peripheral venipuncture for upper limbs procedure

Peripheral Venipuncture

for

Upper Limbs Procedure

PARTICIPANT Worksheet

Name:___________________________

VERSION 1.1

May 2020 2 Version 1.1

Table of Contents

Description

Page

Introduction Course Objectives Course Content Curriculum & Delivery Delivery Strategies and Method Assessment requirements References

3-5

Module Overview

6

Module1: Standard Precaution

7-10

Module 2: Basic Anatomy of Upper Extremity Veins

8-12

Module 3: Types of Venipuncture Equipment

13-17

Module 4: Issues Related to Venipuncture for Upper Limbs

18-21

Module 5: Veins Consideration for Upper Limbs of Venipuncture

22-24

Module 6: Select correct items for Venipuncture Procedure

25-27

Module 7: Demonstrate correct Venipuncture for Upper Limbs

28-31

Annex1: Peripheral Venipuncture for Upper Limbs Skills Guide

32

Annex 2: Tying a disposable tourniquet

33

Annex 3: BD Tube Guide of Draw

34

Annex 4: Quest Lab: tube Guide

35-36

Annex 5: Clinical Log Sample

37


Introduction

This program equips the participants with basic knowledge on peripheral venepuncture

for the upper limbs and provide practical skill training and assessment on the manikin

Course Objectives

Peripheral Venipuncture for the Upper Limbs

1. Demonstrate understanding of Venipuncture for the upper limbs

2. Perform Venipuncture

Course Content

I. Underpinning Knowledge: (HMI Institute)

Participants are expected to verbalize

1. Standard Precautions

2. Basic Anatomy of the Upper Extremity veins used in venipuncture

3. Types of venipuncture equipment /safety

4. Issues related to venipuncture, such as

• Accountability

• Order of Draw

• Interaction with Clients/patients

5. Considerations for choice of vein

• Appropriate Site

• Accessibility

• Medical Precaution of client/patient

• Problems from Venipuncture, e.g. Phlebitis

II. Performance Skills Criteria: (HMI Institute)

Participants are expected to:

1. Select correct items for Venipuncture

2. Demonstrate correct Venipuncture procedure for Upper Limbs

A Certificate of Attendance will be awarded upon successful completion of the program

III. On the Job Training (OJT): (By Industry)

• Participants are advised to complete the Venipuncture Clinical Practice that will be supervised by their industry mentor.

• The Industry will dictate the minimal clinical attempts requirement.


Curriculum and Delivery

The modules will be delivered in the classroom and as self-directed activities.

The following is a breakdown of the teaching for this course:

Online Learning +

activities Classroom with activities

+ practical session Written Assessment Skill Assessment

on Manikin Total hours

8 5 1 2 16

Delivery Strategies and Methods

Delivery of this module is blended. Participant is expected to complete online learning

and worksheet activities via the Learning Management System (LMS) before class.

Assessment Requirements

• Written Test (Closed-book)

• Skill Assessment on Manikin **

** For details refer to Skill Guide (Page 32)


References

• ACAreer (2017). New CLSI Venipuncture Guidelines. American Certification Agency for

Healthcare Professionals. Volume 22, Issue 2. Summer/Fall 2017.

https://acacert.com/files/ACAreerSummer_Fall2017.pdf

• Basic Phlebotomy (2018). https://player.slideplayer.com/20/5946175/#

• Becton, Dickinson and Company (2014). BD Diagnostics, Preanalytical Systems.

www.bd.com

http://sibere.co/blood-collection-tubes-guide.html

• Helen Maxwell (2010) CLSI : Updated Phlebotomy Procedure (2010)

https://phlebotomycoach.com/downloads/clsi-guidelines-blood-drawing.pdf

• ICAS (2018) INFECTION CONTROL GUIDELINE for Intermediate Long Term Care Sector. 2nd

Edition

http://icas.org.sg/guidelines/ILTC%20IC%20guidelines%202nd%20ed%202014%20Final%20-

%20Web.pdf

• MOH (2017). The National Infection Prevention and Control Guidelines for Acute

Healthcare Facilities.

• MOH (2018). The National Infection Prevention and Control Guidelines for Long Term Care

Facilities.

