The antecubital fossa is a collection of veins located within the arm's inner area, opposite of the elbow, where the arm folds in. Hematoma - A venipuncture should not be performed on a hematoma, regardless of how small it may be. Do not use the tip of the finger or the center of the finger. PhlebotomyU offers Certified Phlebotomy Technician (CPT I) courses for aspiring phlebotomists. Identify the patient. Allow another large drop of blood to form. D. Blue, Which of the following conditions should prevent a site from being selected for venipuncture? wikiHow, Inc. is the copyright holder of this image under U.S. and international copyright laws. A warm compress or heel warmer should be used to warm, fingers and heels that are cold, or if a capillary blood gas is being drawn, to. The antecubital fossa is a collection of veins located within the arms inner area, opposite of the elbow, where the arm folds in. -obvious skin infection (including newly tattooed areas). Collect drops of blood into the collectiondevice by gently massaging the heel. How can you tell if you are palpating a vein? Procedure for Capillary Puncture of the Finger: The best site for a finger puncture is just off the center of the finger pad of. This image is not<\/b> licensed under the Creative Commons license applied to text content and some other images posted to the wikiHow website. Source of specimen. Airborne precautions may be considered to provide a level of safety against infectious diseases such as tuberculosis, influenza, and COVID-19. A. standards Proper patient identification MANDATORY. Avoid excessive pressure that may squeeze tissue fluidinto the drop of blood. Choosing an appropriate site for venipuncture is crucial for a successful . Do not bend, break, recap, or resheath needles to avoid accidental needle puncture or splashing of contents. Tourniquet - Wipe off with alcohol and replace frequently. Avoid placing sample onhot surfaces such as bili-lights or monitors. B. the needle is only partially in the vein EDTA and sodium citrate tubes should still be filled to the marked fill line to ensure a correct blood-to-additive ratio. D. 70% isopropyl alcohol. 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. What should you do with a CBC or lavender top tube before putting them down? What are the gray top containers used for? Holder/Adapter - use with the evacuated collection system. It brings the entire family The most commonly used site for a venipuncture is at the bend of the elbow, also called the antecubital fossa 1. A variety of techniques can be employed to reduce pain and anxiety. Switch to the other arm if you can't find anything. var iframe = document.getElementById("zf_div_SBGg-3DTNCwt65i9A6n_zU3SneyGD89SSqM_7F_nCas").getElementsByTagName("iframe")[0]; The first drop contains excess tissue fluid and must be wiped away. X=[Ar]4s23d5Y=[Ar]4s23d104p1Z=[Ar]4s23d104p6. Do not obtain specimens from an arm having a cannula, fistula, or vascular graft. remove needle B. Betadine Re-anchor the vein. While the median cubital, cephalic, and basilic veins are the most popular draw sites for blood draws, phlebotomists may resort to other draw sites if their ability to draw is restricted. Sanders AM, Agger WA, Gray AM, Fischer CM, Kamprud EA. Carry out hand hygiene before and after each patient procedure, before putting on and after removing gloves. The vein may have collapsed; resecure the tourniquet to increase venous
filling. Serum red top or amber tube with red top. D. discarded in the trash, True or False? Needles - The gauge number indicates the bore size: the larger the gauge number, the smaller the needle bore. Blood should NEVER be poured from one tube to another since the tubes can have different additives or coatings (see illustrations at end). What sites should be avoided when drawing blood? CLSI document H04-A6. The puncture should be made perpendicular to the ridges of the fingerprint so that the drop of blood does not run down the ridges. It is observed that if the tourniquet is left on longer than 2 minutes, changes in the value of a total protein test occur. Too tight of a tourniquet may cause the vein to collapse upon needle insertion. Top Vein Sites Used in Phlebotomy | PhlebotomyU | CPT1 Course diet, exercise, stress, basal state). The infograph below provides a detailed description of the venipuncture steps as found in our how to draw blood resource. 