Contains lithium heparin anticoagulant and a gel separator. Do not use the tip of the finger or the center of the finger. Gloves are to be discarded in the appropriate container immediately after the bloodcollection procedure. A government issued photo identification card such as a driver's license can aid in resolving identification issues. Hemoconcentration: An increased concentration of larger molecules and formed elements in the blood may be due to several factors: Prolonged tourniquet application (no more than 1 minute). B. sterilized and reused 4. wikiHow, Inc. is the copyright holder of this image under U.S. and international copyright laws. (b) How would you prepare tetracaine from p-nitrobenzoic acid? A commercial heel warmer may be used. A. in the region of a hematoma 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. A requisition form must accompany each sample submitted to the laboratory. d.appendChild(f); Use a butterfly to compensate for patient movement. wikiHow, Inc. is the copyright holder of this image under U.S. and international copyright laws. Be informed of the hospital rules and regulations regarding patient
conduct. When finished, clean the site and apply pressure with clean gauze to stop the bleeding. })(); The cephalic vein is a safe secondary option if the median cubital vein is not working. 2. followed pre-lab instructions. wikiHow, Inc. is the copyright holder of this image under U.S. and international copyright laws. Apply an adhesive bandage. Dispose of contaminated materials/supplies in designated containers. Clean the site to be punctured with an alcohol sponge. Too tight of a tourniquet may cause the vein to collapse upon needle insertion. A clinical study is performed to determine the optimal time for application of the tourniquet during phlebotomy. A. the plastic sleeve is removed 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. Try rotating the arm to better expose the cephalic or basilic vein. 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. All approved lancets utilized at Akron Childrens are for single use and feature, Heel punctures are performed on infants less than 6 months of age, or on, older premature infants who are the approximate size of a full-term 6 month, old. BD Vacutainer), rather than IV catheter insertions. 2. Allow the blood to soak through and completely fill the pre-printed circle on the filter paper. wikiHow, Inc. is the copyright holder of this image under U.S. and international copyright laws. 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. Such terms as "needs to," "must," "require" and "should" are used to explain how medical professionals should perform capillary blood collection procedures. Nursing Personnel. What is an Approved Phlebotomy School in California. There are three phlebotomy vein sites located in the arm most utilized by medical professionals and three additional draw sites that are last resorts. Green Of course, the phlebotomist may understand this, however, the patient may not. Potential source of test error, particularly from hemolysis, Most lines are flushed with a solution of heparin to reduce the risk of thrombosis, Discard a sample at least three times the volume of the line before a specimen is obtained for analysis. Lightly touch the microtainer capillary collection device (or filter paper) to the LARGE drop of blood. prevent falls, should the patient lose consciousness. If this is not successful, remove the needle, take care of the
puncture site, and redraw. The index finger can be calloused or sensitive and the little finger does not have enough tissue to prevent hitting the bone with the lancet. Proper labeling procedures and completion of laboratory requisitions. These items include: Let's take a quick, high-level look at the venipuncture procedure. This seats the bevel into the lumen of the vein, and is also the technique used to insert an IV catheter. Never draw above an IV site. This image is not<\/b> licensed under the Creative Commons license applied to text content and some other images posted to the wikiHow website. Label the collection tubes at the bedside or drawing area. Most commonly, venipuncture will be performed on the Antecubital Fossa, or the inside of the elbow. -infection at site C. sterile gauze pads 5. To prevent hemolysis when performing a venipuncture, the phlebotomist should: 1. Cap, rotate and invert the microtainer to mix the blood collected. Contains a gel separator and clot activator. wikiHow, Inc. is the copyright holder of this image under U.S. and international copyright laws. If blood is not obtained, change the position of the needle carefully by moving it forward or backward. (See Use of Band-Aids in the Post Phlebotomy. The antecubital fossa is a collection of veins located within the arm's inner area, opposite of the elbow, where the arm folds in. Palpate and trace the path of veins with the index finger. Blood is collected into an attached vial or tube that is airtight and the flexible band is then removed from the arm. -obvious skin infection (including newly tattooed areas). site. D. discarded in the trash, True or False? Impartial access to treatment or accommodations that are available or
medically indicated, regardless of race, creed, sex, national origin, or
sources of payment for care. apply pressure for at least 10 minutes. The basic patient rights endorsed by the JCAHO follow in condensed form are given below. Assess the need for sample recollection and/or rejection. IV lines are very useful in hospitals because some patients require frequent blood tests. Additionally, a hematoma may compress the nerve and lead to long-term damage. C. all disposable equipment has been discarded properly Drawing the patient in a reclined position. Ask the patient to lie on their back. Do not use excessive pressure or heavy massaging because the blood may become diluted with tissue fluid. ACDA or ACDB (pale yellow top). This image is not<\/b> licensed under the Creative Commons license applied to text content and some other images posted to the wikiHow website. Serum iron levels tend to drop during the day. Websites that masquerade as the ones you trust. The service requires full cookie support in order to view this website. A. Syringe the chlorhexidine residue before tying a piece of gauze around the foot. It is large and near the skins surface, making it easier for phlebotomists to see before anchoring the vein. Normal reference ranges are often noted according to
age. Effects of Exercise: Muscular activity has both transient and
