1. In this elbow pit, phlebotomists have easy access to the top three vein sites used in phlebotomy: The median cubital vein, also known as the antecubital vein, is the most common vein for phlebotomy. Our students gain a vast amount of experience with phlebotomy vein sites through our hands-on and engaging curriculum and externship program. Fill the capillary tube(s) or micro collection device(s) as needed. } Arteries pulsate, are most elastic, and have a thick wall. Always thank the patient and excuse yourself courteously when finished. Please enable JavaScript on your browser and try again. Giavarina D, Lippi G. Blood venous sample collection: Recommendations overview and a checklist to improve quality. Make certain that the blood completely saturates all four (4) circles and is visible from bothsides. Cephalic vein. Pre-warm the region of the vein to reduce vasoconstriction and increase blood flow. Give an example of each. Regardless of the source of payment, request and receive an itemized and detailed explanation of the total bill for services rendered in the hospital. 10. Provide for their comfort as much as possible, and gain the patient's cooperation. Wait 2 minutes before reapplying the tourniquet. 9. Applyan adhesive bandage. Tetracaine is a substance used as a spinal anesthetic. Blindly maneuvering the needle within the skin is painful to the patient and you run the risk of hitting a nerve, tendon, or artery. 7. 8. What is the best position to perform venipuncture in? 10. Children, particularly under the age of 10, may experience pain and anxiety during the phlebotomy procedure. As part of presenting a professional appearance, an institutional dress code may include wearing of a laboratory coat or smock. 3. Select the proper approved lancet: The BD Microtainer Contact-Activated. } Label the specimens before leaving the patients bedside. Do not use alcohol for prepping the site when drawing a blood alcohol sample. The blood is bright red (arterial) rather than venous. Specimens; Approved StandardSixth Edition. What are the contraindications to venipuncture? This image is not<\/b> licensed under the Creative Commons license applied to text content and some other images posted to the wikiHow website. As a phlebotomist, it is critical to know which vein sites offer stable flows for blood draws. B. just after needle insertion, but prior to vacutainer activation Safely discard potentially infectious materials. Lippi G, Salvagno GL, Montagnana M, Franchini M, Guidi GC. Do not attempt a capillary puncture more than twice. The venipuncture procedure is complex, requiring both knowledge and skill to perform. A. the tubes are filled and properly labeled Use of hair nets and face masks to decrease blood culture contamination rates. For children over 6 months and adults, the finger is punctured. This image is not<\/b> licensed under the Creative Commons license applied to text content and some other images posted to the wikiHow website. Adjust the angle (the bevel may be against the vein wall). Compared to the standard blood donation which is about sixteen ounces, one ounce is really small. 8. Blood collection tubes must be drawn in a specific order to avoid cross-contamination of additives between tubes. Any microtainerscontaining additives should be tapped to dislodge additives from the walls and top. Assess the patient's physical disposition (i.e. 1. Using a sterile blood lancet, puncture the side of the heel in the appropriate regions shown above in green. Once you establish blood flow, slightly modify your hand position to stabilize the needle against the arm and prevent further movement. 7. Dispose of contaminated materials/supplies in designated containers. Cochrane Database Syst Rev. Press down on the gauze once the needle is out of the arm, applying adequate pressure to avoid formation of a hematoma. Follow institution's guidelines regarding treatment and follow-up. Venipuncture can also happen when patients have intravenous (IV) lines started. He previously worked in a high-volume outpatient lab and is currently employed in an acute care hospital and Level III trauma center in downtown Vancouver. The use of a tourniquet during a venipuncture procedure makes: The most common site(s) for the venipuncture procedure is/are the following: The tourniquet should not be left on a patient more than 1 minute when performing a venipuncture because it is uncomfortable and causes: The needle should always be inserted at the puncture site with the: The correct needle position for a venipuncture is a ______ degree angle with the bevel facing _____. Allow it to air, Grasp the finger, and using a sterile lancet, press firmly against the finger. As a countermeasure, phlebotomists. When working with patients who have undergone a mastectomy, draw from the arm on the opposite side of the mastectomy to avoid edematous tissue. 