Post on 15-Apr-2017
List the required information on a requisition form.
Describe correct patient identification and specimen labeling procedures.
Describe patient preparation and the variables that can affect some laboratory tests.
Correctly assemble venipuncture equipment and supplies.
Name and locate the three most frequently used veins for venipuncture, and describe when these sites would be unacceptable.
Correctly apply a tourniquet and state why the tourniquet can be applied for only 1 minute.
List four methods used to locate veins that are not prominent.
Describe the different antiseptics used to cleanse the venipuncture site.
State the steps in a venipuncture procedure, and correctly perform a routine venipuncture using an evacuated tube system.
Demonstrate safe disposal of contaminated needles and supplies.
Deliver specimens to the laboratory in a timely manner.
Name Identification number Accession number Location Health-care provider’s name Test requested Date and time of collection
Patient’s date of birthSpecial collection informationSpecial patient informationNumbers and type of collection tubes
Status of specimen
Introduce yourself◦ Begin communication process◦ Look and listen
Explain purpose of visit◦ Informed consent◦ Patient has the right to refuse–Patient Bill of Rights
Guilty of assault if patient has the perception that blood collector is ignoring his or her refusal
Wake a sleeping patient Greet unconscious patients
THIS IS THE MOST IMPORTANT STEP !
Written protocol ◦ Hospital inpatients◦ Outpatients
Two identifiers
Primary identifier Always compare with the
requisition Must be worn by the
patient◦ Wrist of older children
and adults◦ Ankles of newborns
Do not trust room and bed signs
Primary identifier◦ Have the patient state full name
Secondary identifier◦ Ask additional information
Date of birth Spell name Compare unique data with the requisition form
CLSI requires a caregiver or family member to provide information on patient’s behalf if patient is unable to before drawing specimen
Document the name of the verifier Drug testing might require photo ID
Unidentified patients◦ Tagged with temporary number◦ Tentative name
Commercial blood bank system◦ Place additional stickers from ID band on:
Specimen Requisition form Units of blood
Reassure the patient Explain procedure
◦ Do not explain the purpose of the test! Do not say procedure is painless!
Alert patient to every step of the procedure Remind patient to hold still
Basal state◦ Preferred state
Fasting Activities
◦ Medications A variety of both prescription and over-the-counter
medications can influence lab test results
Site is convenient and supported◦ Place pillow under arm◦ Place fist under elbow◦ Place arm at downward
angle to prevent reflux Safety
◦ Patient is sitting or lying down
◦ Remove objects from patient’s mouth
◦ Be alert for syncope
Place all supplies close to patient◦ Collection equipment◦ Antiseptic pads◦ Gauze◦ Bandage◦ Needle disposal system◦ Examination requisition
form Number and type of tubes Extra tubes in case of loss of vacuum
Locate tourniquet 3 to 4 inches above site Avoid or cover arms with skin conditions Avoid arms on the side of a mastectomy Do not use a tourniquet for lactate test
Maximum time is 1 minute Apply for site selection Release for 2 minutes Reapply Release when blood flows Prolonged tourniquet application
◦ Causes hemoconcentration Increase in the ratio of certain analytes to plasma Biochemical changes take place in the trapped blood
Other causes◦ Excessive squeezing◦ Probing a site◦ Long-term IV therapy◦ Sclerosed or occluded veins◦ Vigorous fist clenching
Increases cellular elements
Vein of choice◦ Large, well
anchored◦ Closer to surface◦ More isolated from
other structures◦ Least painful–fewer
nerve endings
◦ Located on thumb side of arm
◦ Second site of choice◦ Close to the surface
Use lower angle of needle insertion (15°)
Possible blood spurt◦ May be prominent in
larger patients
◦ Located on the underside of the arm
◦ Third choice for venipuncture (H3-A6 recommends using only as a last resort) Least firmly anchored (vein
may “roll”) Near brachial artery and
median nerve Hematoma formation more
likely Consider using a syringe for
more control
Apply tourniquet 3 to 4 inches above venipuncture site
Have patient form a fist◦ Do not pump fist
Causes hemoconcentration Only acceptable for blood donations
◦ Feeling is more important than sight
◦ Probe with index finger, thumb has a pulse
◦ Push, don’t stroke◦ Determine: size, depth,
direction◦ Remember: veins are
spongy, tendons are rigid, arteries have a pulse
Wrists and hands◦ Apply tourniquet to forearm◦ Consider a smaller needle, syringe, winged blood
collection set H3-A6 states to avoid veins from the
underside of the wrist◦ Possibility of puncturing the radial or ulnar nerve
or artery Can cause permanent nerve
damage and inability to open and close the hand
