what sites should be avoided when performing venipuncture quizlet

2. BD Vacutainer), rather than IV catheter insertions. Allsurfaces are cleaned daily with bleach. Northfield, IL: College of American, NCCLS. -do not rapidly insert the needle. Most reference ranges are based on normal laboratory test values for: Healthy people in a basal state. finger should be avoided. -18, 20, 22 gauge needles. Psychological interventions for needle-related procedural pain and distress in children and adolescents. 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. Some images used in this set are licensed under the Creative Commons through Flickr.com.Click to see the original works with their full license. For example, serum cortisol levels are highest in early morning but are decreased in the afternoon. All other items used for the procedure must be disposed of according to properbiohazardous waste disposal policy. % of people told us that this article helped them. What are the best veins for venipuncture? 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. Then the medical technician or phlebotomist will wrap a flexible band on the upper part of the arm to apply some pressure to that area making the vein enlarge with blood. A typical single vial contains about five milliliters, which is about one teaspoon. The patient who is at ease will be less focused on the procedure. C. Scarring Cleanse in a circular fashion, beginning at the site and working outward. It is not uncommon for adults and children to feel some fear when having blood drawn, which is why any discussion of venipuncture should at least bring this topic to focus. Drawing blood for laboratory analysis is most often a routine and uneventful procedure. The venipuncture procedure is complex, requiring both knowledge and skill to perform. Holder/Adapter - use with the evacuated collection system. Whole blood specimens may not be able to be analyzed if microscopic clots are present. X=[Ar]4s23d5Y=[Ar]4s23d104p1Z=[Ar]4s23d104p6. Hematoma - A venipuncture should not be performed on a hematoma, regardless of how small it may be. The maximum number of times an individual should attempt a venipuncture on a patient is two, True or False? Have an assistant stabilize the arm by firmly locking the elbow joint. 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. Each phlebotomist generally establishes a routine that is comfortable for her or him. } Also found in the antecubital fossa, the basilic vein serves as a last resort for blood draws. Collect drops of blood into the collectiondevice by gently massaging the finger. 2011-2023 Phlebotomy Coach. Label the collection tubes at the bedside or drawing area. Apply only ONE drop of blood per circle. Venipuncture can also happen when patients have intravenous (IV) lines started. This information must match therequisition. Adjust the height and swivel the chair to ensure your body is in line with the vein. Check the requisition form for requested tests, patient information, and any special requirements. }catch(e){} var zf_ifrm_data = evntData.split("|"); 3. The most common complications are bleeding at the puncture site or hematoma formation. 2009 Feb;131(2):195-204. What are the light blue top containers used for? Proper patient identification MANDATORY. Posture: Postural changes (supine to sitting etc.) Certain other sites should also be avoided. Position the infant with the head slightly elevated. When finished, clean the site and apply pressure with clean gauze to stop the bleeding. Adhesive bandages / tape - protects the venipuncture site after collection. The blood is bright red (arterial) rather than venous. hemorrhage or hematoma at site of puncture, remove tourniquet After assembling the appropriate equipment, follow the next steps to perform a proper venipuncture. Choosing an appropriate site for venipuncture is crucial for a successful . To enhance students careers, meet the needs of healthcare providers and improve patient care by providing high quality, cost effective phlebotomy education through industry leading curriculum, current technology and extensive hands on experience. An artery has been punctured (characterized by bright red, pulsating blood), A nerve has been nicked (patient may complain of an electrical sensation up and down the limb), A hematoma starts to form (a bubble under the skin starts to rapidly appear at the site), The patient loses consciousness or starts seizing. Avoid excessive pressure that may squeeze tissue fluid into the, mix the blood. Order of draw for multiple tube phlebotomy. This image is not<\/b> licensed under the Creative Commons license applied to text content and some other images posted to the wikiHow website. By holding the needle either by the plastic wings or the hub, phlebotomists can achieve a shallower angle, typically 10-15 degrees. In most of these cases, the skin on the hand is pierced and a vein is accessed so medications or fluids can be given intravenously. NOTE: The use of post-exposure prophylaxis following blood exposure to HIV has shown effectiveness (about 79%) in preventing seroconversion. Arteries pulsate, are very elastic, and have a thick wall. What should you never do to a site you just cleansed with alcohol? Interruptions and distractions during medical encounters and procedures should be avoided. When using a syringe and needle, avoid drawing the plunger back too forcibly. When there is an IV line present, blood can be drawn from this line. 8. 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. Select the appropriate microtainers for the specimens to be collected. 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} Because most laboratory specimens contain bacteria, it is not necessary to wash hands before collecting them, The tourniquet applied prior to venipuncture is removed: Adjust the angle (the bevel may be against the vein wall). For an inpatient DO NOT DRAW BLOOD IF THE ARMBAND OR BRACELET IS MISSING. (a) the electric power required. Enzymes, proteins, lipids, iron, and calcium are significantly increased with changes in position. Mastering Pediatric Phlebotomy. Center, for Phlebotomy Education, Inc. Focus on what you do best, and find someone who can help you communicate that with your target market. (See, The chlorhexidine is a concern for the premature babies in NICU as it can, be absorbed through the skin. 