what sites should be avoided when performing venipuncture quizlet

\u00a9 2023 wikiHow, Inc. All rights reserved. wikiHow, Inc. is the copyright holder of this image under U.S. and international copyright laws. Clinical and Laboratory Standards Institute. Back the needle out until the bevel is just below the skin. prevent falls, should the patient lose consciousness. Areas of fingers and heels that are cold, swollen, scarred or covered with a rash, should be avoided. Journal of Exotic Pet Medicine. 5. We use cookies to make wikiHow great. How can you decrease the risk of hematoma formation? 6. In fact, many search engines provide the option to avoid dangerous sites by turning on a "safer" search. Warm the heel from which blood is to be obtained. Through a combination of revolutionary treatments and extraordinary patient experiences, our care does more than heal. There are three phlebotomy vein sites located in the arm most utilized by medical professionals and three additional draw sites that are last resorts. Watch for formation of a hematoma. Proper labeling procedures and completion of laboratory requisitions. Thrombosed veins lack resilience, feel cord-like, and roll easily. 2017;148(4):330-335. When finished, clean the site and apply pressure with clean gauze to stop the bleeding. However, do not use too high a temperature warmer, because baby's skin is thin and susceptible to thermal injury. 2. -infection at site the chlorhexidine residue before tying a piece of gauze around the foot. A thin soap bubble of index of refraction 1.33 is viewed with light of wavelength 550.0 nm and appears very bright. }catch(e){} Mastering Pediatric Phlebotomy. Center, for Phlebotomy Education, Inc. A commercial heel warmer may be used. It may be obstructing blood flow. D. Both A and B, A sharps container is identified by its bright ____ color This is a general guide for troubleshooting a venipuncture scenario in which blood flow is not initially established upon needle insertion. Finger - Usually the third or fourth finger is preferred in adults and children. catheter size for the vein, or prolonged use of the same I.V. Subcutaneous tissue feels squishy and muscle feels hard. You should always contact your doctor or other qualified healthcare professional before starting, changing, or stopping any kind of health treatment. What sites should be avoided when drawing blood? Many drugs will have "peak" and "trough" levels that vary according to dosage levels and intervals. 5. Get instant access to our latest tools and our must-read site updates: What Certifications Are Used For Higher Pay For Phlebotomists? C. placed in the sharps container 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. f.style.height="352px"; 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. *NEVER BEND THE ARM*. Source of specimen. When would you use a butterfly/infustion set? Anxiety that results in hyperventilation may cause acid-base imbalances, and increased lactate. For an inpatient the nursing staff can be contacted to aid in identification prior to proceeding. Also found in the antecubital fossa, the basilic vein serves as a last resort for blood draws. The upper extremity on the side of a previous mastectomy - test results may be affected because of lymphedema. Scan the skin for lines of blue indicating a prominently visible vein. Our students gain a vast amount of experience with phlebotomy vein sites through our hands-on and engaging curriculum and externship program. 1. If blood stops flowing into the vacuum tube, the vein may have collapsed. Allow the blood to soak through and completely fill the pre-printed circle on the filter paper. A. Syringe Tip: Lowering the arm below the level of the heart may help to engorge the vessels. Remove your gloves and wash your hands. var zf_perma = zf_ifrm_data[0]; Venipuncture requires good skills in order to perform the procedure not only correctly, but also painlessly. Last draw - additive tubes in this order: SST (red-gray or gold top). Place blood collection equipment away from patients, especially children and psychiatric patients. Contains lithium heparin anticoagulant and a gel separator. Consult the nursing unit or your facility's resources prior to drawing from an IV or PICC line or performing venipuncture on an arm with an IV line in place. Use of hair nets and face masks to decrease blood culture contamination rates. This guide follows the steps as outlined in the World Health Organizations Guidelines on Drawing Blood: Best Practices in Phlebotomy. After the needle selection, phlebotomists begin to look and feel for a viable vein. Because most laboratory specimens contain bacteria, it is not necessary to wash hands before collecting them, The tourniquet applied prior to venipuncture is removed: 8. What are some of the reasons to draw blood? 5. if ( prevIframeHeight != zf_ifrm_ht_nw ) { Allow to air dry. Start with the arm closest to you and palpate the antecubital fossa. When do you release the tourniquet during venipuncture? (a) How would you prepare tetracaine from the corresponding aniline derivative, ArNH2_22? 4. BD Eclipse green-capped) is used for most routine and uncomplicated venipunctures. Remember that veins should ideally feel bouncy. Cannula/fistula/heparin lock - hospitals have special policies regarding these devices. This type of venipuncture procedure is a little different, and sometimes can be a little more involved. Never leave a tourniquet on for more than two minutes. 