Proper Blood Collection: Venipuncture and Capillary Puncture

Question 1

VENIPUNCTURE PROCEDURES

Answer 1

1. Prepare request form of the patient
2. Greet and identify the patient
3. Verify diet restriction, latex sensitivity, and other allergies
4. Sanitize hands and vosition the patient
5. Assemble equipment and supplies
6. Apply TOURNIQUET. Ask the patient to make a fist without vigorous pumping. Select a suitable vein for puncture
7. Put on gloves. Cleanse the venipuncture site with 70% isopropyl alcohol. Allow the area to dry.
8. Anchor the vein firmly.
9. Enter the skin with a needle at approx. 30-degree angle. bevel up.
10. Release the tourniquet. NEVER WITHDRAW THE NEEDLE WITHOUT REMOVING THE TOURNIQUET.
11. Place gauze, withdraw needle and apply pressure
12. Properly recap the needle using “fishing out” technique.
13. Check the condition of the patient.
14. Dispose contaminated material (needle and holder, and syringe) in designated containers using Universal Precautions.
15. Label tubes at the patient’s side.

Question 2

Test request form should contain:

PPPADDDTC

Answer 2

Patient identification number

Physicians name

Patient’s complete name

Age

Date of birth

Date and time the sample is to be obtained

Department or location of the patient

Type of test to be collected

Clinical impression/ diagnosis

Question 3

How to greet

Conscious patients (Out-patient)

Answer 3

Ask patients to give their FULL NAME and spell their last name.

Compare the information on the request form

Question 4

How to greet

Conscious patients (In-patient)

Answer 4

Ask patients to give their FULL NAME and spell their last name.

Compare the information on their identification bracelet and request form

Question 5

How to greet

Sleeping patient

Answer 5

Awaken a sleeping patient before attempting venipuncture

If the patient is already awake, do the same steps as conscious patients

Question 6

How to greet

Semi-conscious or Comatose Patients

Answer 6

Ask the watcher (or nurse, if no watcher is around) to identify the patient.

Compare the information on their identification bracelet and request form

Question 7

How to greet

Too young. mentally incompetent or do not speak the lanquage of a phlebotomist

Answer 7

Ask the watcher (or nurse, if no watcher is around) to identify the patient.

Compare the information on their identification bracelet and request form

Question 8

How to greet

Unidentified Emergency Patient

Answer 8

Upon admission, a temporary identification number will be assigned to the patient.

Use this ID number on all tests.
When a permanent number or when the patient has already been identified, cross-reference it with the temporary number.

Question 9

SITES TO BE AVOIDED:

BED HIM

Answer 9

Burns, scars or tattoos
Edema
Damaged veins
Hematoma
IV line, cannula, fistulas
Mastectomy

Question 10

Avoid due to compromised blood flow and potential contamination from ink or scars.

Answer 10

Burns, scars or tattoos

Question 11

Avoid pain, complications, and difficulty in obtaining a proper blood sample.

Answer 11

Damaged veins

Question 12

Avoiding swollen tissue can obscure veins and increase the likelihood of unsuccessful attempts.

Answer 12

Edema

Question 13

Avoid pain and further tissue damage from puncturing near a hematoma.

Answer 13

Hematoma

Question 14

Mastectomy

Avoid on the side of mastectomy to prevent potential complications and_____.

Answer 14

lymphedema

Question 15

Avoid drawing from these sites to prevent contamination and vessel damage; opt for a different vein if possible.

Answer 15

IV line, cannula, fistula

Question 16

Cleanse the venipuncture site with______. Allow the area to dry.

Answer 16

70% isopropyl alcohol

Question 17

ORDER OF DRAW

BCSHEO

Answer 17

1. Blood culture bottles (sterile procedure)
2. Coagulation tubes
3. Serum tubes w/ or w/o clot activator or gel serum separator
4. Heparin tubes w/ or w/o del plasma separator
5. EDTA tubes
6. Oxalate/fluoride, glycolytic inhibitor tubes

Question 18

Yellow Top

Answer 18

Blood culture bottles (sterile procedure)

Question 19

• Light Blue Top

Answer 19

Coagulation tubes

Question 20

Red/ Gold Tan

Answer 20

Serum tubes w/ or w/o clot activator or gel serum separator

Question 21

Green Top

Answer 21

Heparin tubes w/ or w/o gel plasma separator

Question 22

Lavender Top

Answer 22

EDTA tubes

Question 23

Black Top

Answer 23

Oxalate/fluoride - glycolytic inhibitor tubes

Question 24

Properly recap the needle using “____” technique.

