w7 safe blood collection

Question 1

are bacteria present in blood

Answer 1

yes but usually they are quickly eliminated by white blood cells, liver and spleen.
-bacteremia, septicaemia develop when infection occurs from multiplication of bacteria in blood stream faster than they can be eliminated

Question 2

when are blood cultures ordered

Answer 2

-to aid in diagnosis when there is a fever of unknown origin FUO or pyrexia of unknown origin PUO

Question 3

what do blood cultures help to determine

Answer 3

• presence and extent of infection
• identity of organisms
• antibiotic to which bacteria will be susceptible

Question 4

when to collect cultures

Answer 4

• just before anticipated fever spike
• immediately following a fever spike
• before antibiotic therapy
• from more than one site

Question 5

collection set of blood vials

Answer 5

one aerobic and one anaerobic O2 and AnO2. to detect all types of bacteria present.
-ordered at intervals 2x or 3x to increase the chance of isolation- collected from second collection sites

Question 6

consecutive collection technique

Answer 6

collect both vials from one arm and then the other arm right away -indicate on bottle which arm was used RA or LA- common with patients experiencing acute conditions where administration of antibiotics are immediately required

Question 7

Time interval technique

Answer 7

collect the second site at a given time following the collection of the first set. 20 to 30 minutes are usual time intervals

Question 8

limitations to vials

Answer 8

it is a large volume

10ml taken from each vail, 4 vials taken total 40ml of blood taken

Question 9

where is blood culture taken

Answer 9

performed at bedside

Question 10

what volume are blood vials filled to

Answer 10

10ml mark down on bottle, they will fill more than that - for adults

kid volumes based on weight

Question 11

what to remember

Answer 11

clean with alcohol as usual
clean for 30 seconds with iodine then let dry
dont repalpate unless you clean your finger with iodine and dont touch anything
clean tops of vials and leave alcohol swabs on
in total 3 alcohol swabs, 1 iodine swab

Question 12

what to do if insufficient volume

Answer 12

note it on req
split between the two vials if more than 2ml
if less that two ml inoculate aerobic vial only
do not inoculate paediatric vial in place of adult vial

Question 13

what to clean with for blood culture

Answer 13

70% isopropyl alcohol
povidone iodine then chlorhexidine gluconate do a friction scrub for 30 seconds then allow t0 dry for one to two minutes
-use gauze after because the iodine is sticky

Question 14

what is blood culture done with

Answer 14

butterfly need

*since air is present in tube use aerobic one first

Question 15

order of draw

Answer 15

aerobic, anaerobic, blood tubes in order of draw

Question 16

what to use for blood culture with bad veins

Answer 16

syringe is okay to use, 20ml syringe would be used for fill both - its not recommended because it could contaminate vials.
make sure to use safety transfer device.

Question 17

why avoid taking blood from scarred areas

Answer 17

• difficult to palpate in penetrate
• impaired circulation resulting in erroneous results
• repeated phlebotomy or IV drug therapy

healed burns can create scarred areas

Question 18

why avoid taking blood from abrasions, lesions, fresh tattoos

Answer 18

more susceptible to infection

Question 19

Mastectomy patients

Answer 19

phlebotomy should not be performed in the same side as a radical mastectomy (total breast and adjacent lymph node removal) can cause disruption of lymph circulation and erroneous test results and injury form tourniquet may lead to injury of arm

Question 20

what is a hardened, or sclerosed vein caused from, what to do?

Answer 20

• feel hard lack resistance.
• disease, inflammation, irritation from intravenous drugs or scaring
• hard to penetrate
• NARROW interior diameter – impaired blood flow
• take from other arm or another vein of the same arm, or same vein but farther from damaged area

Question 21

intravenous therapy and blood draw

Answer 21

do not take blood from arm with IV
-blood specimen may be diluted especially if drawn above IV line

you can draw from this arm if you get permission from doctor or nurse if

• iv off for two mins
• tourniquet distal to IV site before venous blood gets to iv site
• on a different vein
• first 5ml discarded
• first 10ml discarded for coag
• note added to req

Question 22

what to do if collecting blood and there is pain or nerve damage

Answer 22

• pain tolerance differs person to person
• differentiate between discomfort and pain
• if patient expresses pain, remove needle
• if patients asks you to remove needle you must remove needle
• remove needle immediately if patient feels shooting or electric like pain toward shoulder or hand, nerve has been provoked.

Question 23

reason for hematoma 6

Answer 23

(accumulation of blood thats raised) blue green to purple bruise- blood escapes vein

• needle penetrated completely through vein, venous fluid leaking out bottom
• bevel only partially penetrated vein- venous blood leaks out to top of hole in vein wall
• vein too small for gauge
• needle removed from arm before tourniquet off
• tourniquet reapplied above recent venipuncture site.
• pressure not applied after needle is removed.

