Recognize complications associated with the phlebotomy procedure. Smaller collection tubes for sample sizes of 2 mL or less may be appropriate in situations where a smaller amount blood should be drawn, as in pediatric patients, or to minimize hemolysis during collection, or to avoid insufficient sample volume in the collection tube. Scan the skin for lines of blue indicating a prominently visible vein. A thin soap bubble of index of refraction 1.33 is viewed with light of wavelength 550.0 nm and appears very bright. Giavarina D, Lippi G. Blood venous sample collection: Recommendations overview and a checklist to improve quality. (a) the electric power required. drawing from hand or foot 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. Select the proper approved lancet: The BD Microtainer Contact-Activated. 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. Wipe away the first drop of blood with sterile 22 gauze. Observe all applicable isolationprocedures. Document that the venipuncture was performed distal to (below) an infusion site. Blood collection tubes must be drawn in a specific order to avoid cross-contamination of additives between tubes. 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. Deliver specimens promptly to the laboratory. Copyright 2023 - PhlebotomyU | Website Design & SEO by, Phlebotomy: 5 Tips on Finding Difficult Veins. -obvious skin infection (including newly tattooed areas) -extensive scarring -don't use same side as mastectomy -avoid previous hematoma -avoid arm w/ fistula/cannula -edamtous extremity What is the most common site for blood sampling? The venipuncture procedure is complex, requiring both knowledge and skill to perform. C. the seal is broken By signing up you are agreeing to receive emails according to our privacy policy. 7. What can happen if you vigorously shake the tubes? Be sure to dispose of the lancet in the appropriate sharps container. -thrombosis Wash hands in warm, running water with an appropriate hand washing product, or if notvisibly contaminated, with a commercial foaming hand wash product before and aftereach patient collection. Gas tubes (must warm the site before collecting the specimen), 4. 3. 12. Describe and perform the venipuncture process including: Appropriate clothing and protective equipment. After cleansing, allow the venipuncture site to air dry. Use pillows or foam wedges to elevate the arm and help with extension. -use correct angle of needle insertion This image is not<\/b> licensed under the Creative Commons license applied to text content and some other images posted to the wikiHow website. 8. 7. Dispose of contaminated materials/supplies in designated containers. Forward completed/dry collections to the laboratory as soon as possible. Holder/Adapter - use with the evacuated collection system. This process is automatic. Valenstein PN, Sirota RL. This makes every subsequent poke harder and harder because scar tissue is more fibrous and tougher to puncture. Each phlebotomist generally establishes a routine that is comfortable for her or him. Over time and with several repeated punctures, significant amounts of scar tissue builds up. This seats the bevel into the lumen of the vein, and is also the technique used to insert an IV catheter. 4. Remove the needle from the patient's arm using a swift backward motion. If this is not successful, remove the needle, take care of the puncture site, and redraw. Needles are available for evacuated systems and for use with a syringe, single draw or butterfly system. If you are using a butterfly, try to retie the tourniquet around the patient's arm to increase pressure and re-establish blood flow. Place blood collection equipment away from patients, especially children and psychiatric patients. 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 needle should form a 15 to 30 degree angle with the surface of the arm. C. Red ; worn to protect the patient and the phlebotomist. Clin Biochem. Wipe away the first drop of blood with sterile 22 gauze. Even if several vials of blood have to be drawn it usually amounts to no more than one ounce. After the needle selection, phlebotomists begin to look and feel for a viable vein. -do not rapidly insert the needle. The rubber stoppers are color coded according to the additive that the tube contains. It may be, necessary, on occasion, to perform a capillary puncture on the toe of a patient, who is severely burned. Look for visual clues which may help assess the patient's condition. Fill the capillary tube(s) or micro collection device(s) as needed. Once you establish blood flow, slightly modify your hand position to stabilize the needle against the arm and prevent further movement. Inadvertently nicking a nerve causes intense pain. You may also remove the tube, wait a few seconds for blood flow to resume, and then engage a short drawtube. } Effective communication - both verbal and nonverbal - is essential. Make sure the venipuncture site is dry before proceeding with draw. The line must be flushed first. It is observed that if the tourniquet is left on longer than 2 minutes, changes in the value of a total protein test occur. PST (light green top). These items include: When multiple vials of blood are collected it can seem like a large amount. 