\u00a9 2023 wikiHow, Inc. All rights reserved. A. the plastic sleeve is removed Phlebotomy Exam Questions - TAU Normal reference ranges are often noted according to age. 5. var zf_perma = zf_ifrm_data[0]; Some individuals are afraid of needles, while others are frightened at the sight of blood. Label all specimens per accepted guidelines. Safely discard potentially infectious materials. 5. 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. Wikipedia. Arteries pulsate, are most elastic, and have a thick wall. Blood is commonly obtained from the median cubital vein on the anterior forearm. Since newborns do not often bleed immediately, use gentle pressure to produce a rounded drop of blood. 2. Position the patient so that the hand is easily accessible. What sites should be avoided when drawing blood? C. all disposable equipment has been discarded properly If an IV is in place, samples may be obtained below but NEVER above the IV site. -use a smaller gauge needle Specimens from infants under the age of 6 months are typically collected by heelstick. Performing a venipuncture on a child under one year of age . Procedure for Capillary Puncture of the Finger: The best site for a finger puncture is just off the center of the finger pad of. Phlebotomists are considered to have occupational exposure to blood borne pathogens. Filter paper should touch only the blood and not the heel or finger. ; worn to protect the patient and the phlebotomist. Wipe away the first drop of blood with sterile 22 gauze. The key elements in labeling are: NOTE: Both of the above MUST match the same on the requisition form. If it is then heated, what can you say about: b) how often the molecules hit the walls of the can. 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. B. Hematoma Gas tubes (must warm the site before collecting the specimen), 4. Do not place too tightly or leave on more than 2 minutes (and no more than a minute to avoid increasing risk for hemoconcentration). Hard and dense structures may be nerves or tendons. Am J Clin Pathol. It is observed that if the tourniquet is left on longer than 2 minutes, changes in the value of a total protein test occur. Use a butterfly to compensate for patient movement. All rights reserved. Carry out hand hygiene before and after each patient procedure, before putting on and after removing gloves. Valenstein PN, Sirota RL. Lightly touch the microtainer capillary collectiondevice (or filter paper) to the LARGE drop of blood. B. the insertion site has stopped bleeding Identification errors in pathology and laboratory medicine. Thrombosed veins lack resilience, feel cord-like, and roll easily. together for emotional support and understanding across multiple locations to reach you in the community where you live. Apply firm pressure. 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. Ask the patient to lie on their back. on patients who are extremely dehydrated or have poor peripheral circulation. What sites should be avoided when drawing blood? Do not bend, break, recap, or resheath needles to avoid accidental needle puncture or splashing of contents. Dispose of items in appropriate containers. Apply the tourniquet 3-4 inches above the selected puncture site. -keep extremity below heart level for a few minutes. Remove the first glove so that it turns inside out during removal A phlebotomy technician is preparing to dispose of contaminated sharps. wikiHow, Inc. is the copyright holder of this image under U.S. and international copyright laws. Have the patient position their arm on the armrest. 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. You will be redirected once the validation is complete. 1. previous experience with vomiting or fainting window.addEventListener('message', function (){ It is large and near the skins surface, making it easier for phlebotomists to see before anchoring the vein. or move it backward (it may have penetrated too far). Start with the arm closest to you and palpate the antecubital fossa. Because most laboratory specimens contain bacteria, it is not necessary to wash hands before collecting them, The tourniquet applied prior to venipuncture is removed: HealthStar Press, Inc. 2001, updated 1/08. Collect drops of blood into the collection device by gently massaging the finger. 13. A. just prior to needle insertion doi: 10.1002/14651858.CD005179.pub3. 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. Areas of the body that look infected, scarred, or burned must also be avoided. While most patients veins are compatible with a standard needle gauge, others require a. . 1. The area where the blood is to be drawn from is first cleaned with a germ-killing solution. wikiHow, Inc. is the copyright holder of this image under U.S. and international copyright laws. Some images used in this set are licensed under the Creative Commons through Flickr.com.Click to see the original works with their full license. var prevIframeHeight = iframe.style.height; D. after needle removal, When drawing blood you should always follow universal ______ Do not attempt a capillary puncture more than twice. 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. therapy is usually associated with acidic or alkaline solutions or solutions that have a high osmolarity. By holding the needle either by the plastic wings or the hub, phlebotomists can achieve a shallower angle, typically 10-15 degrees. If multiple blood samples are to be taken, the phlebotomist must be careful to follow the proper order of draw. if( evntData && evntData.constructor == String ){ 7. If the patient is sitting in a phlebotomy chair, make sure they are sitting upright with their back against the chair. 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. } 3. and "What is your date of birth?". Check for timing instructions for drawing the appropriate samples. The Patient's Bill of Rights has been adopted by many hospitals as declared by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). It brings the entire family Blood Specimen Collection and Processing var f = document.createElement("iframe"); B. above an IV line A typical single vial contains about five milliliters, which is about one teaspoon. Make sure the venipuncture site is dry. The 2nd (index) finger tends to have thicker, callused skin. 5. Blood collection tubes must be drawn in a specific order to avoid cross-contamination of additives between tubes. Because of contacts with sick patients and their specimens, it is important to follow safety and infection control procedures. The service requires full cookie support in order to view this website. EDTA and sodium citrate tubes should still be filled to the marked fill line to ensure a correct blood-to-additive ratio. d.appendChild(f); Allow the blood to soak through and completely fill the pre-printed circle on the filter paper. -infection at site An OSHA acceptable, puncture proof container markedBiohazardous. Factitious biochemical measurements resulting from hematologic conditions. Edematous extremities with swollen tissue alter the results. Cochrane Database Syst Rev. Notify your supervisor or patientsphysician if unsuccessful. Sharps Disposal Container. A thin soap bubble of index of refraction 1.33 is viewed with light of wavelength 550.0 nm and appears very bright. Label the collection tubes at the bedside or drawing area. Never draw above an IV site. wikiHow, Inc. is the copyright holder of this image under U.S. and international copyright laws. Primary effect is hemoconcentration of non-filterable elements (i.e. The blood is normally drawn from a vein on the top of the hand or from the inside of the elbow. 