Question 24

what to do if hematoma starts to form, and a sign its going to form

Answer 24

swelling forms around needle, unless absolutely necessary ( STAT) take tourniquet off and and venipuncture discontinued
-elevate arm while applying direct pressure later ice the site , cover with pressure bandage (pad folded gauze taped securely in place)

**be extra careful with coagulation patients, make sure no bleeding occurs before bandage
elderly patients often are more prone to hematomas
warn patient there will be a bruise if you think that you may have given them a hematoma and that it will go away in a couple of days

Question 25

why does Syncope or fainting occurs

Answer 25

dizzy and faint, patient usually appears apprehensive, strong and healthy patients sometimes do at thought or sight of needle - decrease in blood volume - cardiac arrhythmia - hyperglycemia - hyperventilation - psychological stress ( most common)

Question 26

what is is syncope

Answer 26

affected individual undergoes a reaction that results from inadequate blood supply to vein. = loss of consciousness

Question 27

fainting symptoms 9

Answer 27

- stop talking - waver in their voice - become vague or disorientated - pale - beads of perspiration on their forehead - warn phlebotomist of dizzy feeling - waver back and forth with their head or upper body - roll eyes back into their head - slump suddenly without warning

Question 28

what to do if patient fainting

Answer 28

if they have any symptoms, tourniquet off immediately remove needle and apply pressure to site, position yourself to prevent patient from falling onto floor. - have patient put head between legs, hold them then lower them to floor if they faint call for help - outpatients who previously get faint should lie recumbent on while getting blood drawn, this allows for more blood to brain. plus hazard risk is decreased, can't fall on floor

Question 29

what to do if patient is feeling ill

Answer 29

may feel nauseous, direct them to breath slowly and deeply, venipuncture discontinued of phlebotomist thinks they will throw up emesis ( kidney) basin supplied and cold compress supplied for forehead

Question 30

seizures and convulsions symptoms and what to do

Answer 30

- triggered by physical and emotional stress. - can be due to venipuncture - loss of colour to complexion - eye rolling - arching or stiffening is a sign of seizure, in fainting the body would go slack - discontinue venipuncture immediately and call for help. stay with patient and make sure they don't hurt themselves. - with assistance lower patient to floor, remove glasses, loosen clothing remove sharp objects - call in nurse , outpatient call paramedics, or physician

Question 31

what to do if arterial puncture occurs

Answer 31

-apparent- the blood is bright red. would fill tube or syringe in spurts- evacuated tube forced backward and out of system. ** immediately discontinue venipuncture and PHLEBOTOMIST must apply very firm pressure to site for 5 minutes to ensure needle hole injury has close. this injury must be reported to supervisor

Question 32

two main risks to patient when artery entered

Answer 32

higher blood pressure present and increases risk of significant hematoma when entered with a needle arteries spasm affecting blood supply to area

Question 33

most common complication after venipuncture is?

Answer 33

infection, because hands and feet are more exposed, must disinfect area very well beforehand

Question 34

complication with infant heal puncture

Answer 34

- osteomyelitis or osteochondritis can occur, insufficient skin disinfection and penetration of the calcaneus heal bone with lancet blade - if site is too medial ( arch of foot) disruption of longitudinal fat pad that supports nerves and blood vessels can occur - laceration of the posterior tibial nerve or posterior tibial after can result in denervation of the plantar aspect of the footing results in a painful neuroma and negative intrinsic claw toes

Question 35

what is a vascular access device

Answer 35

VAD device inserted into patient to facilitate the removal of blood specimen and the administration of IV fluids and meds. drawing blood from these devices requires special training, techniques and experience, NOT PERFORMED BY LAB

Question 36

CVC

Answer 36

Central venous line (catheter) usually inserted into subclavian vein which is located in chest area below clavicle and covered with a dressing that covers tubing extending from the skin

Question 37

PICC

Answer 37

peripherally inserted central catheter- line inserted into the peripheral venous system with a lead into the central venous system- inserted in arm basilica or cephalic

Question 38

implanted port

Answer 38

small chamber is surgically inserted beneath skin, attached to an indwelling line

Question 39

Heparin lock

Answer 39

device inserted into VAD to enable access for administration of medication and blood collection, device flushed regularly with heparin to ensure clots dont form

Question 40

Cannula

Answer 40

renal dialysis patient VADs tubular device inserted into kidney patients arm or hand and left there, blood samples drawn with syringe and iv fluids can be delivered

Question 41

fistula

Answer 41

renal dialysis patient VADs artificial shunt whereby vein and arty of renal patients arm have been fused together through surgery, may be called vascular graft and used for hemdialysis. not used for blood collection

Question 42

dialysis shunt arm

Answer 42

renal dialysis patient VADs currently or recently had a shunt for hemodialysis and should not be used for blood collection, scarring and blood vessels will be enlarged and noticeable select other arm