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. After the needle selection, phlebotomists begin to look and feel for a viable vein. Gas tubes (must warm the site before collecting the specimen), 4. B. the needle is inserted into the patient's arm Over time and with several repeated punctures, significant amounts of scar tissue builds up. Allow it to air, Grasp the finger, and using a sterile lancet, press firmly against the finger. Lippi G, Salvagno GL, Montagnana M, Franchini M, Guidi GC. Veins on the underside of the wrist should be avoided. Move it forward (it may not be in the lumen). f.style.transition="all 0.5s ease"; Wipe away the first drop of blood, which tends to contain excess tissue fluid. 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. It is observed that if the tourniquet is left on longer than 2 minutes, changes in the value of a total protein test occur. Confidentiality of all communications and other records pertaining to the patient's care. 4. f.style.border="none"; Press down on the gauze once the needle is out of the arm, applying adequate pressure to avoid formation of a hematoma. (c) How would you prepare tetracaine from benzene? The use of a tourniquet during a venipuncture procedure makes: The most common site(s) for the venipuncture procedure is/are the following: The tourniquet should not be left on a patient more than 1 minute when performing a venipuncture because it is uncomfortable and causes: The needle should always be inserted at the puncture site with the: The correct needle position for a venipuncture is a ______ degree angle with the bevel facing _____. Children, particularly under the age of 10, may experience pain and anxiety during the phlebotomy procedure. Effective methods use distraction. Always thank the patient and excuse yourself courteously when finished. 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. window.addEventListener('message', function (){ Alcohol not dry in the required amount of time B. Veins less prominent and less filling C. Veins more prominent and easier to puncture D. Blood stop flowing to arteries but not veins A The most common site (s) for the venipuncture procedure is/are the following: An outpatient must provide identification other than the verbal statement of a name. An OSHA acceptable, puncture proof container markedBiohazardous. Scan the skin for lines of blue indicating a prominently visible vein. 6. 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. Procedure for Capillary Puncture of the Finger: The best site for a finger puncture is just off the center of the finger pad of, the 3rd (middle) or 4th (ring) finger of the hand. This requisition form must contain the proper information in order to process the specimen. Is the seating comfortable and has the patient been seated for at least 5 minutes to avoid being rushed or confused? 3. Blood Collection Techniques in Exotic Small Mammals. PST (light green top). The upper extremity on the side of a previous mastectomy - test results may be affected because of lymphedema. Be careful not to withdraw the needle completely or else you risk losing the tube's vacuum and starting a hematoma when the bevel exits the skin. 5. Areas of the body that look infected, scarred, or burned must also be avoided. If the blood flow is diminished, repeat the capillary PUNCTURE to complete the collection. Wipe away the first drop of blood with sterile 22 gauze. 1. What should you do with a CBC or lavender top tube before putting them down? A 21-gauge needle (e.g. if ( prevIframeHeight != zf_ifrm_ht_nw ) { Position the patient so that the hand is easily accessible. CLSI document H04-A6. Basilic vein. D. Butterfly, Before leaving the patient's bedside, you must make sure that: Hemolysis may occur, with pseudohyperkalemia. Check for timing instructions for drawing the appropriate samples. Lightly touch the microtainer capillary collectiondevice (or filter paper) to the LARGE drop of blood. -thrombosis McCall, R. E., & Tankersley, C. M. (2016). Swiftly insert the needle through the skin and into the lumen of the vein. As a phlebotomist, it is critical to know which vein sites offer stable flows for blood draws. *NEVER BEND THE ARM*. Select a vein other than the one with the IV. Do not add blood to a circle already filled orpartially filled with blood. Re-anchor the vein. B. evacuated tube Specimens from infants under the age of 6 months are typically collected by heelstick. To request course information, contact PhlebotomyU today. 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. www.mlo-online.com is using a security service for protection against online attacks. When using a syringe inserted into the line, blood must be withdrawn slowly to avoid hemolysis. In the case of an accidental stick, immediately wash the area with an antibacterial soap,express blood from the wound, and contact your supervisor. Have the patient position their arm on the armrest. Avoid prolonged tourniquet application or fist clenching. If this is not successful, remove the needle, take care of the puncture site and redraw at another site. C. the needle has penetrated all the way through the vein (a) How would you prepare tetracaine from the corresponding aniline derivative, ArNH2_22? It doesn't matter . How should you have the patient position their arm after the venipuncture is complete? 2. Change gloves after each patient or when contaminated. Make certain that the blood completely saturates all four (4) circles and is visible from bothsides. Identify the additive, additive function, volume, and specimen considerations to be followed for each of the various color coded tubes. If a patient has an IV giving them fluids in their right arm which arm should be your first choice to draw blood out of? Ernst, Dennis J. Each time a vein is accessed with a needle, scar tissue forms as part of the body's healing process. Proper patient identification procedures. A key element for successful venipuncture is choosing the best vein. Matt Garcia is an experienced phlebotomist in Vancouver, Canada.