\u00a9 2023 wikiHow, Inc. All rights reserved. 8. Areas in which two veins join should be avoided where possible, as valves are often present. What is the most common site for blood sampling? Wipe away the first drop of blood with sterile 22 gauze. While venipuncture is considered to be reasonably safe, the present study investigated the incidence of serious complications occurring in an outpatient setting. Enzymes, proteins, lipids, iron, and calcium are significantly increased with changes in position. How can you tell if you are palpating a vein? -hemorrhage/hematoma. Any attempt to repeat a puncture at the same site increases the risk of complications. UF Health Pathology Laboratories Nontuberculosis Mycobacteria Laboratory, This page uses Google Analytics (Google Privacy Policy), Capillary puncture may be used for obtaining specimens in infants or in adults where. Procedure for Capillary Puncture of the Heel: A heel puncture is performed on the lateral or medial plantar surface of the, foot. Contains a gel separator and clot activator. Phelan MP, Reineks EZ, Berriochoa JP, Schold JD, Hustey FM, Chamberlin J, Kovach A. Label all specimens per accepted guidelines. Back the needle out until the bevel is just below the skin. Because of contacts with sick patients and their specimens, it is important to follow safety and infection control procedures. Other Factors: Age, gender, and pregnancy have an influence on laboratory testing. Erroneous test results may be obtained when the blood is not thoroughly mixed with the additive. Tip: Lowering the arm below the level of the heart may help to engorge the vessels. 11. Several veins in the antecubital fossa provide excellent access. Reasonable informed participation in decisions involving the patient's health care. In some instances, the legs or feet are required for use, but a physician or doctor should be completing the draw, not a phlebotomist. Phlebotomy Essentials 5th Edition Chapter 9. Blood Collection Techniques in Exotic Small Mammals. If blood is not obtained, change the position of the needle carefully by moving it forward or backward. 8. B. collection device While we are ranked among the best children's hospitals in the country, it's our compassionate approach to treatment that makes us truly exceptional. Journal of Exotic Pet Medicine. Posture: Postural changes (supine to sitting etc.) Gloves - can be made of latex, rubber, vinyl, etc. 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. 3. PST (light green top). Avoid prolonged tourniquet application or fist clenching. Websites that masquerade as the ones you trust. Joslin JO. Clin Chem Lab Med. The use of a tourniquet during a venipuncture procedure makes: A. Gloves are to be discarded in the appropriate container immediately after the bloodcollection procedure. 2013 Oct 10;(10):CD005179. Some images used in this set are licensed under the Creative Commons through Flickr.com.Click to see the original works with their full license. The first step to choosing the right vein is to select the appropriate needle gauge. 2. Predict a possible value of the thickness of the soap bubble. Cochrane Database Syst Rev. Perform the venipuncture. It may be, necessary, on occasion, to perform a capillary puncture on the toe of a patient, who is severely burned. The venipuncture procedure is complex, requiring both knowledge and skill to perform. It doesn't matter . var zf_perma = zf_ifrm_data[0]; While most patients veins are compatible with a standard needle gauge, others require a. . } For an inpatient DO NOT DRAW BLOOD IF THE ARMBAND OR BRACELET IS MISSING. The content of this article is not intended to be a substitute for professional medical advice, examination, diagnosis, or treatment. Performing a venipuncture on a child under one year of age . 8. Avoid excessive pressure that may squeeze tissue fluid into the drop of blood. -antiseptic swabs -tourniquet Applyan adhesive bandage. Filter paper should touch only the blood and not the heel or finger. When using a syringe avoid drawing the plunger back too forcefully. The antecubital fossa is a collection of veins located within the arms inner area, opposite of the elbow, where the arm folds in. The basic patient rights endorsed by the JCAHO follow in condensed form are given below. wikiHow, Inc. is the copyright holder of this image under U.S. and international copyright laws. This image is not<\/b> licensed under the Creative Commons license applied to text content and some other images posted to the wikiHow website. C. the seal is broken Cap, rotate and invert the microtainer to mix the blood collected. 