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venipuncture
| Question | Answer |
|---|---|
| ASCP | American Society of Clinical Pathologists |
| NPA | National Phlebotomy Association |
| NCA | National Certification Agency |
| OSHA | Occupational Safety & Health Administration/ They establish rules for safety in the workplace |
| Define Hemoconcentration | A condition in which the concentration of blood cells is increased in proportion to the plasma |
| Define Hemolysis | The destruction or dissolution of red blood cells, c subsequent release of hemoglobin |
| Define Plasma | The liquid portion of whole blood that contains active clotting agents |
| Define Serum | The liquid portion of whole blood that remains after the blood as clotted |
| Define Thixotropic Gel | A material that appears to be solid until subjected to a disturbance, such as centrifugation, where upon it becomes a liquid |
| What do tourniquets do? | Block the blood from flowing (venous)vasodilation |
| Where do you place tourniquets? | 3-4" above site |
| How long can you leave tourniquets on? | 1 Minute |
| What are the complications of leaving tourniquets on too long? | Hemoconcentration, Interstitial fluid leaks into veins & cause hemolysis, numbness, tingling |
| Can you place tourniquets over clothing? | Yes |
| What's the best time to release tourniquet? | When last tube is 3/4 full before taking needle out |
| What can Happen if the needle comes out before the tourniquet is released? | hemoconcentration |
| What is the action of alcohol? | Clean area where needle will go/inhibit bacteria |
| What is the proper way to clean the venipuncture site? | With alcohol pad in a circle inner/outer |
| How long does alcohol need to remain on the skin? | until dry 30-60secs |
| When is alcohol contraindicated? | Allergy, blood draw for alcohol level, blood culture |
| What 3 antiseptics can be used for blood cultures? | Iodine, cholorhexidine gluconate, benzo |
| Light Blue (Click on this box) 1. What additive? 2. how does the additive work? 3. Hematology/coagulation study/Chemistry Test? 4. What is a waste tube and why is it drawn with a light blue tube? | 1.Sodium Citrate (Click on this box) 2. Removes calcium to prevent blood from clotting 3. Coagulation Study 4. Pull clotting factors out, and to clean tube on butterfly |
| Gold/Red Grey 1. What additive? 2. Hematology/coagulation/chemistry | 1. Clot activator/gel 2. Chemistry |
| Red 1. What additive? 2. Hematology/coagulation/chemistry | 1.Clot Activator 2. Chemistry |
| Green 1. What additive? 2. Hematology/coagulation/chemistry | 1.Heparin 2. Chemistry |
| Lavender/pink 1. What additive? 2. How does the additive work? 3. Hematology/coagulation/chemistry | 1.EDTA 2.Removes calcium, prevents from clotting 3.Hematology |
| Grey: Glucose 1. What additive? 2. Hematology/coagulation/chemistry | 1. Potassium oxalate, sodium chloride 2. Chemistry |
| Why is order of draw is important? | So that you don't mix additives |
| Which tubes will always be first in the order of draw? | Blue |
| Do larger tubes have more or less vacuum? Are they more or less likely to collapse a vein? | More More |
| How much serum/plasma can you get from 6ml of blood? | 3ml |
| What is thixotropic gel and how does it work in the venipuncture tube? | a material that appears to be solid until subject to a disturbance, such as centrifuge, where it becomes liquid |
| When a tube contains thixotropic gel, what is it called? | red-gray serum separator/pst(green-grey) plasma separator tube |
| How does it take blood to clot in a tube when there is no clot activator? | 30-60min |
| What is a short draw? | not enough blood in tube |
| What is the normal adult gauge? | 21gauge(-20) |
| What is a multidraw needle and what is its purpose? | They are used when several tubes are drawn during a single venipuncture. They are double printed.... |
| When should you consider using a butterfly needle? | On small veins. Pediatric, elderly, dehydration |
| How does butterfly tubing affect the vacuum applied to the veins? | less powerful. Decreases it and prevents from collapsing. |
| When should you consider doing a syringe draw? | When you think the section in a vacuum will collapse vein |
| When should you transfer the blood to the tube and why? | Immediately, because it will clot in the barrel. |
| How do you choose the correct size syringe? | Depending on how much blood you draw |
| How do you know if you are pulling the plunger back too fast? | headspace more than 1ml |
| What are the 3 blood borne pathogens? | HBV, HIV, HCV |
| Who writes the needle safety guidelines? | OSHA |
| What is an SESIP and what is its purpose? | Sharp c engineered sharps injury protection/device to prevent needle sticks |
| What do you do when there is an accidental needlestick? | Wash for 10 minutes with antibacterial soap. Squeeze, tell supervisor, report (HIV) same day, 6 weeks;12 weeks;6months blood draw |
