\u00a9 2023 wikiHow, Inc. All rights reserved. d.appendChild(f); Select the proper approved lancet: The BD Microtainer Contact-Activated. Greet the patient and identify yourself and indicate the procedure that will take place. Failure to do this results in an unequal blood-to-additive ratio, making the specimen unsuitable for analysis. Avoid excessive pressure that may squeeze tissue fluidinto the drop of blood. X=[Ar]4s23d5Y=[Ar]4s23d104p1Z=[Ar]4s23d104p6. Please enable JavaScript on your browser and try again. Because of contacts with sick patients and their specimens, it is important to follow safety and infection control procedures. (function() { Deliver specimens promptly to the laboratory. Needles are available for evacuated systems and for use with a syringe, single draw or butterfly system. Warm the heel from which blood is to be obtained. Prepare the patient's arm using an alcohol prep. The best locations for fingersticks are the 3rd (middle) and 4th (ring) fingers of the non-dominant hand. Use of hair nets and face masks to decrease blood culture contamination rates. This image is not<\/b> licensed under the Creative Commons license applied to text content and some other images posted to the wikiHow website. Place labeled specimens in zip lock bag and deliver to the laboratory as soon as possible. A 21-gauge needle (e.g. the chlorhexidine residue before tying a piece of gauze around the foot. Guidelines established by the Clinical and Laboratory Standards Institute (CLSI) dictate that a phlebotomist shall not attempt a venipuncture more than two times, and a maximum of three attempts shall be undertaken on a patient. 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. BD Eclipse green-capped) is used for most routine and uncomplicated venipunctures. window.addEventListener('message', function (){ Several essential steps are required for every successful collection procedure: Patient comfort. D. all of the above, Julie S Snyder, Linda Lilley, Shelly Collins, Zoology Chapter 16 & 17: Invertebrate Deutero. together for emotional support and understanding across multiple locations to reach you in the community where you live. What are the red top containers used for? 4. Be informed of the hospital rules and regulations regarding patient conduct. A. the plastic sleeve is removed 2013 Oct 10;(10):CD005179. The median cubital vein is used the most for its accessibility. Whole blood specimens may not be able to be analyzed if microscopic clots are present. 13. It is large and near the skins surface, making it easier for phlebotomists to see before anchoring the vein. wikiHow, Inc. is the copyright holder of this image under U.S. and international copyright laws. www.mlo-online.com is using a security service for protection against online attacks. Which of the following actions should the technician take? Hyperextend the patient's arm. The patient has the right to refuse participation in such activity. Effects of Exercise: Muscular activity has both transient and longer lasting effects. Extensive scarring or healed burn areas should be avoided Specimens should not be obtained from the arm on the same side as a mastectomy. C. the needle has penetrated all the way through the vein Do not place too tightly or leave on more than 2 minutes (and no more than a minute to avoid increasing risk for hemoconcentration). (2017). When there is an IV line present, blood can be drawn from this line. Follow the same procedure as for performing a finger, Order of Draw for a Capillary Puncture: Proper collection of tubes when. Clin Lab Med. Transferring a sample from one collection tube to another or mixing blood from different collection tubes must be avoided. Over time and with several repeated punctures, significant amounts of scar tissue builds up. Clinical and Laboratory Standards Institute. 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. Identification errors in pathology and laboratory medicine. 3. This is very painful, risks damage to underlying structures, and widens the needle hole to prolong bleeding time. Green Occupational Safety and Health Administration, United States Department of Labor. Specimens from infants under the age of 6 months are typically collected by heelstick. Using a sterile lancet, make a skin puncture just off the center of the finger pad. 5. 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. Allow another large drop of blood to form. Proper patient identification procedures. Websites that masquerade as the ones you trust. In some cases, a phlebotomist may have to switch sites if they find the blood is not properly flowing from the vein. 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. What should you never do to a site you just cleansed with alcohol? 2. HealthStar Press, Inc. 2001, updated 1/08. try{ Most commonly, venipuncture will be performed on the Antecubital Fossa, or the inside of the elbow. apply pressure for at least 10 minutes. Focus on what you do best, and find someone who can help you communicate that with your target market. Once again, please be aware that these are only guidelines for blood draws and nurses should consult with the appropriate hospital personnel regarding performing this procedure on patients. (See picture.) Enzymes, proteins, lipids, iron, and calcium are significantly increased with changes in position. 4. Examples of labeled collection tubes are shown below: THE FOLLOWING ARE NEEDED FOR ROUTINE VENIPUNCTURE: Evacuated Collection Tubes - The tubes are designed to fill with a predetermined volume of blood by vacuum. The recommended order of draw for plastic collection tubes is: First - blood culture bottle or tube (yellow or yellow-black top). This information must be given when requesting microbiology, cytology, fluid analysis, or other testing where analysis and reporting is site specific. 