9. B. Betadine Forward completed/dry collections to the laboratory as soon as possible. 2013 Oct 10;(10):CD005179. D. it is wiped with alcohol, Venipuncture at sites with each of the following could effect the results EXCEPT: Be informed of the hospital rules and regulations regarding patient conduct. This image is not<\/b> licensed under the Creative Commons license applied to text content and some other images posted to the wikiHow website. D. Near a tattoo, Needles are used once and then: })(); The cephalic vein is a safe secondary option if the median cubital vein is not working. Verify the patient's condition. B. sterilized and reused With risk for blood spatter a face shield provides protection. prevent falls, should the patient lose consciousness. Drawing blood for laboratory analysis is most often a routine and uneventful procedure. Kiechle FL. proteins). Uman LS, Birnie KA, Noel M, et al. Because of contacts with sick patients and their specimens, it is important to follow safety and infection control procedures. Warning: Do not make lateral (side-to-side) movements with the needle. What are the gray top containers used for? It is observed that if the tourniquet is left on longer than 2 minutes, changes in the value of a total protein test occur. Adjust the height and swivel the chair to ensure your body is in line with the vein. -use a smaller gauge needle 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. The best locations for fingersticks are the 3rd (middle) and 4th (ring) fingers of the non-dominant hand. What is the procedure to draw blood from an arm with an IV in it? Question. For a detailed breakdown of each step of the venipuncture test scroll down. Holder/Adapter - use with the evacuated collection system. Sites to avoid: Extensive scarring from burns or surgery The upper extremity on the side that a mastectomy was performed. The diagram below indicates in green the proper area to use for heel punctures for blood collection: Prewarming the infant's heel (42 C for 3 to 5 minutes) is important to obtain capillary blood gas samples and warming also greatly increases the flow of blood for collection of other specimens. Diurnal Rhythms: Diurnal rhythms are body fluid and analyte fluctuations during the day. Gloves are to be discarded in the appropriate container immediately after the bloodcollection procedure. wikiHow, Inc. is the copyright holder of this image under U.S. and international copyright laws. 6. These items include: Avoid bruising the infants heel when obtainingblood. If multiple blood samples are to be taken, the phlebotomist must be careful to follow the proper order of draw. Never leave a tourniquet on for more than two minutes. 5. It may be obstructing blood flow. 5. Recognize complications associated with the phlebotomy procedure. Two forms of active identification are required. PROBLEMS OTHER THAN AN INCOMPLETE COLLECTION: A hematoma forms under the skin adjacent to the puncture site - release the tourniquet immediately and withdraw the needle. This seats the bevel into the lumen of the vein, and is also the technique used to insert an IV catheter. Move it forward (it may not be in the lumen). if ( (iframe.src).indexOf('formperma') > 0 && (iframe.src).indexOf(zf_perma) > 0 ) { Sign up for wikiHow's weekly email newsletter. Refuse treatment to the extent permitted by law. After the needle selection, phlebotomists begin to look and feel for a viable vein. Also consider adjusting the angle of the needle. Recommended order of collection for microtainer specimens: 7. Why? Ask the patient to lie on their back. The service requires full JavaScript support in order to view this website. Phlebotomy issues and quality improvement in results of laboratory testing. Never draw above an IV site. It is large and near the skins surface, making it easier for phlebotomists to see before anchoring the vein. Arteries pulsate, are very elastic, and have a thick wall. Please enable cookies on your browser and try again. Serum iron levels tend to drop during the day. If a patient has an IV giving them fluids in their right arm which arm should be your first choice to draw blood out of? }catch(e){} 4. Calculate H\Delta \mathrm { H }H of this reaction. Identify the additive, additive function, volume, and specimen considerations to be followed for each of the various color coded tubes. What are the best veins for venipuncture? wikiHow, Inc. is the copyright holder of this image under U.S. and international copyright laws. What is the most common complication of venipuncture? Mix and label all appropriate tubes at the patient bedside. Edematous