Phlebotomy: incision in vein for the purpose of drawing blood. Vacutainer tubes: sterile glass or plastic blood collection tube with a closure that is evacuated to create a vacuum inside the tube facilitating the draw of a predetermined volume of blood/liquid. Standard precautions: set of basic infection prevention practices intended to prevent transmission of infectious diseases from one person to another (gloves, hand- washing, goggles, etc. ) Needleless adapters: device providing a way to access IV lines without the use of a needle. Fasting: to abstain from all or some kinds of food or drink for a certain period of time.
Backflow: reversal of normal flow of current. Tourniquet: a device for compression of an artery or a vein; uses include stopping excessive bleeding of a hemorrhage, maintenance of a nearly bloodless operative field, prevention of spread of snake venom after a snakebite, and aiding in obtaining blood samples or giving intravenous injections. Hematoma: a localized mass of extravasated blood that is relatively or completely confined within an organ or tissue, a space, or a potential space; blood is typically clotted; bruise. STAT order: urgent or rush.
Lab requisition: a request from the lab for something. Hemolysis: alteration, dissolution, or destruction of red blood cells in such a manner that hemoglobin is liberated into the medium in which the cells are suspended. Antecubital fossa: triangular cavity of the elbow. Routine order: orders used for every patient that doctor sees when admitted to the hospital. 1. What equipment is required for collecting blood specimens by venipuncture? Safety needle 22g or less, butterfly needle 21g or less, syringes, blood collection tubes, tourniquets, antiseptic, 2×2 gauze, sharps disposal container, bandages or tape 2. A tourniquet should be kept on a client no longer than 1 minute.
3. The best method for determining the “best site” for phlebotomy? You should apply the tourniquet to the upper extremity and look for the best vein visible in the antecubital fossa. 4. Are there contraindications to using certain sites? Describe them. If there is venous fibrosis on palpation, any presence of hematoma, presence of a VAD, presence of vascular shunt or graft, or evidence of cellulitis or abscess. 5. List five unexpected outcomes of venipuncture and related interventions.
-hematoma forms at venipuncture site—solution: apple pressure using 2×2 gauze and continue to monitor the patient for pain and discomfort -bleeding at site continues—solution: apply pressure to site or have patient apply pressure, monitor patient and notify health care provider -signs and symptoms of an infection at venipuncture site occur—solution: notify health care provider and apply moist heat to the site -laboratory tests reveal abnormal blood results—solution: notify health care provider -can’t get needle into vein—solution: try a smaller needle, such as butterfly needle or a different location 6. Why is the color of the lab specimen tube top important?
They stand for different tests being run and different additives in the tubes. They must be filled in a certain order and they have different amount of times to be inverted. 7. What is the correct order for drawing blood tubes? Sterile/blood cultures (yellow stopper), light blue coagulation tube, red- non- additive which has clot activator, red gel separator tube, green heparin, green/gray mottled plasma separator tube(PST) with heparin, lavender/purple and/or pink(EDTA), gray top (potassium oxalate/sodium fluoride tube).
8. How will you know if you have collected the correct amount of blood to run the test? In a vacuum tube, they are set to draw a predetermined volume of blood. The flow of blood will stop when the correct amount is in there. 9. What are the potential complications associated with phlebotomy? Be prepared to describe interventions to minimize the risk. Hematoma- occurs when blood leaks out of a damaged vein; to prevent, person preforming must carefully perform the venipuncture making sure to only go through the top wall of the vein instead of all the way through and ensure removal of tourniquet.
Nerve injury- most commonly occur when blood is drawn from antecubital veins; to prevent deep needle sticks should be avoided. Infection- when germs and other bacteria enter blood stream and tissue; to prevent ensure cleaning skin properly, wash hands before performing, and wear gloves. 10. Interventions to minimize hemolysis of the specimen. I would follow all of the proper steps to collecting the specimen.
One important thing is to select the proper needle size for the patient. Also make sure not to pull the plunger back too quickly if collecting the blood with a needle and syringe. Make sure to gently invert the vials of blood unless they don’t have a clot activator. They could be hand carried to the lab or sent by pneumatic tubes. 11. Compare and contrast phlebotomy for routine blood specimens with a blood specimen drawn for culture and sensitivity. Prepping the area is all the same. The difference is the containers for the C&S are 10-15 mL where the routine is typically a little smaller. It is also important to clean the tops of the C&S tubes for 15 seconds before injecting sample.
The needles must also be changed for both procedures before putting the samples in the containers. 12. How will you prep the site if drawing a specimen for a blood alcohol level? Instead of using alcohol wipes, I would use PVP Iodine prep pads. 13. How will you transfer blood collected by the syringe method to the collection tube? The needle must be a safety needle and must be 21g or larger in order to facilitate rapid flow into and out of the syringe minimizing hemolysis. A 20 mL syringe is recommended. Perform venipuncture in normal steps.
When entered the vein, grasp the barrel of syringe firmly and pull firmly on plunger until required amount of blood is in syringe; remove tourniquet and needle after amount of blood has been obtained. Place gauze on site. Then use a safety transfer device for transferring the blood from the syringe to vacuum tubes or blood culture bottles. On the syringe with the blood, remove the needle from the arm, activate safety feature, remove and discard needle and attach hub of syringe to safety transfer device. Transfer the blood into the tube. 14. How might you modify for a frail elderly patient? It is best to use a syringe.
It helps to apply a warm compress before hand. -Blood doesn’t flow into the syringe or collection tube I would ensure that the needle didn’t go all the way through the vein or that it is not just up against a wall by pulling back a tiny bit and readjusting. I could also loosen the tourniquet. If I was using a vacutaining tube, I could also try a new tube. -Patient complains of extreme pain during venipuncture I would immediately remove the needle in the case that I punctured a nerve. I would perform in a different site and notify supervisor. -Patient develops a hematoma at the puncture site.
I would apply pressure or put a dressing on that applies pressure for at least 8 hours. I would apply ice packs or warm, moist compresses. -You failed to properly label the specimens prior to transporting to the lab. I would have to redraw the specimens in order to ensure proper verification and to ensure all the tests were accurate. -You sustained a clean needle stick during the procedure. I would discard the needle, immediately wash area with soap and water, and follow facility policy and notify the supervisor. -You sustained a dirty needle stick during the procedure.
I would discard the needle properly, immediately wash area with soap and water and maybe even an antiseptic solution, and seek care right away. -Your patient is combative and/or refuses the procedure. I would try to explain to the patient the reason for it and talk them into it. If they are combative I would either not do the procedure and contact the health care provider or seek additional help. -Your client was not fasting for the designated amount of time. I would explain to them the importance of the reason for fasting and have them come back a different time for the tests.