\u00a9 2023 wikiHow, Inc. All rights reserved. Wear gloves and a lab coat or gown when handling blood/body fluids. The median cubital creates less bruising and pain than other draw sites. Remember -- the rst vein found is not always the best vein. Place blood collection equipment away from patients, especially children and psychiatric patients. Press down on the gauze once the needle is out of the arm, applying adequate pressure to avoid formation of a hematoma. var zf_perma = zf_ifrm_data[0]; (2017). Edematous extremities - tissue fluid accumulation alters test results. B. collection device ROUTINE CAPILLARY PUNCTURE BLOOD COLLECTION GUIDELINES. 6. The needle may have pulled out of the vein when switching tubes. In fact, many search engines provide the option to avoid dangerous sites by turning on a "safer" search. The blood is normally drawn from a vein on the top of the hand or from the inside of the elbow. We use cookies to make wikiHow great. Clean up any blood spills with a disinfectant such as freshly made 10% bleach. 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. Let's take a quick, high-level look at the venipuncture procedure. Gloves - can be made of latex, rubber, vinyl, etc. 7. 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. Anxiety that results in hyperventilation may cause acid-base imbalances, and increased lactate. D. discarded in the trash, True or False? Drawing from these sites can cause blood clotting and hemostasis. Begin by selecting the proper, approved lancet, such as: BD Microtainer Quikheel Lancet, 2.5 mm for full-term babies (green), BD Microtainer Quickheel Preemie Lancet, 1.75 mm for neonatal, Unistick2 Neonatal 18G, 1.2mm Lancet for neonatal babies less than, Prepare the heel by cleaning it with a Chlorhexadine wipe. 1. 8. Select the appropriate microtainers for the specimens to be collected. Tip: In spite of a difficult draw, remember to invert your tubes. A. the tubes are filled and properly labeled This information must be given when requesting microbiology, cytology, fluid analysis, or other testing where analysis and reporting is site specific. Cap, rotate and invert the microtainer to mix the blood collected. Hematoma formation is a problem in older patients. 4. The first step to choosing the right vein is to select the appropriate needle gauge. Let's take a look at the types of websites you and your staff need to be wary of and how to avoid them. A. just prior to needle insertion Sanders AM, Agger WA, Gray AM, Fischer CM, Kamprud EA. The patient has the right to refuse participation in such activity. To prevent hemolysis when performing a venipuncture, the phlebotomist should: 1. 8. WHO guidelines on drawing blood: best practices in phlebotomy. The creatine kinase (CK), aspartate aminotransferase (AST), lactate dehydrogenase (LDH), and platelet count may increase. Patches of purple or yellow may suggest bruising after a recent venipuncture. 7. Carry out hand hygiene before and after each patient procedure, before putting on and after removing gloves. Never draw above an IV site. To determine the best vein, use both sight and touch. When finished, clean the site and apply pressure with clean gauze to stop the bleeding. After the third attempt, further medical directions must be sought with the attending physician before proceeding. Matt Garcia is an experienced phlebotomist in Vancouver, Canada. Too tight of a tourniquet may cause the vein to collapse upon needle insertion. 2004;24(4):979-96, vii. Tubes with different additives are used for collecting blood specimens for specific types. Punctures to the posterior curvature of the heel cab cause damage to the bones. What are the contraindications to venipuncture? A. excessive probing with the needle A. standards The area where the blood is to be drawn from is first cleaned with a germ-killing solution. Tip: BD Vacutainer tubes use a translucent stopper to identify short draw variants. Dry the cleaned area with a dry cotton sponge. These items include: Heparin light or dark green top tube, 5. Tip: Patients who need regular bloodwork (e.g. The best locations for fingersticks are the 3rd (middle) and 4th (ring) fingers of the non-dominant hand. Predict a possible value of the thickness of the soap bubble. Contains acid citrate dextrose. This image is not<\/b> licensed under the Creative Commons license applied to text content and some other images posted to the wikiHow website. Pediatric Pointers. Center for Phlebotomy Education, Inc. Ernst, Dennis J. and Catherine Ernst. Label the collection tubes at the bedside or drawing area. The fluid may dilute the specimen, so collect from the opposite arm. D. Blue, Which of the following conditions should prevent a site from being selected for venipuncture? The needle should form a 15 to 30 degree angle with the surface of the arm. Order of draw for multiple tube phlebotomy. 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. D. All of the above, Needles are sterile until: Apply blood to the printed side of the filter paper. Tetracaine is a substance used as a spinal anesthetic. What are some of the reasons to draw blood? Also consider adjusting the angle of the needle. prevent falls, should the patient lose consciousness. For an inpatient DO NOT DRAW BLOOD IF THE ARMBAND OR BRACELET IS MISSING. What is the most common complication of venipuncture? An OSHA acceptable, puncture proof container markedBiohazardous. 8. What are the green/lavender top containers used for? A tin can containing air is sealed. 9. Enzymes, proteins, lipids, iron, and calcium are significantly increased with changes in position. Certain larger molecules are not filterable into the tissue, therefore they are more concentrated in the blood. 11. 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. A. Some individuals are afraid of needles, while others are frightened at the sight of blood. B. Hematoma 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. Therefore, an arm containing an IV should not be used to draw blood specimens if it can be avoided. Label the specimens before leaving the patients bedside. 5. Allow another large drop of blood to form. (b) the power developed by the output shaft. If blood stops flowing into the vacuum tube, the vein may have collapsed. Any microtainerscontaining additives should be tapped to dislodge additives from the walls and top. Observe universal (standard) safety precautions. var evntData = event.data; The basic patient rights endorsed by the JCAHO follow in condensed form are given below. Promptly send the specimens with the requisition to the laboratory. f.src = 'https://forms.zohopublic.com/healthservicesacademy/form/RequestCourseInformationCPTIAccelerated/formperma/SBGg-3DTNCwt65i9A6n_zU3SneyGD89SSqM_7F_nCas?zf_rszfm=1'; 1-kg of R-134a initially at 600 kPa and 25C25^{\circ} \mathrm{C}25C undergoes a process during which the entropy is kept constant until the pressure drops to 100 kPa.