what sites should be avoided when performing venipuncture quizlet

The patient should either sit in a chair, lie down or sit up in bed. However, if there is no alternative and an arm with an IV line in place must be used for venipuncture, try to choose a site away from and below the location of the IV. In fact, many search engines provide the option to avoid dangerous sites by turning on a "safer" search. Begin by selecting the proper, approved lancet, such as: BD Microtainer Quikheel Lancet, 2.5 mm for full-term babies (green), BD Microtainer Quickheel Preemie Lancet, 1.75 mm for neonatal, Unistick2 Neonatal 18G, 1.2mm Lancet for neonatal babies less than, Prepare the heel by cleaning it with a Chlorhexadine wipe. 4. Collect the drops of blood into the collection device by gently massaging, Avoid excessive pressure that may squeeze tissue fluid into the drop of, When full, cap and then gently invert the collection device 5-10 times to, Hold a gauze pad over the puncture site for a short time to stop the, Dispose of the contaminated materials and lancet in the appropriate waste, Place a band-aid on the patients finger or have someone continue to hold, gauze on the finger. ; worn to protect the patient and the phlebotomist. Patients who are dehydrated, obese, terminally ill, or hard sticks often get their blood drawn in other locations rather than the antecubital fossa. Tip: If you realize you've collected in the wrong order of draw, remove the tube, insert the correct one, fill it halfway before discarding it, then insert a new tube and fill it completely. Significant increases can be found in total protein, aspartate aminotransferase (AST), total lipids, cholesterol, iron, Affects packed cell volume and other cellular elements. Adjust the height and swivel the chair to ensure your body is in line with the vein. 5. WHO guidelines on drawing blood: best practices in phlebotomy. Select the appropriate microtainers for the specimens to be collected. A. Source of specimen. 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. Any attempt to repeat a puncture at the same site increases the risk of complications. Dorsal hand veins are often utilized for intravenous infusions but are viable options for blood draw sites. Pre-warm the region of the vein to reduce vasoconstriction and increase blood flow. catheter size for the vein, or prolonged use of the same I.V. Tip: In spite of a difficult draw, remember to invert your tubes. Stress: May cause transient elevation in white blood cells (WBC's) and elevated adrenal hormone values (cortisol and catecholamines). Intravenous therapy (IV) / blood transfusions - fluid may dilute the specimen, so collect from the opposite arm if possible. Edematous extremities - tissue fluid accumulation alters test results. 6. While this may be effective in some difficult draws, the risk of a needlestick injury is higher if the patient has a withdrawal reflex and the needle recoils back into your finger. are known to vary lab results of some analytes. The patient has the right to refuse participation in such activity. wikiHow, Inc. is the copyright holder of this image under U.S. and international copyright laws. C. Red Compared to the standard blood donation which is about sixteen ounces, one ounce is really small. 7. It is large and near the skins surface, making it easier for phlebotomists to see before anchoring the vein. Areas of fingers and heels that are cold, swollen, scarred or covered with a rash, should be avoided. When finished, elevate the heel, place a piece of clean, dry cotton on the puncture site, and hold it in place until the bleeding has stopped. Cleanse in a circular fashion, beginning at the site and working outward. Identify the patient using two different identifiers, asking open ended questions such as, "What is your name?" Contains a gel separator and clot activator. Patient care following completion of venipuncture. What is the most common complication of venipuncture? World Health Organization. True or False? Gauze sponges - for application on the site from which the needle is withdrawn. The content of this article is not intended to be a substitute for professional medical advice, examination, diagnosis, or treatment. Which element has the highest ionization energy? ROUTINE CAPILLARY PUNCTURE BLOOD COLLECTION GUIDELINES. https://www.ncbi.nlm.nih.gov/books/NBK138650/pdf/Bookshelf_NBK138650.pdf (Accessed June 13, 2022). Recommended order of collection for microtainer specimens: 7. Use of hair nets and face masks to decrease blood culture contamination rates. While most patients veins are compatible with a standard needle gauge, others require a. . Confidentiality of all communications and other records pertaining to the patient's care. Move it forward (it may not be in the lumen). This image is not<\/b> licensed under the Creative Commons license applied to text content and some other images posted to the wikiHow website. Venipuncture can also happen when patients have intravenous (IV) lines started. Wikipedia. (c) the rate of heat transfer. Effective methods use distraction. Giavarina D, Lippi G. Blood venous sample collection: Recommendations overview and a checklist to improve quality. 4. There are three phlebotomy vein sites located in the arm most utilized by medical professionals and three additional draw sites that are last resorts. }catch(e){} Consult the nursing unit or your facility's resources prior to drawing from an IV or PICC line or performing venipuncture on an arm with an IV line in place. It is an employer's responsibility to provide, clean, repair, replace, and/or dispose of personal protective equipment/clothing. The median cubital vein is used the most for its accessibility. By signing up you are agreeing to receive emails according to our privacy policy. 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. Diurnal variations associated with some blood components are: puncture site downward and gently applying intermittent pressure to the surrounding tissue (or proximal to the puncture site when the blood is obtained from a finger). www.mlo-online.com is using a security service for protection against online attacks. 