Answer 24

fishing out

Question 25

Problems encountered in Venipuncture PANNTS CCD

Answer 25

Pain Allergy Nerve damage Nausea Trembling Syncope/ fainting Cardiac arrest Continuous bleeding Diabetic shock

Question 26

PAIN

Answer 26

Reposition the needle Release the tourniquet Discontinue venipuncture Avoid deep, probing venipunctures

Question 27

NERVE DAMAGE • If the nerve is ONLY TOUCHED, not damaged, it may be gone in a____ • If damaged, numbness could be___. •_____ venipuncture

Answer 27

few hours or days PERMANENT Discontinue

Question 28

NAUSEA

Answer 28

• Make the patient as comfy as possible • Instruct him/her to breathe slowly • Apply COLD COMPRESS if necessary • Give waste basket or container and have tissues and water ready

Question 29

SYNCOPE/FAINTING • Warning signs:

Answer 29

Perspiration beads on the forehead Hyperventilation Loss of color

Question 30

- fainting due to abrupt pain or trauma

Answer 30

Vasovagal syncope

Question 31

What to do when patient faints

Answer 31

• Lower the head and arms • Discontinue venipuncture

Question 32

DIABETIC SHOCK • Experience______ because they fasted

Answer 32

hypoglycemia

Question 33

What to do during diabetic shock

Answer 33

If conscious, let them drink a glass of ORANGE JUICE or COLA will temporarily help If unconscious, call a PHYSICIAN

Question 34

• Patient become unconscious and exhibit mild to violent uncontrollable movements

Answer 34

TREMBLING

Question 35

What to do when patient is trembling

Answer 35

DO NOT RESTRAIN the patient Move object out of the way; PROTECT THE HEAD Patients will usually recover after a few minutes.

Question 36

Patient falls into unconsciousness, no pulse or respiration, dilated eyes and pale skin

Answer 36

CARDIAC ARREST

Question 37

What to do when patient undergoes cardiac arrest

Answer 37

IMMEDIATE CPR

Question 38

CONTINUOUS BLEEDING • Some patients take more than___ MINUTES for the site to stop bleeding • Continue to wrap an elastic gauze around the arm with a pad • Leave it on for___ MINUTES or until the bleeding stops.

Answer 38

5 15

Question 39

ALLERGY Some patient are allergic to latex, tape or iodine What to do?

Answer 39

use hypoallergenic tape and non-latex elastic wrap

Question 40

What to do when there is НЕМАТОМА

Answer 40

Discontinue venipuncture and apply pressure

Question 41

UNUSUAL BLOOD SPECIMENS

Answer 41

Icteric samples Lipemic samples Hemolyzed samples

Question 42

• Serum/plasma that contains large amounts of BILIRUBIN • Patient presents with jaundice

Answer 42

ICTERIC SAMPLES

Question 43

• Serum/plasma contains large amounts of FATS and LIPIDS. • May be due to the patient NOT FASTING.

Answer 43

LIPEMIC SAMPLES

Question 44

• Serum/plasma contaminated with RBC contents.

Answer 44

HEMOLYZED SAMPLES

Question 45

CAUSES OF HEMOLYSIS DR PFRM

Answer 45

Drawing from a hematoma Rupturing of RBCs by using needle that is too small ALCOHOL on the site of venipuncture that entered the blood sample Pulling the plunger too forcibly Fast drip/ expelling blood vigorously as it is transferred to the tube Redirecting Mixing tubes vigorously

Question 46

POSSIBLE CAUSES FOR FAILED VENIPUNCTURE VC BBUNN

Answer 46

1. Vacuum in tube is not working 2. Collapsed vein 3. Bevel against the vein wall 4. Bevel inserted too far 5. Undetermined needle position 6. Needle partially inserted 7. Needle slipped beside the vein

