A lab coat or gown must be worn during blood collection procedures. Lancets are disposed of in an appropriate sharps container as one unit. Veins on the underside of the wrist should be avoided. Various sizes are available. A variety of techniques can be employed to reduce pain and anxiety. What are the light blue top containers used for? Adapted from Phlebotomy for Nurses and. 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. 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. Patient identification is critical for safety. Occupational Safety and Health Administration, United States Department of Labor. Unlike the cephalic and basilic veins, the median cubital vein is not near major nerves or arteries. Perform the venipuncture. It is large and near the skins surface, making it easier for phlebotomists to see before anchoring the vein. C. Scarring This image is not<\/b> licensed under the Creative Commons license applied to text content and some other images posted to the wikiHow website. Veins sometimes roll away from the point of the needle and puncture site. What are the best veins for venipuncture? D. Both A and B, A sharps container is identified by its bright ____ color What are the complications that can occur when performing a venipuncture? Adjust the angle (the bevel may be against the vein wall). Wear gloves and a lab coat or gown when handling blood/body fluids. Northfield, IL: College of American, NCCLS. Stress: May cause transient elevation in white blood cells (WBC's)
and elevated adrenal hormone values (cortisol and catecholamines). This image is not<\/b> licensed under the Creative Commons license applied to text content and some other images posted to the wikiHow website. Avoid bruising the infants heel when obtainingblood. 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. (function() { The 2nd (index) finger tends to have thicker, callused skin. D. all of the above, Common causes of hematomas that form during a venipuncture include: Using a sterile lancet, puncture the fingertip in the fleshy part of the finger, slightly to the sideof the center and across (perpendicular to) the grooves of the fingertip. 1. EDTA and sodium citrate tubes should still be filled to the marked fill line to ensure a correct blood-to-additive ratio. Performing a venipuncture on a child under one year of age . C. the seal is broken 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. The content of this article is not intended to be a substitute for professional medical advice, examination, diagnosis, or treatment. A. given to the patient f.style.transition="all 0.5s ease"; D. 70% isopropyl alcohol. C. Red Procedure for Capillary Puncture of the Finger: The best site for a finger puncture is just off the center of the finger pad of. Sites to avoid: Extensive scarring from burns or surgery The upper extremity on the side that a mastectomy was performed. The median cubital creates less bruising and pain than other draw sites. 4. Tetracaine is a substance used as a spinal anesthetic. 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. Procedures and Devices for the Collection of Diagnostic Capillary Blood. B. the insertion site has stopped bleeding 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. Is the seating comfortable and has the patient been seated for at least 5 minutes to avoid being rushed or confused? When working with patients who have undergone a mastectomy, draw from the arm on the opposite side of the mastectomy to avoid edematous tissue. Wipe away the first drop of blood with a piece of clean, dry cotton. Cleanse in a circular
fashion, beginning at the site and working outward. While hand veins may be utilized for blood draws and intravenous infusions, veins in the feet and legs should be avoided for adults. He holds a Diploma in Medical Laboratory Assistance and is certified under the British Columbia Society of Laboratory Science. The creatine kinase (CK), aspartate aminotransferase (AST), lactate dehydrogenase (LDH), and platelet count may increase. wikiHow, Inc. is the copyright holder of this image under U.S. and international copyright laws. 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. This image is not<\/b> licensed under the Creative Commons license applied to text content and some other images posted to the wikiHow website. ACDA or ACDB (pale yellow top). Each time a vein is accessed with a needle, scar tissue forms as part of the body's healing process. Diurnal Rhythms: Diurnal rhythms are body fluid and analyte fluctuations during the day. Lines - Drawing from an intravenous line may avoid a difficult venipuncture, but introduces problems. For children over 6 months and adults, the finger is punctured. 5. Effects of Exercise: Muscular activity has both transient and
longer lasting effects. The dorsal venous network is the next most common vein site for phlebotomists. This is very painful, risks damage to underlying structures, and widens the needle hole to prolong bleeding time. This type of venipuncture procedure is a little different, and sometimes can be a little more involved. What are some of the reasons to draw blood? Use a butterfly to compensate for patient movement. 9. Tip: In spite of a difficult draw, remember to invert your tubes. Date, time and initials of the phlebotomist must be on the label of EACH tube. 7. 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. Drawing blood for laboratory analysis is most often a routine and uneventful procedure. Additionally, blood samples should not be taken on an arm with a fistula used for dialysis treatments. 