8. Avoid puncturing a finger that is cold or cyanotic, swollen, scarred, or covered with a rash. The blood is normally drawn from a vein on the top of the hand or from the inside of the elbow. Therefore, your anchor should be gentle but firm to prevent the vein from moving away from you. To request course information, contact PhlebotomyU today. Primary effect is hemoconcentration of non-filterable elements (i.e. Do not use the tip of the finger or the center of the finger. wikiHow, Inc. is the copyright holder of this image under U.S. and international copyright laws. The needle should form a 15 to 30 degree angle with the surface of the arm. 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. Phlebitis can also occur as a result of vein trauma during insertion, use of an inappropriate I.V. Greet the patient and identify yourself and indicate the procedure that will take place. A warm compress or heel warmer should be used to warm, fingers and heels that are cold, or if a capillary blood gas is being drawn, to. If the patient is sitting in a phlebotomy chair, make sure they are sitting upright with their back against the chair. Step 3: Venipuncture. If another site is not available, collect the specimen distal to the hematoma. Look at the dorsum of the hand as a last resort. A needle is then gently inserted into the vein. Remember that veins should ideally feel bouncy. 4. The patient shall be informed if the hospital proposes to engage in or perform human experimentation or other research/educational profits affecting his or her care or treatment. This image is not<\/b> licensed under the Creative Commons license applied to text content and some other images posted to the wikiHow website. Basilic vein. A tin can containing air is sealed. Potassium A phlebotomy technician is removing his gloves after a venipuncture procedure. Additionally, a hematoma may compress the nerve and lead to long-term damage. Using a sterile blood lancet, puncture the side of the heel in the appropriate regions shown above in green. The first drop contains excess tissue fluid and must be wiped away. Use a butterfly to compensate for patient movement. Try rotating the arm to better expose the cephalic or basilic vein. 3. What is the best position to perform venipuncture in? 6. Within the antecubital fossa, this vein poses the least amount of risk. Last draw - additive tubes in this order: SST (red-gray or gold top). If the blood flow is diminished, repeat the capillary PUNCTURE to complete the collection. In other words, there is no need for another venipuncture procedure. D. Blue, Which of the following conditions should prevent a site from being selected for venipuncture? Individually packaged 70% isopropyl alcohol wipes. Laboratory coats or work smocks are not typically needed as personal protective equipment during routine venipuncture, but an employer must assess the workplace to determine whether certain tasks, workplace situations, or employee skill levels may result in an employee's need for laboratory coats or other personal protective equipment to prevent contact with blood. Each time a vein is accessed with a needle, scar tissue forms as part of the body's healing process. In some instances, the legs or feet are required for use, but a physician or doctor should be completing the draw, not a phlebotomist. Arteries pulsate, are very elastic, and have a thick wall. obvious areas of skin infections *NEVER BEND THE ARM*. Expect that any discussion or consultation involving the patient's case will be conducted discretely and that individuals not directly involved in the case will not be present without patient permission. You must check the timing of these variations for the desired collection point. The first attempt is the antecubital fossa area, starting with the median cubital vein, then the cephalic vein, and the basilic vein. Additionally, blood samples should not be taken on an arm with a fistula used for dialysis treatments. 2013 Oct 10;(10):CD005179. PhlebotomyU offers Certified Phlebotomy Technician (CPT I) courses for aspiring phlebotomists. This image is not<\/b> licensed under the Creative Commons license applied to text content and some other images posted to the wikiHow website. If a vein feels hard, it may be scarred or sclerosed. While we are ranked among the best children's hospitals in the country, it's our compassionate approach to treatment that makes us truly exceptional. var prevIframeHeight = iframe.style.height; The maximum number of times an individual should attempt a venipuncture on a patient is two, True or False? f.style.transition="all 0.5s ease"; A. Edema Apply the tourniquet approximately 4-5 finger-widths above the planned venepuncture site. The use of a tourniquet during a venipuncture procedure makes: A. 6. C. at a mastectomy site Capillary Specimens may be used immediately for point-of-care testing. B. evacuated tube 2017;148(4):330-335. Watch for formation of a hematoma. This is very painful, risks damage to underlying structures, and widens the needle hole to prolong bleeding time. f.style.width="100%"; wikiHow, Inc. is the copyright holder of this image under U.S. and international copyright laws. A. standards very small or difficult vein, Ch 46 Phlebotomy & Ch 47 Hematology (MULTIPLE, Chapter 47: Phlebotomy and Blood Collection, Positive and negative feedback & examples, Meds Vanessa doesn't need because she sleeps, Medical Terminology: Learning Through Practice, April Lynch, Jerome Kotecki, Karen Vail-Smith, Laura Bonazzoli. In some cases, a phlebotomist may have to switch sites if they find the blood is not properly flowing from the vein. Do not use the central portion of the heel because you might injure the underlying bone, which is close to the skin surface. Allow the blood to soak through and completely fill the pre-printed circle on the filter paper. 2017;50(10-11):568-573. advantageous in certain adult populations, such as: those with severe burns, obese patients, those with thrombotic tendencies, and for point-of-care testing, when a small volume of blood is needed. How far above a venipuncture sight should you place a tourniquet? var zf_ifrm_ht_nw = ( parseInt(zf_ifrm_data[1], 10) + 15 ) + "px"; Press down on the gauze once the needle is out of the arm, applying adequate pressure to avoid formation of a hematoma. -keep extremity below heart level for a few minutes. As a countermeasure, phlebotomists anchor the vein with their hand to stabilize it for the draw.