• Quest Laboratories Pte Ltd [SG] (2017).Order of Draw

https://www.questlabs.com.sg/order-of-draw/

• Sarah M. Billings-Berg (2016). Phlebotomy basics. Nursing made Incredibly Easy. Wolters

Kluwer Health Ic. https://www.nursingcenter.com/cearticle?an=00152258-201607000-

00008&Journal_ID=417221&Issue_ID=3564188

• Stassi, M.E., (2005). Basic Nurse Assisting. USA : ELSevier Saunders

http://www.rd411.com/index.php?option=com_content&view=article&id=241:measuring-

weight-and-height&catid=113:clinical-inservices&Itemid=381

• Terry Kotrla, ASCP (2016).Vacuum Blood Collection: Revised by Lois Wagoner (ASCP).

https://slideplayer.com/slide/9484119/

• World Health Organization (2010). HO Guidelines on Drawing Blood: Best Practices in

Phlebotomy. Geneva:. 2, Best practices in phlebotomy. Available from:

https://www.ncbi.nlm.nih.gov/books/NBK138665/

https://acacert.com/files/ACAreerSummer_Fall2017.pdf

http://sibere.co/blood-collection-tubes-guide.html

https://phlebotomycoach.com/downloads/clsi-guidelines-blood-drawing.pdf

http://icas.org.sg/guidelines/ILTC%20IC%20guidelines%202nd%20ed%202014%20Final%20-%20Web.pdf

http://icas.org.sg/guidelines/ILTC%20IC%20guidelines%202nd%20ed%202014%20Final%20-%20Web.pdf

https://www.questlabs.com.sg/order-of-draw/

https://www.nursingcenter.com/cearticle?an=00152258-201607000-00008&Journal_ID=417221&Issue_ID=3564188

https://www.nursingcenter.com/cearticle?an=00152258-201607000-00008&Journal_ID=417221&Issue_ID=3564188

http://www.rd411.com/index.php?option=com_content&view=article&id=241:measuring-weight-and-height&catid=113:clinical-inservices&Itemid=381

http://www.rd411.com/index.php?option=com_content&view=article&id=241:measuring-weight-and-height&catid=113:clinical-inservices&Itemid=381

https://slideplayer.com/slide/9484119/

https://www.ncbi.nlm.nih.gov/books/NBK138665/


Modules Overview There are 5 modules on the Venipuncture essential knowledge.

1) Standard Precaution, 2) Basic Anatomy of the Upper Limbs, 3) Types of Venipuncture Equipment, 4) Issues related to Venipuncture 5) Vein consideration for Venipuncture.

There will be 2 modules on Skills Performance

1)Select Basic items for Venipuncture 2)Demonstrate the correct steps for blood collection.

Upon successful completion of classroom learning, participants will hone their Venipuncture skills at their respective industries. The industry qualified mentors will oversee participants’ on-the-job practices until they are competent. The minimal clinical attempts stipulated is in accordance to with industry requirement and trainers’ recommendation during classroom assessment. Practice makes perfect! But bear in mind safety is important.

Note to Participants

There are a number of exercises provided to reinforce your learning. Fill in your answers in the blank spaces. It will help to facilitate learning. Do enjoy and have fun.

7 May 2021 Version 1.1

MODULE 1: STANDARD PRECAUTION

In this module, the objective is to be familiar about standard precaution.

Instructions Fill in the blanks in the given slides and answer the questions. You may find the answers in the online platform

1) _____________________

2) _____________________

SLIDE 1


HAND HYGIENE Steps

1. Wet Hands with water 7. _____________________

2. Apply Soap 8. _____________________

3. ______________________ 9. _____________________

4. _______________________ 10. Rinse with water

5. _______________________ 11. Dry your hands thoroughly

6._________________________ 12. Hands are now clean

3.

4.

8.

9. 11

.

6.

7.

5.

12

.

SLIDE 2

1

. 2

.

10

1.


Observe 5 MOMENTS of Hand Hygiene

1. BEFORE __________________

2. BEFORE clean or Aseptic Procedure

3. AFTER body fluid exposure Risk

4. AFTER __________________

5. AFTER __________________

SLIDE 3


GLOVES

1. Change gloves after ______________ contact with client

2. Do NOT soil clean area with _____________________ gloves.

3. Once task is completed, ____________________________ remove gloves.

4. __________ gloves before handling, telephones, equipment or doorknobs

5. Avoid ________ _________that may affect gloves’ integrity.

SLIDE 5

SLIDE 4


MODULE 2: BASIC ANATOMY OF UPPER EXTREMITY VEINS

For module 2, the basic anatomy of the upper arm focuses on veins in the antecubital fossa region and the selection choices of preferred veins to perform venipuncture.

Name the veins in the Cubital fossa, according to the Selection Choice of 3 Preferred Veins in the slide 6.

1. _________________

2. ____________

3. _________________

33

1 33 3

.

SLIDE 6

2.

1.


MODULE 2 : QUIZ – from Online Learning BASIC ANATOMY OF THE UPPER LIMBS

ANSWER

ANSWER

ACTIVITY

Instructions Choose ONE answer for the questions below. You may find the answers from the online learning.


