VENIPUNCTURE (NEEDLE AND SYRINGE)

Question 1

The most frequently performed procedure in
phlebotomy

Answer 1

Venipuncture

Question 2

is the general term for the blood collection

Answer 2

Phlebotomy

Question 3

types of phlebotomy

Answer 3

• Venipuncture
• Capillary Puncture
• Arterial Puncture

Question 4

All phlebotomy (specimen collection) procedures begin with the receipt of a___________

Answer 4

test requisition form

Question 5

must contain certain basic information
to ensure that the sample drawn and the test
results are correlated with the appropriate patient

Answer 5

Requisition form

Question 6

states which ward is the
patient and the floor, with the room number
(pediatrics, surgical, etc.)

Answer 6

Patient’s location

Question 7

(t/f)
In the Philippines, the number of requisition
form can be more than 1 for each patient
(chemistry tests, blood-relates [hematology],
urinalysis, fecalysis, etc.)

Answer 7

TRUE

Question 8

(TRUE OR FALSE)
Some specimens will be requested immediately
or upon receipt of the requisition form, and
some requests will have a specific time
[Example: A patient has malaria, which have
certain periods of activity during the day, so for
the doctor to have an accurate diagnosis, he will request a CBC or a differential smear in a
certain date or time, more specifically, time.]

Answer 8

true

Question 9

if it is ASAP, immediate collection, etc.

Answer 9

Status of sample

Question 10

usually found in barcode systems wherein this
information is found

Answer 10

Number and type of collection tubes

Question 11

T OR F

If the test requested by the physician includes
that a patient should be fasted, it could be
indicated in the form [ask the patient when is
his last meal, if over fasted or under fasted, do
not collect]

Answer 11

true

Question 12

TRUE OR FALSE

Ask the patient if he is allergic to latex [non-
latex tourniquet and gloves should be readied]

Answer 12

true

Question 13

(true or false)

To ensure that the blood is drawn from the right patient, identification is made by comparing information obtained verbally and from the patient’s wrist ID band with the information on the requisition form. (CLSI)

Answer 13

true

Question 14

(true or false)

When confined, you will be given a wrist ID
band that will be barcoded (for some) or
handwritten. Nevertheless, you, as a
phlebotomist, should confirm the identification
of the patient.

Answer 14

true

Question 15

preferred site for venipuncture is the _______ located anterior and below the bend of the elbow

Answer 15

antecubital fossa

Question 16

tourniquet should last
in only 1 minute) If exceeded, you are forming something called

Answer 16

hemoconcentration

Question 17

two functions:
- Impedes venous blood flow, causing blood to
accumulate in the veins making them more
easily located
- Provides a larger amount of blood for collection

Answer 17

tourniquet

Question 18

should be worn when performing a
venipuncture procedure! (OSHA Mandate)

Answer 18

Gloves

Question 19

Located near the center; preferred vein for
venipuncture because it is large, stationary, least painful due to less nociceptor and bruises less easily

Answer 19

MEDIAN CEPHALIC VEIN

Question 20

Lateral aspect; second choice; hard to palpate but fairly well anchored and the only vein can be felt in obese

Answer 20

CEPHALIC VEIN

Question 21

Medial side; not well anchored and rolls easily, high risk of puncturing median cutaneous nerve or the brachial artery

Answer 21

BASILIC VEIN

Question 22

have 2 choices of the median vein

Answer 22

M pattern

Question 23

1 choice of median vein

Answer 23

H pattern

Question 24

• 70% Isopropyl alcohol
• Concentric circles (2-3 inches in diameter)

Answer 24

CLEANSING THE SITE

Question 25

• Check equipment for defects - Experimentation dates • Check needle and syringe if properly screwed • Extra tubes should be near at hand • Do not place collection tray on patient’s bed - Use the bedside table

