\u00a9 2023 wikiHow, Inc. All rights reserved. Do not bend, break, recap, or resheath needles to avoid accidental needle puncture or splashing of contents. How to Troubleshoot a Difficult Venipuncture. Sites that should be avoided include areas with extensive scarring, healed burns, inflamed sites, edematous sites, previous puncture sites, earlobes and thumbs. Sign up for wikiHow's weekly email newsletter. 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. Other Factors: Age, gender, and pregnancy have an influence on laboratory testing. Warning: Make sure you are confident that the structure you're palpitating is indeed a vein. All of the following are common types of equipment used for venipuncture EXCEPT: Phlebotomy Essentials 5th Edition Chapter 9. If a vein feels hard, it may be scarred or sclerosed. Additionally, a hematoma may compress the nerve and lead to long-term damage. 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. It may be, necessary, on occasion, to perform a capillary puncture on the toe of a patient, who is severely burned. Never draw from a thrombosed or scarred vein. Apply the tourniquet approximately 4-5 finger-widths above the planned venepuncture site. Obtain from the practitioner complete and current information about diagnosis, treatment, and any known prognosis, in terms the patient can reasonably be expected to understand. Needles - The gauge number indicates the bore size: the larger the gauge number, the smaller the needle bore. 3. Avoid excessive pressure that may squeeze tissue fluidinto the drop of blood. Such terms as "needs to," "must," "require" and "should" are used to explain how medical professionals should perform capillary blood collection procedures. The needle may have pulled out of the vein when switching tubes. (Uman et al, 2013). 4. The first step to choosing the right vein is to select the appropriate needle gauge. EDTA and sodium citrate tubes should still be filled to the marked fill line to ensure a correct blood-to-additive ratio. Identify the patient. The hydrostatic pressure causes some water and filterable elements to leave the extracellular space. Several essential steps are required for every successful collection procedure: Patient comfort. Re-secure the tourniquet to increase venous filling. Because most laboratory specimens contain bacteria, it is not necessary to wash hands before collecting them, The tourniquet applied prior to venipuncture is removed: IV lines are very useful in hospitals because some patients require frequent blood tests. The venipuncture procedure is complex, requiring both knowledge and skill to perform. Make sure the venipuncture site is dry. HealthStar Press, Inc. 2001, updated 1/08. Stop the procedure and remove the needle if: Thanks to all authors for creating a page that has been read 43,712 times. Let's take a look at the types of websites you and your staff need to be wary of and how to avoid them. IF AN INCOMPLETE COLLECTION OR NO BLOOD IS OBTAINED: Change the position of the needle. Specimens; Approved StandardSixth Edition. At least two patient identifiers, such as name and date of birth, are needed. Adjust the angle (the bevel may be against the vein wall). 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. Background: Venipuncture is the most common invasive medical procedure performed by health care providers. You should not perform this technique unless you are certain that the needle is in the immediate vicinity of the vein. In fact, many search engines provide the option to avoid dangerous sites by turning on a "safer" search. Summarize the problems that may be encountered in accessing a vein, including the procedure to follow when a specimen is not obtained. 6. 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. This enables the bloodto form as a drop on the fingertip. To prevent hemolysis when performing a venipuncture, the phlebotomist should: 1. By using our site, you agree to our. Draw 5 ml of blood and discard before drawing the specimen tubes for testing. After the needle selection, phlebotomists begin to look and feel for a viable vein. site. 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} Effective communication - both verbal and nonverbal - is essential. Proper patient identification procedures. (Partial penetration may allow blood to leak into the soft tissue surrounding the vein by way of the needle bevel). When the last tube to be drawn is filling, remove the tourniquet. The rubber stoppers are color coded according to the additive that the tube contains. Do not use the central portion of the heel because you might injure the underlying bone, which is close to the skin surface. Re-anchor the vein. 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. Wait 2 minutes before reapplying the tourniquet. wikiHow, Inc. is the copyright holder of this image under U.S. and international copyright laws. Matt Garcia is an experienced phlebotomist in Vancouver, Canada. Apply blood to the printed side of the filter paper. Prepare the patient's arm using an alcohol prep. remove needle drawing from hand or foot Avoid excessive probing ("fishing"). Label all specimens per accepted guidelines. For an inpatient DO NOT DRAW BLOOD IF THE ARMBAND OR BRACELET IS MISSING. (function() { Contains lithium heparin anticoagulant and a gel separator. diet, exercise, stress, basal state). If just a routine coagulation assay is the only test ordered, then a single light blue top tube may be drawn. Answer. together for emotional support and understanding across multiple locations to reach you in the community where you live. Each time a vein is accessed with a needle, scar tissue forms as part of the body's healing process. (2017). 4. })(); The cephalic vein is a safe secondary option if the median cubital vein is not working. Extensive scarring or healed burn areas should be avoided Specimens should not be obtained from the arm on the same side as a mastectomy. What is the most common site for blood sampling? 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. 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. If the patient is sitting in a phlebotomy chair, make sure they are sitting upright with their back against the chair. Specimens from infants under the age of 6 months are typically collected by heelstick. *NEVER BEND THE ARM*. Drawing the patient in a reclined position. ROUTINE CAPILLARY PUNCTURE BLOOD COLLECTION GUIDELINES. Contains a gel separator and clot activator. Avoid areas of hematoma. Drawing blood from major vessels (e.g. Blood is collected into an attached vial or tube that is airtight and the flexible band is then removed from the arm. Allow the blood to soak through and completely fill the pre-printed circle on the filter paper. Hematoma - A venipuncture should not be performed on a hematoma, regardless of how small it may be. wikiHow, Inc. is the copyright holder of this image under U.S. and international copyright laws. A. Edema Preanalytical phase of the testing process begins for the laboratory when a: Test is ordered by a patient's physician. For children over 6 months and adults, the finger is punctured. The diagram below indicates in green the proper area to use for heel punctures for blood collection: Prewarming the infant's heel (42 C for 3 to 5 minutes) is important to obtain capillary blood gas samples and warming also greatly increases the flow of blood for collection of other specimens. Give an example of each. Avoid previous hematoma (draw distal of hematoma) Avoid excessive pressure that may squeeze tissue fluid into the drop of blood. 5. Individually packaged 70% isopropyl alcohol wipes. Therapeutic Drug Monitoring: different pharmacologic agents have patterns of administration, body distribution, metabolism, and elimination that affect the drug concentration as measured in the blood. C. Iodine A. EMLA Check the requisition form for requested tests, patient information, and any special requirements. Areas in which two veins join should be avoided where possible, as valves are often present. Drawing from these sites can cause blood clotting and hemostasis. A clinical study is performed to determine the optimal time for application of the tourniquet during phlebotomy. Cleanse the heel with alcohol prep, then dry with a sterile 22 as alcohol can influence testresults. Certain other sites should also be avoided. Basilic vein. Patient identification is critical for safety. Allow another large drop of blood to form. 6. 7. Asking the patient about their previous blood draw experiences is beneficial, especially if they are a hard stick and know which area works best. A 21-gauge needle (e.g. Hard and dense structures may be nerves or tendons. Penetrate the skin at a 30 to 45 angle at first (even less with a butterfly), then once you get a flash, reduce the angle by bringing the needle assembly down closer to the arm and advance the needle a tiny bit further into the vein. This image may not be used by other entities without the express written consent of wikiHow, Inc.
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