m7 veni complication

• Pre-examination variables


  • Diet
  • Exercise
  • Stress
  • Smoking
  • Altitude
  • Age and Gender
  • Pregnancy
  • Diurnal Variation
  • Medications
• Diet


  The ingestion of food and beverages alters the level of certain blood components. The tests most affected are glucose and triglycerides. Certain beverages can also affect laboratory tests. Alcohol consumption can cause a transient elevation in glucose levels, and chronic alcohol consumption affects tests associated with the liver and increases triglycerides. Caffeine can affect hormone levels while hemoglobin levels and electrolyte balance can be altered by drinking too much liquid.
• Exercise


  Moderate or strenuous exercise affects laboratory test results by increasing the blood levels of creatinine, fatty acids, lactic acid, aspartate aminotransferase (AST), creatine kinase (CK), lactic dehydrogenase (LD), aldolase, hormones (antidiuretic hormone, catecholamines, growth hormone, cortisol, aldosterone, renin, angiotensin), bilirubin, uric acid, high-density lipoprotein (HDL), and white blood cell (WBC) count and decreasing arterial pH and PCO2.
• Stress


  Failure to calm a frightened, nervous patient before sample collection may increase levels of adrenal hormones (cortisol and catecholamines), increase WBC counts, decrease serum iron, and markedly affect arterial blood gas (ABG) results.
• Smoking


  The immediate effects of nicotine include increased plasma catecholamines, cortisol, glucose, blood urea nitrogen (BUN), cholesterol, and triglycerides.
• Altitude


  RBC counts and hemoglobin (Hgb) and hematocrit (Hct) levels are increased in high-altitude areas such as the mountains where there are reduced oxygen levels.
• Age and Gender


  Laboratory results vary between infancy, childhood, adulthood, and the elderly because of the gradual change in the composition of body fluids. Hormone levels vary with age and gender. RBC, Hgb, and Hct values are higher for males than for females. Normal reference ranges are established for the different patient age and gender groups.
• Pregnancy


  Physiological changes in the body during pregnancy affects some laboratory results including increased in plasma volume. The increased plasma volume may cause a dilutional effect and cause lower RBC counts, protein, alkaline phosphatase, estradiol, free fatty acids, and iron values. The ESR and coagulation factors may also be increased.
• Diurnal Variation


  The concentration of some blood constituents is affected by the time of day. Diurnal rhythm is the normal fluctuation in blood levels at different times of the day based on a 24-hour cycle of eating and sleeping.
• Medications


  Administration of medication prior to sample collection may affect tests results, either by changing a metabolic process within the patient or by producing interference with the testing procedure. IV administration of dyes used in diagnostic procedures, including radiographic contrast media for kidney disorders and fluorescein used to evaluate cardiac blood vessels can interfere with the testing procedures. So, the phlebotomists should be aware of any procedures being performed at the time they are collecting a sample and note this on the requisition form.
• Patient complications


  • Apprehensive Patients
  • Fainting (Syncope)
  • Seizure
  • Petechiae
  • Allergies
  • Vomiting
• Apprehensive Patients


  In cases of apprehensive patients, assistance from the nurse or parent is frequently required when working with children. Phlebotomists also may require nursing assistance when encountering patients in fixed positions, such as those in traction or body casts.
• Fainting (Syncope)


  Is the spontaneous loss of consciousness caused by insufficient blood flow to the brain. This can be triggered by: The sight of blood, Having blood drawn, Fear of bodily injury, Standing for a long period of time, Heat exposure, and Exertion can cause vasovagal syncope.
• Seizure


  It is rare for patients to develop seizures during venipuncture, but if this situation occurs, the tourniquet and needle should be removed, pressure applied to the site, and help should be called.
• Petechiae


  Patients who present with small, non-raised red hemorrhagic spots (petechiae) may have prolonged bleeding following venipuncture.
• Allergies


  Patients are occasionally allergic to alcohol, iodine, latex, or the glue used in adhesive bandages.
• Vomiting


  A patient may experience nausea or vomiting before, during, or after blood collection. If the patient is nauseated, instruct the patient to breath deeply and slowly and apply cold compress to the patient's forehead.
• Equipment assembly


  • Tourniquet Application
  • Hemoconcentration
  • Site Selection
  • Areas to be Avoided
  • Damage Veins
  • Hematoma
  • Edema
  • Burns, Scars, and Tattoos
  • Mastectomy
  • Obesity
  • IV Therapy
  • Heparin and Saline Locks
  • Canulas and Fistulas
• Tourniquet Application


  When dealing with patients with skin conditions or sensitivity and open sores, it may be necessary to place the tourniquet over the patient's gown or to cover the area with gauze or a dry cloth before application. If possible, another area should be selected for venipuncture.
• Hemoconcentration