longer lasting effects. Feel for the median cubital first, the cephalic vein second, and the basilic vein third. Wipe away the first drop of blood with a piece of clean, dry cotton. The first drop contains excess tissue fluid and must be wiped away. Use a smaller tube with less vacuum. Observe all applicable isolationprocedures. Since newborns do not often bleed immediately, use gentle pressure to produce a rounded drop of blood. Patients who are dehydrated, obese, terminally ill, or hard sticks often get their blood drawn in other locations rather than the antecubital fossa. 2. Safely dispose of potentially infectious materials. It is an employer's responsibility to provide, clean, repair, replace, and/or dispose of personal protective equipment/clothing. 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? 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. Order of draw for multiple tube phlebotomy. 12. 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. 70% isopropyl alcohol -thrombosis However, drawing blood from the hand is affiliated with higher levels of pain and less control. B. just after needle insertion, but prior to vacutainer activation https://www.ncbi.nlm.nih.gov/books/NBK138650/pdf/Bookshelf_NBK138650.pdf (Accessed June 13, 2022). D. all of the above, Common causes of hematomas that form during a venipuncture include: If an IV is in place, samples may be obtained below but NEVER above the IV site. 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. This image is not<\/b> licensed under the Creative Commons license applied to text content and some other images posted to the wikiHow website. With risk for blood spatter a face shield provides protection. Remove the first glove so that it turns inside out during removal A phlebotomy technician is preparing to dispose of contaminated sharps. Have the patient position their arm on the armrest. Squeeze puncture site to promote bleeding. 6. Prepare the equipment, the patient and the puncture site. Kiechle, Frederick L. So Youre Going to Collect a Blood Specimen: An, Introduction to Phlebotomy, 11th Edition. 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. Drawing blood from major vessels (e.g. The median cubital creates less bruising and pain than other draw sites. PST (light green top). 10. 2019;95(1):15-19. doi: 10.1016/j.diagmicrobio.2019.04.001. The recommended location for blood collection on a newborn baby or infant is the heel. Potassium A phlebotomy technician is removing his gloves after a venipuncture procedure. 6. Press down on the gauze once the needle is out of the arm, applying adequate pressure to avoid formation of a hematoma. If multiple blood samples are to be taken, the phlebotomist must be careful to follow the proper order of draw. Source of specimen. The median cubital vein is used the most for its accessibility. Provide for their comfort as much as possible, and gain the patient's cooperation. If an inpatient is able to respond, ask for a full name and always check the armband or bracelet for confirmation. 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 Email is the #1 attack vector cybercriminals use to lure you into a malicious website. Even if several vials of blood have to be drawn it usually amounts to no more than one ounce. If blood stops flowing into the vacuum tube, the vein may have collapsed. This article has been viewed 43,712 times. Make sure the venipuncture site is dry before proceeding with draw. Dorsal hand veins are often utilized for intravenous infusions but are viable options for blood draw sites. the 3 rd (middle) or 4 th (ring) finger of the hand. (a) How would you prepare tetracaine from the corresponding aniline derivative, ArNH2_22? Arteries pulsate, are very elastic, and have a thick wall. Valenstein PN, Sirota RL. Diurnal variations associated with some blood components are: Fasting, dietary restrictions, medications, timing, and medical treatment are all of concern and should be noted on the lab requisition. Phelan MP, Reineks EZ, Berriochoa JP, Schold JD, Hustey FM, Chamberlin J, Kovach A. Apply the tourniquet approximately 4-5 finger-widths above the planned venepuncture site. This image is not<\/b> licensed under the Creative Commons license applied to text content and some other images posted to the wikiHow website. Located in the antecubital fossa, the median cubital vein is a well anchored, stable vein that rarely rolls during venipuncture. 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. Mastering Pediatric Phlebotomy. Center, for Phlebotomy Education, Inc. Patches of purple or yellow may suggest bruising after a recent venipuncture. increase the circulation of blood to the area. Specimens from infants under the age of 6 months are typically collected by heelstick. 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. Filter paper should touch only the blood and not the heel or finger. This image is not<\/b> licensed under the Creative Commons license applied to text content and some other images posted to the wikiHow website. Apply the tourniquet 3-4 inches above the selected puncture site. To prevent hemolysis (which can interfere with many tests): Mix tubes with anticoagulant additives gently 4-6 times, Avoid drawing the plunger back too forcefully, if using a needle and syringe, or too small a needle, and avoid frothing of the sample. 5. C. Iodine Avoid drawing blood from a hematoma; select another draw site. Dispose of contaminated materials in appropriate waste receptacles. 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. What can happen if you vigorously shake the tubes? You must check the timing of these variations for the desired collection point. f.style.height="352px"; Warning: Make sure you are confident that the structure you're palpitating is indeed a vein. A. excessive probing with the needle The creatine kinase (CK), aspartate aminotransferase (AST), lactate dehydrogenase (LDH), and platelet count may increase. For the CLSI Updated Phlebotomy Procedures please click here. therapy is usually associated with acidic or alkaline solutions or solutions that have a high osmolarity. Do not place too tightly or leave on more than 2 minutes (and no more than a minute to avoid increasing risk for hemoconcentration). 4. 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. Sign up for wikiHow's weekly email newsletter. Tip: BD Vacutainer tubes use a translucent stopper to identify short draw variants. Applyan adhesive bandage. Each phlebotomist generally establishes a routine that is comfortable for her or him. 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. -cotton sponges Psychological interventions for needle-related procedural pain and distress in children and adolescents. We use cookies to make wikiHow great. The needle may have pulled out of the vein when switching tubes. This is a general guide for troubleshooting a venipuncture scenario in which blood flow is not initially established upon needle insertion. Remove the needle from the patient's arm using a swift backward motion. Gauze sponges - for application on the site from which the needle is withdrawn. If using a syringe, make sure the needle is fitted securely on a syringe to avoid frothing. Clin Lab. In the case of an accidental stick, immediately wash the area with an antibacterial soap,express blood from the wound, and contact your supervisor. Summarize the problems that may be encountered in accessing a vein, including the procedure to follow when a specimen is not obtained. (b) the power developed by the output shaft.