Nursing Personnel. Make sure you have one in your venipuncture equipment. 1. The ideal sites for venipuncture are typically in the cubital fossa of the forearm, which has the shape of an isosceles triangle with the biceps forming the base, and the lateral and medial groups of the antebrachial muscles forming the sides respectively 26).. CLSI document H3-A6. It all depends on your preparation and equipment. In the end, they can only lead to injuries. If you are drawing blood from an arm, make sure to sit near the patient, as close as possible. Anxious patients could faint, so they must be sitting or lying in a safe position when the sample is taken. While doing all of this, make sure to penetrate the skin with one quick move. In order to prevent hematoma, you should only puncture the uppermost wall. Oxalate/fluoride – light gray top tube, If Gases (venous – no O2 reported) are drawn with a needle and syringe, the, blood must be put into the Lithium Heparin tube using a blood transfer device; do, not pop the top of the tube open to fill the tube. Positioning of the Tourniquet . Like most medical procedures, phlebotomy can be really easy or really hard. Make sure to find a vein that is properly hydrated. Continuous interaction can help distract a person during this time. It is the best thing for patients with low blood pressure. The venipuncture procedure is complex and requires both knowledge and skill. Reassure the patient. You need to have a firm, strong grip on patient’s hand. The band/tourniquet retains blood within the arm and makes the veins more visible. 12. If a person is overweight, it might be harder for a professional to find the vein. In order to prevent it, professional will have to avoid phlebotomy from a hematoma and to avoid drawing plunger forcefully. If using a needle, and syringe, avoid drawing the plunger back too forcefully. Dismiss patient Apply online Phlebotomy Certificate from CDPH. E. Grasp patient’s arm firmly. Medical professional also has to be a salesman of the sort. Proper patient positioning depends on the type and length of procedure, anesthesia access to the patient, devices required and other factors. Do not attempt a venipuncture more than twice. When drawing a blood specimen, the trained phlebotomist must: 1).  Edematous extremities – tissue fluid accumulation can alter test results. Prepare the accession order. Invert a BP cuff so that the blood can go to the lower regions of the limb. B. If you are drawing blood from an arm, make sure to sit near the patient, as close as possible. If the patient is seated, place the … You need to keep their attention and make sure they do not notice the needle. 10. 8. Also, it is the basis of diagnostics. It is also possible to apply multiple tourniquets. This means chairs without arm rests are not acceptable for venipuncture; nor are exam tables and patient beds unless the patient is recumbent. Ask the patient to continue holding the gauze over the wound. However, you will need a doctor’s permission for this. 4 Apply a tourniquet on the arm 3 – 4 inches above the site to be examined. Adapted from Phlebotomy for Nurses and. This helps you build trust with a patient even further. On top of that, there are a lot of individuals who fear (or dislike) going to a doctor. 6). In fact, based on this, the entire procedure can be harder or easier. SST red or gold top – this tube contains a gel separator and clot, 9. It needs to remain loose. Position the patient that make him or her comfortable 9. phlebotomy - phlebotomy test ch 1-11. a nurse just came out of a patient's rm stating that the patient threw his arm up when she was performing a venipuncture and that the needle jabbed her as it … The concerns related to venipuncture of veins in a patient's hands or wrists also have application for veins in the patient's ankles or feet.  Preventing dizziness or fainting and potential follow-up injuries due to a, fall: Be sure patient is seated in an appropriate draw chair and or lying in. If you haven’t rested properly, this can affect your ability to perform venipuncture and can lead to critical mistakes which you, as a professional, cannot afford. An elastic band/ tourniquet is tied around the arm/ site. When you encounter such a case, make sure to use blood pressure cuff or try one of the other tricks we shared in our guidelines. As first-line ambassadors of the laboratory, the manner in which a phlebotomist greets a patient can often set the tone for the remainder of the procedure. The venipuncture should be repeated in a, different site. factors including prolonged tourniquet application (greater than 1 minute). 4. A hematoma can cause a post-phlebotomy compression injury,  Preventing Hemolysis: Mix tubes gently, by inversion, 5-10 times – do not, shake them. Do not place, tightly or leave on for more than 1 minute.  Apply adequate pressure to the puncture site to stop the bleeding and, avoid formation of a hematoma. Instruct the patient to make a, fist and hold it; do not have them pump their hand. 4). Think of an anecdote or a story you would like to share. If you are a bit stiffer while rubbing the alcohol, it will prepare the hand for the procedure. Although this is something you might’ve seen a lot in the movies, you should always avoid it. Phlebotomy - Venipuncture Phlebotomy, what does it mean? You are able to confuse the nerves before the insertion. Safely positioning the patient is a team effort. Hyperextend the patient's arm. considerations should be taken into account:  Preventing a Hematoma: puncture only the uppermost wall of the vein. Blood pressure cuff is a great method of extracting blood in case that the veins are not visible enough. Assemble necessary supplies and don gloves. If you are using a tourniquet for, preliminary vein selection, it should be released after one minute, left off for two. If there is not an alternate vein to draw. “Pediatric Pointers.” Center for Phlebotomy Education, Inc. Ernst, Dennis J. and Catherine Ernst. In the end, if other medical experts managed to draw blood from a particular vein, you can do the exact same thing. If using a blood, transfer device to fill vacutainer tubes, allow the vacuum to pull the blood, into the tubes; do not use the plunger on the syringe to force the blood into,  Preventing Hemoconcentration: An increased concentration of larger, molecules