1. Collect the drops of blood into the collection device by gently massaging, Avoid excessive pressure that may squeeze tissue fluid into the drop of, When full, cap and then gently invert the collection device 5-10 times to, Hold a gauze pad over the puncture site for a short time to stop the, Dispose of the contaminated materials and lancet in the appropriate waste, Place a band-aid on the patients finger or have someone continue to hold, gauze on the finger. Observe all applicable isolationprocedures. Change gloves after each patient or when contaminated. Start with the arm closest to you and palpate the antecubital fossa. Procedure for Capillary Puncture of the Heel: A heel puncture is performed on the lateral or medial plantar surface of the, foot. You will be redirected once the validation is complete. Sites that should be avoided include areas with extensive scarring, healed burns, inflamed sites, edematous sites, previous puncture sites, earlobes and thumbs. Matt Garcia is an experienced phlebotomist in Vancouver, Canada. EDTA and sodium citrate tubes should still be filled to the marked fill line to ensure a correct blood-to-additive ratio. The basic patient rights endorsed by the JCAHO follow in condensed form are given below. 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. doi: 10.1002/14651858.CD005179.pub3. Unlike the cephalic and basilic veins, the median cubital vein is not near major nerves or arteries. 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. B. the needle is only partially in the vein Discarding the first set minimizes the effects of any potential additive contamination. Hematoma formation is a problem in older patients. In this elbow pit, phlebotomists have easy access to the top three vein sites used in phlebotomy: Median cubital vein. f.style.height="352px"; Allow another large drop of blood to form. Make the cut across the heelprint lines so that a drop of blood can well up and not run down along the lines. Diagn Microbiol Infect Dis. Tip: Lowering the arm below the level of the heart may help to engorge the vessels. McCall, R. E., & Tankersley, C. M. (2016). Look for visual clues which may help assess the patient's condition. When wearing gloves, change them between each patient and wash your hands frequently. 2009 Feb;131(2):195-204. -hemorrhage/hematoma. C. After all specimens have been collected Giavarina D, Lippi G. Blood venous sample collection: Recommendations overview and a checklist to improve quality. Venipuncture can also happen when patients have intravenous (IV) lines started. 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. Capillary Specimens may be used immediately for point-of-care testing. Safely dispose of potentially infectious materials. But since each patient's medical condition varies, so does their veins. ACDA or ACDB (pale yellow top). Blood should NEVER be poured from one tube to another since the tubes can have different additives or coatings (see illustrations at end). The infograph below provides a detailed description of the venipuncture steps as found in our how to draw blood resource. f.style.transition="all 0.5s ease"; B. Yellow Verify the patient's condition. Dispose of contaminated materials/supplies in designated containers. Do not bend, break, recap, or resheath needles to avoid accidental needle puncture or splashing of contents. Northfield, IL: College of American, NCCLS. 9. When the last tube to be drawn is filling, remove the tourniquet. -tourniquet The phlebotomist's role requires a professional, courteous, and understanding manner in all contacts with the patient. Hematoma - A venipuncture should not be performed on a hematoma, regardless of how small it may be. Get instant access to our latest tools and our must-read site updates: What Certifications Are Used For Higher Pay For Phlebotomists? The essential elements of the requisition form are: Patient's surname, first name, and middle initial. In fact, many search engines provide the option to avoid dangerous sites by turning on a "safer" search. Puncture no deeper than 2.4mm (approximately 0.1 inches). A. EMLA This information must match therequisition. Avoid areas of hematoma. 3. C. laws The vein may have collapsed; resecure the tourniquet to increase venous filling. var prevIframeHeight = iframe.style.height; The first attempt is the antecubital fossa area, starting with the median cubital vein, then the cephalic vein, and the basilic vein. 2. Areas in which two veins join should be avoided where possible, as valves are often present. 4. The most common complications are bleeding at the puncture site or hematoma formation. Reassure the patient that the minimum amount of blood required for testing will be drawn. }, false); Perform the venipuncture. This guide follows the steps as outlined in the World Health Organizations Guidelines on Drawing Blood: Best Practices in Phlebotomy. Ask the patient orcaregiver to state the patients name and date of birth. Tip: In spite of a difficult draw, remember to invert your 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. Not making it mobile friendly. Because most laboratory specimens contain bacteria, it is not necessary to wash hands before collecting them, The tourniquet applied prior to venipuncture is removed: This image may not be used by other entities without the express written consent of wikiHow, Inc.
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