Question 47

TECHNIQUES TO ENHANCE VEIN AND RECOVER A FAILED VENIPUNCTURE

Answer 47

• Retie the tourniquet • use a blood pressure cuff in place of a tourniquet • Massage the arm or warm the location • Lower the patient's arm • Reseat the tube holder • Use a different tube • Place your finger below the venipuncture site and stretch the vein slightly • Pull back or advance the needle slightly • Rotate the needle ONE QUARTER to ONE HALF TURN. make sure to pull a little backward before redirecting • Venipuncture attempts should be upto 2 tries only. Ask someone else to do it (endorse to another staff)

Question 48

MOST COMMON ERRORS IN SPECIMEN COLLECTION MMMESHHIP

Answer 48

• Misidentification of patient • Mislabeling of specimen • Mixing problems/ clots • Exposure to light/ extreme temperatures • Short draws/wrong Anticoagulant-Blood ratio • Hemolysis/ lipemia • Hemoconcentration from prolonged tourniquet time • Improperly timed specimen/ delayed delivery to the laboratory • Processing errors:

Question 49

Processing errors

Answer 49

Incomplete centrifugation Improper storage

Question 50

LANCET/INCISION DEVICES

Answer 50

• Finger puncture • Heel puncture • Laser lancet

Question 51

COLLECTION CONTAINERS

Answer 51

• Capillary tubes (w/ different anticoagulants) • Microtainers (w/ different anticoagulants)

Question 52

COMPOSITION OF CAPILLARY BLOOD

Answer 52

• Arterial Blood • Venous Blood • Interstitial Fluid • Intracellular Fluid

Question 53

INDICATIONS FOR PERFORMING CAPILLARY PUNCTURE ***ADULTS***

Answer 53

• No accessible veins • To save veins for chemotherapy • Clotting tendencies • POCT procedures such as glucose monitoring

Question 54

INDICATIONS FOR PERFORMING CAPILLARY PUNCTURE ***CHILDREN AND INFANTS***

Answer 54

• To prevent anemia • To prevent cardiac arrest from removal of large quantities of blood • Venipuncture injury • When capillary blood is preferred

Question 55

STEPS IN CAPILLARY PUNCTURE

Answer 55

1. Prepare request form of the patient 2. Greet and identify the patient 3. Verify diet restriction, latex sensitivity, and other allergies 4. Sanitize hands and position the patient 5. Select puncture/ incision site 6. Warm site if applicable 7. Cleanse and air-dry site 8. Prepare equipment 9. Puncture the site and discard the lancet 10. Wipe away the first blood drop 11. Fill and mix tubes/ containers in order of draw 12. Place gauze and apply pressure 13. Label specimen and observe special handling instructions 14. Check the site and apply bandage 15. Dispose of used and contaminated materials 16. Thank patient, remove gloves and sanitize hands 17. Transport specimen to the laboratory

Question 56

Capillary Puncture Adults and older children (Over 1 year old)

Answer 56

Use the palmar surface of the distal or end segment of the middle or ring finger of the ***nondominant hand.*** Fleshy area, slightly off center, ***perpendicular to whorls of fingerprint.***

Question 57

Capillary puncture Infants (Less than 1 year old)

Answer 57

use the medial or lateral plantar surface of the heel

Question 58

Capillary puncture For both finger and heel punctures

Answer 58

• place lancet firmly against site • Warn the patient • Depress lancet trigger • Discard lancet in sharps container

Question 59

Capillary puncture Fill and mix tubes/ containers in order of draw

Answer 59

• Gentle intermittent pressure, do not milk, position site downward to enhance flow • SLIDE FIRST, then EDTA, other ADDITIVES, SERUM

Question 60

Capillary puncture _______: use capillary action _______: touch blood drop, do not "scoop" or touch site Mix gently.

Answer 60

Microhematocrit tube Microcollection containers

Question 61

Capillary puncture Label specimen and observe special handling instructions Label with appropriate information • Apply label directly to______ • Place_______ in a nonadditive tube then label that tube. • Ice, body temperature, protection from light, etc.

Answer 61

microcollection container microhematocrit tubes

Question 62

TEST THAT CANNOT BE PERFORMED BY CAPILLARY PUNCTURE

Answer 62

• Erythrocyte sedimentation rate • Coagulation studies that requires plasma • Blood cultures • Tests that require large volumes of blood