venipuncture - syringe method & evacuated tube system

Question 1

what are the advantages for ETS and syringe method

Answer 1

ETS: (closed system)
o direct and efficient - not time consuming and no need to transfer unlike syringe system
o allows collection for larger volumes and multiple tubes

syringe system: (needle and syringe)
o allows collection from patients with small, fragile, or weak veins
* Pediatrics = infants and children
* Geriatrics = elderly

Question 2

what is the disadvantages of syringe system

Answer 2

higher risk of needle stick injury - cos there is many needle manipulations

Question 3

what are the materials needed for blood collection

Answer 3

ETS:
multisample needle
tube holder

syringe system:
needle and syringe
transfer device

both:
complete ppe (gloves, face mask, lab gown) - N95 mask if patient has an airborne disease
torniquet
alcohol pads
bandages
evacuated tube
sharps container

Question 4

what is the procedure for ETS method

Answer 4

1. Receive, Review, and Accession the Test Request
2. Approach, Greet, and Identify the Patient
3. Explain Procedure and Obtain Consent (alw ask permission before touching the patient)
4. verify collection requirements and identify sensitives and potential problems
5. sanitize hands and put on gloves
   visibly soiled - hand washing
   not - hand disinfectants
6. position the patient, apply torniquet and ask the patient to make a fist
   - place the arm straight downward, relax arm
7. select vein, release torniquet and ask the patient to open fist
   [this is where u prep equipment and check the syringe and tubes]
8. clean and air-dry the site
9. prepare equipment [while waiting for it to dry, double check the equipment, place tube on the rack based on their order of draw]
   - select right equipment
10. reapply the torniquet and uncap and inspect the needle
11. ask the patient to make a fist, anchor the vein and insert the needle
12. establish blood flow, release the torniquet and open fist
13. fill, remove and mix tubes in order of draw
    - mix immediately/ invert after removal from hub
14. withdraw the needle, place gauze, activate the needle safety feature and apply pressure
    - remove needle before placing hub
15. discard blood collection unit
16. label and prepare tubes for handling and transport
17. check the patient’s arms and apply a bandage
18. dispose of used materials and reposition moved items
    - items must be returned to their original position
    -replenish supplies everyday
19. thank the patient, remove gloves and sanitize hands
    - instructing fasting patients that they may eat
20. transport specimens to the lab promptly
    - transport to the lab so that can process immediately
    - pneumatic system

Question 5

process of recording in the order of received tests wherein a unique number is assigned to identify the specimen or test order number

Answer 5

accession

is like giving each medical test or specimen its own “ID number” when it arrives at the lab

Question 6

receive, review and accession the test request

Answer 6

complete details (full name, age, biological gender)

date and time of collection

priority

dietary restrictions or special circumstances
- history of fainting
- fasting
- allergy
- arm precautions

status designation
- ASAP, as soon as possible
urgent test need to be done right away
emergency situations

• TIMED
  test must be done at specific times
  ex: blood sugar test at exactly 2 hours after eating
• ROUTINED
  regular, non urgent test
  can be done during normal lab hours
  no specific time requiremnets

test request
ex: cbc

Question 7

approach, greet and identify the patient

Answer 7

proper bedside manner
ask the patient to state and spell their name and DOB

Question 8

verify collection requirements and identify sensitives and potential problems

Answer 8

fasting
previous problems during collection
allegies
fainting

Question 9

what happens when the patient faint during drawing of blood

Answer 9

stop immediately and secure the patient in a reclined or recumbent position

Question 10

why do you need to open the fist after palpating vein

Answer 10

to restore circulation, 2 minute rest

Question 11

why do we have to always ask the nurse if the patient has diabetes

Answer 11

because patient w diabetes has viscous blood which travel slow/ slow circulation

Question 12

what to do/ ensure when you are selecting a vein before puncturing it

Answer 12

to not leave the torniquet for more than a min
palpate veins at median > lateral, cephalic > medial, basilic > other arm

Question 13

this requires written permission from MD

Answer 13

drawing blood at legs or foot

Question 14

how do you clean the site

Answer 14

CLSI recommended:
friction scrub - back and forth movement

not recommended:
inward to outward, circulation method

Question 15

what do you have to do when you want to repalpitate

Answer 15

gloved finger must be cleaned with alcohol

Question 16

why do we have to airdry the site before drawing blood

Answer 16

to not make it painful
to avoid hemolysis as there might be contamination of alcohol

• dont fan, blow or dry the alcohol w gauze as it is sterile and to prevent from contaminating it

Question 17

how do u anchor the vein

Answer 17

stretch the skin or “L” hold technique

Question 18

needle insertion level

Answer 18

bevel up
less than 30 degrees needle insertion
- if shallow, smaller angle
- if deeper, arnd 30

*back flow - wait for a flash of blood to enter the needle hub

Question 19

how do u insert the evacuated tube in the multisample needle

Answer 19

• Holder flange: middle and index finger
• Bottom of the tube: thumb

Question 20

true or false:
release torniquet when there is a backflow of blood in the needle hub