| What should you do if you patient has limited language skills? | Have a family member or caregiver present |
| How do you obtain consent for routine venipuncture? | Nonverbal, implied |
| What position should your patient be in for routine venipuncture? | Seated in a chair or laying down |
| What position should your patient be in if they have problems getting their blood drawn? | Laying Down |
| How do you choose your venipuncture site? | By palpating to feel for veins |
| Which veins are most commonly used for venipuncture? | Forearm or elbow(Antecubital) hand, cephalic, median basilic |
| Which Conditions might cause you to use an alternate site for venipuncture? | Nerve Damage |
| What symptoms might suggest you are too close to a nerve? What should you do? | Numbness, tingling, or shooting pain/ Stop and find another site. |
| What is the purpose of making a fist? | Encourages vein easy to find |
| Why do we tell patients not to "pump" their fist more than one or two times? | Because it may increase potassium and ionized calcium in the blood. |
| What angle of needle insertion do you use for the antecubital site? | 15 degrees |
| What are the complications of inserting the needle too deeply? | Hitting an artery, causing hematoma |
| What is the purpose of anchoring the vein or "pulling taut"? | So blood will flow, easy to puncture,, stops vein from rolling |
| When should you tell your patient to release their first? | When blood enters the tube |
| What is the proper way to change out your tubes? | With your thumb |
| Why is venipuncture considered a surgical procedure? | Because you are puncturing the skin. |
| When should you invert your tubes? | Immediately, AFTER DRAW |
| What are the inversions for each of the following tubes: 1. Light Blue 2. Gold/red/red grey 3. Green 4. Lavender/pink 5. Gray | 1. 3-4 2. 5 3. 8-10 4. 8-10 5. 8-10 |
| What can happen to your specimen if you don't invert the tubes properly? | The additive wont mix properly and it can develop small clots |
| What do you do to the site right after the needle is removed? | Hold gauze over puncture site . Apply pressure tostop bleeding |
| If bleeding at the site doesn't stop, what techniques, in addition to pressure, can you use to stop the bleeding? | Continue applying pressure, elevatearm above the heart, ice |
| How long do you observe the site before applying the bandage? | 5-10secs |
| What is a hematoma? | A large painful bruised area at the puncture site caused by blood leaking in tissue. |
| What are the most common causes of a hematoma? | Excessive probing, failure to insert needle far enough, needle goes through the vein. Take needle out before tourniquet, not enough pressure. |
| What do you do if a hematoma forms during the venipuncture procedure? | Discontinue stat apply pressure for a minimum of 3 minutes and then an ice pack to area. |
| What should you do if your patient faints? | Remove tourniquet and needle secure pt. call for help |
| What are smelling salts and how do you use them? | Amonia, crus, 4" under the nose(Wave) |
| What should you do if your patient complains of nausea? | Keep going, talk to them, cool compression |
| What is the most common cause of specimen rejection? | Hemolized specimen |
| List 7 Common Cause of Specimen rejection? | Unlabeled or mislabeled specimens. Insufficient quantity . Hemolysis clotted blood in anticoagulated tube defective tube improper handling incorrect tubes used for test |
| Hemolysis | rupture or destruction of red blood cells |
| What is a hemolyzed specimen? | Broken RBC's in specimenBubbles |
| What is frothing? | Bubbles in the blood |
| What are the 4 causes of frothing? | Loose connection, pulling needle out of vein before tube is completely full, needle too big needle to small |
| How does frothing cause hemolysis? | Creates a turbulence and air breaks cell |
| List 5 other causes of hemolysis from your book and how they cause hemolysis | 1. Alcohol not dry 2. Specimen gets too hot or cold 3. Not transported upright inverting too vigorously 4. Prolong tourniquet time 5. Short draw-ratio chemical/blood |
| What size and type of needle used for children under 2? | Butterfly 23guage/pediatric vacuum |
| What site for children under 2? | Dorsal hand |
| What is the preferred method to collect blood in children under 2? | Dermal Puncture |
| When should serum specimens be spun down in the centrifuge? | After 30 minutes/within 2hrs of blood clotting |
| How long can whole blood be refridgerated? | 72hrs |
| How should filled venipuncture tubes be transported? | Biohazard bag, upright |
| What does chain of custody mean and what is its purpose? | A legal term that refers to the ability to guarantee the identity and integrity of the specimen from collection to reporting test results..... |
| What kind of testing requires chain of custody? | Drug and alcohol testing, DNA analysis or parentage testing |
Created by:
t4achange
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