PhlebotomyU offers Certified Phlebotomy Technician (CPT I) courses for aspiring phlebotomists. Sites that should be avoided include areas with extensive scarring, healed burns, inflamed sites, edematous sites, previous puncture sites, earlobes and thumbs. Significant increases can be found in total protein, aspartate aminotransferase (AST), total lipids, cholesterol, iron, Affects packed cell volume and other cellular elements. If superficial veins are not readily apparent, you can force blood into
the vein by massaging the arm from wrist to elbow, tap the site with index and
second finger, apply a warm, damp washcloth to the site for 5 minutes, or lower
the extremity over the bedside to allow the veins to fill. Please enable JavaScript on your browser and try again. Reasonable informed participation in decisions involving the patient's
health care. Joslin JO. Phlebotomy is the practice of drawing blood from patients to gather data about their health. Allow thefinger to dry or wipe dry with a sterile 22 gauze. A. Several veins in the antecubital fossa provide excellent access. Because of contacts with sick patients and their specimens, it is important to follow safety and infection control procedures. D. mandates, The most common antiseptic used in venipuncture is: var iframe = document.getElementById("zf_div_SBGg-3DTNCwt65i9A6n_zU3SneyGD89SSqM_7F_nCas").getElementsByTagName("iframe")[0]; Gloves - can be made of latex, rubber, vinyl, etc. Allow it to air, Grasp the finger, and using a sterile lancet, press firmly against the finger. The recommended order of draw for plastic collection tubes is: First - blood culture bottle or tube (yellow or yellow-black top). While venipuncture is considered to be reasonably safe, the present study investigated the incidence of serious complications occurring in an outpatient setting. remove needle When storing a blood specimen what temp should it be at 2-8 degrees c If a patient starts to seize during a draw what should you do Stop the draw When should you use a capillary instead of venipuncture A patients veins are inaccessible What can cause a hemolysis in a specimen Shaking a tube vigorously If using a needle and syringe, avoid drawing the plunger back too forcefully. Perform the venipuncture, collecting the sample(s) in the appropriate container(s). Warning: Some phlebotomists use a method of anchoring called the "C-hold", in which the index finger pulls upwards superiorly while the thumb pulls downwards inferiorly. Dorsal hand veins are often utilized for intravenous infusions but are viable options for blood draw sites. Dorsal hand veins are often utilized for intravenous infusions but are viable options for blood draw sites. The sides and the tip of the. Have an assistant stabilize the arm by firmly locking the elbow joint. Not making it mobile friendly. For operation at steady state, determine for the motor, each in kW\mathrm{kW}kW Draw 5 ml of blood and discard before drawing the specimen tubes for testing. Reassure the patient that the minimum amount of blood required for testing will be drawn. Avoid placing sample onhot surfaces such as bili-lights or monitors. wikiHow, Inc. is the copyright holder of this image under U.S. and international copyright laws. https://www.osha.gov/laws-regs/standardinterpretations/2007-10-26 and https://www.osha.gov/OshDoc/data_BloodborneFacts/bbfact03.pdf (Accessed June 13, 2022). Dispose of needles immediately upon removal from the patient's vein. Avoid prolonged tourniquet application or fist clenching. The upper extremity on the side of a previous mastectomy - test results may be affected because of lymphedema. var zf_ifrm_ht_nw = ( parseInt(zf_ifrm_data[1], 10) + 15 ) + "px"; BD Eclipse green-capped) is used for most routine and uncomplicated venipunctures. The needle may have pulled out of the vein when switching tubes. doi: 10.1002/14651858.CD005179.pub3. f.style.width="100%"; https://www.ncbi.nlm.nih.gov/books/NBK138650/pdf/Bookshelf_NBK138650.pdf (Accessed June 13, 2022). Move it forward (it may not be in the lumen). Areas in which two veins join should be avoided where possible, as valves are often present. 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. While most patients veins are compatible with a standard needle gauge, others require a. . In some instances, the legs or feet are required for use, but a physician or doctor should be completing the draw, not a phlebotomist. -use correct angle of needle insertion Allow another large drop of blood to form. Clin Lab Med. var zf_perma = zf_ifrm_data[0]; C. all disposable equipment has been discarded properly 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. 2009;18(2):117-139. Loosen the tourniquet. Copyright 2023 - PhlebotomyU | Website Design & SEO by, Phlebotomy: 5 Tips on Finding Difficult Veins. Concentrations of fluids and medications could affect baseline test results. Antiseptic. What is an Approved Phlebotomy School in California. Order of draw for multiple tube phlebotomy. Provide for their comfort as much as possible, and gain the patient's cooperation. If an IV is in place, samples may be obtained below but NEVER above the IV site. What is the most common site for blood sampling? Pre-warm the region of the vein to reduce vasoconstriction and increase blood flow. Avoid areas of hematoma. Allsurfaces are cleaned daily with bleach. 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 . Wipe away the first drop of blood with a sterile 22 gauze. 1. A government issued photo identification card such as a driver's license can aid in resolving identification issues. 