  Application of the tourniquet for more than 1 minute will interfere with some results, which is why the CLSI set the limit on tourniquet application time to be 1 minute and states that the tourniquet should be released as soon as the vein is accessed. Prolonged tourniquet time causes hemoconcentration because the plasma portion of the blood passes into the tissue, which results in an increased concentration of protein-based analytes in the blood.
• Site Selection


  Not all patients have median cubital, cephalic, or basilic vein that becomes immediately prominent when tourniquet is applied. So, the phlebotomist may have to use variety of techniques to locate a suitable puncture site and palpation of the possible sites may prove beneficial.
• Areas to be Avoided

  • Blood collected from edematous areas
  • Blood collected from veins with hematomas
  • Blood collected from arms containing an IV
  • Sites contaminated with alcohol or iodine
• Damage Veins


  Veins that have been subjected to numerous venipuncture often feel hard (sclerosed) and should be avoided as they may be blocked and have impaired circulation.
• Hematoma


  Presence of hematoma indicates that blood has accumulated in the tissue surrounding a vein during or following venipuncture. Puncturing into a hematoma is not only painful for the patient but will result in the collection of old, hemolyzed blood from the hematoma rather than the circulating venous blood.
• Edema


  Drawing blood from areas containing excess tissue fluid (edema) also is not recommended because the sample will be contaminated with tissue fluid and yield inaccurate test results.
• Burns, Scars, and Tattoos


  Extensively burned and scarred areas, including tattoos, are more susceptible to infection. They also have decreased circulation and can yield inaccurate test results. Veins in these areas are difficult to palpate and penetrate. Tattooed areas contain dyes that can interfere in testing.
• Mastectomy


  Applying a tourniquet to or drawing blood from an arm located on the same side of the body as a recent mastectomy can be harmful to the patient and produce erroneous test results. Removal of lymph nodes in the mastectomy procedure interferes with the flow of lymph fluid (lymphostasis) and increases the blood level of lymphocytes and waste products normally contained. Patients are in danger of developing lymphedema in the affected area, and this could be increased by application of a tourniquet.
• Obesity


  Veins on obese patients are often deep and difficult to palpate. Often, the cephalic vein is more prominent and easier to palpate.
• IV Therapy


  Whenever possible, blood should be drawn from the other arm because the sample maybe contaminated with IV fluid.
• Heparin and Saline Locks


  Are winged infusion sets connected to a stopcock or cap with a diaphragm that can be left in a vein for up to 48 hours to provide a means for administering frequently required medications and for obtaining blood samples.
• Canulas and Fistulas


  Patients receiving renal dialysis have a permanent surgical fusion of an artery and a vein called fistula in one arm, and this arm should be avoided for venipuncture because the possibility of infection.
• Cleansing the site


  • Povidone-iodine
  • Tincture of iodine
  • Chlorhexidine gluconate
• Certain procedures like blood cultures and ABGs, require that the site be cleansed with a stronger antiseptic.
• The most frequently used solutions are povidone-iodine and tincture of iodine or chlorhexidine gluconate for persons allergic to iodine.
• Examination of puncture equipment

  • Pulling the plunger back and pushing forward to ensure it will move freely
  • Examining the needle point for imperfections
• Performing the venipuncture


  When using the syringe, pulling the plunger back faster than the rate of blood flow may cause the walls of the vein to collapse and cause hemolysis. It is important to anchor the hand holding the syringe firmly on the patient's arm so that the needle will not move when the plunger is pulled.
• Technical complications


  • Failure to Obtain the Blood
  • Needle Position Bevel Against the Wall of the Vein
  • Needle Too Deep
  • Needle Too Shallow
  • Collapsed Vein
  • Needle Beside the Vein
  • Faulty Evacuated Tube
  • Collection Attempts
  • Nerve Injury
  • Hemolyzed Sample
• Needle Position Bevel Against the Wall of the Vein


  Often this occurs because the angle of the needle is incorrect; a too shallow angle of needle insertion can cause the needle to lay against the upper wall of the vein and a too steep angle can cause the needle to lay against the lower wall of the vein. Failure to insert the needle with the bevel up also can obstruct blood flow into the needle.
• Needle Too Deep


  When the angle of needle insertion is too steep (> 30 degrees) or while advancing the evacuated tube onto the tube stoppering needle when the holder is not firmly braced against the skin, the needle may penetrate through the vein into the tissue. Blood can leak into the tissues, forming a hematoma. Gently pulling the needle back may produce blood flow.
• Needle Too Shallow


  If the needle angle is too shallow (< 15 degrees), the needle may only partially enter the lumen of the vein, causing the blood to leak into the tissues, forming a hematoma. Slowly advancing the needle into the vein may correct the problem.