2009 Feb;131(2):195-204. The phlebotomist's role requires a professional, courteous, and understanding manner in all contacts with the patient. For a detailed breakdown of each step of the venipuncture test scroll down. Many drugs will have "peak" and "trough" levels that vary according to dosage levels and intervals. C. all disposable equipment has been discarded properly 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. Areas of fingers and heels that are cold, swollen, scarred or covered with a rash, should be avoided. 3. The first step to choosing the right vein is to select the appropriate needle gauge. Basilic vein. 9. Observe universal (standard) safety precautions. 4. apply pressure for at least 10 minutes. The median cubital vein and the cephalic vein in the wrist area should be avoided when possible. Tetracaine is a substance used as a spinal anesthetic. wikiHow is where trusted research and expert knowledge come together. Get instant access to our latest tools and our must-read site updates: What Certifications Are Used For Higher Pay For Phlebotomists? Avoid excessive pressure that may squeeze tissue fluid into the drop of blood. Venipuncture Flashcards | Quizlet Mastering Pediatric Phlebotomy. Center, for Phlebotomy Education, Inc. Free Flashcards about Phlebotomy Chapter 9 - StudyStack Discarding the first set minimizes the effects of any potential additive contamination. Avoid UE on same side of mastectomy (lymphedema) Loosen the tourniquet. When using a syringe inserted into the line, blood must be withdrawn slowly to avoid hemolysis. 6. Blood is commonly obtained from the median cubital vein on the anterior forearm. Prepare the patient's arm using an alcohol prep. Applyan adhesive bandage. Never draw blood through a hematoma. Other draw sites, particularly below the waist, are rarely used. Posture: Postural changes (supine to sitting etc.) 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 equipment used during the venipuncture test can vary, but the following are most commonly used for routine venipuncture: Phlebotomists may choose to draw blood from several different sites of the body. 5. var prevIframeHeight = iframe.style.height; How To Draw Blood | A Step-by-Step Guide - Nurse.org A government issued photo identification card such as a driver's license can aid in resolving identification issues. Veins sometimes roll away from the point of the needle and puncture site. If the tech is not comfortable with any of the veins in the inside elbow area, they may choose a dorsal vein in the hand or, as a last resort, choose a vein in the foot. Preanalytical phase of the testing process begins for the laboratory when a: Test is ordered by a patient's physician. https://www.osha.gov/laws-regs/standardinterpretations/2007-10-26 and https://www.osha.gov/OshDoc/data_BloodborneFacts/bbfact03.pdf (Accessed June 13, 2022). Using the smallest acceptable needle size can help reduce the risk of bleeding or hematoma . ROUTINE CAPILLARY PUNCTURE BLOOD COLLECTION GUIDELINES. DOC Blood Collection by Venipuncture - Michigan Avoid trauma and excessive probing. 3. If blood stops flowing into the vacuum tube, the vein may have collapsed. 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} Complications of venipuncture | How to avoid | Aimvein Dorsal hand veins are often utilized for intravenous infusions but are viable options for blood draw sites. This makes every subsequent poke harder and harder because scar tissue is more fibrous and tougher to puncture. Venipuncture Quiz Flashcards | Quizlet Place a pillow under the patient's arm if additional support is needed. 5. 6. You will be redirected once the validation is complete. Using a sterile lancet, make a skin puncture just off the center of the finger pad. B. sterilized and reused This requisition form must contain the proper information in order to process the specimen. If this is not successful, remove the needle, take care of the
