PMLS LAB EXAM 3 (Winged Infusion Set and ETS)

• Position hand, apply tourniquet, ask patient to close the hand.

  Rationale:

  Proper arm position is important to the comfort of the patient and the success of venipuncture. Support the hand on the bed or armrest. Have the patient bend the fingers slightly or make a fist.

  A tourniquet is necessary to increase venous filling and aid in vein selection. Apply it proximal to the wrist bone.

  A closed hand or clenched fist sometimes makes the veins easier to see and feel.
• Select vein, release tourniquet, ask patient to relax hand.

  Rationale:

  Select a vein that has bounce or resilience and can be easily anchored. Wiping the hand with alcohol sometimes makes the veins more visible.

  Finding a suitable vein can take a while. Releasing the tourniquet and opening the fist allows blood flow to return to normal and minimizes effects of hemoconcentration.
• Prepare equipment and put on gloves.

  Rationale:

  It is easier to select appropriate equipment after the vein has been chosen. Preparing it while the site is drying saves time.

  Attach the butterfly to an ETS holder. Grasp the tubing near the needle end and run your fingers down its length, stretching it slightly to help keep it from coiling back up. Position the first tube in the holder now or wait until after needle entry.
• Reapply tourniquet, uncap and inspect needle.

  Rationale:

  The tourniquet aids needle entry.

  Hold the wing portion of the butterfly between

  your thumb and index finger or fold the wings upright and grasp them together. Cradle the tubing and holder in the palm of your dominant hand or lay it next to the patient’s hand. Uncap and inspect the needle for defects and discard it if flawed.
• Anchor vein and insert needle.

  Rationale:

  Anchoring stretches the skin so the needle enters easily and with less pain, and it keeps the vein from rolling.

  Insert the needle into the vein at a shallow angle between 10 and 15 degrees. A “flash” or small amount of blood will appear in the tubing when the needle is in the vein. “Seat” the needle by slightly threading it within the lumen of the vein to keep it from twisting back out of the vein if you let go of it.
• Establish blood flow and release tourniquet.

  Rationale:

  The flash of blood in the tubing indicates vein entry. Blood will not flow until the needle pierces a tube stopper. Place a tube in the holder and push it part way onto the needle with a clockwise twist. Grasp the holder flanges with your middle and index fingers, pulling back slightly to keep the holder from moving, and push the tube onto the needle with your thumb.

  Releasing the tourniquet allows blood flow to normalize (see step 6).
• Fill, remove, and mix tubes in order of draw.

  Rationale:

  Maintain tubing and holder below the site, and positioned so that the tubes fill from the bottom up to prevent reflux. Fill additive tubes until the vacuum is exhausted to ensure the correct blood-to-additive ratio and mix them immediately upon removal from the holder, using 3 to 8 gentle inversions (depending on type and manufacturer) to prevent clot formation. Follow the If a coagulation tube is the first or only tube collected, draw a discard tube first to remove air in the tubing and assure proper filling of the coagulation tube
• Place gauze, remove needle, activate safety device, and apply pressure.

  Rationale:

  A clean, folded gauze square is placed over the site so pressure can be applied immediately after needle removal.

  Remove the needle in one smooth motion without lifting it up or pressing down on it. Immediately apply pressure to the site with your free hand while simultaneously activating the needle safety device with the other to prevent the chance of a needlestick.
• Discard collection unit.

  Rationale:

  According to OSHA, the needle and tube holder must go into the sharps container as a unit because

  removing a needle from the holder exposes the user to sharps injury.