3. In this elbow pit, phlebotomists have easy access to the top three vein sites used in phlebotomy: Median cubital vein. 9. While this may be effective in some difficult draws, the risk of a needlestick injury is higher if the patient has a withdrawal reflex and the needle recoils back into your finger. 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. wikiHow, Inc. is the copyright holder of this image under U.S. and international copyright laws. The use of a tourniquet during a venipuncture procedure makes: The most common site(s) for the venipuncture procedure is/are the following: The tourniquet should not be left on a patient more than 1 minute when performing a venipuncture because it is uncomfortable and causes: The needle should always be inserted at the puncture site with the: The correct needle position for a venipuncture is a ______ degree angle with the bevel facing _____. Practice hygiene for the patient's protection. Contains a gel separator and clot activator. Blood Collection Techniques in Exotic Small Mammals. Wait 2 minutes before reapplying the tourniquet. Label all specimens per accepted guidelines. What is the most common complication of venipuncture? It may be obstructing blood flow. Follow institution's guidelines regarding treatment and follow-up. (c) How would you prepare tetracaine from benzene? 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. 10. Tip: BD Vacutainer tubes use a translucent stopper to identify short draw variants. 1. 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. Prepare the patient's arm using an alcohol prep. Finger - Usually the third or fourth finger is preferred in adults and children. (See, The chlorhexidine is a concern for the premature babies in NICU as it can, be absorbed through the skin. 4. Pre-warm the region of the vein to reduce vasoconstriction and increase blood flow. Allsurfaces are cleaned daily with bleach. For children over 6 months and adults, the finger is punctured. increase the circulation of blood to the area. Change gloves after each patient or when contaminated. There may be no vacuum in the tube being used. This type of venipuncture procedure is a little different, and sometimes can be a little more involved. Assess the need for sample recollection and/or rejection. HealthStar Press, Inc. 2001, updated 1/08. This enables the bloodto form as a drop on the fingertip. For a detailed breakdown of each step of the venipuncture test scroll down. The service requires full JavaScript support in order to view this website. 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. Clean up any blood spills with a disinfectant such as freshly made 10% bleach. Allow to air dry. Hematoma formation is a problem in older patients. As a countermeasure, phlebotomists anchor the vein with their hand to stabilize it for the draw. Remove the first glove so that it turns inside out during removal A phlebotomy technician is preparing to dispose of contaminated sharps. The most commonly used site for a venipuncture is at the bend of the elbow, also called the antecubital fossa 1. The antecubital fossa is a collection of veins located within the arms inner area, opposite of the elbow, where the arm folds in. if ( zf_ifrm_data.length == 2 ) { 1. previous experience with vomiting or fainting 8. f.src = 'https://forms.zohopublic.com/healthservicesacademy/form/RequestCourseInformationCPTIAccelerated/formperma/SBGg-3DTNCwt65i9A6n_zU3SneyGD89SSqM_7F_nCas?zf_rszfm=1'; Venipuncture can also happen when patients have intravenous (IV) lines started. Try rotating the arm to better expose the cephalic or basilic vein. 9. chemistries, serology, immunnology, blood bank. Apply firm pressure. 6. Position the patient. -tourniquet Swiftly insert the needle through the skin and into the lumen of the vein. Move it forward (it may not be in the lumen). try{ We use cookies to make wikiHow great. But since each patient's medical condition varies, so does their veins. https://www.ncbi.nlm.nih.gov/books/NBK138650/pdf/Bookshelf_NBK138650.pdf (Accessed June 13, 2022). Avoid areas of hematoma. Each time a vein is accessed with a needle, scar tissue forms as part of the body's healing process. Such terms as "needs to," "must," "require" and "should" are used to explain how medical professionals should perform capillary blood collection procedures. Follow the procedure as outlined above for greeting and identifying the patient. Other draw sites, particularly below the waist, are rarely used. are known to vary lab results of some analytes. Expect that any discussion or consultation involving the patient's case will be conducted discretely and that individuals not directly involved in the case will not be present without patient permission. Am J Clin Pathol. What equipment is needed for a venipuncture? In other words, there is no need for another venipuncture procedure. Using a sterile blood lancet, puncture the side of the heel in the appropriate regions shown above in green. Stop the procedure if a hematoma occurs. McCall, R. E., & Tankersley, C. M. (2016). The dorsal venous network is the next most common vein site for phlebotomists. Additionally, blood samples should not be taken on an arm with a fistula used for dialysis treatments. 