoided. (See, The chlorhexidine is a concern for the premature babies in NICU as it can, be absorbed through the skin. Apply firm pressure. 5. What are the contraindications to venipuncture? A. All of the following are common types of equipment used for venipuncture EXCEPT: Drawing blood from major vessels (e.g. Of course, the phlebotomist may understand this, however, the patient may not. C. at a mastectomy site Contains lithium heparin anticoagulant and a gel separator. Drawing the patient in a reclined position. Additionally, blood samples should not be taken on an arm with a fistula used for dialysis treatments. Feel for the median cubital first, the cephalic vein second, and the basilic vein third. Place labeled specimens in zip lock bag and deliver to the laboratory as soon as possible. 8. 9. Tetracaine is a substance used as a spinal anesthetic. 4. Allow it to air, Grasp the foot, and using a sterile lancet, press firmly against the heel to, Collect the drops of blood into the collection device by gently squeezing, the foot. 6. Summarize the problems that may be encountered in accessing a vein, including the procedure to follow when a specimen is not obtained. 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. The median cubital vein, a superficial vein that forms a connection point between the cephalic and basilic veins of the arm is large, and therefore easier to see and feel. B. Hematoma Draw 5 ml of blood and discard before drawing the specimen tubes for testing. try{ If using a needle and syringe, avoid drawing the plunger back too forcefully. 9. The blood is bright red (arterial) rather than venous. B. Betadine Most commonly, venipuncture will be performed on the Antecubital Fossa, or the inside of the elbow. Punctures to the posterior curvature of the heel cab cause damage to the bones. When 25.0 mL of 0.500 M H2S04 is added to 25.0 mL of 1.00 M KOH in a coffee-cup calorimeter at 23.50C23.50 ^ { \circ } \mathrm { C }23.50C the temperature rises to 30.17C30.17 ^ { \circ } \mathrm { C }30.17C . Kiechle, Frederick L. So Youre Going to Collect a Blood Specimen: An, Introduction to Phlebotomy, 11th Edition. Any microtainerscontaining additives should be tapped to dislodge additives from the walls and top. This image is not<\/b> licensed under the Creative Commons license applied to text content and some other images posted to the wikiHow website. Assess the need for sample recollection and/or rejection. wikiHow, Inc. is the copyright holder of this image under U.S. and international copyright laws. 3. Some individuals are afraid of needles, while others are frightened at the sight of blood. This is especially important when collecting EDTA (lavender top) or heparin (green top) tubes. 2017;148(4):330-335. 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. Be methodical in your search for a vein. It may be, necessary, on occasion, to perform a capillary puncture on the toe of a patient, who is severely burned. NOTE: The use of post-exposure prophylaxis following blood exposure to HIV has shown effectiveness (about 79%) in preventing seroconversion. Allow thefinger to dry or wipe dry with a sterile 22 gauze. Procedures and Devices for the Collection of Diagnostic Capillary Blood. Gas tubes (must warm the site before collecting the specimen), 4. }, false); var f = document.createElement("iframe"); doi: 10.1002/14651858.CD005179.pub3. D. Near a tattoo, Needles are used once and then: Precautions include a medical grade face mask. Palpate and trace the path of veins with the index finger. Because most laboratory specimens contain bacteria, it is not necessary to wash hands before collecting them, The tourniquet applied prior to venipuncture is removed: However, drawing blood from the hand is affiliated with higher levels of pain and less control. Take enough time to assess the vein before beginning the venipuncture procedure. Smaller collection tubes for sample sizes of 2 mL or less may be appropriate in situations where a smaller amount blood should be drawn, as in pediatric patients, or to minimize hemolysis during collection, or to avoid insufficient sample volume in the collection tube. The median cubital vein and the cephalic vein in the wrist area should be avoided when possible. Concentrations of fluids and medications could affect baseline test results. 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