Requisitions
• ER- telephone
• pick up at desk
• ID-ID# might need written on requisition
Greeting the pt.
• Asleep- wake up
• Unconscious- talk to them
• Psychiatric- get RN to help
• Visitors- ask to step out or stay pt. choice
• MD/clergy- wait unless STAT or timed test
• Not in room- check nsg. station
• document
ID
• NO ID-check ankle-not ok if on bed
• NO ID- RN must band
• Nsg. home/pysch might not have, RN to ID
• Unidentified- follow policy
Pt prep
Preanalytical variables
• Basal state- when resting, no activity
• best in AM
• Fasting- nothing to eat/drink x 8-10 hours
Diet
• Fasting ??
• Lipemic- blood milky/cloudy
• high fat diet
• Alcohol, caffeine
• No chewing gum, candy while blood draw= choking
Posture
• Should sit/lay
• If pass out- standing they could fall
• Change in position can affect tests
Other issues
• Stress• Scared-increase
hormones level• Crying child- may
increase levels
• Smoking
• May increase or decrease blood tests
Other issues
• Diurnal:
• Blood levels vary according to time of day
• Medications:
• May affect metabolism
• Meds affect many tests- MD responsibility
• Herbs- affect bleeding• Document meds
Complications of the pt.
• Apprehensive – need help to hold
• Syncope- fainting
• remove needle, pressure, lower to ground
• apply cold compress
• when awake make them stay
• Seizures: take out needle, pressure, help
Complications of the pt.Con’t
• Petichiae- indicates bleeding problem
• hold site longer ( 5 minutes)
• Pt refusal- their right,
• notify MD
• document
Venapuncture
• Equipment:
• Take extra tubes• Check needle
• Tourniquet Application:
• Skin condition: watch for tears
• Don’t leave on more than 1 minute
• Hemolysis- excessive squeezing, long-term IV, sclerosed or occluded veins
Site Selection
• Can’t find veins: palpate• tap veins• massaging• hang down arm• apply heat• use wrist and hand • do not use veins in feet/legs•
Areas to be avoided
• Contain thrombi• Feel hard -sclerosis • Poor circulation• Hematoma• Edema• Burns• Scarred• Mastectomy• IV site-below site
Cannulas and fistulas
Fistula
• Fuse a vein & artery together
Cannula
• special tube in chest
• connects vein and artery to draw blood
Cleaning the site
• Alcohol- routine
• Betadine- sterile
• Soap and water- alcohol tests
Examination of equipment
• Check syringe –does plunger work?
• Needle straight?
• Everything sterile?
Performing venapuncture
• Syringe:• Advantage: blood enters
hub-easy to tell if in vein• Better control of suction• Disadvantage: collapse
vein, needle sticks• Make sure you use small
syringe on small veins
• Winged set (Butterfly)• Use for difficult sticks,
small, fragile veins• Advantage: better control• Lower angle- 10-15
degrees• Collect with vacuatainers• Disadvantage: increase
sticks
Syringe Butterfly
Central Venous Access
• Specific guidelines
• Special training-sterile technique• 4 types: nontunneled- temporary, subclavin
– tunneled-permanent, broviac, hickman– implanted- under skin, port– PICC ( Peripheral lines)- peripheral
Broviac
Causes of failure to obtain blood
1. Resting against wall of vein- rotate needle, pull back, advance some
2. Go through the vein- angle too much
3. Needle rests on top of vein- angle too shallow
4. Vein rolls- vein not anchored
5. Vein collapses- vacutainer too big, to much pressure
2 ATTEMPTS ONLY AFTER THAT REQUEST ANOTHER PHLEBOTOMIST TO DO !!!
Incorrect needle placement
Causes of hemolyzed specimens
• Using a needle with gauge < 23• Using small needle with large tube• Needle not attached to syringe- cause frothing• Pull plunger back too fast• Draw from hematoma* Vigorously mixing tubes*Forcing blood into tube• Failing to allow blood to run down tube• Collect blood from IV lines• Applying tourniquet too close to site
Causes of hematomas
• Failure to take off tourniquet prior to needle removal• Inadequate pressure to site• Bending arm while applying pressure• Excessive probing• Failure to insert needle far enough in vein• Going through the vein• Elderly- decrease vein elasticity• To Treat: remove tourniquet and needle, apply pressure
and ? Ice• Find new site
Label tubes and bandaging arm
• If no preprinted label make one.
• Bandaging:
• anticoagulant meds- hold site x 5 minutes
• If arterial stick- hold x 10 minutes
• Allergies to adhesive: use gauze
• Hairy arms- no bandage
• Children < 2 no bandage
Leaving pt.
• Position as found
• Rails as ordered
• If they need bathroom, drink get RN
Reasons for rejection of specimen
• Unlabeled/mislabeled• QNS• Wrong tube• Hemolysis• Lipemia• Clot in coag tube• No requisition• Contaminated specimen container
Top Related