puncture site, and redraw. If the blood flow is diminished, repeat the capillary PUNCTURE to complete the collection. 1. 3. The service requires full JavaScript support in order to view this website. However, if there is no alternative and an arm with an IV line in place must be used for venipuncture, try to choose a site away from and below the location of the IV. Allow to air dry. Tip: If you realize you've collected in the wrong order of draw, remove the tube, insert the correct one, fill it halfway before discarding it, then insert a new tube and fill it completely. Tip: Patients who need regular bloodwork (e.g. 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. Certain other sites should also be avoided. Observe all applicable isolationprocedures. Dispose of items in appropriate containers. Finally, when the necessary blood is collected, the needle will be removed and properly disposed of in a Sharps container and the puncture site will be covered to stop the bleeding. What equipment is needed for a venipuncture? Hold the baby's foot firmly to avoid sudden movement. What are the complications that can occur when performing a venipuncture? 6. performing a capillary puncture is as follows: 1. Place labeled specimens in zip lock bag and deliver to the laboratory as soon as possible. In this elbow pit, phlebotomists have easy access to the top three vein sites used in phlebotomy: Median cubital vein. NOTE: The use of post-exposure prophylaxis following blood exposure to HIV
has shown effectiveness (about 79%) in preventing seroconversion. }, false); Impact of Use of Smaller Volume, Smaller Vacuum Blood Collection Tubes on Hemolysis in Emergency Department Blood Samples. 5. Never draw above an IV site. Try another tube. Apply only ONE drop of blood per circle. Most commonly, venipuncture will be performed on the Antecubital Fossa, or the inside of the elbow. doi: 10.1002/14651858.CD005179.pub3. What Is Venipuncture? Procedures, Risks & Fears - Phlebotomy Coach 8. Capillary specimens are collected in microtainers with colored caps that are used to. Within the antecubital fossa, this vein poses the least amount of risk. What can happen if you vigorously shake the tubes? avoid sites of extensive scarring (burns, surgery, injuries) 9. Position the infant with the head slightly elevated. But since each patient's medical condition varies, so does their veins. 11. D. mandates, The most common antiseptic used in venipuncture is: -antiseptic swabs This is very painful, risks damage to underlying structures, and widens the needle hole to prolong bleeding time. Remove the first glove so that it turns inside out during removal A phlebotomy technician is preparing to dispose of contaminated sharps. How to Troubleshoot a Difficult Venipuncture. 8. Contains acid citrate dextrose. Avoid excessive probing ("fishing"). {"smallUrl":"https:\/\/www.wikihow.com\/images\/thumb\/6\/68\/Troubleshoot-a-Difficult-Venipuncture-Step-1.jpg\/v4-460px-Troubleshoot-a-Difficult-Venipuncture-Step-1.jpg","bigUrl":"\/images\/thumb\/6\/68\/Troubleshoot-a-Difficult-Venipuncture-Step-1.jpg\/aid11732774-v4-728px-Troubleshoot-a-Difficult-Venipuncture-Step-1.jpg","smallWidth":460,"smallHeight":345,"bigWidth":728,"bigHeight":546,"licensing":" \u00a9 2023 wikiHow, Inc. All rights reserved. Adapted from Phlebotomy for Nurses and. Start with the arm closest to you and palpate the antecubital fossa. Phlebotomy Essentials 5th Edition Chapter 9. Blood Collection Techniques in Exotic Small Mammals. Our students gain a vast amount of experience with phlebotomy vein sites through our hands-on and engaging curriculum and externship program. Scan the skin for lines of blue indicating a prominently visible vein. Have the patient drink fluids if dehydrated. Patient care following completion of venipuncture. By using our site, you agree to our. The needle should form a 15 to 30 degree angle with the
surface of the arm. Avoid areas of hematoma. Gauze sponges - for application on the site from which the needle is
withdrawn. 8. However, drawing blood from the hand is affiliated with higher levels of pain and less control. 3. Summarize the problems that may be encountered in accessing a vein,
including the procedure to follow when a specimen is not obtained. B. above an IV line What are the best veins for venipuncture? A. excessive probing with the needle A lab coat or gown must be worn during blood collection procedures. 5 Common Capillary Puncture Blood Collection Sites - Neoteryx Wayne, PA: Clinical and Laboratory Standards Institute; 2008. Tip: When using a butterfly and sodium citrate is the first to be collected in the order of draw, a discard tube must always be filled first to purge the air from the tubing. However, blood samples that are normally taken are actually very small. 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. This image may not be used by other entities without the express written consent of wikiHow, Inc. \u00a9 2023 wikiHow, Inc. All rights reserved. 2017;148(4):330-335. Clean up any blood spills with a disinfectant such as freshly made 10%