extremities with swollen tissue alter the results. A commercial heel warmer may be used. Predict a possible value of the thickness of the soap bubble. Firmly grasp the flanges of the tube holder to avoid advancing the needle further into the vein as you change tubes. The area where the blood is to be drawn from is first cleaned with a germ-killing solution. The sides and the tip of the, Select the proper approved lancet: The BD Microtainer Contact-Activated, Lancet 1.5 mm (lavender) is used for glucometers and the BD Microtainer, Contact-Activated Lancet 2.0 mm (blue) is used any time you need more, Prepare the finger by cleaning it with a Chlorhexadine wipe. Keep in mind that elderly patients often have fragile veins. Phelan MP, Reineks EZ, Berriochoa JP, Schold JD, Hustey FM, Chamberlin J, Kovach A. Do not use the central portion of the heel because you might injure the underlying bone, which is close to the skin surface. The performance of routine vascular access procedures by skilled phlebotomists requires, at a minimum, the use of gloves to prevent contact with blood. If superficial veins are not readily apparent, you can force blood into the vein by massaging the arm from wrist to elbow, tap the site with index and second finger, apply a warm, damp washcloth to the site for 5 minutes, or lower the extremity over the bedside to allow the veins to fill. Puncture only the uppermost wall of the vein, Remove the tourniquet before removing the needle, Make sure the needle fully penetrates the upper most wall of the vein. When storing a blood specimen what temp should it be at 2-8 degrees c If a patient starts to seize during a draw what should you do Stop the draw When should you use a capillary instead of venipuncture A patients veins are inaccessible What can cause a hemolysis in a specimen Shaking a tube vigorously Check for any allergies to antiseptics, adhesives, or latex by observing for armbands and/or by asking the patient. If a vein feels hard, it may be scarred or sclerosed. The median cubital vein, a superficial vein that forms a connection point between the cephalic and basilic veins of the arm is large, and therefore easier to see and feel. 2009;47(2):143-53. Punctures to the posterior curvature of the heel cab cause damage to the bones. -laceration of vein if ( prevIframeHeight != zf_ifrm_ht_nw ) { Using a sterile lancet, puncture the most medial or lateral portion of the plantar surface of theheel, medial to a line drawn posteriorly from the mid great toe to the heel. Primary effect is hemoconcentration of non-filterable elements (i.e. Wipe away the first drop of blood with a sterile 22 gauze. Of course, the phlebotomist may understand this, however, the patient may not. Watch for formation of a hematoma. Contains acid citrate dextrose. (See picture.) NOTE: The use of post-exposure prophylaxis following blood exposure to HIV has shown effectiveness (about 79%) in preventing seroconversion. Apply the tourniquet 3-4 inches above the selected puncture site. Additionally, blood samples should not be taken on an arm with a fistula used for dialysis treatments. Choosing an appropriate site for venipuncture is crucial for a successful . Expect reasonable safety congruent with the hospital practices and environment. Then the medical technician or phlebotomist will wrap a flexible band on the upper part of the arm to apply some pressure to that area making the vein enlarge with blood. X=[Ar]4s23d5Y=[Ar]4s23d104p1Z=[Ar]4s23d104p6. If using a syringe, make sure the needle is fitted securely on a syringe to avoid frothing. are known to vary lab results of some analytes. Sanders AM, Agger WA, Gray AM, Fischer CM, Kamprud EA. If it is then heated, what can you say about: b) how often the molecules hit the walls of the can. Tubes with different additives are used for collecting blood specimens for specific types. Transferring a sample from one collection tube to another or mixing blood from different collection tubes must be avoided. It doesn't matter . Avoid excessive pressure that may squeeze tissue fluidinto the drop of blood. 