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: Various sizes are available. 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. Capillary Specimens may be used immediately for point-of-care testing. Press down on the gauze once the needle is out of the arm, applying adequate pressure to avoid formation of a hematoma. A clinical study is performed to determine the optimal time for application of the tourniquet during phlebotomy. Stop the procedure and remove the needle if: Thanks to all authors for creating a page that has been read 43,712 times. It is observed that if the tourniquet is left on longer than 2 minutes, changes in the value of a total protein test occur. The most commonly used site for a venipuncture is at the bend of the elbow, also called the antecubital fossa 1. 4. 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. Needles are available for evacuated systems and for use with a syringe, single draw or butterfly system. What are the helpful hints for finding veins? You will be redirected once the validation is complete. Clin Lab. A typical single vial contains about five milliliters, which is about one teaspoon. A tin can containing air is sealed. % of people told us that this article helped them. Cap, rotate and invert the collection device to mix the blood collected. 9. Firmly grasp the flanges of the tube holder to avoid advancing the needle further into the vein as you change tubes. Our courses are designed to provide students with the skills and knowledge necessary to work in a variety of medical settings including: Hospitals, Clinical Laboratories, Clinics, Physicians Offices, Blood Banks and much more. For a detailed breakdown of each step of the venipuncture test scroll down. 8. 5. (a) the electric power required. This image is
not<\/b> licensed under the Creative Commons license applied to text content and some other images posted to the wikiHow website. Hold
equipment firmly and place fingers against patient's arm, using the flange
for leverage when withdrawing and inserting tubes. Valenstein PN, Sirota RL. The median cubital vein is used the most for its accessibility. Source of specimen. Extremity is edematous. This is why a required skill for most phlebotomy jobs is to have excellent people skills with the ability to keep the patient calm during the venipuncture procedure. 5. 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. What is the best position to perform venipuncture in? Make certain that the blood completely saturates all four (4) circles and is visible from bothsides. D. 70% isopropyl alcohol. increase the circulation of blood to the area. Avoid UE on same side of mastectomy (lymphedema) }, false); B. the needle is only partially in the vein Several essential steps are required for every successful collection procedure: Patient comfort. 1. The hydrostatic pressure causes some water and filterable elements to leave the extracellular space. 8. What sites should be avoided when drawing blood? Finally, when the necessary blood is collected, the needle will be removed and properly disposed of in a Sharps container and the puncture site will be covered to stop the bleeding. Occupational Safety and Health Administration, United States Department of Labor. wikiHow, Inc. is the copyright holder of this image under U.S. and international copyright laws. Patients in these populations are often nervous and may flail their limbs. Contains a gel separator and clot activator. Punctures to the posterior curvature of the heel cab cause damage to the bones. 3. Clin Chem Lab Med. Hard and dense structures may be nerves or tendons. Blood should NEVER be poured from one tube to another since the tubes can have different additives or coatings (see illustrations at end). This guide follows the steps as outlined in the World Health Organizations Guidelines on Drawing Blood: Best Practices in Phlebotomy. -keep extremity below heart level for a few minutes. Fill the capillary tube(s) or micro collection device(s) as needed. What are the light blue top containers used for? CLSI document H04-A6. If the blood flow is diminished, repeat the capillary PUNCTURE to complete the collection. with their hand to stabilize it for the draw. 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. Lippi G, Salvagno GL, Montagnana M, Franchini M, Guidi GC. Never draw above an IV site. D. discarded in the trash, True or False? Proper Handling of an Uncooperative Patient in an Outpatient Setting Akron. 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. If blood is not obtained, change the position of the needle carefully by moving it forward or backward. -cotton sponges diet, exercise, stress, basal state). Phlebotomy is not a one size fits all; each patient is different and may have their blood drawn at other sites with varying needle sizes. Each phlebotomist generally establishes a routine that is comfortable for her or him. Holder/Adapter - use with the evacuated collection system. Which of the following actions should the technician take? 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. Cap, rotate and invert the microtainer to mix the blood collected. Position the infant with the head slightly elevated. Tip: BD Vacutainer tubes use a translucent stopper to identify short draw variants. Carry out hand hygiene before and after each patient procedure, before putting on and after removing gloves. Over time and with several repeated punctures, significant amounts of scar tissue builds up. 