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VP Site selection
Site selection
| Question | Answer |
|---|---|
| Antecubital fossa | A triangular cavity of the elbow joint that contains tendons, veins, median nerve and brachial artery |
| 3 Major veins located in antecubital fossa | 1. Median cubital 2. Cephalic 3. Basilic |
| Median cubital vein | •large & easier to palpate •closer to surface of skin •more secure when the needle is inserted - well anchored •less painful to the pt •Lies over the bicipital aponeurosis (a fibrous membrane) - this offers protection to underlying nerves&arteries |
| Cephalic vein | The second choice. Why? It is usually more difficult to locate and has a tendency to move (It is fairly well anchored). It is the most prominent vein in obese patients |
| Basilic vein | Last choice in the antecubital fossa area. Located near the brachial artery and median nerve •It is not well anchored •increased possibility of accidental puncture of the median nerve or brachial artery •More painful to the patient |
| Necessary materials for routine venepuncture (name 9) | Requisition form Antiseptic alcohol pad (webcol) Vacutainer holder Vacutainer needle Evacuated tubes Tourniquet Cotton wool / gauze Plaster Gloves Sharps container Hand sanitiser |
| Tests that require fasting | Glucose, Lipogram, Triglycerides,Apo-lipo protein(a), C-peptide, Gastrin, Growth hormone, Homocysteine, Insulin, Chromogranin A, Pyruvate, Renin and Aldosterone (preferred), Lactate, Plasma metanephrine |
| Basal state | When the patient has fasted and refrained from strenous exercise for 12hours before drawing the blood |
| Where is the Cephalic vein located | Located on the lateral aspect of the arm |
| Fistula | Permanent surgical connection between an artery and a vein. Fistulas are used for dialysis. Must not be used for venepuncture. Fistula arm must be avoided |
| Scarred or sclerosed veins | Veins feel hard. Do not use this vein. This can be from numerous venepunctures in the same vein or chemotherapy |
| IV therapy | Do not draw venous blood from an arm with an IV insitu. The fluid will alter the test results |
| Edema | The accumulation of fluid in the tissues. Collection from edematous tissue alters test results |
| Mastectomy | Removal of breast. Do not draw blood on the same arm as the mastectomy side |
| Hematoma | A swelling or mass of blood, caused by blood leaking from a blood vessel during or after blood collection. Do not use the hematoma area to collect blood |
| Name 7 sites to be avoided due to pre-existing conditions | Haematoma Oedema Mastectomy Burns, scars & tattoos IV arm Fistula arm Frequently punctured or thrombosed veins |
| Sites to avoid for venous blood collection | •A catheter implanted surgically into the jugular or subclavian vein •A subcutaneous port or heparin lock •A fistula or cannula joining a vein and an artery •Scalp veins •Umbilical veins in infants |
| How to select a vein | Most prominent veins are mostly in the dominant arm Palpating to determine size, depth, direction and patency |
| M-pattern veins | 1. Median vein 2. Median cephalic vein 3. Median basilic vein |
| Name the artery found in close proximity to the basilic vein | Brachial artery |
| Explain why the veins on the inside of the wrist area not suitable for venepuncture. | • Painful • Veins are fragile • Not well anchored • Lie close to nerves and tendons and arteries |
| It is not advisable to take blood from the same side as a mastectomy because | Lymphostasis results following a mastectomy. There is an increase of lymphocytes and waste products in the blood. Results may be erroneous |
| Why would the blood test result be erroneous if drawn above an IV site | The IV fluid drawn into the tube with the blood will cause erroneous results leading to incorrect management of the patient |
| Legs and feet veins are to be avoided especially in patients suffering from certain conditions. Name these conditions | • Diabetes Mellitus • cardiac problems • varicose veins • coagulation disorders |
| Name two reasons why you should not draw blood from a haematoma site | • These areas are more painful to the patient • The old haemolysed blood surrounding the vein may contaminate the specimen • Obstruction of the blood flow by the haematoma and the effects of the coagulation process may lead to inaccurate test results |
| Explain the reason why drawing blood from an edematous site will lead to erroneous results | Specimens will be contaminated with tissue fluid |
| Name the muscle on the medial aspect of the forearm that allows one to bend the wrist | Flexor carpi radialis |
| Name the muscle that lies closest to the antecubital fossa | Pronator teres |
| Identify the 3 bones found in the upper limb | Humerus, radius and ulna |
| Name the plexus from which the nerves in the arm originate | Brachial plexus |
| Identify possible complications of drawing blood from leg and feet veins | •More susceptible to infection •Increased risk of the formation of thrombi. •The blood circulation in the feet and legs of a patient at bed rest may not be good and therefore the sample will not necessarily truly represent the condition of the patient |
Created by:
cisca