bleach. 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. 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. iframe.style.height = zf_ifrm_ht_nw; 3. A commercial heel warmer may be used. 3. If another site is not
available, collect the specimen distal to the hematoma. Please enable cookies on your browser and try again. 13 Websites to Avoid If You Value Your Time | PCMag The blood is normally drawn from a vein on the top of the hand or from the inside of the elbow. The creatine kinase (CK), aspartate aminotransferase (AST), lactate dehydrogenase (LDH), and platelet count may increase. Best practices in capillary blood collection - Medical Laboratory Observer A test that has been ordered may be cancelled due to problems unrelated to drawing the specimen, and these are the most common causes for cancellations: A test may be cancelled due to a technical problem in the specimen collection process: Identification of the specimen is suspect. The dorsal venous network is the next most common vein site for phlebotomists. -infection at site Therefore, your anchor should be gentle but firm to prevent the vein from moving away from you. 5. What Is Venipuncture? Psychological interventions for needle-related procedural pain and distress in children and adolescents. 2004;24(4):979-96, vii. therapy is usually associated with acidic or alkaline solutions or solutions that have a high osmolarity. PDF Venipuncture - Central Zone - Alberta Health Services wikiHow, Inc. is the copyright holder of this image under U.S. and international copyright laws. if ( prevIframeHeight != zf_ifrm_ht_nw ) { Phlebitis can also occur as a result of vein trauma during insertion, use of an inappropriate I.V. This information must be given when requesting microbiology, cytology, fluid analysis, or other testing where analysis and reporting is site specific. Allow thefinger to dry or wipe dry with a sterile 22 gauze. Am J Clin Pathol. var zf_perma = zf_ifrm_data[0]; try{ Cannula/fistula/heparin lock - hospitals have special policies regarding
these devices. Cleanse the fingertip of the 3rd (middle) or 4th (ring) finger with an alcohol prep. Fill the microtainer tube(s) as needed, adhering to the order of draw. However, do not use too high a temperature warmer, because baby's skin is thin and susceptible to thermal injury. 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. Cleanse the heel with alcohol prep, then dry with a sterile 22 as alcohol can influence testresults. For children over 6 months and adults, the finger is punctured. Expect reasonable safety congruent with the hospital practices and
environment. https://www.ncbi.nlm.nih.gov/books/NBK138650/pdf/Bookshelf_NBK138650.pdf (Accessed June 13, 2022). Specimen Collection Procedure - PERFORMING A VENIPUNCTURE | Akron Cephalic vein. Hematoma formation is a problem in older patients. 9. Each time a vein is accessed with a needle, scar tissue forms as part of the body's healing process. INR for patients on warfarin) are often knowledgeable on the veins that are most likely to work. When the last tube to be drawn is filling, remove the tourniquet. 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. The sides and the tip of the. The fifth finger tends to have less soft tissue overlying the bone. Interruptions and distractions during medical encounters and procedures should be avoided. Blood samples drawn from an IV line should be documented and analyzed with care. 4. Remove your gloves and wash your hands. A scooping motion to collect blood and strong repetitive pressure (milking) MUST be avoided, as both procedures may result in hemolysis or tissue-fluid contamination fo the specimen. 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. This is more common in humeral and femoral punctures than radial punctures. Position the patient with the arm extended to form a straight-line form shoulder to wrist. Consult a specialist at the patient's own request and expense. Punctures to the posterior curvature of the heel cab cause damage to the bones. As part of presenting a professional appearance, an institutional dress code may include wearing of a laboratory coat or smock. Warm the heel from which blood is to be obtained. To determine the best vein, use both sight and touch. Stress: May cause transient elevation in white blood cells (WBC's)
