what sites should be avoided when performing venipuncture quizletmaya diffuser instructions

\u00a9 2023 wikiHow, Inc. All rights reserved. As a phlebotomist, it is critical to know which vein sites offer stable flows for blood draws. Hematoma - A venipuncture should not be performed on a hematoma, regardless of how small it may be. For an inpatient the nursing staff can be contacted to aid in identification prior to proceeding. 2004;24(4):979-96, vii. A key element for successful venipuncture is choosing the best vein. The median cubital creates less bruising and pain than other draw sites. If blood is not obtained, change the position of the needle carefully by moving it forward or backward. (c) How would you prepare tetracaine from benzene? Extremity is edematous. the 3 rd (middle) or 4 th (ring) finger of the hand. 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. What is the most common site for blood sampling? Background: Venipuncture is the most common invasive medical procedure performed by health care providers. We use cookies to make wikiHow great. wikiHow is where trusted research and expert knowledge come together. Apply only ONE drop of blood per circle. https://www.ncbi.nlm.nih.gov/books/NBK138650/pdf/Bookshelf_NBK138650.pdf (Accessed June 13, 2022). A. in the region of a hematoma Wayne, PA: Clinical and Laboratory Standards Institute; 2008. Try another tube. A commercial heel warmer may be used. Avoid excessive pressure that may squeeze tissue fluid into the drop of blood. Avoid excessive pressure that may squeeze tissue fluid into the, mix the blood. Each time a vein is accessed with a needle, scar tissue forms as part of the body's healing process. For the CLSI Updated Phlebotomy Procedures please click here. var evntData = event.data; When finished, clean the site and apply pressure with a clean gauze to stop the bleeding. This makes every subsequent poke harder and harder because scar tissue is more fibrous and tougher to puncture. Applyan adhesive bandage. Avoid puncturing a finger that is cold or cyanotic, swollen, scarred, or covered with a rash. hemorrhage or hematoma at site of puncture, remove tourniquet var d = document.getElementById("zf_div_SBGg-3DTNCwt65i9A6n_zU3SneyGD89SSqM_7F_nCas"); Safely dispose of potentially infectious materials. 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. Because of contacts with sick patients and their specimens, it is important to follow safety and infection control procedures. Sharps Disposal Container. (function() { Larger tube sizes typically provide for collection of samples from 6 to 10 mL. Blood is collected into an attached vial or tube that is airtight and the flexible band is then removed from the arm. Switch to the other arm if you can't find anything. 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. When wearing gloves, change them between each patient and wash your hands frequently. Let's take a quick, high-level look at the venipuncture procedure. 1. Through a combination of revolutionary treatments and extraordinary patient experiences, our care does more than heal. Position the patient so that the hand is easily accessible. Have the patient drink fluids if dehydrated. 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. Thrombosed veins lack resilience, feel cord-like, and roll easily. But since each patient's medical condition varies, so does their veins. Areas of fingers and heels that are cold, swollen, scarred or covered with a rash, should be avoided. B. collection device If an IV is in place, samples may be obtained below but NEVER above the IV site. Label the specimens before leaving the patients bedside. This preliminary action allows you to safely adjust the needle's position. When would you use a butterfly/infustion set? 4. Penetrate the skin at a 30 to 45 angle at first (even less with a butterfly), then once you get a flash, reduce the angle by bringing the needle assembly down closer to the arm and advance the needle a tiny bit further into the vein. The area of the arch should be avoided, as should the posterior, curvature of the heel; a puncture in these areas could cause injury to the, All babies in the neonatal unit must be warmed before performing a. puncture. The Patient's Bill of Rights has been adopted by many hospitals as declared by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). Blood Collection Techniques in Exotic Small Mammals. Primary effect is hemoconcentration of non-filterable elements (i.e. B. evacuated tube Because most laboratory specimens contain bacteria, it is not necessary to wash hands before collecting them, The tourniquet applied prior to venipuncture is removed: Such terms as "needs to," "must," "require" and "should" are used to explain how medical professionals should perform capillary blood collection procedures. Here phlebotomists will typically choose from three veins: the median cubital vein, the cephalic vein or the basilic vein. This image is not<\/b> licensed under the Creative Commons license applied to text content and some other images posted to the wikiHow website. Effective communication - both verbal and nonverbal - is essential. window.addEventListener('message', function (){ This is a general guide for troubleshooting a venipuncture scenario in which blood flow is not initially established upon needle insertion. -Vacutainer barrel 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. While hand veins may be utilized for blood draws and intravenous infusions, veins in the feet and legs should be avoided for adults. 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. 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. Make sure the venipuncture site is dry before proceeding with draw. B. Hematoma 5. Dispose of items in appropriate containers. Syringes - may be used in place of the evacuated collection tube for special circumstances. To prevent hemolysis when performing a venipuncture, the phlebotomist should: 1. In some instances, the legs or feet are required for use, but a physician or doctor should be completing the draw, not a phlebotomist. Wait 2 minutes before reapplying the tourniquet. 