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. Position the patient so that the hand is easily accessible. There are some slight risks associated with venipuncture which may include excessive bleeding, feeling light-headed, fainting, nerve damage, hematoma (accumulation of blood under the skin), and infection. Label all specimens per accepted guidelines. Apply blood to the printed side of the filter paper. on patients who are extremely dehydrated or have poor peripheral circulation. How many time should you invert them? However, blood samples that are normally taken are actually very small. Once you establish blood flow, slightly modify your hand position to stabilize the needle against the arm and prevent further movement. Diagn Microbiol Infect Dis. Also found in the antecubital fossa, the basilic vein serves as a last resort for blood draws. This vein lies close to the surface of the skin and there is not a large nerve supply. or move it backward (it may have penetrated too far). 2017;50(10-11):568-573. A 21-gauge needle (e.g. Label collection tubes after identification of the patient. We use cookies to make wikiHow great. A. Syringe 2. The needle may have pulled out of the vein when switching tubes. 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. 2019;95(1):15-19. doi: 10.1016/j.diagmicrobio.2019.04.001. Place labeled specimens in zip lock bag and deliver to the laboratory as soon as possible. -laceration of vein D. Butterfly, Before leaving the patient's bedside, you must make sure that: Clin Chem Lab Med. 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. Ernst, Dennis J. 1. 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. wikiHow, Inc. is the copyright holder of this image under U.S. and international copyright laws. Re-anchor the vein. Identify the patient. Swiftly insert the needle through the skin and into the
lumen of the vein. Any attempt to repeat a puncture at the same site increases the risk of complications. Greet the patient and identify yourself and indicate the procedure that will take place. Cap, rotate and invert the collection device to mix the blood collected. 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. 12. B. sterilized and reused The rubber stoppers are color coded according to the additive that the tube contains. Promptly send the specimens with the requisition to the laboratory. 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. Allsurfaces are cleaned daily with bleach. PST (light green top). 9. Uman LS, Birnie KA, Noel M, et al. The maximum number of times an individual should attempt a venipuncture on a patient is two, True or False? avoid sites of extensive scarring (burns, surgery, injuries) X=[Ar]4s23d5Y=[Ar]4s23d104p1Z=[Ar]4s23d104p6. Allow the blood to soak through and completely fill the pre-printed circle on the filter paper. 1-kg of R-134a initially at 600 kPa and 25C25^{\circ} \mathrm{C}25C undergoes a process during which the entropy is kept constant until the pressure drops to 100 kPa. diet, exercise, stress, basal state). Last draw - additive tubes in this order: SST (red-gray or gold top). What are the gold top containers used for? Blood collection tubes must be drawn in a specific order to avoid cross-contamination of additives between tubes. Effective methods use distraction. Never draw from a thrombosed or scarred vein. Try rotating the arm to better expose the cephalic or basilic vein. https://www.ncbi.nlm.nih.gov/books/NBK138650/pdf/Bookshelf_NBK138650.pdf (Accessed June 13, 2022). Needles are available for evacuated systems and for use with a syringe, single draw or butterfly system. It brings the entire family 7. BD Vacutainer), rather than IV catheter insertions. BD Eclipse green-capped) is used for most routine and uncomplicated venipunctures. Using the smallest acceptable needle size can help reduce the risk of bleeding or hematoma . UF Health Pathology Laboratories Nontuberculosis Mycobacteria Laboratory, This page uses Google Analytics (Google Privacy Policy), Capillary puncture may be used for obtaining specimens in infants or in adults where. Foot veins are a last resort because of the higher probability of complications. Inadvertently nicking a nerve causes intense pain. -do not rapidly insert the needle. 9. Always wear a clean lab coat or gown. Larger tube sizes typically provide for collection of samples from 6 to 10 mL. Warning: Make sure you are confident that the structure you're palpitating is indeed a vein. 10. This requisition form must contain the proper information in order to process the specimen. It may be, necessary, on occasion, to perform a capillary puncture on the toe of a patient, who is severely burned. Squeeze puncture site to promote bleeding. Compared to the standard blood donation which is about sixteen ounces, one ounce is really small. 10. 8. Stop the procedure and remove the needle if: Thanks to all authors for creating a page that has been read 43,712 times. Avoid excessive pressure that may squeeze tissue fluidinto the drop of blood. Failure to do this results in an unequal blood-to-additive ratio, making the specimen unsuitable for analysis. Calculate H\Delta \mathrm { H }H of this reaction. Perform the venipuncture, collecting the sample(s) in the appropriate container(s). This is more common in humeral and femoral punctures than radial punctures. The most common complications are bleeding at the puncture site or hematoma formation. Certain other sites should also be avoided. Contaminated surfaces must be cleaned with freshly prepared 10% bleach solution. Factitious biochemical measurements resulting from hematologic conditions. Observe all applicable isolationprocedures. 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. Place blood collection equipment away from patients, especially children and psychiatric patients. wikiHow, Inc. is the copyright holder of this image under U.S. and international copyright laws. An assortment of needles and syringes of different sizes Tourniquet Alcohol and alcohol swabs Gauze or cotton balls Laboratory forms and blood-specimen labels Transportation bags and sharps container Step 2: Prepping The Patient Once you have the necessary supplies, it's time to ready the patient. The puncture should be made perpendicular to the ridges of the fingerprint so that the drop of blood does not run down the ridges. Recommended order of collection for microtainer specimens: 7.