MODULE 3: TYPES OF VENIPUNCTURE EQUIPMENT

In module 3, the basic types of equipment used for Venipuncture will be examined.

LABELS CRITICAL STEP The labeling on tube and specimen form in Client’s presence are;

1. 2 Identifiers –______________and _______________ or ___________ 2. Blood Collection ___________ and ____________ 3. Phlebotomist’s initial.

SLIDE 7


NEEDLES

1. A needle should never be ___________.

Once the needle shield is broken, never use it. It should not be recap,

cut, bend or even break it.

2. After venipuncture, needle should be drop immediately into

________________ __________________.

3. The size of needle ____________should match the size of the vein.

4. The recommended angle of needle insertion is _____ to _____ degree.

5. The sharp container should be ______________ resistant and have

_____________________ marking.

SLIDE 8


BLOOD TUBES

1. The Vacutainer Blood tubes contain ___________.

2. All Blood tubes have an ___________ date.

TOURNIQUETS

1. The tourniquet should be place ___-____cm or ____- ____ fingers

________ puncture site.

2. Tourniquets should be left on the arm LESS than ___ minutes.

3. To prevent hemolysis, avoid rigorous ____ clenching, ________ pumping

or ___________ at puncture site.

4. Place Tourniquet ___________ client’s sleeve or making it obviously

__________, will minimize the chance of it left forgotten on the arm.

5. The 2 tail-ends of a disposable tourniquet when tied to the arm should

be_________ from the puncture site.

1.

.

SLIDE 9


ALCOHOL SWABS 1. The preferred agent for cleaning the puncture site is Isopropyl alcohol ________.

2. The advantages of an alcohol agent are i) leave no residue, ii) _______ fast, iii) not irritating, or iv) dry the skin and v) importantly does not _______________ the site.

PROTECTIVE SHEET & BIOHAZARD BAG

1. The protective sheet secures a___________ area, absorbs potential________ spillage and protect working ____________.

2. The ___________ bag is used to dispatch blood specimen together with the test request form.

3. When specimen is properly sealed, it will prevent ___________ or missing tube.

SLIDE 10


MODULE 3 : QUIZ – from Online Learning TYPES OF VENIPUNCTURE EQUIPMENT

ANSWER

ANSWER

ACTIVITY



MODULE 4: ISSUES RELATED TO VENIPUNCTURE FOR UPPER LIMBS

Issues such as phlebotomist’s accountability, color blood tubes & order of draw and interaction with client is considered in Module 4.

ACCOUNTABILITY

1. The phlebotomist is accountable to write ____________ and __________ on the

specimen label.

2. Phlebotomist is expected to practice ____________ ______________.

3. A certified staff is allowed the maximum of ____ attempts to perform venipuncture

for __________ client.

4. In the event of a failed _____ attempt, another trained personnel assume

the responsibility.

SLIDE 11


COLOR BLOOD TUBES & ORDER OF DRAW

1. The Adult Light Blue Full blood fill amount is ____ ml, whereas pediatric tube fill is 1.8ml.

2. Inversion time for Light Blue tube is _____ times compared to purple EDTA tube of ______

times.

3. The Red and Yellow tube have to been inverted for _____ time.

4. The grey tube for Lactic Acid test has to be transported in _____ _______.

5. Each Blood tube must be _______________ but gently inverted according to Tube Guide

Chart.

6. The Purple tube is filled (before/after) the Light Blue Tube according to the order of draw.

7. The Yellow tube is filled (before/after) the Grey Tube according to the order of draw.

8. The next tube to filled after the Blood Culture bottles is the ______________ tube.

9. The green tube is filled (before/after) the purple EDTA tube.

10. According to Tube Guide Chart, the order of draw after blood culture is ___________ tube,

red tube, __________ tube, __________ tube and grey fluoride tube.

SLIDE 12


*Use the Tube Guide Chart above to fill in the blanks.

INTERACTION WITH CLIENT

1. Approach and _______________ the correct client for venipuncture with 2 identifiers.

2. The 2 identifiers could be either ____________, Identity number, DOB or _____________.

3. It is important to obtain a verbal _______________ before performing venepuncture.

4. Check if client is allergic to latex. If there is allergy, use gloves that are made of

_______________ _ material.

5. It is helpful, to enquire about client experience on blood drawn, such as dizziness,

Chest pain, nausea or ________________.

6. If Client had problem with venipuncture asked about ____________, bruises or prolong

bleeding time.

7. If client tends to faint during blood collection before, allow client to _________ down

or be in a _________________ position to prevent injury.

