\u00a9 2023 wikiHow, Inc. All rights reserved. 3. Remove the needle from the patient's arm using a swift backward motion. The patient has the right to refuse participation in such activity. 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. This process is automatic. Adjust the height and swivel the chair to ensure your body is in line with the vein. Make sure the venipuncture site is dry before proceeding with draw. (b) How would you prepare tetracaine from p-nitrobenzoic acid? Preferred venous access sites, and factors to consider in site selection, and ability to differentiate between the feel of a vein, tendon and artery. The most commonly used site for a venipuncture is at the bend of the elbow, also called the antecubital fossa 1. Potassium A phlebotomy technician is removing his gloves after a venipuncture procedure. Clinical and Laboratory Standards Institute. Using the smallest acceptable needle size can help reduce the risk of bleeding or hematoma . Wipe away the first drop of blood with a sterile 22 gauze. For children over 6 months and adults, the finger is punctured. To request course information, contact PhlebotomyU today. 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. Finger - Usually the third or fourth finger is preferred in adults and children. Confidentiality of all communications and other records pertaining to the patient's care. Complications of Peripheral I.V. Therapy | NursingCenter Second - coagulation tube (light blue top). Recognize complications associated with the phlebotomy procedure. The median cubital vein is used the most for its accessibility. Stop the procedure and remove the needle if: Thanks to all authors for creating a page that has been read 43,712 times. Sanders AM, Agger WA, Gray AM, Fischer CM, Kamprud EA. A requisition form must accompany each sample submitted to the laboratory. Free Flashcards about Phlebotomy Chapter 9 - StudyStack If the puncture is parallel to the lines of the fingerprint, theblood will not form as a drop but will run down the finger making collection difficult. 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. Larger tube sizes typically provide for collection of samples from 6 to 10 mL. -keep extremity below heart level for a few minutes. Avoid excessive pressure that may squeeze tissue fluid into the, mix the blood. Look for visual clues which may help assess the patient's condition. Make the cut across the heelprint lines so that a drop of blood can well up and not run down along the lines. f.style.height="352px"; var iframe = document.getElementById("zf_div_SBGg-3DTNCwt65i9A6n_zU3SneyGD89SSqM_7F_nCas").getElementsByTagName("iframe")[0]; Whole blood specimens may not be able to be analyzed if microscopic clots are present. Stabilize the needle as you're inserting your tubes. 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. What angle should you insert the needle at? This guide follows the steps as outlined in the World Health Organizations Guidelines on Drawing Blood: Best Practices in Phlebotomy. Re-secure the tourniquet to increase venous filling. Valenstein PN, Sirota RL. The sides and the tip of the, Select the proper approved lancet: The BD Microtainer Contact-Activated, Lancet 1.5 mm (lavender) is used for glucometers and the BD Microtainer, Contact-Activated Lancet 2.0 mm (blue) is used any time you need more, Prepare the finger by cleaning it with a Chlorhexadine wipe. Allow the blood to soak through and completely fill the pre-printed circle on the filter paper. 12. The creatine kinase (CK), aspartate aminotransferase (AST), lactate dehydrogenase (LDH), and platelet count may increase. 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? For a detailed breakdown of each step of the venipuncture test scroll down. Deliver specimens promptly to the laboratory. This enables the bloodto form as a drop on the fingertip. Anxiety that results in hyperventilation may cause acid-base imbalances, and increased lactate. Over time and with several repeated punctures, significant amounts of scar tissue builds up. What are the red top containers used for? To prevent hemolysis when performing a venipuncture, the phlebotomist should: 1. What sites should be avoided when drawing blood? Such terms as "needs to," "must," "require" and "should" are used to explain how medical professionals should perform capillary blood collection procedures. When wearing gloves, change them between each patient and wash your hands frequently. (See, The chlorhexidine is a concern for the premature babies in NICU as it can, be absorbed through the skin. 7. How far above a venipuncture sight should you place a tourniquet? Wait 2 minutes before reapplying the tourniquet. A. EMLA Select the proper approved lancet: The BD Microtainer Contact-Activated. Gloves are to be discarded in the appropriate container immediately after the bloodcollection 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. 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. 5. Loosen the tourniquet. Drawing blood from major vessels (e.g. If you stick yourself with a contaminated needle: Remove your gloves and dispose of them properly. In other words, there is no need for another venipuncture procedure. Kiechle FL. Concentrations of fluids and medications could affect baseline test results. What is the most common site for blood sampling? Wipe away the first drop of blood, which tends to contain excess tissue fluid. The patient who is at ease will be less focused on the procedure. Since newborns do not often bleed immediately, use gentle pressure to produce a rounded drop of blood. Arteries pulsate, are most elastic, and have a thick wall. For example, serum cortisol levels are highest in early morning but are decreased in the afternoon. This information must be given when requesting microbiology, cytology, fluid analysis, or other testing where analysis and reporting is site specific. When finished, clean the site and apply pressure with clean gauze to stop the bleeding. What should you do with a CBC or lavender top tube before putting them down? Avoid bruising the infants heel when obtainingblood. Prepare the equipment, the patient and the puncture site. Phlebitis is inflammation of a vein. Foot veins are a last resort because of the higher probability of complications. INR for patients on warfarin) are often knowledgeable on the veins that are most likely to work. 3. 