Module 1: Phlebotomy Equipment Methodologies and Regulations in Specimen Collection and Management.
Basic Principles of Phlebotomy Part IV: The Patient, Collection Site and Problems with Collection...
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Transcript of Basic Principles of Phlebotomy Part IV: The Patient, Collection Site and Problems with Collection...
Basic Principles of Phlebotomy Part IV:
The Patient, Collection Site and Problems with Collection Sites
CLS 424 Phlebotomy
Student Lab Rotation
2
The Patient:
• Approach• Communication• Empathy• Handling special situations• Patient identification
– Arm band– Legal document
• Prepare patient for blood draw– Latex allergy?
3
Selecting the Site:
• Antecubital area most often accessed
• Hand or wrist• Remember: 2 arms• Use tip of index finger
on non-dominant hand to palpate area to feel for the vein
4
5
Collection Site Problems:• Veins that lack
resiliency
• Extensive
scarring
• Hematomas
• Edematous
area
• Side of mastectomy
6
Collection Site Problems:
• Intravenous line– NEVER draw above
an IV
– Draw from other arm
– Draw from hand
on other arm
– Draw below the IV
7
Draw Below IV site:
8
Collection Site Problems:
• Indwelling lines:– Hickman catheters– Heparin locks
• Used to administer medication
• Only nurse may access these lines
• Can obtain blood: called a ‘line draw’
• Must clear line of heparin contamination by discarding first 5-10 cc of blood
9
Hickman Catheter:
10
Inserting the Needle:
• Anchor the vein– Grasp arm with your
non-dominant hand– Use thumb to pull skin
taut
• Smoothly and confidently insert the needle bevel up– 15-30 degree angle
11
12
No Needle Movement!
• You must anchor the blood-drawing equipment on the patient’s arm to minimize chance of injury
13
14
Fill Tubes:• Use correct order of draw:
– Blood cultures– Red top– Blue (baby blue)– Green– Purple– Grey
15
Be careful not to:
• Push needle further into vein when engaging evacuated tube
• Pull needle out of vein when disengaging tube
• Pull needle out of vein as you pull back on the plunger
• Pull up or press down when needle in vein
• Forget to mix additive tubes 8-10 times
16
Withdraw Needle:
• First release tourniquet
• Disengage tube
• Place cotton directly over needle, without pressing down
• Withdraw needle in swift, smooth motion
• Immediately apply pressure to wound
• Do not bend arm
17
Label Tubes Immediately:
• In sight of patient
• Patient name• Identification
number• Date of draw• Time of draw
(military time)• Your initials
18
Recheck Draw Site:
19
Failure to Obtain Blood:
• Check tube position and vacuum– Always have back up tubes near by
• Needle position
• Collapsed vein
20
Needle Position:
21
You should try again
• Look at alternate site– Other arm– Hand
• Use clean needle• Use fresh syringe if
contaminated
• Only try twice
22
Poor Collection Techniques:• Venous stasis
– Prolonged application of tourniquet (>1 min)
• Hemodilution– Drawing above IV– Short draw (blood to anticoagulant ratio)
• Hemolysis– Traumatic stick– Too vigorous mixing– Alcohol still wet– Using too small of needle– Forcing blood into syringe
23
Poor Collection Techniques:• Clotted sample
– Inadequate mixing– Traumatic stick
• Partially filled tubes– Short draw– Sodium citrate tube draw volume critical
• Using wrong anticoagulant
24
Poor Collection Techniques:• Specimen contamination
– Using incorrect cleanser– Alcohol still wet– Powder from gloves– Drawing above IV
• Specimen handling– Exposure to light– Pre-chilled tube– Body temperature