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. Lippi G, Salvagno GL, Montagnana M, Franchini M, Guidi GC. Be careful not to withdraw the needle completely or else you risk losing the tube's vacuum and starting a hematoma when the bevel exits the skin. Several essential steps are required for every successful collection procedure: Patient comfort. 6. }, false); Adapted from Phlebotomy for Nurses and. The service requires full cookie support in order to view this website. Therefore, your anchor should be gentle but firm to prevent the vein from moving away from you. Practice hygiene for the patient's protection. Arteries pulsate, are very elastic, and have a thick wall. This type of venipuncture procedure is a little different, and sometimes can be a little more involved. 2. This complication of peripheral I.V. The first drop contains excess tissue fluid and must be wiped away. Avoid bruising the infants heel when obtainingblood. Wipe away the first drop of blood with sterile 22 gauze. Deliver specimens promptly to the laboratory. 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. Label the specimens before leaving the patients bedside. 3. In most of these cases, the skin on the hand is pierced and a vein is accessed so medications or fluids can be given intravenously. Press down on the gauze once the needle is out of the arm, applying adequate pressure to avoid formation of a hematoma. Phlebotomy is the practice of drawing blood from patients to gather data about their health. A thin soap bubble of index of refraction 1.33 is viewed with light of wavelength 550.0 nm and appears very bright. Sanders AM, Agger WA, Gray AM, Fischer CM, Kamprud EA. 11. Have an assistant stabilize the arm by firmly locking the elbow joint. C. sterile gauze pads The diagram below indicates in green the proper area to use for heel punctures for blood collection: Prewarming the infant's heel (42 C for 3 to 5 minutes) is important to obtain capillary blood gas samples and warming also greatly increases the flow of blood for collection of other specimens. Giavarina D, Lippi G. Blood venous sample collection: Recommendations overview and a checklist to improve quality. Drawing blood from major vessels (e.g. Check for any allergies to antiseptics, adhesives, or latex by observing for armbands and/or by asking the patient. Recommended order of collection for microtainer specimens: 7. This image is not<\/b> licensed under the Creative Commons license applied to text content and some other images posted to the wikiHow website. While most patients veins are compatible with a standard needle gauge, others require a. . Phlebitis can also occur as a result of vein trauma during insertion, use of an inappropriate I.V. 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 median cubital vein is used the most for its accessibility. They are also. Include your email address to get a message when this question is answered. Do not use a previous puncture site. 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. 1. The venipuncture procedure is complex, requiring both knowledge and skill to perform. This image is not<\/b> licensed under the Creative Commons license applied to text content and some other images posted to the wikiHow website. What are some of the reasons to draw blood? The patient who is at ease will be less focused on the procedure. Hard and dense structures may be nerves or tendons. Gauze sponges - for application on the site from which the needle is withdrawn. Also consider adjusting the angle of the needle. 6. C. all disposable equipment has been discarded properly (b) the power developed by the output shaft. f.style.border="none"; A typical single vial contains about five milliliters, which is about one teaspoon. 8. 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. Be methodical in your search for a vein. This guide follows the steps as outlined in the World Health Organizations Guidelines on Drawing Blood: Best Practices in Phlebotomy. However, drawing blood from the hand is affiliated with higher levels of pain and less control. -infection at site Have the patient position their arm on the armrest. Firmly grasp the flanges of the tube holder to avoid advancing the needle further into the vein as you change tubes. site. Subcutaneous tissue feels squishy and muscle feels hard. 4. Blood is commonly obtained from the median cubital vein on the anterior forearm. Allow thefinger to dry or wipe dry with a sterile 22 gauze. Venipuncture requires good skills in order to perform the procedure not only correctly, but also painlessly. Effective methods use distraction. Patients in these populations are often nervous and may flail their limbs. 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. If possible, speak with the patient during the process. Diurnal variations associated with some blood components are: Change gloves after each patient or when contaminated. f.src = 'https://forms.zohopublic.com/healthservicesacademy/form/RequestCourseInformationCPTIAccelerated/formperma/SBGg-3DTNCwt65i9A6n_zU3SneyGD89SSqM_7F_nCas?zf_rszfm=1'; Track marks are not only found on IV drug users, but also on chronically ill patients requiring repeated vascular access and blood draws and may be a sign of an anticipated difficult draw. 7. Using the requisition for reference, ask a patient to provide additional information such as a birthdate. 2. followed pre-lab instructions. Any attempt to repeat a puncture at the same site increases the risk of complications. A. the tubes are filled and properly labeled 9. Greet the patient and identify yourself and indicate the procedure that will take place. Place a pillow under the patient's arm if additional support is needed. var zf_perma = zf_ifrm_data[0]; Assess the need for sample recollection and/or rejection. Puncture no deeper than 2.4mm (approximately 0.1 inches). Check for timing instructions for drawing the appropriate samples. It doesn't matter . Follow institution's guidelines regarding treatment and follow-up.