SLIDE 13


MODULE 4 : QUIZ – from Online Learning ISSUES RELATED TO VENIPUNCTURE

ANSWER

ANSWER

ANSWER

ACTIVITY



MODULE 5: VEINS CONSIDERATION FOR UPPER LIMBS VENIPUNCTURE

The appropriate site, unsuitable veins, some client medical condition, complications from venipuncture are discussed in this module.

APPROPRIATE SITES

1. The preferred 1st Choice vein for venipuncture is ____________ _______________ vein.

It is in the _____________________ of antecubital fossa, it usually does not __________.

In obese patient the median cubital vein is not easily seen but _________________.

2. The Cephalic vein is the _______ choice, as it is a _____________ vein and located

on the lateral aspect of the arm.

3. The 3rd choice for venipuncture is the ________________ vein as it is very close to the

brachial ARTERY. It is located at the ______________ aspect of the antecubital area.

SLIDE 14


UNSUITABLE VEIN CONDITIONS

1. The unsuitable vein conditions that phlebotomist need to be alerted are sclerosis,

tortuous veins, thrombotic veins, ___________________ veins that are usually found on the

elderly. They are thin, dark, close to the surface and _________________ easily.

2. __________________ means the vein is red, inflamed and tender to touch.

3. If venipuncture is performed on those unsuitable veins, it maybe difficulty

to _______________ and impossible to puncture. Client may feel ____________.

The veins might be ____________ and blood supply to the area will be____________ as well.

MEDICAL CONDITIONS TO AVOID

1. The definite NO! NO! to blood draw in medical conditions are Dialysis _______________,

Surgically created and consist of venous and arterial blood, _________________ with poor

blood circulation, _____________ and skin with impaired integrity.

2. Skin Impaired integrity refers to _______________________, cellulitis, laceration, abrasion Or a ____________ at the site.

3. An arm with intravenous fluid should not have blood taken above or ______________

the IV line as blood component will be _____________with the transfusing solution.

4. Some potential problems could arise from Venipuncture it may be Phlebitis,

Thrombophlebitis, Tissue necrosis refers to the ______________ of tissue cells.

5. Phlebotomist need to take extra care to prevent an artery or nerve being

___________________ or ____________________.


MODULE 5 : QUIZ – from Online Learning VEINS CONSIDERATION FOR VENIPUNCTURE

ANSWER

ANSWER


ACTIVITY


MODULE 6: SELECT CORRECT ITEMS FOR VENIPUNCTURE PROCEDURE

The selection of appropriate items for venipuncture ease the process of blood collection.

IMPORTANT PRINCIPLES

1. The order forms must tally with the client’s ________________.

2. The Upper Limbs sites to avoid for no draw are ______________________, mastectomy side,

facture, intravenous fluid line and impaired skin Integrity such as inflammation,

____________________, laceration, abrasion and ________________ at the site.

3. The recommended angle of needle insertion is ______ to _______ degree.

4. It is advisable not to ______________ the vein when needle is inserted.

5. The needle bevel has to face_ ________ at the point when needle is to be inserted.

6. The commonly used upper limbs veins are _______________ vein, ______________vein

and the ______________ vein.

7. When tourniquet is tied on the upper limb the duration should be less than

_______ minute.

8. Gloves are to be changed upon ________ contact with a different client for venipuncture.

SLIDE 15


Basic items for Venipuncture No. Column A: Items Match Column B: Description

1. PPE/

Fitting Gloves

A For disposal of needles and sharp objects

2. Client’s Label B Apply pressure with it to cease bleeding

3. Specimen Form C It is use to disinfect puncture site.

4. Disposal Dish/ Tray

D For Standard Precaution

5. Protective Sheet E This is use with vacuum tubes and needles

6. Sharp Container F It is used to obtain specimen according to order of draw

7. Tourniquet G The appropriate gauge has to be selected to match vein

8. Alcohol Swabs H It is tie to the arm for less than 1 minute

9. Needles/

Winged set

I It contains required items for venipuncture

10. Vacutainer holder J For tube & form with Name / DOB / Date & Time / Phlebotomist’s Initial.

11. Blood Tubes K It provides a clean area and prevent blood stains on surfaces

12. Gauze/Band Aid L Check and confirm request test on it.

Instructions Match Column A with Column B’s description of each items. You may find the answers in the online platform

SLIDE 16


MODULE 6 : QUIZ – from Online Learning SELECT BASIC ITEMS FOR VENIPUNCTURE PROCEDURE

ANSWER

ACTIVITY

Instructions Choose ONE answer for the question below. You may find the answers from the online learning.