9. Be informed of the hospital rules and regulations regarding patient conduct. 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. 2019;95(1):15-19. doi: 10.1016/j.diagmicrobio.2019.04.001. Other Factors: Age, gender, and pregnancy have an influence on laboratory testing. All rights reserved. Warm the heel from which blood is to be obtained. To enhance students careers, meet the needs of healthcare providers and improve patient care by providing high quality, cost effective phlebotomy education through industry leading curriculum, current technology and extensive hands on experience. 6. www.mlo-online.com is using a security service for protection against online attacks. 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. Sharps Disposal Container. This information must be given when requesting microbiology, cytology, fluid analysis, or other testing where analysis and reporting is site specific. Areas of fingers and heels that are cold, swollen, scarred or covered with a rash, should be avoided. 2. If an IV is in place, samples may be obtained below but NEVER above the IV site. Capillary specimens are collected in microtainers with colored caps that are used to. -keep extremity below heart level for a few minutes. Psychological interventions for needle-related procedural pain and distress in children and adolescents. on patients who are extremely dehydrated or have poor peripheral circulation. 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. List six areas to be avoided when performing venipuncture and the reasons for the restrictions. C. placed in the sharps container Avoid trauma and excessive probing. Position the patient so that the hand is easily accessible. It is large and near the skins surface, making it easier for phlebotomists to see before anchoring the vein. 8. Phlebotomy is the practice of drawing blood from patients to gather data about their health. Feel for the median cubital first, the cephalic vein second, and the basilic vein third. Give an example of each. Lippi G, Salvagno GL, Montagnana M, Franchini M, Guidi GC. C. all disposable equipment has been discarded properly Never attempt venipuncture in an artery. Tubes with different additives are used for collecting blood specimens for specific types. Determine the final temperature of the R-134a and the final specific internal energy. -infection at site Puncture no deeper than 2.4mm (approximately 0.1 inches). 3. Avoid excessive pressure that may squeeze tissue fluidinto the drop of blood. Diagn Microbiol Infect Dis. C. laws Collect drops of blood into the collectiondevice by gently massaging the heel. Identify the patient using two different identifiers, asking open ended questions such as, "What is your name?" The content of this article is not intended to be a substitute for professional medical advice, examination, diagnosis, or treatment. Blood samples drawn from an IV line should be documented and analyzed with care. Cephalic vein. Within the antecubital fossa, this vein poses the least amount of risk. Allow another large drop of blood to form. In general, blood should not be drawn from an arm with a fistula or cannula without consulting the attending physician. Tip: Patients who need regular bloodwork (e.g. 5. Follow the same procedure as for performing a finger, Order of Draw for a Capillary Puncture: Proper collection of tubes when. Avoid previous hematoma (draw distal of hematoma) together for emotional support and understanding across multiple locations to reach you in the community where you live. Position the infant with the head slightly elevated. Dispose of contaminated materials in appropriate waste receptacles. 12. Tetracaine is a substance used as a spinal anesthetic. Arteries pulsate, are very elastic, and have a thick wall. B. precautions What are the helpful hints for finding veins? True or False? -antiseptic swabs The area where the blood is to be drawn from is first cleaned with a germ-killing solution. Never draw over scars or a new tattoo sites. Avoid prolonged tourniquet application or fist clenching. This image is not<\/b> licensed under the Creative Commons license applied to text content and some other images posted to the wikiHow website. If multiple blood samples are to be taken, the phlebotomist must be careful to follow the proper order of draw. EDTA and sodium citrate tubes should still be filled to the marked fill line to ensure a correct blood-to-additive ratio. 5. 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. In this elbow pit, phlebotomists have easy access to the top three vein sites used in phlebotomy: The median cubital vein, also known as the antecubital vein, is the most common vein for phlebotomy. Identification errors in pathology and laboratory medicine. This image may not be used by other entities without the express written consent of wikiHow, Inc.