Answer 20

false - Release tourniquet: after blood flow is established and not left >1 min

Question 21

how long do u have to apply pressure at the site after blood collection

Answer 21

3 to 5 min

Question 22

discard blood collection unit
Black Bin:
Yellow Bin:
Sharps Container:

Answer 22

Black Bin:
packaging of the syringe

Yellow Bin:
used cotton balls
gauze
prep pads
used tubes

Sharps Container:
needles
broken tubes

Question 23

where do u place the tube during transportation

Answer 23

in an upright position in biohazard specimen bag during transport
* label (Full Name, Age/Gender, Date and Time of Collection, Date of Birth, Initials)

Question 24

how long do u have to observe the site to check for signs of bleeding

Answer 24

5 - 10 sec

Question 25

why should we tell the patient to limit exertion and pressure

Answer 25

prevent bruising and reopening the site avoid: Heavy lifting Strenuous exercise Excessive arm movement

Question 26

what happens if the bleeding still occurs more than 5 minutes

Answer 26

notify the medical doctors

Question 27

how long do u have to leave the bandage on for

Answer 27

15 - 30 min so that it is fully clotted more than 30 min = skin irritation

Question 28

Works like a bank drive-through tube system Uses air pressure to move containers through tubes Connects different parts of hospital/facility Much faster than walking

Answer 28

pneumatic system

Question 29

what is the procedure for syringe system

Answer 29

steps 1 - 12 are the same 13. fill syringe - slowly pull back the plunger 14. withdraw needle, place gauze, activate needle safety feature and apply pressure 15. remove syringe needle and discard it in a sharps container 16. attach the syringe hub to transfer device, rotating it to ensure secure attachment - avoid leakage upon transfer - reduce the risk of accidental needle stick injury and confines the aerosol or spraying that may e generated as the tube is removed 17. hold the syringe vertically w the tip down and transfer device at the bottom - ensures tht tube fills from bottom to top - do not push plunger as it may cause hemolysis -upright position to avoid crossover contamination 18. place ETS tube in the transfer device, push it all the way to the end 19. let the tubes fill the vacuum draw of the tube - do not push the syringe plunger 20. when finished, discard the syringe and transfer device unit in a sharps container step 16 - 20 are the same

Question 30

why is bending of arms is not allowed after drawing blood

Answer 30

prone to hematoma if hematoma occurs = instruct the patient to apply ice on the puncture site

Question 31

what do u have to do in a procedural risk

Answer 31

stop, assess and correct o two unsuccessful try = ask another phlebotomist o whatever the reason of the inability to obtain specimen, notify the MD or RN o arterial is not an alternative o if patient refuses, try to convince up to two times if not make them sign the request form REFUSED: Patient’s Signature over Printed Full Name Phlebotomist’s Signature over Printed Full Name/Initials Date and Time

Question 32

what do u have to do in a procedural error and failure ▪ Failure to mix tubes immediately ▪ Pulling plunger too quickly ▪ Syringe was filled too slowly ▪ Failure to apply pressure on puncture site

Answer 32

▪ Failure to mix tubes immediately clot formation (micro clots) ▪ Pulling plunger too quickly hemolysis (hemolyzed sample) ▪ Syringe was filled too slowly may form clots ▪ Failure to apply pressure on puncture site hematoma

Question 33

what are the procedural risk in pediatric collection

Answer 33

▪ Check the tests and the volume required ▪ Not more than 10% of the total blood volume (hospitals do have their own policy) o may lead to shock or cardiac arrest ▪ Risks to iatrogenic anemia o increased risk for children due to repeated blood collection’ o may cause a drop in hemoglobin and hematocrit ▪ Ask parents or guardians about history of blood collection o behavior and approach that will work ▪ Option should be given: Stay or Wait outside the room ▪ Lower yourself to the patient’s level ▪ Never tell a child that it will not hurt ▪ Approaches o videos o games o songs o counting ▪ EMLA/12 to 24% sucrose solution o EMLA – topical anesthetic (lidocaine) o Sucrose solution – heighten pain tolerance ▪ Methods of Restraining

Question 34

EMLA vs Sucrose soln

Answer 34

EMLA: It's a numbing cream Contains lidocaine (local anesthetic) Put on skin 30-60 minutes before procedure Makes needles hurt less Works like temporary numbing of the skin Common use: before blood draws or IV insertion sucrose soln: 12-24% sugar water solution Given to babies during painful procedures Works as natural pain reliever Both are used to: Reduce pain Make procedures more comfortable Decrease anxiety Especially helpful for: Children Patients afraid of needles Sensitive patients

Question 35

what are the challenges in geriatric collection

Answer 35

o skin discoloration o hearing and vision problems o mobility issues o diabetics o mental and emotional problems

Question 36

what happens if the skin loses elasticity and lack of hydration in elderly patients

Answer 36

o harder to anchor the vein o prone to rolling and collapsing vein o increased bruising