MODULE 7: DEMONSTRATE CORRECT VENIPUNCTURE FOR UPPER LIMBS

In this last module, the objective is to provide a guide on performing venipuncture for the upper limb on a client. The process is divided into 4 phases to aid retention.

The phases are;

1) Preparation Phase, 2) Preview Venipuncture Site, 3) Perform Blood Collection, 4) Post Procedure

PREPARATION PHASE

1. ________________ the order.

2. ________________ the supply onto a tray.

3. ___ ____________ yourself.

4. Approach, _________________ and prepare the client.

5. Place the ______________________ sheet

6. Perform ________________ _____________________.

SLIDE 17


PREVIEW VENIPUNCTURE SITE

1. _____________ tourniquet, ask client to make a __________ and ______________the upper arm.

2. ____________ a vein, ___________________ site & allow _________________ to dry.

3. __ _______________ tourniquet and let client ________________ fist.

4. Apply _______________ gloves and __________________ equipment.

PERFORM BLOOD COLLECTION

1. Reapply ______________________, as client make a fist

2. Uncap the _________________, anchor the _________________ by stretching the skin.

3. Insert the _____________ with bevel (down/up), establish blood flow.

4. Invert each tube ___________________________ when filled as per_______________ of draw.

5. _______________ the tourniquet and client relax fist before the _ _________ tube.

6. Place _______________, remove ____________ and apply _________-_ _ to the site.

SLIDE 18


POST PROCEDURE

1. _____________ the collection unit.

2. __ _________ ___ the tubes.

3. Implement ______________ handling such as Biohazard bag or ice bag.

4. Check client’s _ _____________ and apply ________________ if bleeding has stopped.

5. Remove _______________ and perform __ _____________ hygiene.

6. Thank the ________________.

7. Transport __ __________________ to the laboratory.

SLIDE 19


KEY POINTS REMINDERS

1. Proper tying of tourniquet is ___________ 1 minute.

2. Stabilized vein without _______________________________ the site.

3. The angle of needle insertion is _______ to _________ degree.

4. Support vacutainer holder with _______ fingers without exchanging hand.

5. Apply vacutainer tube (before/after) needle insertion to retain

vacuum in the tube.

SLIDE 20


ANNEX 1

SKILL GUIDE

Demonstrate correct Upper Limb Venipuncture Attempt Attempt

Preparation Phase

• Review the order

• Collect the supply onto kidney dish

• Introduce yourself

• Approach, identify and prepare the client

• Place the protective sheet

Preview Venipuncture Site

• Apply tourniquet, ask client to make a fist and assess the arm

• Select a vein, disinfect site & allow alcohol to dry

• Release tourniquet and let client relaxes fist

• Apply clean gloves and assemble equipment

Perform Blood Collection

• Recap tourniquet, as client make a fist

• Uncap the needle, anchor the vein

• Insert the needle, establish blood flow

• Winged/Butterfly needle to prime tubing for Sodium Citrate

• Invert each tube quickly when filled as per order of draw

• Release the tourniquet and client relaxes fist before last tube filled up

• Place gauze, remove needle and apply pressure to the site

Post Procedure

• Discard the collection unit

• Label the tubes

• Implement special handling – Biohazard bag/Ice bag

• Check client’s arm and apply bandage

• Dispose soiled material and clean up

• Remove gloves, perform hand hygiene

• Thank the client

• Transport specimen to the laboratory

ANNEX


ANNEX 2

TYING A DISPOSABLE TOURNIQUET

ANNEX


ANNEX 3

BD TUBE GUIDE -ORDER OF DRAW

ANNEX


ANNEX 4 (1)

QUEST LABORATORIES – TUBE GUIDE.

ANNEX


ANNEX 4 (2)

QUEST LABORATORIES – TUBE GUIDE.

ANNEX


ANNEX 5

CLINICAL LOG: 30 Cases

This is the clinical log which the participant must complete in order to fulfil the basic requirement of 30 samples of venepunture at

a clinical facility, supervised by a certified mentor.

A certificate of participation will be issued to the participant upon submission of the completed clinical log by the host institution

Participant Name: ________________________________ ID (last 4 ID digits) _____________________

Case Facility Date Certified Mentor: Signature of candidate

Remarks Name Signature

1

2

3

4

5

6

ANNEX


Case Facility Date Certified Mentor: Signature of candidate

Remarks

Name Signature 7

8

9

10

11

12

13

14

15

16

17

18

19


Case Facility Date Certified Mentor: Signature of

candidate

Remarks

Name Signature

20

21

22

23

24

25

26

28

28

29

30

Remarks

peripheral venipuncture for upper limbs procedure

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