MLSP 2

• Hematoma


  Solid swelling or mass of blood in the tissue caused by the leakage of blood from the vessels during venipuncture
• Obesity


  Condition in which the individual is overweight, making veins deep and difficult to locate
• Heparin or Saline Lock


  Intravenous catheter attached to a stopcock or cap with the diaphragm, providing access to administering medicine or drawing blood from the patient
• Arteriovenous Shunt or Fistula


  A passageway created through surgery to connect an artery and a vein directly, used for hemodialysis treatment or pathological processes
• Problem Areas to Avoid and Troubleshooting in Site Selection

  • Burns
  • Scars
  • Tattoos
  • Damaged veins
  • Edema
  • Hematoma
  • Mastectomy
  • Intravenous Sites
  • Obesity
  • Vascular Access Sites and Devices
• Mastectomy


  Procedure often done to breast cancer patients where blood drawn becomes a challenge due to obstructed lymph flow
• Edema


  Abnormal swelling caused by the accumulation of fluid in the tissues
• Arterial Line

  1. Obtain samples for arterial blood gas and laboratory studies

  2. Critically ill patients require arterial lines where a thin catheter is inserted into an artery
• IV sites should not be used for blood draw if there is an IV device in place
• Blood-sampling device


  Used to collect blood from the arterial or central venous catheter to prevent infections and reduce wastage from line draws
• Pre-analytical Testing

  1. Includes procedures such as laboratory handling and identification, which take place prior to any laboratory testing

  2. Proper control measures are placed to avoid subsequent issues
• Collecting blood from arterial or central venous catheter

  1. Connected to Heparin or Saline Lock

  2. Commonly called "hep-lock"

  3. Intravenous catheter attached to a stopcock or cap with the diaphragm

  4. Provides access to administering medicine or drawing blood from the patient
• Avoiding and Handling Procedural Error Risks and Failure to Draw Blood

  1. Hematoma Formation: Hold pressure over the site immediately after discontinuing the draw

  2. Iatrogenic Anemia: Blood loss due to blood draw

  3. Inadvertent Arterial Puncture: Blood filling up the tube rapidly with rapid formation of hematoma

  4. Infection: Avoided by not touching the sterile area or removing cap just before venipuncture

  5. Nerve Injury/Vein Damage: Improper site selection, rapid needle insertion, blind probing

  6. Reflux of Anticoagulant: Blood flowing back into the vein from the collection tube may cause adverse reactions

  7. Troubleshooting Failed: Improper seating of the tube, failure of needle to go through the stopper

  8. Venipuncture: Various issues like needle not inserted enough, bevel position, vein collapse

  9. Collapsed Vein: Due to strong pressure, tourniquet issues

  10. Tube Vacuum: Loss of vacuum, check bevel and tube condition
• Central Vascular Access Devices (CVADs)


  1. Also known as indwelling lines

  2. Tube is inserted into the main vein or artery for blood collection, monitoring of blood pressure, and administering medications and fluids

  3. 3 types of CVADS: Central venous catheter, Implanted port, Peripherally inserted central catheter
• Intravenous (IV) Sites


  1. The IV line is a thin plastic tube or catheter inserted into a vein in the forearm to inject a volume of fluids into the bloodstream

  2. Phlebotomist should avoid collecting blood from the arm with IV to prevent contamination with IV fluid
• Handling Patient Complications Associated with Blood Collection

  1. Allergies to Equipment and Supplies

  2. Excessive Bleeding

  3. Fainting: Patients prone to fainting during venipuncture are asked to lie down

  4. Nausea and Vomiting: Discontinue until the patient feels better

  5. Pain: If extreme pain or numbness, remove the needle and apply ice

  6. Petechiae: Small red or purple spots appear when tourniquet is applied

  7. Seizures or Convulsions
• Handling patient complications associated with blood collection - Petechiae


  Appearance of small red or purple spots where the tourniquet was applied
• Handling patient complications associated with blood collection - Excessive bleeding

