basic principles of phlebotomy part iv: the patient, collection site and problems with collection...
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![Page 1: Basic Principles of Phlebotomy Part IV: The Patient, Collection Site and Problems with Collection Sites CLS 424 Phlebotomy Student Lab Rotation](https://reader035.vdocument.in/reader035/viewer/2022062722/56649f355503460f94c53b0c/html5/thumbnails/1.jpg)
Basic Principles of Phlebotomy Part IV:
The Patient, Collection Site and Problems with Collection Sites
CLS 424 Phlebotomy
Student Lab Rotation
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The Patient:
• Approach• Communication• Empathy• Handling special situations• Patient identification
– Arm band– Legal document
• Prepare patient for blood draw– Latex allergy?
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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
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Collection Site Problems:• Veins that lack
resiliency
• Extensive
scarring
• Hematomas
• Edematous
area
• Side of mastectomy
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Collection Site Problems:
• Intravenous line– NEVER draw above
an IV
– Draw from other arm
– Draw from hand
on other arm
– Draw below the IV
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Draw Below IV site:
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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
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Hickman Catheter:
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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
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No Needle Movement!
• You must anchor the blood-drawing equipment on the patient’s arm to minimize chance of injury
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Fill Tubes:• Use correct order of draw:
– Blood cultures– Red top– Blue (baby blue)– Green– Purple– Grey
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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
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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
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Label Tubes Immediately:
• In sight of patient
• Patient name• Identification
number• Date of draw• Time of draw
(military time)• Your initials
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Recheck Draw Site:
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Failure to Obtain Blood:
• Check tube position and vacuum– Always have back up tubes near by
• Needle position
• Collapsed vein
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Needle Position:
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You should try again
• Look at alternate site– Other arm– Hand
• Use clean needle• Use fresh syringe if
contaminated
• Only try twice
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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
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Poor Collection Techniques:• Clotted sample
– Inadequate mixing– Traumatic stick
• Partially filled tubes– Short draw– Sodium citrate tube draw volume critical
• Using wrong anticoagulant
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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