6. B. Betadine To determine the best vein, use both sight and touch. To enhance students careers, meet the needs of healthcare providers and improve patient care by providing high quality, cost effective phlebotomy education through industry leading curriculum, current technology and extensive hands on experience. A tin can containing air is sealed. if ( zf_ifrm_data.length == 2 ) { Otherwise, satisfactory samples may be drawn below the IV by following these procedures: Turn off the IV for at least 2 minutes before venipuncture. Mix and label all appropriate tubes at the patient bedside. Avoid excessive pressure that may squeeze tissue fluidinto the drop of blood. You must check the timing of these variations for the desired collection point. Blood samples drawn from an IV line should be documented and analyzed with care. Hematoma - A venipuncture should not be performed on a hematoma, regardless of how small it may be. World Health Organization. The vein may have collapsed; resecure the tourniquet to increase venous filling. Label all appropriate tubes at the patient bedside. A government issued photo identification card such as a driver's license can aid in resolving identification issues. Do not obtain specimens from an arm having a cannula, fistula, or vascular graft. and "What is your date of birth?". B. the needle is only partially in the vein Even if several vials of blood have to be drawn it usually amounts to no more than one ounce. var prevIframeHeight = iframe.style.height; finger should be avoided. This is why a required skill for most phlebotomy jobs is to have excellent people skills with the ability to keep the patient calm during the venipuncture procedure. Consider three elements with the following abbreviated electron configurations: X=[Ar]4s23d5Y=[Ar]4s23d104p1Z=[Ar]4s23d104p6\mathrm{X} = \mathrm{[Ar]4s^23d^5}~~~\mathrm{Y}=\mathrm{[Ar]4s^23d^{10}4p^1}~~~\mathrm{Z}=\mathrm{[Ar]4s^23d^{10}4p^6} As a countermeasure, phlebotomists anchor the vein with their hand to stabilize it for the draw. B. evacuated tube 7. Swiftly insert the needle through the skin and into the lumen of the vein. 2009;18(2):117-139. The most commonly used site for a venipuncture is at the bend of the elbow, also called the antecubital fossa 1. The needle may have pulled out of the vein when switching tubes. (Partial penetration may allow blood to leak into the soft tissue surrounding the vein by way of the needle bevel). Regardless of the source of payment, request and receive an itemized and detailed explanation of the total bill for services rendered in the hospital. Lippi G, Salvagno GL, Montagnana M, Franchini M, Guidi GC. Never draw above an IV site. Greet the patient and identify yourself and indicate the procedure that will take place. Avoid excessive probing ("fishing"). (Assume that the total volume is the sum of the individual volumes and that the density and specific heat capacity of the solution are the same as for pure water.). This is very painful, risks damage to underlying structures, and widens the needle hole to prolong bleeding time. 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. Describe and perform the venipuncture process including: Appropriate clothing and protective equipment. C. Lancet Please enable cookies on your browser and try again. The rubber stoppers are color coded according to the additive that the tube contains. After the needle selection, phlebotomists begin to look and feel for a viable vein. What are some of the reasons to draw blood? In other words, there is no need for another venipuncture procedure. Dispose of needles immediately upon removal from the patient's vein. But since each patient's medical condition varies, so does their veins. If none of these veins work, then the phlebotomists use the hand veins. Place labeled specimens in zip lock bag and deliver to the laboratory as soon as possible. What are the gold top containers used for? ACDA or ACDB (pale yellow top). 4. Switch to the other arm if you can't find anything. The median cubital creates, The dorsal venous network is the next most common vein site for phlebotomists. EDTA and sodium citrate tubes should still be filled to the marked fill line to ensure a correct blood-to-additive ratio. Have the patient position their arm on the armrest. As a countermeasure, phlebotomists. Step 3: Venipuncture. Know the identity and professional status of individuals providing service and to know which physician or other practitioner is primarily responsible for his or her care. Collection tubes can vary in size for volume of blood drawn, appropriate to the tests ordered with sample size required, and vary in the kind of additive for anticoagulation, separation of plasma, or preservation of analyte. var f = document.createElement("iframe"); Laboratory coats or work smocks are not typically needed as personal protective equipment during routine venipuncture, but an employer must assess the workplace to determine whether certain tasks, workplace situations, or employee skill levels may result in an employee's need for laboratory coats or other personal protective equipment to prevent contact with blood. Tip: Patients who need regular bloodwork (e.g. Serum red top or amber tube with red top. There may be no vacuum in the tube being used. jugular) or a central venous catheter is