Require physician approval More susceptible to infection and thrombi
Avoid in patients with diabetes, cardiac problems, coagulation disorders
Occluded veins◦ Thrombi◦ Multiple punctures◦ Feel hard◦ Impaired circulation
Hematomas◦ Do not puncture hematoma, noncirculation of blood◦ Draw below hematoma◦ Use other arm
Areas with edema Areas with extensive burns, scars or tattoos
◦ More susceptible to infection◦ Decreased circulation◦ Difficult to palpate
Mastectomies◦ Lymphostasis
Increased lymphocytes Increased waste products
◦ Patient danger Lymphedema Infection
Double Mastectomies◦ Consult physician◦ Possibly perform fingerstick
Never obtain blood from a finger on the side affected by a mastectomy (CLSI H$A6) without physician-written permission
IV Fluids◦ Ideally use other arm◦ Avoid sites of previous IVs for 24–48 hours◦ Note same arm collection on requisition◦ Select site below infusion site, caregiver turns off IV for 2
minutes ◦ Preferably use a different vein◦ Avoid drawing blood at the same time dye for radiological
procedure or blood components are being infused
Fistulas◦Renal dialysis patients ◦Permanent artery-vein connection◦Must avoid this arm ◦Possibility of infection
Cannula◦Temporary (external) AV shunt◦T-tube connector with diaphragm◦Only specially trained personnel can draw from a cannula
Turn off IV for at least 2 minutes◦ Discard first 5 mL blood◦ Collect specimen in a new syringe◦ Coagulation tests, discard 10 mL
Second 5 mL can be used for other tests Document the type of IV fluid and location
on requisition
Apply 70% isopropyl alcohol using a circular motion cleanse from inside to outside
Allow to air dry, 30–60 seconds will give maximum bacteriostatic action
Avoid wiping off with gauze Failure to let alcohol dry
causes a stinging sensation for patient
Specimen hemolysis
Blood cultures or arterial blood gases◦Povidone-iodine◦Tincture of iodine◦Chlorhexidine gluconate
Blood Alcohol Collection◦Do not cleanse site with alcohol◦Soap and water are recommended◦Iodine or benzalkonium chloride (Zephiran
Chloride) may be acceptable
Perform while alcohol is drying Screw the stopper-puncturing end
of needle into the holder Insert first collection tube into the
holder Advance tube only to mark on holder
Reapply tourniquet Confirm puncture site Cleanse gloved palpating finger if
necessary Place holder in dominant hand
Place thumb on top, fingers underneath After insertion, fingers can be braced on
patient’s arm
Place thumb of nondominant hand 1–2 inches below site
Place fingers on back of arm
Do not anchor above and below site with thumb and index finger◦ Possible accidental self-
puncture
Brace the hand holding the holder against the patient’s arm
Gently twist tubes on and off the needle
Mix tubes as they are removed from the holder needle◦ Can be done before next tube is inserted
Remove and mix the last tube before removing the needle from the vein◦ Blood will drip from the needle
Remove the tourniquet if still applied Failure to remove can cause
a hematoma Patient may relax fist Withdraw needle and apply
pressure to gauze at the same time
Capable patients can apply pressure using digital pressure
Arm is raised and outstretched◦ Do not bend the elbow
Collector must apply pressure if necessary
Immediately activate needle safety device
Dispose in a conveniently located sharps container
NEVER BEND, CUT, OR RECAP NEEDLE
Label tube before leaving the patient Less chance of tubes being
mixed up Use a pen Confirm information on
preprinted labels Verify correct labeling with
the patient (CLSI H3-A6)
Patient’s name and ID number Date and time of collection Collector’s initials Additional information
◦ Blood bank identification
Check arm before bandaging H3-A6 states collector must
observe for hematoma formation before applying bandage
Apply hypoallergenic bandage over gauze for extra pressure
Self-adhering material Patient’s instructions
Avoid carrying heavy objects Remove bandage within 1
hour
Pressure must be applied until bleeding stops◦ Patients on anticoagulants/aspirin/herb therapy
Accidental arterial puncture◦ Collector must apply pressure for 5 minutes or until bleeding
has stopped◦ Notify nursing staff and physician
Allergy to adhesive◦ Avoid use in children under 2 years old
Observe any special handling procedures Deliver as soon as possible
◦ No longer than 45 minutes Transport in an upright position
◦ Facilitate clotting◦ Prevent hemolysis
Complete all required paperwork
Separate serum and plasma from the cells within 2 hours of collectiono Hemolysis severely affects potassium valueso Cellular metabolism decreases glucose levels
Coagulation specimens for a PTT can remain at RT for 4 hours; if patient is on unfractionated heparin, the plasma must be removed from the cells within 1 hour, test within 4
PT are stable for 24 hours at RT Blood smears from EDTA tubes should be
made within 1 hour of collection. Specimen can be refrigerated for up to 4
hours