Slide 1

Report
Basic Principles of
Phlebotomy Part IV:
The Patient, Collection Site and
Problems with Collection Sites
CLS 424 Phlebotomy
Student Lab Rotation
The Patient:
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•
•
•
•
Approach
Communication
Empathy
Handling special situations
Patient identification
– Arm band
– Legal document
• Prepare patient for blood draw
– Latex allergy?
2
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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4
Collection Site Problems:
• Veins that lack
resiliency
• Extensive
scarring
• Hematomas
• Edematous
area
• Side of mastectomy
5
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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13
Fill Tubes:
• Use correct order of draw:
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–
–
–
–
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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
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–
–
–
–
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
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