\n<\/p>


\n<\/p><\/div>"}, {"smallUrl":"https:\/\/www.wikihow.com\/images\/thumb\/c\/c2\/Troubleshoot-a-Difficult-Venipuncture-Step-9.jpg\/v4-460px-Troubleshoot-a-Difficult-Venipuncture-Step-9.jpg","bigUrl":"\/images\/thumb\/c\/c2\/Troubleshoot-a-Difficult-Venipuncture-Step-9.jpg\/aid11732774-v4-728px-Troubleshoot-a-Difficult-Venipuncture-Step-9.jpg","smallWidth":460,"smallHeight":345,"bigWidth":728,"bigHeight":546,"licensing":"

\u00a9 2023 wikiHow, Inc. All rights reserved. Focus on what you do best, and find someone who can help you communicate that with your target market. Predict a possible value of the thickness of the soap bubble. f.style.height="352px"; Procedure for Capillary Puncture of the Heel: A heel puncture is performed on the lateral or medial plantar surface of the, foot. This image is not<\/b> licensed under the Creative Commons license applied to text content and some other images posted to the wikiHow website. 10. 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. Do not attempt a capillary puncture more than twice. 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. 1. Needles - The gauge number indicates the bore size: the larger the gauge number, the smaller the needle bore. Hemolysis may occur, with pseudohyperkalemia. Label the specimens before leaving the patients bedside. What sites should be avoided when drawing blood? Step 3: Venipuncture. 2. Normal reference ranges are often noted according to age. B. Betadine A. the plastic sleeve is removed 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. This is a general guide for troubleshooting a venipuncture scenario in which blood flow is not initially established upon needle insertion. The patient should make a fist without pumping the hand. Ernst, Dennis J. A. standards 6. The performance of routine vascular access procedures by skilled phlebotomists requires, at a minimum, the use of gloves to prevent contact with blood. (See picture.) Specimens from infants under the age of 6 months are typically collected by heelstick. Verify the patient's condition. Avoid a probing, traumatic venipuncture. List several effects of exercise, posture, and tourniquet application upon laboratory values. Summarize the problems that may be encountered in accessing a vein, including the procedure to follow when a specimen is not obtained. 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. Check the requisition form for requested tests, patient information, and any special requirements. 2. 3. The 2nd (index) finger tends to have thicker, callused skin. Blood is collected into an attached vial or tube that is airtight and the flexible band is then removed from the arm. if ( (iframe.src).indexOf('formperma') > 0 && (iframe.src).indexOf(zf_perma) > 0 ) { Second - coagulation tube (light blue top). Wikipedia. Adjust the height and swivel the chair to ensure your body is in line with the vein. }catch(e){} } The vein may have collapsed; resecure the tourniquet to increase venous filling. The puncture should be made perpendicular to the ridges of the fingerprint so that the drop of blood does not run down the ridges. Precautions include a medical grade face mask. This article was co-authored by Matt Garcia. This image is not<\/b> licensed under the Creative Commons license applied to text content and some other images posted to the wikiHow website. Procedure for Capillary Puncture of the Finger: The best site for a finger puncture is just off the center of the finger pad of. Use of hair nets and face masks to decrease blood culture contamination rates. Then the medical technician or phlebotomist will wrap a flexible band on the upper part of the arm to apply some pressure to that area making the vein enlarge with blood. If possible, speak with the patient during the process. 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. Collect drops of blood into the collection device by gently massaging the finger. How can you decrease the risk of hematoma formation? Lightly touch the microtainer capillary collection device (or filter paper) to the LARGE drop of blood. 