out of the scope of practice of a certified phlebotomist and should only be performed by a physician or advanced nurse. *NEVER BEND THE ARM*. https://www.osha.gov/laws-regs/standardinterpretations/2007-10-26 and https://www.osha.gov/OshDoc/data_BloodborneFacts/bbfact03.pdf (Accessed June 13, 2022). Phlebotomy is not a one size fits all; each patient is different and may have their blood drawn at other sites with varying needle sizes. Needle disposal unit - needles should NEVER be broken, bent, or recapped. Perform the venipuncture, collecting the sample(s) in the appropriate container(s). Check the requisition form for requested tests, patient information, and any special requirements. The median cubital vein is used the most for its accessibility. The thumb has a pulse and is likely to bleed excessively. D. Both A and B, A sharps container is identified by its bright ____ color -18, 20, 22 gauge needles. However, if there is no alternative and an arm with an IV line in place must be used for venipuncture, try to choose a site away from and below the location of the IV. Valenstein PN, Sirota RL. After the third attempt, further medical directions must be sought with the attending physician before proceeding. are known to vary lab results of some analytes. Lightly touch the microtainer capillary collection device (or filter paper) to the LARGE drop of blood. Include your email address to get a message when this question is answered. Second - coagulation tube (light blue top). C. Red BD Eclipse green-capped) is used for most routine and uncomplicated venipunctures. Fasting, dietary restrictions, medications, timing, and medical treatment are all of concern and should be noted on the lab requisition. Avoid bruising the infants heel when obtainingblood. wikiHow, Inc. is the copyright holder of this image under U.S. and international copyright laws. The patient who is at ease will be less focused on the procedure. Although the skill set and procedures may apply to both instances, this content is primarily aimed towards venous blood collection using evacuated tube systems (e.g. If an IV is in place, samples may be obtained below but NEVER above the IV site. Provide for their comfort as much as possible, and gain the patient's cooperation. When using a syringe and needle, avoid drawing the plunger back too forcibly. However, drawing blood from the hand is affiliated with higher levels of pain and less control. (c) the rate of heat transfer. All other items used for the procedure must be disposed of according to properbiohazardous waste disposal policy. 9. Lancets are disposed of in an appropriate sharps container as one unit. How can you decrease the risk of hematoma formation? try{ Several essential steps are required for every successful collection procedure: Patient comfort. IF AN INCOMPLETE COLLECTION OR NO BLOOD IS OBTAINED: Change the position of the needle. 8. -obvious skin infection (including newly tattooed areas). B. the insertion site has stopped bleeding D. Butterfly, Before leaving the patient's bedside, you must make sure that: Specimens from infants under the age of 6 months are typically collected by heelstick. C. the needle has penetrated all the way through the vein Always wear a clean lab coat or gown. Determine the final temperature of the R-134a and the final specific internal energy. -use correct angle of needle insertion An assortment of needles and syringes of different sizes Tourniquet Alcohol and alcohol swabs Gauze or cotton balls Laboratory forms and blood-specimen labels Transportation bags and sharps container Step 2: Prepping The Patient Once you have the necessary supplies, it's time to ready the patient. outstretched or raised If just a routine coagulation assay is the only test ordered, then a single light blue top tube may be drawn. 9. Capillary Specimens may be used immediately for point-of-care testing. NOTE: The use of post-exposure prophylaxis following blood exposure to HIV has shown effectiveness (about 79%) in preventing seroconversion. Apply an adhesive bandage. -do not rapidly insert the needle. 7. However, do not use too high a temperature warmer, because baby's skin is thin and susceptible to thermal injury. Blindly maneuvering the needle within the skin is painful to the patient and you run the risk of hitting a nerve, tendon, or artery. Warm the heel from which blood is to be obtained. This vein lies close to the surface of the skin and there is not a large nerve supply. 9. A requisition form must accompany each sample submitted to the laboratory. f.style.border="none"; {"smallUrl":"https:\/\/www.wikihow.com\/images\/thumb\/6\/68\/Troubleshoot-a-Difficult-Venipuncture-Step-1.jpg\/v4-460px-Troubleshoot-a-Difficult-Venipuncture-Step-1.jpg","bigUrl":"\/images\/thumb\/6\/68\/Troubleshoot-a-Difficult-Venipuncture-Step-1.jpg\/aid11732774-v4-728px-Troubleshoot-a-Difficult-Venipuncture-Step-1.jpg","smallWidth":460,"smallHeight":345,"bigWidth":728,"bigHeight":546,"licensing":"