and elevated adrenal hormone values (cortisol and catecholamines). Let's take a quick, high-level look at the venipuncture procedure. Drawing from these sites can cause blood clotting and hemostasis. If the puncture is parallel to the lines of the fingerprint, theblood will not form as a drop but will run down the finger making collection difficult. The maximum number of times an individual should attempt a venipuncture on a patient is two, True or False? Move it forward (it may not be in the lumen). Compared to the standard blood donation which is about sixteen ounces, one ounce is really small. 2. f.style.width="100%"; D. all of the above, Common causes of hematomas that form during a venipuncture include: He holds a Diploma in Medical Laboratory Assistance and is certified under the British Columbia Society of Laboratory Science. B. the insertion site has stopped bleeding Dalal BI, Brigden ML. Allow it to air, Grasp the finger, and using a sterile lancet, press firmly against the finger. Select the appropriate microtainers for the specimens to be collected. Dispose of contaminated materials in appropriate waste receptacles. The most common complications are bleeding at the puncture site or hematoma formation. Avoid previous hematoma (draw distal of hematoma) Venipuncture can also happen when patients have intravenous (IV) lines started. Syringes - may be used in place of the evacuated collection tube for special circumstances. Hyperextend the patient's arm. Capillary puncture should not be used. This guide follows the steps as outlined in the World Health Organizations Guidelines on Drawing Blood: Best Practices in Phlebotomy. The upper extremity on the side of a previous mastectomy - test results may be affected because of lymphedema. Phlebitis is inflammation of a vein. Phlebotomy is the practice of drawing blood from patients to gather data about their health. Tubes with different additives are used for collecting blood specimens for specific types. Adjust the angle (the bevel may be against the vein wall). Here phlebotomists will typically choose from three veins: the median cubital vein, the cephalic vein or the basilic vein. -do not rapidly insert the needle. Joslin JO. Performing a venipuncture on a child under one year of age . var d = document.getElementById("zf_div_SBGg-3DTNCwt65i9A6n_zU3SneyGD89SSqM_7F_nCas"); This image may not be used by other entities without the express written consent of wikiHow, Inc. \u00a9 2023 wikiHow, Inc. All rights reserved. C. placed in the sharps container If a vein feels hard, it may be scarred or sclerosed. The upper extremity on the side of a previous mastectomy - test results may be affected because of lymphedema. Wear gloves and a lab coat or gown when handling blood/body fluids. Wipe away the first drop of blood with sterile 22 gauze. Anxiety that results in hyperventilation may cause acid-base imbalances, and increased lactate. -Vacutainer barrel For an inpatient DO NOT DRAW BLOOD IF THE ARMBAND OR BRACELET IS MISSING. Do not use excessive pressure or heavy massaging because the blood may become diluted with tissue fluid. Give an example of each. What is the procedure to draw blood from an arm with an IV in it? Patient identification is critical for safety. Hemolysis may occur, with pseudohyperkalemia. Label the collection tubes at the bedside or drawing area. Blood Collection Process: Venipuncture - University of Florida It doesn't matter . Lines - Drawing from an intravenous line may avoid a difficult venipuncture, but introduces problems. 13. Last draw - additive tubes in this order: SST (red-gray or gold top). B. evacuated tube 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. Make certain that the blood completely saturates all four (4) circles and is visible from bothsides. All other items used for the procedure must be disposed of according to properbiohazardous waste disposal policy. Normal reference ranges are often noted according to
age. The performance of routine vascular access procedures by skilled phlebotomists requires, at a minimum, the use of gloves to prevent contact with blood. When wearing gloves,
change them between each patient and wash your hands frequently. Document that the venipuncture was performed distal to (below) an infusion site. They are also. 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. Preferred venous access sites, and factors to consider in site selection,
and ability to differentiate between the feel of a vein, tendon and artery. For example, serum cortisol levels are highest in early morning but are decreased in the afternoon.
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