2. Clin Lab Med. Potassium A phlebotomy technician is removing his gloves after a venipuncture procedure. Gauze sponges - for application on the site from which the needle is withdrawn. Two forms of active identification are required. Try another tube. -hemorrhage/hematoma. 5. ACDA or ACDB (pale yellow top). What are the red top containers used for? Place labeled specimens in zip lock bag and deliver to the laboratory as soon as possible. 2. Reasonable informed participation in decisions involving the patient's health care. wikiHow, Inc. is the copyright holder of this image under U.S. and international copyright laws. 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. Located in the antecubital fossa, the median cubital vein is a well anchored, stable vein that rarely rolls during venipuncture. Wipe away the first drop of blood with a sterile 22 gauze. diet, exercise, stress, basal state). Extensive scarring or healed burn areas should be avoided Specimens should not be obtained from the arm on the same side as a mastectomy. 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. Capillary Specimens may be used immediately for point-of-care testing. Have the patient drink fluids if dehydrated. Also consider adjusting the angle of the needle. Over 52 percent of all web traffic is from mobile devices . Erroneous test results may be obtained when the blood is not thoroughly mixed with the additive. (a) How would you prepare tetracaine from the corresponding aniline derivative, ArNH2_22? Warning: Do not make lateral (side-to-side) movements with the needle. If using a syringe, make sure the needle is fitted securely on a syringe to avoid frothing. 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. Our students gain a vast amount of experience with phlebotomy vein sites through our hands-on and engaging curriculum and externship program. var zf_ifrm_ht_nw = ( parseInt(zf_ifrm_data[1], 10) + 15 ) + "px"; Date, time and initials of the phlebotomist must be on the label of EACH tube. At least two patient identifiers, such as name and date of birth, are needed. Promptly send the specimens with the requisition to the laboratory. The patient has the right to refuse participation in such activity. Most commonly, venipuncture will be performed on the Antecubital Fossa, or the inside of the elbow. 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. Effective methods use distraction. B. the insertion site has stopped bleeding Tip: In spite of a difficult draw, remember to invert your tubes. It is an employer's responsibility to provide, clean, repair, replace, and/or dispose of personal protective equipment/clothing. If blood is not obtained, change the position of the needle carefully by moving it forward or backward. antecubital fossa What are the best veins for venipuncture? finger should be avoided. B. above an IV line Websites that masquerade as the ones you trust. This image may not be used by other entities without the express written consent of wikiHow, Inc.
\n<\/p>


\n<\/p><\/div>"}, {"smallUrl":"https:\/\/www.wikihow.com\/images\/thumb\/0\/0d\/Troubleshoot-a-Difficult-Venipuncture-Step-6.jpg\/v4-460px-Troubleshoot-a-Difficult-Venipuncture-Step-6.jpg","bigUrl":"\/images\/thumb\/0\/0d\/Troubleshoot-a-Difficult-Venipuncture-Step-6.jpg\/aid11732774-v4-728px-Troubleshoot-a-Difficult-Venipuncture-Step-6.jpg","smallWidth":460,"smallHeight":345,"bigWidth":728,"bigHeight":546,"licensing":"

\u00a9 2023 wikiHow, Inc. All rights reserved. Contains acid citrate dextrose. Allow the blood to soak through and completely fill the pre-printed circle on the filter paper. What are some of the reasons to draw blood? Have an assistant stabilize the arm by firmly locking the elbow joint. A. the tubes are filled and properly labeled {"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.