Question 37

what are some of the procedural risk in geriatric collection

Answer 37

▪ Skin loses elasticity and lack of hydration ▪ Hearing problems may have a hard time in answering questions ▪ Guide or escort those who are visually impaired ▪ Speak clearly and slowly and expect to repeat statements or questions ▪ Never force arms of patients with arthritis ▪ Blood thinners o expect bleeding (coagulation problems) ▪ Diabetes mat cause scarring of skin punctures o warm the site to avoid this ▪ Help patients who experience tremors (Parkinson’s disease)

Question 38

true or false: we can rely on patient's nodding as a response

Answer 38

false - do not rely * ask the patient's companion for help

Question 39

how do you avoid scarring of skin punctures in diabetes

Answer 39

warm the site

Question 40

how do you help patient with tremors (parkinson's disease)

Answer 40

Position: Support the shaking arm/hand Use pillows or arm rests Help stabilize their arm Have them sit in a comfortable position Timing: Ask when tremors are usually less severe Some patients have better times of day Work around their medication schedule Be patient and wait for calmer moments Techniques: Hold their arm gently but firmly Use your hands to stabilize the area Draw from larger, more visible veins Work quickly but carefully when tremors lessen Support: Stay calm and reassuring Don't rush the process Let them know it's okay to take time Ask if they need a break Remember: Safety first - if tremors are too severe, consider rescheduling or getting help from another staff member.

Question 41

how do you perform collection in elderlies on wheelchair

Answer 41

while being seated in wheelchair use pillow or padded boards

Question 42

this should not be used in dialysis patients when taking bp or venipuncture

Answer 42

AV (arteriovenous) shunt or fistula

Question 43

what should u consider when drawing blood from hospice patients

Answer 43

Terminally ill patients should be approached with care, kindness, and respect

Question 44

they are elderly or disabled patients who can’t take care of themselves

Answer 44

long-term care patients

Question 45

procedural risk in home care patients

Answer 45

▪ Bedridden patients who are staying at home ▪ Mobile blood collection o phlebotomist should have exceptional skills o all necessary equipment should be brought o protect samples during transport

Question 46

techniques to enhance the vein and recover a failed venipuncture

Answer 46

1. Retie the tourniquet 2. Use a blood pressure cuff in place of the tourniquet 3. Massage the arm o do not slap the arm 4. Lower the patient’s arm 5. Warm the venipuncture location 6. Reseat the tube in the holder 7. Use a different tube 8. Place your finger below the venipuncture site and stretch the vein sightly 9. Rotate the needle 10. Pull back or advance the needle slightly

Question 47

true or false: labelling of evacuated tube should be done in presence of the patient and right after blood collection

Answer 47

True

Question 48

true or false: it is okay to pre-label

Answer 48

false

Question 49

what are the minimum information required when labelling

Answer 49

o patient’s full name o patient-specific identifier o date of birth o age and biological gender o date and time of collection o phlebotomist’s initials o additional information = “fasting” or “STAT”

Question 50

what to do after labelling the evacuated tubes

Answer 50

compare with the request form and patient’s ID band or ask the patient to verify

Question 51

why is the torniquet placed 3 - 4 inches abv the intended venipuncture site

Answer 51

to ensure adequate dilation of the vein without interfering with the actual puncture area allows space for proper cleaning of site

Question 52

what happens if too much tension is applied in fastening a torniquet

Answer 52

it can cause discomfort to the patient blocking arterial flow = inaccurate test result cause bruising or damage to the surrounding tissue

Question 53

what is the purpose of the loop created during the tourniquet application

Answer 53

ez and rapid removal of tourniquet

Question 54

why is it important to release the torniquet within 1 min

Answer 54

prevent prolonged blood statis hemoconcentration

Question 55

what happens if you push the syringe plunger while transferring into an evacuated tube

Answer 55

it can be hemolyze the specimen cause the tube stopper to pop off - splashing the tube content

Question 56

it is the dialysis patient's lifeline

Answer 56

Arteriovenous fistula - phlebotomist must be able to recognize it

Question 57

true or false: laboratory personnel will assume that blood in the microtubules is capillary blood. if venous blood is placed in a microtubule, it is important to label the specimens

Answer 57

true

Question 58

STAT requests takes priority over all others for ER STAT take over

Answer 58

- inpatients and outpatients - inpatient STAT requests

Question 59

why is it required to follow a series of steps that must be performed to ensure that the specimen is collected from

Answer 59

the correct patient in a timely manner under the required conditions in a professional manner that is safe for both the patient and phlebotomist

Question 60

who has begun using the terms "pre-examination", "examination" and "pot examination" in place of "preanalytical", "analytical" and "postanalytical"

Answer 60

international standards organization clinical and laboratory standards institute

Question 61

DNR: DNAR:

Answer 61

DNR: do not resuscitate DNAR: do not attempt resuscitation

Question 62

the behavior of a healthcare provider towards or as perceived by a patient

Answer 62

bedside manner

Question 63

the process of verifying a patient's identity is the most crucial step in specimen collection

Answer 63

patient identification - shld not be rushed or any part skipped to save time

Question 64

what are the 3 way ID

Answer 64

1. the patient's verbal statement 2. a check on the ID band 3. a visual comparison of the labeled comparison