4. -use a smaller gauge needle What is the procedure to draw blood from an arm with an IV in it? 3. Make certain that the blood completely saturates all four (4) circles and is visible from bothsides. wikiHow, Inc. is the copyright holder of this image under U.S. and international copyright laws. Position the patient. This requisition form must contain the proper information in order to process the specimen. C. sterile gauze pads Because of contacts with sick patients and their specimens, it is important to follow safety and infection control procedures. These may include listening to music or a story, watching a video, playing with a toy, having a parent provide distraction with talk or touch, using flash cards, and squeezing a rubber ball. 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. After assembling the appropriate equipment, follow the next steps to perform a proper venipuncture. Blood is collected into an attached vial or tube that is airtight and the flexible band is then removed from the arm. WHO guidelines on drawing blood: best practices in phlebotomy. Matt Garcia is an experienced phlebotomist in Vancouver, Canada. In some instances, the legs or feet are required for use, but a physician or doctor should be completing the draw, not a phlebotomist. What are the contraindications to venipuncture? NOTE: The use of post-exposure prophylaxis following blood exposure to HIV has shown effectiveness (about 79%) in preventing seroconversion. Use pillows or foam wedges to elevate the arm and help with extension. 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. Patients in these populations are often nervous and may flail their limbs. In this elbow pit, phlebotomists have easy access to the top three vein sites used in phlebotomy: Median cubital vein. 5. 3. The Patient's Bill of Rights has been adopted by many hospitals as declared by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). Never draw blood through a hematoma. wikiHow, Inc. is the copyright holder of this image under U.S. and international copyright laws. Unlike the cephalic and basilic veins, the median cubital vein is not near major nerves or arteries. Venipuncture can also happen when patients have intravenous (IV) lines started. A clinical study is performed to determine the optimal time for application of the tourniquet during phlebotomy. Provide for their comfort as much as possible, and gain the patient's cooperation. Allsurfaces are cleaned daily with bleach. 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. wikiHow is where trusted research and expert knowledge come together. Apply blood to the printed side of the filter paper. 1. This article was co-authored by Matt Garcia. Try another tube. Avoid excessive pressure that may squeeze tissue fluid into the drop of blood. Remember -- the rst vein found is not always the best vein. 10. Place labeled specimens in zip lock bag and deliver to the laboratory as soon as possible. The antecubital fossa is a collection of veins located within the arm's inner area, opposite of the elbow, where the arm folds in. 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. Proper patient identification MANDATORY. Re-secure the tourniquet to increase venous filling. 7. What are the gray top containers used for? Observe all applicable isolationprocedures. 7. 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. Apply the tourniquet 3-4 inches above the selected puncture site. Syringes - may be used in place of the evacuated collection tube for special circumstances. Press down on the gauze once the needle is out of the arm, applying adequate pressure to avoid formation of a hematoma. The infograph below provides a detailed description of the venipuncture steps as found in our how to draw blood resource. try{ Needles should be placed in a proper disposal unit IMMEDIATELY after their use. It is large and near the skins surface, making it easier for phlebotomists to see before anchoring the vein. This image is not<\/b> licensed under the Creative Commons license applied to text content and some other images posted to the wikiHow website. and "What is your date of birth?". 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. If none of these veins work, then the phlebotomists use the hand veins. Give an example of each. All other items used for the procedure must be disposed of according to properbiohazardous waste disposal policy. 1. previous experience with vomiting or fainting Patches of purple or yellow may suggest bruising after a recent venipuncture. When there is an IV line present, blood can be drawn from this line. Erroneous test results may be obtained when the blood is not thoroughly mixed with the additive. Avoid placing sample onhot surfaces such as bili-lights or monitors. Have the patient drink fluids if dehydrated. if( evntData && evntData.constructor == String ){ Such terms as "needs to," "must," "require" and "should" are used to explain how medical professionals should perform capillary blood collection procedures. Document that the venipuncture was performed distal to (below) an infusion site. Change your approach when dealing with uncooperative patients, such as pediatrics and those with neurodevelopmental or psychiatric disorders. A. EMLA Using a sterile lancet, puncture the most medial or lateral portion of the plantar surface of theheel, medial to a line drawn posteriorly from the mid great toe to the heel. The content of this article is not intended to be a substitute for professional medical advice, examination, diagnosis, or treatment. 1. finger should be avoided. 