and formed elements in the blood may be due to several. Do not attempt a venipuncture more than twice. If the blood is flowing, slowly, gently adjust the angle to see if the needle is sitting up against the, wall of the vein. The ideal sites for venipuncture are typically in the cubital fossa of the forearm, which has the shape of an isosceles triangle with the biceps forming the base, and the lateral and medial groups of the antebrachial muscles forming the sides respectively 26).. Venepuncture is a routine invasive procedure that involves puncturing a vein with a needle to gain venous access, either for phlebotomy (the collection of blood) or the provision of intravenous therapy. You can try several approaches mentioned earlier in our venipuncture guidelines that will increase the vein. A lot of patients have the needle phobia. Instead of forcefully tapping the vein, it is much better if you start stroking them. Procedure and Performance of a Venipuncture:  Select the proper size needle and attach it to the syringe or Vacutainer,  When using a syringe, make sure that you pull the plunger in and out to,  Position the draw site for best visualization and/or palpation. Both the hands and the feet have increased ... Anchor the vein and position the needle appropriately. Re-confirm the patients identification; Decontaminate your hands and position the patient’s arm underneath a pillow with the inco pad; Apply the tourniquet, select a suitable vein, remove the tourniquet and carry on with the procedure Positioning bariatric patients properly for venipuncture procedures is critical for the patient’s comfort as well as the ability to locate veins. Prepare the accession order. Hopefully, these 50 tips will help you establish what is ok and what is not. Impaired venous return to the heart, and ventilation-to-perfusion mismatching are common complications. Besides that, there are some additional considerations. 2. 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. opposite arm, then blood should be drawn from BELOW (distal to) the IV. The procedure itself is known as a venipuncture. Position the patient with the arm extended to form a straight-line form shoulder to wrist. This was evident for both the platelet count and MPV that were significantly biased when patients changed position from standing to the supine position . Examine the patient for the drawing of blood or let the patient decide. In fact, most of the procedures cannot be performed if you don’t have a clear head on your shoulders. Ask the patient to clench his or her fist. Avoid drawing blood from a hematoma. This one goes without saying but is still something that needs to be emphasized. As we mentioned, it is your duty as a medical professional to ensure the patient that everything will be ok. Position the patient with the arm extended to form a straight-line form shoulder to wrist. Specifically, patient positioning goals include: Provide patient comfort and safety. Usually, it happens due to squeezing or massaging around the site or due to prolonged application of the tourniquet. a bed. Afterward, make sure to store them properly. Examine the veins in the area by palpating them with your finger. Manage the tubes and label it in view of the patient 12. A. Procedure of Venipuncture The patient can be made to sit in a chair, or sitting or lying on a bed. Solid line – bias. In the case of children or uncooperative individuals, restraints are an option but they should be avoided at all costs. In certain cases, the patient may move a bit which may result in you sticking the needle in your own finger. Before you start injecting needles into people, make sure to get a proper training and get used to the entire process. Always try to draw blood from veins that are lowest. Check to make sure the tourniquet is snug but not tight. Some patients have hypovolemia or reduced volume of circulating blood. The patient's posture prior to and during blood collection can affect some laboratory test values. Positioning the patient. Besides proper knowledge, you will also have to have a good head on your shoulders and to make sure you follow these venipuncture guidelines closely. Greet the patient and introduce yourself. No matter how a patient looks like, it is necessary for a medical professional to protect himself. Venipuncture or drawing blood is one of the most common procedures performed in any medical center. venipuncture site by palpating with the gloved index finger. Respiratory. Although this is a benign, temporary effect, it can be quite misleading and can lead to the bad diagnosis. movement) with the needle should be avoided. Loosen the tourniquet, as it may be obstructing blood, flow. You need full access to the arm so you will have to sit in front of the patient, a bit to his side. Wash hands and put on gloves. Avoid excessive probing. Next step is explaining the procedure. Nitroglycerine is yet another substance that can help you out during phlebotomy. 5). Gloves are a must. Scar tissue can especially be problematic as it is hard to penetrate. When drawing a blood specimen, the trained phlebotomist must: 1). This represents the massive concentration of certain molecules in the blood. Definition. This can pose a real problem as their veins collapse quicker. You need to overcome those fears by exuberating confidence and persuading a person that everything will be alright. 4. This can be a real time saver and it is also the best way of finding the right insertion point. Make sure that no one gets directly exposed to blood. It will easily increase the smaller veins. Additional equipment such as goggles and splash shields should also be worn in extreme situations. In the case of a difficult venipuncture, an, individual may make a maximum of two attempts before having, someone else try. Always start by thinking that a patient is infectious and that he can spread a disease. Identify the patient using two patient identifiers as mandated by JCAHO. retract from the vein and the safety device will cover the needle. The tourniquet should be applied between the IV site and the venipuncture. Sometimes, you may see a tendon thinking that it is a vein. As a result, this will lead to the release of histamine increasing the vein. Tubes with additives or clot, activators must be thoroughly mixed by gentle inversion, 5-10 times.