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. Be informed of the hospital rules and regulations regarding patient conduct. When do you release the tourniquet during venipuncture? (c) the rate of heat transfer. Stress: May cause transient elevation in white blood cells (WBC's) and elevated adrenal hormone values (cortisol and catecholamines). Press down on the gauze once the needle is out of the arm, applying adequate pressure to avoid formation of a hematoma. If possible, speak with the patient during the process. 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. Apply the tourniquet below the IV site. A requisition form must accompany each sample submitted to the laboratory. Never draw from a thrombosed or scarred vein. In some cases, a phlebotomist may have to switch sites if they find the blood is not properly flowing from the vein. Avoid prolonged tourniquet application or fist clenching. Get instant access to our latest tools and our must-read site updates: What Certifications Are Used For Higher Pay For Phlebotomists? 7. Individually packaged 70% isopropyl alcohol wipes. Calculate H\Delta \mathrm { H }H of this reaction. Determine the final temperature of the R-134a and the final specific internal energy. iframe.style.height = zf_ifrm_ht_nw; 11. Patients in these populations are often nervous and may flail their limbs. D. discarded in the trash, True or False? Place a pillow under the patient's arm if additional support is needed. Follow the procedure as outlined above for greeting and identifying the patient. How to Troubleshoot a Difficult Venipuncture: 14 Steps - wikiHow What are the gray top containers used for? https://www.osha.gov/laws-regs/standardinterpretations/2007-10-26 and https://www.osha.gov/OshDoc/data_BloodborneFacts/bbfact03.pdf (Accessed June 13, 2022). A. in the region of a hematoma What two things should you make sure you discuss with your patients prior to venipuncture? 9. (b) the power developed by the output shaft. Wipe away the first drop of blood, which tends to contain excess tissue fluid. Holder/Adapter - use with the evacuated collection system. Avoid excessive pressure that may squeeze tissue fluidinto the drop of blood. 2004;24(4):979-96, vii. 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. When there is an IV line present, blood can be drawn from this line. This complication of peripheral I.V. There may be no vacuum in the tube being used. What are the green/lavender top containers used for? Wear gloves and a lab coat or gown when handling blood/body fluids. Any attempt to repeat a puncture at the same site increases the risk of complications. For children over 6 months and adults, the finger is punctured. Cephalic vein. ROUTINE CAPILLARY PUNCTURE BLOOD COLLECTION GUIDELINES. PhlebotomyU offers Certified Phlebotomy Technician (CPT I) courses for aspiring phlebotomists. C. at a mastectomy site The rubber stoppers are color coded according to the additive that the tube contains. 6. BD Vacutainer), rather than IV catheter insertions. The sides and the tip of the. f.style.border="none"; When using a syringe and needle, avoid drawing the plunger back too forcibly. Journal of Exotic Pet Medicine. Select a vein other than the one with the IV. A variety of techniques can be employed to reduce pain and anxiety. } If another site is not available, collect the specimen distal to the hematoma. 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. Move it forward (it may not be in the lumen). avoid sites of extensive scarring (burns, surgery, injuries) 3. C. the needle has penetrated all the way through the vein Practice hygiene for the patient's protection. If a vein feels hard, it may be scarred or sclerosed. As a countermeasure, phlebotomists. In this elbow pit, phlebotomists have easy access to the top three vein sites used in phlebotomy: Median cubital vein. Approach the patient in a friendly, calm manner. Safely dispose of potentially infectious materials. This image is not<\/b> licensed under the Creative Commons license applied to text content and some other images posted to the wikiHow website. The median cubital creates, The dorsal venous network is the next most common vein site for phlebotomists. 5. When wearing gloves, change them between each patient and wash your hands frequently. B. the needle is only partially in the vein 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. Drawing the patient in a reclined position. Airborne precautions may be considered to provide a level of safety against infectious diseases such as tuberculosis, influenza, and COVID-19. Punctures to the posterior curvature of the heel cab cause damage to the bones. (See Use of Band-Aids in the Post Phlebotomy. 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. This is very painful, risks damage to underlying structures, and widens the needle hole to prolong bleeding time. 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 . Venipuncture sites should be carefully assessed for contraindications, such as pain, wounds, decreased circulation, a previous cerebral vascular accident (CVA), dialysis fistulas, or a mastectomy on the same side. Adapted from Phlebotomy for Nurses and. Source of specimen. D. 70% isopropyl alcohol. Adjust the angle (the bevel may be against the vein wall). The service requires full JavaScript support in order to view this website. This image is not<\/b> licensed under the Creative Commons license applied to text content and some other images posted to the wikiHow website. Inadvertently nicking a nerve causes intense pain. What are the complications that can occur when performing a venipuncture? Veins sometimes roll away from the point of the needle and puncture site. 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. https://www.ncbi.nlm.nih.gov/books/NBK138650/pdf/Bookshelf_NBK138650.pdf (Accessed June 13, 2022). Phlebitis can also occur as a result of vein trauma during insertion, use of an inappropriate I.V. Phlebotomy Essentials 5th Edition Chapter 9. Heparin light or dark green top tube, 5. C. laws Answer. How To Draw Blood | Phlebotomy Coach This image may not be used by other entities without the express written consent of wikiHow, Inc.
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