5. This information must match therequisition. At least two patient identifiers, such as name and date of birth, are needed. He holds a Diploma in Medical Laboratory Assistance and is certified under the British Columbia Society of Laboratory Science. Other Factors: Age, gender, and pregnancy have an influence on laboratory testing. While the median cubital, cephalic, and basilic veins are the most popular draw sites for blood draws, phlebotomists may resort to other draw sites if their ability to draw is restricted. If using a needle and syringe, avoid drawing the plunger back too forcefully. Heparin light or dark green top tube, 5. var iframe = document.getElementById("zf_div_SBGg-3DTNCwt65i9A6n_zU3SneyGD89SSqM_7F_nCas").getElementsByTagName("iframe")[0]; Gas tubes (must warm the site before collecting the specimen), 4. As a countermeasure, phlebotomists anchor the vein with their hand to stabilize it for the draw. 3. catheter size for the vein, or prolonged use of the same I.V. Switch to the other arm if you can't find anything. Other draw sites, particularly below the waist, are rarely used. While this may be effective in some difficult draws, the risk of a needlestick injury is higher if the patient has a withdrawal reflex and the needle recoils back into your finger. Povidone-iodine wipes/swabs - Used if blood culture is to be drawn. The most commonly used site for a venipuncture is at the bend of the elbow, also called the antecubital fossa 1. Hemoconcentration: An increased concentration of larger molecules and formed elements in the blood may be due to several factors: Prolonged tourniquet application (no more than 1 minute). Adhesive bandages / tape - protects the venipuncture site after collection. C. all disposable equipment has been discarded properly var prevIframeHeight = iframe.style.height; For an inpatient the nursing staff can be contacted to aid in identification prior to proceeding. C. the needle has penetrated all the way through the vein Reasonable informed participation in decisions involving the patient's health care. Change gloves after each patient or when contaminated. 2. Wear gloves and a lab coat or gown when handling blood/body fluids. 4. To determine the best vein, use both sight and touch. Thrombosed veins lack resilience, feel cord-like, and roll easily. var zf_perma = zf_ifrm_data[0]; In most of these cases, the skin on the hand is pierced and a vein is accessed so medications or fluids can be given intravenously. Do not use excessive pressure or heavy massaging because the blood may become diluted with tissue fluid. How can you tell if you are palpating a vein? 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. What Is Venipuncture? Finally, when the necessary blood is collected, the needle will be removed and properly disposed of in a Sharps container and the puncture site will be covered to stop the bleeding. 7. hemorrhage or hematoma at site of puncture, remove tourniquet Examples of labeled collection tubes are shown below: THE FOLLOWING ARE NEEDED FOR ROUTINE VENIPUNCTURE: Evacuated Collection Tubes - The tubes are designed to fill with a predetermined volume of blood by vacuum. 4. A needle is then gently inserted into the vein. The creatine kinase (CK), aspartate aminotransferase (AST), lactate dehydrogenase (LDH), and platelet count may increase. 1. Intravenous therapy (IV) / blood transfusions - fluid may dilute the specimen, so collect from the opposite arm if possible. Various sizes are available. While hand veins may be utilized for blood draws and intravenous infusions, veins in the feet and legs should be avoided for adults. Factitious biochemical measurements resulting from hematologic conditions. Discarding the first set minimizes the effects of any potential additive contamination. D. mandates, The most common antiseptic used in venipuncture is: very small or difficult vein, Ch 46 Phlebotomy & Ch 47 Hematology (MULTIPLE, Chapter 47: Phlebotomy and Blood Collection, Positive and negative feedback & examples, Meds Vanessa doesn't need because she sleeps, Medical Terminology: Learning Through Practice, April Lynch, Jerome Kotecki, Karen Vail-Smith, Laura Bonazzoli. Summarize the problems that may be encountered in accessing a vein, including the procedure to follow when a specimen is not obtained. This makes every subsequent poke harder and harder because scar tissue is more fibrous and tougher to puncture. Blood is collected into an attached vial or tube that is airtight and the flexible band is then removed from the arm. Although the larger and fuller median cubital and cephalic veins of the arm are used most frequently, the basilic vein on the dorsum of the arm or dorsal hand veins are also acceptable for venipuncture. Date, time and initials of the phlebotomist must be on the label of EACH tube. the chlorhexidine residue before tying a piece of gauze around the foot. -obvious skin infection (including newly tattooed areas) -extensive scarring -don't use same side as mastectomy -avoid previous hematoma -avoid arm w/ fistula/cannula -edamtous extremity What is the most common site for blood sampling? For an inpatient DO NOT DRAW BLOOD IF THE ARMBAND OR BRACELET IS MISSING. (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.). 