Adverse Reactions
This possibly happens if patient is on an anticoagulant therapy and intervention includes applying pressure at site until bleeding stops.
excessive bleeding
Why shouldnt venipuncture be performed on thrombosed veins?
lack resilience (elasticity)
feel much like a rope cord
roll easily
Shouldnt do it here because nerves lie very close to venous network and can easily be injured by needle probing
anterior side of hand/wrist
Blood sometimes stops flowing into the tube before it is adequately filled during venipuncture due to the bevel of the needle being against blood vessel preventing flow, and vacuum in tube too strong causing vein to collapse. What are some interventions to fix this?
repositioning needle slightly.
if thats ineffective you might need to redraw
This is obtained using heparinized syringes, and performed by healthcare professionals who have been specially trained in puncture for it
arterial blood gas checks
This is immediate swelling around site while needle is being inserted, and later will become a large painful bruise. Usually happens when needle bevel is halfway in the vein and halfway in surrounding tissues and blood escapes into surrounding tissues
hematoma
You shouldnt use veins in these areas due to susceptibility to infection
burns
This causes increased chance of infection if performed in arm where axillary lymph nodes have been removed because without lymph vessels to remove fluid, swelling occurs on affected side of body
radical mastectomy
Hemolysis or destruction of RBCs causes inaccurate results in some blood tests, how might this occur?
shaking collection tube vigorously
using needle to small
poor technique
some physiological conditions
These are used for collecting a blood sample for testing hematocrit, is open at both ends, one end filled with a sealant to prevent blood from leaking out and other end left open, blood automatically goes into tube when tube held at a 45-90 degree angle, and after specimen is obtained its placed in a centrifuge to separate blood elements from plasma
capillary tube testing
This intervention includes promoting safety by not letting the pt to fall, having the patient put their head between knees while seated, applying cold compress to back of neck, using ammonia salts under their nose, discontinuing procedure, supporting patient and calling for help. Which reaction is this for?
syncope
This causes difficulty in finding a vein and the specimen may be diluted with tissue fluid which causes inaccurate results
edema
The quality of the lab test depends on technique for specimen collection and the time to lab for processing. What time frame should the specimen be taken to the lab?
transport to lab within 45 minutes and no later than 2 hours
Sometimes if you have a faulty tube or you accidentally push the tube onto the needle prematurely, it might cause a lack of vacuum in collection tube. How can you fix this?
Always carrying an extra tube and exchanging out the faulty tube
Where is another site you shouldnt use for a puncture site and why?
any site with edema or frequently used as swelling may contaminate/alter specimen results
This intervention is adjusting depth of needle to keep it from reaction enlarging, if that doesnt work, remove the tourniquet and needle immediately and applying pressure for 2 minutes. Which reaction is this for?
hematoma
This causes inaccurate test results when its performed ABOVE infusion site
IV Infusion in arm
When is skin preparation done?
before tourniquet is applied
Sometimes the needle will loosen from the holder during blood draw usually to inadequate tightening of the needle into the holder, what are nursing interventions for this?
discontinuing the blood draw, loosening the tourniquet immediately and repeating the procedure
DONT try to reconnect the needle while inside a vein
contaminated specimen
discrepancy between lab requisition and labeled tube
excessive delay in processing specimen
improper transportation
improper collection tube
insufficient quanitity of specimen
outdated and expired equipment supplies or reagents
unlabeled tubes
This can be caused from insufficient blood flow to the brain often caused by hyperventilation and fear of needles, blood, or phlebotomy.
syncope
This causes venipuncture to be difficult or impossible, and may cause decrease in blood in blood specimen amount
scarred veins
What should you do to the tops of collection tubes before using them?
follow facility policy but usually you swab top of culture tubes minimally with alcohol before using
Sometimes the needle wont enter the vein due to rolling veins, vein not anchoring well, needle not inserted deep enough, and holding the needle bevel against the vessel wall. What are possible nursing interventions for this?
redirect needle slightly, but dont probe
discontinue draw and try again
if specimen NOT obtained on 2nd stick, you need to ask another healthcare professional to obtain it, you dont get more then 2 tries
Where should you not perform a routine skin puncture?
central arch areas or posterior curve or infants heel due to risk of nerve injury
fingers in infants less then 1 year of age because you can risk hitting their bone
fifth small finger as you might hit bone
thumb has a pulse
index finger, its highly sensitive