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. It may be obstructing blood flow. wikiHow, Inc. is the copyright holder of this image under U.S. and international copyright laws. It is an employer's responsibility to provide, clean, repair, replace, and/or dispose of personal protective equipment/clothing. D. it is wiped with alcohol, Venipuncture at sites with each of the following could effect the results EXCEPT: A. the tubes are filled and properly labeled C. Scarring Label the collection tubes at the bedside or drawing area. on patients who are extremely dehydrated or have poor peripheral circulation. It is large and near the skins surface, making it easier for phlebotomists to see before anchoring the vein. Never draw above an IV site. A typical single vial contains about five milliliters, which is about one teaspoon. 4. Fill the capillary tube(s) or micro collection device(s) as needed. 5 Common Capillary Puncture Blood Collection Sites - Neoteryx NOTE: The use of post-exposure prophylaxis following blood exposure to HIV has shown effectiveness (about 79%) in preventing seroconversion. When finished, clean the site and apply pressure with a clean gauze to stop the bleeding. Asking the patient about their previous blood draw experiences is beneficial, especially if they are a hard stick and know which area works best. (Uman et al, 2013). therapy is usually associated with acidic or alkaline solutions or solutions that have a high osmolarity. Within the antecubital fossa, this vein poses the least amount of risk. The performance of routine vascular access procedures by skilled phlebotomists requires, at a minimum, the use of gloves to prevent contact with blood. C. sterile gauze pads 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. 5. 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. Tip: Lowering the arm below the level of the heart may help to engorge the vessels. Promptly send the specimens with the requisition to the laboratory. Select the appropriate microtainers for the specimens to be collected. When using a syringe avoid drawing the plunger back too forcefully. After the third attempt, further medical directions must be sought with the attending physician before proceeding. The content of this article is not intended to be a substitute for professional medical advice, examination, diagnosis, or treatment. Pre-warm the region of the vein to reduce vasoconstriction and increase blood flow. Many drugs will have "peak" and "trough" levels that vary according to dosage levels and intervals. However, drawing blood from the hand is affiliated with higher levels of pain and less control. Dispose of contaminated materials/supplies in designated containers. 8. 23-gauge needles (e.g. If an IV is in place, samples may be obtained below but NEVER above the IV site. Serum iron levels tend to drop during the day. Adhesive bandages / tape - protects the venipuncture site after collection. Uman LS, Birnie KA, Noel M, et al. WHO guidelines on drawing blood: best practices in phlebotomy. Patient identification is critical for safety. What are the light blue top containers used for? Most reference ranges are based on normal laboratory test values for: Healthy people in a basal state. Apply blood to the printed side of the filter paper. What is the procedure to draw blood from an arm with an IV in it? Proper patient identification procedures. Patient care following completion of venipuncture. By signing up you are agreeing to receive emails according to our privacy policy. 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. Place labeled specimens in zip lock bag and deliver to the laboratory as soon as possible. A clinical study is performed to determine the optimal time for application of the tourniquet during phlebotomy. Sites to avoid: Extensive scarring from burns or surgery The upper extremity on the side that a mastectomy was performed. Blood Collection Process: Venipuncture - University of Florida Use a smaller tube with less vacuum. 2009;18(2):117-139. There may be no vacuum in the tube being used. If multiple blood samples are to be taken, the phlebotomist must be careful to follow the proper order of draw. Patches of purple or yellow may suggest bruising after a recent venipuncture. The vein may have collapsed; resecure the tourniquet to increase venous filling. Select a vein other than the one with the IV. iframe.style.height = zf_ifrm_ht_nw; The Patient's Bill of Rights has been adopted by many hospitals as declared by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). 8. Any microtainerscontaining additives should be tapped to dislodge additives from the walls and top. But since each patient's medical condition varies, so does their veins. Avoid trauma and excessive probing. Switch to the other arm if you can't find anything. B. collection device -obvious skin infection (including newly tattooed areas) -extensive scarring -don't use same side as mastectomy -avoid previous hematoma -avoid arm w/ fistula/cannula -edamtous extremity What is the most common site for blood sampling? 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 obtain specimens from an arm having a cannula, fistula, or vascular graft. Make certain that the blood completely saturates all four (4) circles and is visible from bothsides. Airborne precautions may be considered to provide a level of safety against infectious diseases such as tuberculosis, influenza, and COVID-19. Collect drops of blood into the collection device by gently massaging the finger. When multiple vials of blood are collected it can seem like a large amount. Press down on the gauze once the needle is out of the arm, applying adequate pressure to avoid formation of a hematoma. This image may not be used by other entities without the express written consent of wikiHow, Inc.
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