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. Performing a venipuncture on a child under one year of age . If you stick yourself with a contaminated needle: Remove your gloves and dispose of them properly. Drawing blood from major vessels (e.g. Background: Venipuncture is the most common invasive medical procedure performed by health care providers. World Health Organization. Drawing the patient in a reclined position. The blood is normally drawn from a vein on the top of the hand or from the inside of the elbow. Nursing Personnel. Tubes with different additives are used for collecting blood specimens for specific types. Stop the procedure if a hematoma occurs. What are the gold top containers used for? They are also. The content of this article is not intended to be a substitute for professional medical advice, examination, diagnosis, or treatment. In other words, there is no need for another venipuncture procedure. Is the seating comfortable and has the patient been seated for at least 5 minutes to avoid being rushed or confused? Wash hands in warm, running water with an appropriate hand washing product, or if notvisibly contaminated, with a commercial foaming hand wash product before and aftereach patient collection. You may also remove the tube, wait a few seconds for blood flow to resume, and then engage a short drawtube. Basilic vein. wikiHow, Inc. is the copyright holder of this image under U.S. and international copyright laws. Calculate H\Delta \mathrm { H }H of this reaction. -laceration of vein What are the red top containers used for? d.appendChild(f); It is large and near the skins surface, making it easier for phlebotomists to see before anchoring the vein. If another site is not
available, collect the specimen distal to the hematoma. Do not use the central portion of the heel because you might injure the underlying bone, which is close to the skin surface. This makes every subsequent poke harder and harder because scar tissue is more fibrous and tougher to puncture. To request course information, contact PhlebotomyU today. Warm the heel from which blood is to be obtained. This type of venipuncture procedure is a little different, and sometimes can be a little more involved. Otherwise, satisfactory samples may be drawn below the IV by following these procedures: Turn off the IV for at least 2 minutes before venipuncture. 10. 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. Phlebotomy issues and quality improvement in results of laboratory testing. (Partial penetration may allow blood to leak into the soft tissue surrounding the vein by way of the needle bevel). Avoid previous hematoma (draw distal of hematoma) Label all specimens per accepted guidelines. Assess the need for sample recollection and/or rejection. Similarly, it's quite easy to get lost in a "Wikipedia wormhole." Indeed, Wikipedia's depth is infinite, as you link from subject to subject, never able to stop. containers. -18, 20, 22 gauge needles. Certain larger molecules are not filterable into the tissue, therefore they are more concentrated in the blood. Since newborns do not often bleed immediately, use gentle pressure to produce a rounded drop of blood. 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. Remember that veins should ideally feel bouncy. What should you do with a CBC or lavender top tube before putting them down? This image is not<\/b> licensed under the Creative Commons license applied to text content and some other images posted to the wikiHow website. D. all of the above, Common causes of hematomas that form during a venipuncture include: (2017). Puncture only the uppermost wall of the vein, Remove the tourniquet before removing the needle, Make sure the needle fully penetrates the upper most wall of the vein. Capillary Specimens may be collected on filter paper and sent to lab for testing for. 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. Enzymes, proteins, lipids, iron, and calcium are significantly increased with changes in position. Blood collection tubes must be drawn in a specific order to avoid cross-contamination of additives between tubes. 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. 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. Dispose of items in appropriate containers. apply pressure for at least 10 minutes. The patient should either sit in a chair, lie down
or sit up in bed. Predict a possible value of the thickness of the soap bubble. Lightly touch the microtainer capillary collectiondevice (or filter paper) to the LARGE drop of blood. Certain other sites should also be avoided. www.mlo-online.com is using a security service for protection against online attacks. 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. Do not bend, break, recap, or resheath needles to avoid accidental needle puncture or splashing of contents. Arteries
pulsate, are most elastic, and have a thick wall. All rights reserved. 1. Identify the additive, additive function, volume, and specimen
considerations to be followed for each of the various color coded tubes. This image is not<\/b> licensed under the Creative Commons license applied to text content and some other images posted to the wikiHow website. 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. Document that the venipuncture was performed distal to (below) an infusion site. Diurnal variations associated with some blood components are: Of course, the phlebotomist may understand this, however, the patient may not. Journal of Exotic Pet Medicine. This image may not be used by other entities without the express written consent of wikiHow, Inc.