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. If another site is not available, collect the specimen distal to the hematoma. Approach the patient in a friendly, calm manner. Make sure the venipuncture site is dry. Assess the need for sample recollection and/or rejection. For the CLSI Updated Phlebotomy Procedures please click here. var iframe = document.getElementById("zf_div_SBGg-3DTNCwt65i9A6n_zU3SneyGD89SSqM_7F_nCas").getElementsByTagName("iframe")[0]; What equipment is needed for a venipuncture? For example, serum cortisol levels are highest in early morning but are decreased in the afternoon. (Partial penetration may allow blood to leak into the soft tissue surrounding the vein by way of the needle bevel). Assess the patient's physical disposition (i.e. https://www.ncbi.nlm.nih.gov/books/NBK138650/pdf/Bookshelf_NBK138650.pdf (Accessed June 13, 2022). Gloves are to be worn during all blood collection procedures, and changed betweenpatient collections. Palpate and trace the path of veins with the index finger. Prepare the patient's arm using an alcohol prep. 8. This complication of peripheral I.V. For a detailed breakdown of each step of the venipuncture test scroll down. The upper extremity on the side of a previous mastectomy - test results may be affected because of lymphedema. 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. Position the patient's arm in a comfortable extended position that provides adequate access to the planned venepuncture site. 1. 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. Some DNS services support web filtering, too. Background: Venipuncture is the most common invasive medical procedure performed by health care providers. Do not use the central portion of the heel because you might injure the underlying bone, which is close to the skin surface. Some individuals are afraid of needles, while others are frightened at the sight of blood. Avoid excessive pressure that may squeeze tissue fluidinto the drop of blood. Alcohol not dry in the required amount of time B. Veins less prominent and less filling C. Veins more prominent and easier to puncture D. Blood stop flowing to arteries but not veins A The most common site (s) for the venipuncture procedure is/are the following: The median cubital creates, The dorsal venous network is the next most common vein site for phlebotomists. Lippi G, Salvagno GL, Montagnana M, Franchini M, Guidi GC. Wipe away the first drop of blood with a piece of clean, dry cotton. Avoid excessive pressure that may squeeze tissue fluid into the, mix the blood. 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. Although the skill set and procedures may apply to both instances, this content is primarily aimed towards venous blood collection using evacuated tube systems (e.g. Look at the dorsum of the hand as a last resort. If just a routine coagulation assay is the only test ordered, then a single light blue top tube may be drawn. Allow it to air, Grasp the foot, and using a sterile lancet, press firmly against the heel to, Collect the drops of blood into the collection device by gently squeezing, the foot. The basic patient rights endorsed by the JCAHO follow in condensed form are given below. 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). Identify the additive, additive function, volume, and specimen considerations to be followed for each of the various color coded tubes. Proper Handling of an Uncooperative Patient in an Outpatient Setting Akron. Arteries pulsate, are most elastic, and have a thick wall. if ( (iframe.src).indexOf('formperma') > 0 && (iframe.src).indexOf(zf_perma) > 0 ) { Have an assistant stabilize the arm by firmly locking the elbow joint. Reassure the patient that the minimum amount of blood required for testing will be drawn. 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. Order of draw for multiple tube phlebotomy. site. B. Yellow Carry out hand hygiene before and after each patient procedure, before putting on and after removing gloves. List six areas to be avoided when performing venipuncture and the reasons for the restrictions. The sides and the tip of the. The first drop contains excess tissue fluid and must be wiped away. Joslin JO. 2006;52(5-6):217-30. % of people told us that this article helped them. 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 . This image is not<\/b> licensed under the Creative Commons license applied to text content and some other images posted to the wikiHow website. Blood is commonly obtained from the median cubital vein on the anterior forearm. 2009 Feb;131(2):195-204. The recommended order of draw for plastic collection tubes is: First - blood culture bottle or tube (yellow or yellow-black top). Diurnal Rhythms: Diurnal rhythms are body fluid and analyte fluctuations during the day. Lippi G, Blanckaert N, Bonini P, Green S, Kitchen S, Palicka V, Vassault AJ, Mattiuzzi C, Plebani M. Causes, consequences, detection, and prevention of identification errors in laboratory diagnostics. Safely dispose of potentially infectious materials. Heparin light or dark green top tube, 5. If you are using a butterfly, try to retie the tourniquet around the patient's arm to increase pressure and re-establish blood flow. How should you have the patient position their arm after the venipuncture is complete? Promptly send the specimens with the requisition to the laboratory. Do not obtain specimens from an arm having a cannula, fistula, or vascular graft. Dorsal hand veins are often utilized for intravenous infusions but are viable options for blood draw sites. Avoid the side of the finger where there is less soft tissue, where vessels and nerves are located, and where the bone is closer to the surface.