venipunture final
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| order of draw | lt blue, red, gold/red gray, green, lavender/pink, gray
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| light blue | sodium citrate, invert 3-4x, stand time 0, centrifuge 15 min, plasma
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| red | clot activator, invert 5x, stand time 30min, centrifuge 10min/2hrs, serum
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| gold/red gray | gel/clot activator, invert 5x, stand time 30 min, centrifuge 10min/2hrs serum
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| green | heparin, invert 8-10x, stand time 0, centrifuge 0, plasma
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| lavender/pink | edta, invert 8-10x, stand time 0, centrifuge 0, plasma
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| gray | sodium fluoride, invert 8-10x stand time 0, centrifuge 0, plasma
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| what is serum | the liquid portion with clotting factors removed
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| what types of test are run from a serum specimen | red/gold- chemistry
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| what is plasma | liquid portion of blood
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| what types of test are run from a plasma specimen | (green ,gray), (lav,pink), (blue)- chemistry, hematology, coagulation
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| how much blood do you need to draw to collect 2ml of serum? | 4ml
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| what is a separator tube? | separates cells/clots from plasma or serum
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| what does a separator tube contain | synthetic gel
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| why is it important to draw in the correct order | avoid contamination of additives
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| which would be drawn first; cbc or coagulation study | coagulation
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| whole blood specimens used for blood counts (RBC, WBC, etc.) should be refrigerated and tested with in | 72 hrs
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| what size needle is used on a child under 2yrs of age | 23g butterfly, dorsal hand
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| local anesthetic cream may be applied on a child before drawing blood. when should it be applied before the procedure | 1hr
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| when a pt is diabetic and a glucose test is required, which tube is used and what is the correct draw | gray first
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| cbc, rbc, platelet count, HgB, Hct | hematology, lavender, plasma
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| cholesterol, sodium chloride, potassium, electrolytes | chemistry, gold, serum
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| PT/NR | coagulation, light blue, plasma
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| why do we chart what we have done or not done | if its not in the chart it didn't happen
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| what info is recorded in the pt chart | date, time, what was done, site, what was done w/ the specimen
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| what info is recorded on the tube | pt name. DOB, date, time
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| in which types of situations would you choose to perform a syringe blood draw? | fragile veins, young child, suction might collapse vein, dehydrated pt, poor distention, elderly
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| how do you know you are "pulling" the blood at the correct speed? | no more than 1ml of head space
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| what might occur if you are "pulling" the blood to quickly | hemolysis
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| are these tubes sterile | yes
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| where are blood cultures in the order of draw | 1st
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| is the venipuncture procedure an aseptic or sterile procedure | aseptic
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| why is hand-hygiene important during venipuncture | reduce risk of transmitting infection
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| when are hands washed | before and after procedure
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| when are gloves worn | during actual VP - ok to palpate and prepare without gloves on
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| how do you make sure you have the correct patient | verify name and dob
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| what are appropriate communication to tell or ask your pt before beginning a procedure | ask permission to draw their blood, explain the procedure, ask if patient has a history of problems with blood draw
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| where should your supplies be during the procedure | on your non-dominate side
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| the median vein is most commonly used and is located | in the antecubital area
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| the basilic vein is located is avoided due to its proximity to the | brachial artery and median nerve
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| the best vein to draw blood from are those that you can | palpate
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| 70% alcohol should not be used for | blood cultures
alcohol allergy
blood alcohol test
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| what can happen if you perform the procedure before the alcohol is dry | hemolysis, stinging
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| what is the correct tourniquet placement | 3-4 inches above the elbow
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| the tourniquet should be released when | the last tube is 1/2 to 3/4 full
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| can the tourniquet be placed over clothing | yes
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| what are the complications of leaving a tourniquet on too long | hemoconcentration, altered test results, petechiae, pain, nerve damage, hemolysis
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| how long should you observe the vp site before applying the gauze and tape | 5 to 10 sec
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| what is the purpose of asking the patient to "pump and hold twice" | distend the vein with blood
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| what is SESIP | self sheathing retractacle needle
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| what do you do if the needle comes out | partially-push it back in; completely-stop procedure
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| what is frothing | blood come out so fast it froths or bubbles
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| what causes frothing | needle lumen too long, loose connection of equipment, removing the needle while tube still intact, tourniquet in tight
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| why is frothing avoided | hemolysis
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| what are possible causes of hematoma | excessive probing, failure to insert the needle far enough into the vein, needle goes through the vein
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| what is hemoconcentration | concentration of blood cells is increased in proportion to the plasma
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| how do u avoid this complication | don't leave tourniquet on longer than 1 min
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| what is hemolysis | breakdown of rbc release of hemogloblin from cell
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| how do you know when a specimen is hemolyzed ? | rosy color to bright red serum or plasma
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| what are petechiae | small pin-point hemorrhage in the skin
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| how do you avoid this complication | tourniquet is on too long or too tight
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| what would you do if you saw petechiae developing while drawing blood | loosen tourniquet and keep drawing
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| what to do if the antecubital space has been recently burned | choose another site because these areas are prone to infections
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| what must you consider when drawing blood from an obese pt | veins are deeper, difficult to palpate, deeper angle
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| what does it mean when your pt becomes nauseous during the procedure | talk through it, offer emesis basin, cool compress deep breaths
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| what must you consider with a pt with a history of fainting or become light-headed during venipuncture | lay them down for procedure
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| how do smelling salts work | ampule filled with ammonium carbonate
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| how are smelling salts applied | break ampule, wave it back n forth 4 inches under nostrils until regain consciousness
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| what must you consider with a pt taking anti-coagulant medication | bleeding is more likely and requires extended pressure
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| what causes collapsing veins | suction in tube is too great
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| your pt complains of a stinging sensation with the venipuncture procedure most likely cause | alcohol not dry
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| what is necessary prior to drawing blood specimens from the lower extremity | doctors order
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| list 3 ways you can cause nerve damage during the venipuncture procedure | wrong site
excessive probing
inserted too deeply
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| what percent of physicians base their treatment decisions on blood test | 80%
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| how does this apply to you | DO IT RIGHT !!
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