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Venipuncture is the process of collecting or "drawing" blood from a vein and most common way to collect blood specimens for laboratory testing
phlebotomist most important step in this procedure is patient identification
venipuncture steps-step 1 Review and accession test request
venipuncture steps-step 2 Approach, identify and prepare patient
venipuncture steps-step 3 Verify diet restrictions and latex sensitivity
venipuncture steps-step 4 sanitize hands
venipuncture steps-step 5 position patient, apply tourniquet and ask pt to make a fist
venipuncture steps-step 6 Select vein, release tourniquet and ask pt to open fist
venipuncture steps-step 7 clean and air-dry the site
venipuncture steps-step 8 prepare equipment and put on gloves
venipuncture steps-step 9 step reapply tourniquet, uncap and inspect needle
venipuncture steps-step 10 ask pt to remake fist, anchor vein and insert needle
venipuncture steps-step 11 establish blood flow, release tourniquet, and ask pt to open fist
venipuncture steps-step 12 fill, remove and mix tubes in order of draw or fill syringe
venipuncture steps-step 13 place gauze, remove needle,activate safety feature and apply pressure
venipuncture steps-step 14 discard collection unit, syringe needle or transfer device
venipuncture steps-step 15 label tubes
venipuncture steps-step 16 observe special handlling instructions
venipuncture steps-step 17 check patients arem and apply bandage
venipuncture steps-step 18 dispose of contaminated materials
venipuncture steps-step 19 thank patient, remove gloves and sanitize hands
venipuncture steps-step 20 transport specimen to the lab
blood collection procedures legally begin with the test request
requisition the form on which test orders are entered
verbal test requests used in emergencies
required requistion information ordering physician's name, pts first-last & middle initial, pt medical record number,pts DOB, room number,type of test preformed, date test to be preformed,billing info and ICD-9 codes, test status (timed,fasting, priority),special precautions (ie latex)
requistions come in manual and computer generated
manual requistions-have 3 parts request, report and billing form
computer requistions contain actual labels for specimen tubes, pt information and test status some additional ie potential bleeder or no venipuncture right arm
computer generated what are we required to write write time of collection and his or her initials on the label after collection
computer requisitions for inpatients usually print out special computer terminal at phlebotomist station in laboratory
outpatients are given laboratory requistions or prescriptions for taking them to blood collection site
blood collection site is responsible for all required information is on the requistion provided by the patient or to fill out a requistions from the physicians prescription slip
reviewing a requisiton check to see all required info is present and complete, verify the tests fo be collected (date and time), identifiy diet restrictions or other special circumstances, determine test status or collection priority
acesssion is the process of recording in the order received -take steps to connect the specimen and the accompanying paperwork with specific individual
stat requests take priority over all others
approach looking for signs containing information concerning the pt is an important part of the approach
signs are posted on the door to the pts room or wall or head of pt bed
what prohibits blood draw signs indicating infection-control- limits visits to the room/fall precautions, severe allergy
DNR do not resuscitate
DNAR do not attempt resuscitation-no code order
code is a way to transmit a message via numbers or words
picture of fall leaves precaution against falling
picture of a fallen leaf with a teardrop obstetric - indicate pt has lost a baby
entering a pts room polite and make presence known, protect privacy
physicians and clergy present in pt room do not interupt
family members and vistiors ask to step out of prefer to stay ask to steady arm
identify yourself stat name, title, and why you are there
before initial veipuncture obtain pt consent
bedside manner behavior of a healthcar provider
ID band or braclet arm band or wrist band
MR number medical record- pt name and hosptial identificaiton number
3 way ID pts verbal id statement, check ID band, and visual comparison
where could IV pts ID be around ankle
ER Emergency room
ED emergency department
ER procedures assign temporay number, fill out label by hand or computer,apply them to tests and speciamans,when permanent number is issued and cross reference to temporary, attach ID band same as temporary
baby id name, DOB, Gender, MR number, mothers last name or name of person at registration
outpatient ID outpatient collection site's receptionist verifies the pts identitiy and fills out the proper lab requistion
informed consent regardless of difficulty involved, you must always determine the the pt understands what is about to take place and obtain permission before proceeding
addressing pt inquiries handle by stating that it is best to have the doctor or nurse explain
handling pt objectives remind DR ordered test and needs the results to provide proper care will sometimes convince pt to cooperate
if pt truly objects and refuses blood draw write on requistion, that the patient has refused to have blood drawn, notifiy appropriate personnel pt refusal-a form may be required stating why
needle phobia intense fear of needles
needle phobia pts may experience a shock type reaction-includes pallor(paleness), profuse sweating, light-headedness,nausea and fainting
needle phobia extreme cases experience arrhythmia and even cardiac arrest
needle phobia % 10 %, some avoid medical care
needle phobia steps to minimize trauma have pt lie down during the procedure, legs elevated, apply an ice pack to site for 10 to 15 mins, have only the most experienced phlebotomist--future have personnel trained in CPR and defibrillator
Diet Restrictions most common to fast (refrain from eating) typically overnight or after last meal of the day or after midnight (8 to 12 hours)
diet restrictions- water drink water to eliminate dehydration
if pt eaten non fasting
hands decontaminated by washing or use of alcohol based sanitizers (gels or foams)--if hand washing facilities are not available, should be cleaned with detergent-containing wipes followed by alcohol based hand cleaner--then put gloves on
in patients have blood draw (position) lying down
out patients have blood draw (position) sitting up/blood draw chairs
due to fainting pt postion never standing or backless chaie
venipuncture area for needle (preferred site) antecubital area
venipuncture arm postion should extend downward in a straight line from shoulder to wrist and not bent at the elbox-no hyperextension
fix veins veins so they are less apt to roll and makes easier to locate because gravity is necessary to ensure ensure blood collection tubes fill from the bottom
blood tubes fill from the bottom prevents reflux or backflow of tube contents as well to prevent additive carryover
how far above venipuncture site to place tourniquet 3 to 4 inches ti restrict venous blood flow
position of tourniquet for hand vein applied proximal to the wrist bone
tourniquet tight enough to slow venous flow without affecting areterial flow
if pt has sensitive skin or dermatitis apply over dry washcloth or gauze wrapped around the arm or hospital gown sleeve
tourniquet in place pt should not what with fist pumping (repeatedly opening and closing the fist should be prohibited as it causes muscle movement tha can make vein location more difficult can also cause changes in blood components that could affect results
H pattern veins median cubital, cephalic and basilic
M pattern veins median, median cephalic, median basilic
first vein choice median cubital and median veins- nerve injury least
2nd vein choice cephalic and median cephalic veins
last vein choice basilic , median basilic--last choice because they are near the median nerve and brachial artery which could puncture accidentially
palpate examine by touch or feel
patency state of being freely open
patent means open
turgid distended from being filled with blood giving bounce and resilience
concentric circles circles with a common center
most commly used needle 23 gauge
the gauge of the needle the smaller the number the bigger the needle
hub it can be attached to a syringe
2nd type hub it can be multisample Luer adapter that can be threaded onto an ETS holder
luer lock used for draw and a syringe transfer device to transfer blood from the syringe to the ETS tubes
what test is taken without a tourniquet lactic acid
use non dominant hand to anchor
use dominant hand to insert needle
L hold finger at back of arm thumb in front-anchoring
Created by: NadineDmetriuc