6. If the tech is not comfortable with any of the veins in the inside elbow area, they may choose a dorsal vein in the hand or, as a last resort, choose a vein in the foot. The recommended order of draw for plastic collection tubes is: First - blood culture bottle or tube (yellow or yellow-black top). (See Use of Band-Aids in the Post Phlebotomy. (Partial penetration may allow blood to leak into the soft tissue surrounding the vein by way of the needle bevel). var evntData = event.data; 2. A face mask reduces risk for blood culture specimen contamination. D. All of the above, Needles are sterile until: 11. D. after needle removal, When drawing blood you should always follow universal ______ 70% isopropyl alcohol If none of these veins work, then the phlebotomists use the hand veins. Make the cut across the heelprint lines so that a drop of blood can well up and not run down along the lines. Promptly send the specimens with the requisition to the laboratory. But since each patient's medical condition varies, so does their veins. Phlebitis is inflammation of a vein. Lightly touch the microtainer capillary collectiondevice (or filter paper) to the LARGE drop of blood. D. Both A and B, A sharps container is identified by its bright ____ color Never draw over scars or a new tattoo sites. Allow another large drop of blood to form. 6. 2. followed pre-lab instructions. f.style.height="352px"; Re-anchor the vein. Do not use a previous puncture site. Lines - Drawing from an intravenous line may avoid a difficult venipuncture, but introduces problems. Venipuncture (sometimes referred to as venapuncture, venepuncture or even venu puncture) is the collection of blood from a vein which is usually done for laboratory testing. Journal of Exotic Pet Medicine. Tip: BD Vacutainer tubes use a translucent stopper to identify short draw variants. List six areas to be avoided when performing venipuncture and the reasons for the restrictions. Most reference ranges are based on normal laboratory test values for: Healthy people in a basal state. This image is not<\/b> licensed under the Creative Commons license applied to text content and some other images posted to the wikiHow website. The fifth finger tends to have less soft tissue overlying the bone. When multiple vials of blood are collected it can seem like a large amount. Clinical and Laboratory Standards Institute. Mastering Pediatric Phlebotomy. Center, for Phlebotomy Education, Inc. Include your email address to get a message when this question is answered. Unlike the cephalic and basilic veins, the median cubital vein is not near major nerves or arteries. Avoid the side of the finger where there is less soft tissue, where vessels and nerves are located, and where the bone is closer to the surface. The puncture should be made perpendicular to the ridges of the fingerprint so that the drop of blood does not run down the ridges. Have the patient make a fist and flex the arm, which helps engorge muscles to fill veins. 5. Effects of Exercise: Muscular activity has both transient and longer lasting effects. World Health Organization. This image is not<\/b> licensed under the Creative Commons license applied to text content and some other images posted to the wikiHow website. iframe.style.height = zf_ifrm_ht_nw; 8. If the puncture is parallel to the lines of the fingerprint, theblood will not form as a drop but will run down the finger making collection difficult. Background: Venipuncture is the most common invasive medical procedure performed by health care providers. Start with the arm closest to you and palpate the antecubital fossa. Do not obtain specimens from an arm having a cannula, fistula, or vascular graft. Blood clots, and the serum is separated by centrifugation, Chemistries, Immunology and Serology, Blood Bank (Crossmatch), Serum separator tube (SST) contains a gel at the bottom to separate blood from serum on centrifugation, Plasma Separating Tube (PST) with Lithium heparin, Anticoagulates with lithium heparin; Plasma is separated with PST gel at the bottom of the tube, Hematology (CBC) and Blood Bank (Crossmatch); requires. Wipe away the first drop of blood with a piece of clean, dry cotton. Do not add blood to a circle already filled orpartially filled with blood. Never draw blood through a hematoma. Label the collection tubes at the bedside or drawing area. Re-secure the tourniquet to increase venous filling. Source of specimen. BD Eclipse black-capped) have a smaller diameter and may be more suitable for smaller veins. Extremity is edematous. remove needle How can you decrease the risk of hematoma formation? -18, 20, 22 gauge needles. For the CLSI Updated Phlebotomy Procedures please click here. Step 3: Venipuncture. (b) the power developed by the output shaft. Apply firm pressure for more than 5 minutes. -do not rapidly insert the needle. Clin Biochem. Label collection tubes after identification of the patient.