PHLEB LEC ( venipuncture, pre-analytical, capillary )

• process of collecting or “drawing” blood from a vein and the most common way to collect blood specimens for laboratory testing


  VENIPUNCTURE
• most important step in venipuncture

  patient identification
• STEP 1 in venipuncture

  REVIEW AND ACCESSION TEST REQUEST 
• the first step for the laboratory in the pre-analytical (before analysis) or pre-examination phase of the testing process

  REVIEW AND ACCESSION TEST REQUEST
• the form on which test orders are entered

  requisition
• A thorough ___ helps to avoid duplication of orders, ensures that the specimen is collected at the right time and under the proper conditions, and identifies special equipment that may ber equired.

  review of the requisition
• the process of recording in the order received

  Accession
• The phlebotomist should arrange the requisitions according to priority and review them to see that needed equipment are ready before approaching px room

  APPROACHING THE PATIENT 
• ID discrepancies

  px nurse should be notified
• Missing ID

  put on ankle or IV pole
• Sleeping px


  wake the person gently
• Unconscious px


  ask relative to identify px 
• AABB means

  American Association of Blood Banks
• Explaining the procedure

  statement for intent to collect a specimen
• (some) allow phlebotomist to tell the test to be performed

  Addressing px inquiries
• aware of test

  bedside testing
• remind them of doctor’s orders. If persists, write on requisition form that the px refused

  Handling px objections
• Handling difficult px


  remain calm and professional and treat the px in caring manner
• Addressing needle phobia

  treat w/ empathy and special attention
• Addressing objects in px mouth

  objects in the mouth can cause choking
• Tourniquet applied __ in above puncture site

  3 to 4
• Preferred site in venipuncture

  antecubital area of arm
• antecubital area of arm involve the ff:

  median, cephalic, and basilic
• Clean with a circular motion and moving outward in ever widening ___

  concentric circles
• Clean with a circular motion and moving outward in ever widening concentric circles approximately ___

  2 to 3 inches in diameter
• dry the site for ___

  30 to 1 minute
• Anchor the vein using non-dominant hand and place a thumb ___

  1 or 2 inches below anchor site
• to stable the vein and less pain

  anchor
• Insertion

  bevel of the needle should be facing up
• Angle for insertion

  15 to 45 degrees
• After __, remove toruniquet

  1 minute
• Apply pressure to the site for ___ until bleeding stops

  3 to 5 mins
• venipuncture in children under age of 2 should be limited to ___ and not deep, hard-to-find veins

  superficial veins
• most accessible in children

  veins of the antecubital fossa and forearm
•  is a procedure in which patients whose kidneys do not function adequately have their blood artifically filtered to remove waste products.

  Dialysis
• Do not use arm with __ for venipuncture

  AV fistula
•  is a type of care for patients who are terminally ill. It allows them to spend their last days in a peaceful, supportive atmosphere that emphasizes pain management to help keep them comfortable.

  Hospice