Phlebotomy
Potpourri
Potpourri
Term meaning 'all patients, bodily fluids and blood should be treated as potentially infectious.'
Standard precautions
Why must the alcohol be dry before performing venipuncture?
The additive in lavender top tubes and one or more department(s) they are collected for.
K:EDTA, used in hematology, also in blood bank (large lavender), Hgb A1C (central chemistry) and some hospital chemistries (PTH).
What steps should be taken immediately following needle removal?
1. Apply pressure to gauze
2. Engage safety device
In the antecubital area which vein would you choose first, second and third?
Median cubital, cephalic, basilic.
What resource provides the steps to take following an accidental dirty needle stick?
Why is stretching the skin before performing venipuncture useful?
To anchor the vein and thin the skin for less painful and quicker entry.
What does sodium fluoride do to RBCs? Why is this important for lactic acid testing and in certain circumstances glucose tolerance testing?
Sodium fluoride inhibits glycolysis of RBCs. In the absence of O2 RBCs will continue to metabolize glucose anaerobically producing lactic acid. In glucose tolerance testing, if the specimen cannot be spun immediately sodium fluoride tubes may be used to prevent glycolysis, preventing a falsely decreased glucose value.
If a patient refuses to be drawn what steps should be taken?
Outpatient - Use your customer service skills if due to unsuccessful stick and thank them for their time.
Inpatient - Notify nurse or Dr. unable to draw, notate in Antrim. Nursing staff will follow up with patient.
Forcing a patient against their will can lead to assault charges/civil liability!!!
What 3 pieces of information do you assess when palpating for a vein?
Size, depth and direction.
What device is used to sterilize the site of collection for blood culture bottles and why? This device should not be used in which patients? Describe the procedure for each device.
Chloraprep sponge device should be used on patients >2 months old using a 30 sec friction rub. For patients <2 months, a 60 second friction rub with alcohol should be used.
Why must the bevel of the needle be facing up?
Specimens collected in sodium citrate tubes are collected for which department(s)? Name a test for each department.
Coag - PT, PTT, fibrinogen, D-dimer, PFA
Flow cytometry - CD4/CD8, HLA typing, PNH, T-helper-inducer cell
Name 2 ways to minimize movement of the needle while performing venipuncture.
1. Apply pressure against the patient's arm with the hand holding the needle
2. Keep your eye on the needle
3. Use the phalange on the vacutainer holder when engaging/disengaging tubes.
3 ways to make it easier to find a difficult vein.
1. Warm compress
2. Tie tourniquet tighter
3. Rotate wrist
4. Lower the arm/hyperextend elbow
5. Closed fist (not pumping of the fist)
What are the handling requirements for an SS tube, L tube and B tube?
SS: 30 min - 1 hr
L: greater than 1/3
B: fill line
What is the angle of insertion and why?
15-30 degrees, this allows blood to flow more freely and increases the chance of a successful needle stick (increases the distance the needle can travel before exiting the vein).
Specimens in heparin tubes are collected for which department(s)? Name a test for each department.
Special chemistry - Ionized calcium, EtOH, Quantiferon
Cytogenetics - B cell, chromosome analysis
Flow cytometry - leukemia/lumphoma panel
When you have no Antrim labels, what information must be on all tubes?
Outpatient - full name, DOB, date/time of collection and phlebotomist's initials
Inpatient - full name, DOB, date/time of collection, phleb initials and MRN number.
3 reasons you may not be able to perform venipuncture in the antecubital region.
1. Cast or dressing 2. Bruising 3. Edema
4. Scarred or burned 5. Overused vein
6. Above an IV 7. Fistula, cannula or shunt
What is the effect of having a tourniquet on too long?
Hemoconcentration can affect multiple tests (Ca, K, lactic acid).
A patient has a cast on their left arm and an IV in their right arm and must be drawn. What's the best way to get a quality specimen?
Ask the nursing staff to turn off the IV for at least 2 minutes prior to drawing, apply the tourniquet below the IV, try to use a different vein than the one with an IV and document that the sample was collected from an arm with an IV on line 14.
You accidentally draw a lavender tube before an SST tube. How would you proceed?
If you have access to a waste tube you can use it to decontaminate needle then draw the SST tube.
If you do not have access to a waste tube the phlebotomist should stop venipuncture, restick the patient and draw the SST tube.
When do you label your specimens. What steps come after?
After venipuncture and before letting the patient go. Patient must verify information on tube is correct.
Why are veins on the foot our last choice for veinipuncture?
Patients with poor circulation (diabetics) are more prone to thrombosis (clot circulating in blood), which could cause potentially life-threatening pulmonary or coronary embolism.