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\u00a9 2023 wikiHow, Inc. All rights reserved. Edematous extremities - tissue fluid accumulation alters test results. 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. The area where the blood is to be drawn from is first cleaned with a germ-killing solution. avoid sites of extensive scarring (burns, surgery, injuries) Collect drops of blood into the collectiondevice by gently massaging the heel. Potassium A phlebotomy technician is removing his gloves after a venipuncture procedure. Patient care following completion of venipuncture. Sign up for wikiHow's weekly email newsletter. A. EMLA If this is not successful, remove the needle, take care of the
puncture site, and redraw. Any attempt to repeat a puncture at the same site increases the risk of complications. } Butterflies are incredibly valuable tools for tackling difficult draws, owing to their precision, shorter shaft length, and maneuverability. This is a general guide for troubleshooting a venipuncture scenario in which blood flow is not initially established upon needle insertion. 9. List several effects of exercise, posture, and tourniquet application
upon laboratory values. Cannula/fistula/heparin lock - hospitals have special policies regarding
these devices. Position the patient. 23-gauge needles (e.g. A face mask reduces risk for blood culture specimen contamination. What caution should you observe when using a Vacutainer? Dispose of contaminated materials in appropriate waste receptacles. This process is automatic. This seats the bevel into the lumen of the vein, and is also the technique used to insert an IV catheter. Previous puncture sites should be avoided. D. it is wiped with alcohol, Venipuncture at sites with each of the following could effect the results EXCEPT: Place blood collection equipment away from patients, especially children and psychiatric patients. Puncture no deeper than 2.4mm (approximately 0.1 inches). Let's take a look at the types of websites you and your staff need to be wary of and how to avoid them. This is more common in humeral and femoral punctures than radial punctures. 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. Check for timing instructions for drawing the appropriate samples. Needles should be placed in a proper disposal unit IMMEDIATELY after their use. 5. Additionally, a hematoma may compress the nerve and lead to long-term damage. This vein lies close to the surface of the skin and there is not a large nerve supply. Phlebitis is inflammation of a vein. 2. Place labeled specimens in zip lock bag and deliver to the laboratory as soon as possible. Certain areas are to be avoided when choosing a site: Extensive scars from burns and surgery - it is difficult to puncture the scar tissue and obtain a specimen. Try rotating the arm to better expose the cephalic or basilic vein. Therefore, your anchor should be gentle but firm to prevent the vein from moving away from you. Blindly maneuvering the needle within the skin is painful to the patient and you run the risk of hitting a nerve, tendon, or artery. 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. 1. Deliver specimens promptly to the laboratory. Avoid bruising the infants heel when obtainingblood. Take enough time to assess the vein before beginning the venipuncture procedure. How should you have the patient position their arm after the venipuncture is complete? Syringes - may be used in place of the evacuated collection tube for special circumstances. The median cubital vein and the cephalic vein in the wrist area should be avoided when possible. Observe universal (standard) safety precautions. 3. Erroneous test results may be obtained when the blood is not thoroughly mixed with the additive. are known to vary lab results of some analytes. Drawing blood for laboratory analysis is most often a routine and uneventful procedure. The antecubital fossa is a collection of veins located within the arms inner area, opposite of the elbow, where the arm folds in. In some cases, a phlebotomist may have to switch sites if they find the blood is not properly flowing from the vein. B. the needle is inserted into the patient's arm 5. Foot veins are a last resort because of the higher probability of complications. The median cubital creates less bruising and pain than other draw sites. Other draw sites, particularly below the waist, are rarely used. LTD: Performing a Capillary Puncture Version 7, General Guidelines for a Capillary Puncture: Capillary punctures are ideal for, small children when only a small volume of blood is needed. Although the larger and fuller median cubital and cephalic veins of the arm are used most frequently, the basilic vein on the dorsum of the arm or dorsal hand veins are also acceptable for venipuncture. When finished, clean the site and apply pressure with a clean gauze to stop the bleeding. So You're Going to Collect a Blood Specimen: An Introduction to Phlebotomy, 13th Edition (2010), College of American Pathologists, Northfield, IL. This enables the bloodto form as a drop on the fingertip. This image is not<\/b> licensed under the Creative Commons license applied to text content and some other images posted to the wikiHow website. Areas of the body that look infected, scarred, or burned must also be avoided. Avoid excessive probing ("fishing"). The rubber stoppers are color coded according to the additive that the tube contains. If an inpatient is able to
respond, ask for a full name and always check the armband or bracelet for confirmation. The vein may have collapsed; resecure the tourniquet to increase venous
filling. Anxiety that results in hyperventilation may cause acid-base imbalances, and increased lactate.