  1. When the patient is on aspirin or anticoagulant, bleeding may take a longer time

  2. Apply pressure to the site until the bleeding stops

  3. Call the attention of authorized personnel if bleeding continues after 5 minutes
• Handling patient complications associated with blood collection

  1. Allergies to equipment & supplies

  2. Excessive bleeding

  3. Fainting

  4. Nausea and vomiting

  5. Pain

  6. Petechiae

  7. Seizures or convulsions
• Handling patient complications associated with blood collection - Nausea and vomiting

  1. Discontinue until the patient feels better

  2. Provide an emesis basin or waste basket and apply a cold damp washcloth to the forehead
• Handling patient complications associated with blood collection - Allergies


  1. When the patient has adhesive allergy, a gauze should be placed over the area and removed after 15 minutes

  2. Alternative is to ask the patient to apply pressure for five minutes

  3. When the patient has antiseptic allergy, use a different antiseptic

  4. When the patient has latex allergy, look for a sign indicating the allergy and use a non-latex alternative for gloves, tourniquet, and bandage
• Handling patient complications associated with blood collection - Seizures or convulsions

  1. Discontinue blood draw quickly

  2. Apply pressure over the site ensuring movement is not restricted

  3. Ensure the mouth is free from any obstruction and the patient is protected from injury
• Handling patient complications associated with blood collection - Fainting


  Patients prone to fainting during venipuncture are asked to lie down during the procedure
• Handling patient complications associated with blood collection - Pain


  If the patient complains of extreme pain or numbness, remove the needle and apply ice to the site as it may indicate nerve involvement
• Hematoma formation is caused by excessive or blind probing, inadvertent arterial puncture, vein is too small, needle perforation has gone all through the vein, needle is not completely inserted, tourniquet is still on when the needle was removed, and the pressure is not adequate
• Latrogenic anemia If 10% of the blood volume is removed from the body, the patient could face a threat
• Blood loss due to blood draw can cause iatrogenic anemia
• Blood is filling up the tube rapidly and there is a rapid formation of hematoma on the site
• Improper site selection, needle insertion, blind probing
• Infection may be avoided by not touching the sterile area or cap is removed just before venipuncture
• Improper seating of the tube and failure of the needle to go through the stopper
• REFLUX OF ANTICOAGULANT Blood that has already drawn flowing bags into the vein from the collection tube may cause averse reaction because of the additives in the tube
• Hematoma formation - Excessive or blind probing -Inadvertent arterial puncture -Vein is too small -Needle perforation has gone all through the vein -Needle is not completely inserted -Tourniquet is still on when the needle was removed -The pressure is not adequate
• 3. Inadvertent Arterial puncture

  • Blood is filling up the tube rapidly and there is a rapid formation ma on the site.

  9. Infection

  • infection may be avoided by not touching the sterile ara or cap is removed just before veni puncture

  5. nerve injury) vein damage

  • Improper site selection, rapid needle insertion, blind probing

  6.Reflux of Anticoagulant

  • Blood that has already drawn flowing back into the vein from the collection tube may cause adverse reaction because of the of tube additives

  7 Trouble shooting Failed

  • Improper seating of the tube and failure of the needle to go through the stopper.
• Collapsed vein

  • strong pressure in the vacuum of the tube or plunger, the tourniquet is too close to the site, or too tight, tourniquet has been removed during the draw
  • strong pressure in the vacuum of the tube or plunger, the tourniquet is too close to the site, or too tight, tourniquet has been removed during the draw Tube vacuum
  • Loss of vacuum make sure that the bevel is not partially out of the skin and the tube is not damaged
• Collapsed rein

  • strong pressure in the vacuum of the tube or plunger, the tourniquet is too close to the site, or too tight, tourniquet has been removed during the draw

  Tube vacuum

  • loss of vacuum make sure that the bevel is not partially out of the skin and the tube is not damaged