Answer 25

ASSEMBLY OF EQUIPMENT

Question 26

IMPORTANT: RE-APPLY TOURNIQUET FIRST 1. Examine needle – BEVEL UP (butas ng needle; should be pointed upwards) 2. Anchoring Vein 3. Insertion of Needle (30-40 degrees) 4. Filling Tubes 5. Removal of Needle

Answer 26

PERFORMING THE VENIPUNCTURE

Question 27

6. Disposal of Needle 7. Labelling Tubes (full name, age, sex, date and time of collection, initials of the phlebotomist [include the time of the last meal of the patient, if fasting]) 8. Bandaging Patient’s Arm 9. Disposing Used Supplies 10. Leaving Patient (check the patient if the patient is fine [numbing, signs of nausea, pain]

Answer 27

REMOVE TOURNIQUET BEFORE NEEDLE

Question 28

Seek assistance form attending nurse/nurse station to locate patient

Answer 28

UNAVAILABLE PATIENT

Question 29

The ideal time to collect blood from a patient: - Refrained from strenuous exercise - Has not ingested food or beverages except water for 12 hours - The patient did not change position for 10-15 mins.

Answer 29

BASAL STATE

Question 30

Increase in the number formed elements in blood due to decrease plasma volume • Happens on prolonged tourniquet application! - Follow the 1 minute during the first tourniquet application - The second tourniquet application, you can go as far as 2 minutes

Answer 30

HEMOCONCENTRATION OR VENOUS STASIS

Question 31

• Tourniquet and needle should be removed, pressure applied to the site, and summon help - If the needle is first removed because of seizure, recap then detach the tourniquet - If seizure is controlled, follow the procedure [tourniquet is removed first, before the needle] • Restrain the patient only to the extent that injury is prevented • Document the time that the seizure started and stopped according to institutional policy • Make sure that the patient do not further harm himself

Answer 31

SEIZURES

Question 32

• Small, nonraised red hemorrhagic spots - Will appear immediately • May have prolonged bleeding following venipuncture - Expect bruising later on; avoid hematoma - Patients that have platelet disorders are common to this • Additional pressure should be applied to the puncture site following needle removal

Answer 32

PETECHIAE

Question 33

• If the patient is nauseated, instruct the patient to breathe deeply and slowly; apply cold compresses to the patient’s forehead • If the patient vomits, stop the blood collection and provide an emesis basin or wastebasket and tissues • Notify the patient’s nurse or designated first aid personnel

Answer 33

VOMITTING

Question 34

• May result in loss of movement to the arm or hand • Permanent injury in the venipuncture procedure is damage to the median antebrachial cutaneous nerve

Answer 34

NERVE INJURY

Question 35

Shooting pain, electric-like tingling or numbness, running up or down the arm or in the fingers of the arm

Answer 35

SIGNS

Question 36

DELAYED LOCAL COMPLICATIONS Formation of blood clots inside the lumen of the vein due to trauma

Answer 36

THROMBOSIS OF VEINS

Question 37

DELAYED LOCAL COMPLICATIONS Inflammation of the vein caused by thrombus

Answer 37

THROMBOPHLEBITIS

Question 38

DELAYED LOCAL COMPLICATIONS • Blue or black skin discoloration commonly due to repeated trauma or puncture of the veins • Most common one (pagpapasa) - If the needle penetrates through the vein - The vein is fragile - Fishing through the patient’s vein

Answer 38

HEMATOMAS

Question 39

AREAS TO AVOID

Answer 39

• Damaged veins • Hematoma • Edema Burns Arm on the same side of a mastectomy IV Therapy

Question 40

COMMON DIFFICULTIES ENCOUNTERED DURING COLLECTION AND PROCESSING OF BLOOD

Answer 40

HEMOLYSIS and LIPEMIA OR LACTESCENSE

Question 41

This is caused by transient rise in chylomicrons following a meal containing fat - Can be used after doing more procedures in the specimen • It causes interference with large number of chemical analyses because of turbidity • It disturbs the following investigations particularly strongly: - Amylase

Answer 41

LIPEMIA OR LACTESCENSE