PMLS 2 LEC MODULE 7

• During a venipuncture, failure to initially draw blood may be caused by a variety of procedural errors

  
• Being aware of these errors and knowing how to correct them may determine whether you obtain blood on the first try or have to repeat the procedure
• Needle position


  It is important for the effectiveness of venipuncture to insert the venipuncture needle so that the bevel is correctly located inside the vein

  
• Needle

  • Bevel
  • Penetration depth
  • Angle of insertion
• Troubleshooting a failed venipuncture

  1. Check needle position

  2. Check for collapsed vein

  3. Check tube position

  4. Check tube vacuum
• Needle not inserted far enough

  Blood flow cannot be established

  
• Correcting needle not inserted far enough

  Slowly advance the needle forward until blood flow is established

  
• Needle beside the vein


  Vein may roll away and needle slides to the side
• Correcting needle beside the vein

  Disengage tube, withdraw needle slightly, anchor vein, redirect needle into vein, re-engage tube
• Bevel partially into the vein

  Blood fills the tube very slowly
• Correcting bevel partially into the vein

  Gently push the needle forward into the vein

  
• Bevel partially through the vein

  Blood may leak into the tissue and develop a hematoma
• Correcting bevel partially through the vein

  Pull the needle back slightly until normal blood flow is established

  
• Bevel completely through the vein


  There may be a tiny spurt of blood through the tube, or there may be no blood flow at all
• Correcting bevel completely through the vein

  Slowly withdraw the needle until blood flow is established

  
• Bevel against a vein wall

  Blood flow may be compromised
• Correcting bevel against a vein wall

  Remove the tube from the needle, slightly pull the needle back, force the tube back onto the needle
• Bevel partially out of the skin

  Tube will lose its vacuum and fail to fill with blood
• Correcting bevel partially out of the skin

  Advance the needle slowly until the bevel is under the skin before engaging a new tube
• Undetermined needle position


  Remove the tube, withdraw the needle, palpate the arm to attempt to determine the needle position and vein location

  
• Collapsed vein

  Vein walls draw together temporarily, shutting off blood flow
• Correcting collapsed vein


  Reintroduce pressure by twisting the tourniquet, apply pressure to the vein above the needle, use a smaller-volume tube or pull more slowly on the plunger
• Tube position


  The location of the tube is important, ensure it is correctly seated and the needle has penetrated the tube stopper
• Tube vacuum


  A tube can lose its vacuum if the needle bevel is not completely under the skin, or during shipment and storage
• Correcting tube vacuum


  Try using a new tube if you think the tube has lost its vacuum
• Disassembly of needle from syringe or other devices

  1. Leave the needle cap on the surface and guide the tip of the used needle tip into it using only one hand

  2. Place the needle cap against a firm upright surface with its opening towards the phlebotomist, and place the used needle tip into it

  3. Lift the needle and syringe vertically and, once the tip is covered, use the other hand to fix the cap into place

  
• One-hand scoop technique


  Method for safely removing a used needle from a syringe
• Needle pliers


  Hold the needle with pliers or artery forceps, dislodge the needle by unscrewing or pulling it off, discard immediately into a sharps container
• Needle guard (mushroom)


  Place the cap in the device, insert the needle tip into the cap vertically and turn firmly to fix the needle in the cap, lift the syringe or barrel and remove the covered needle, discard immediately
• Never disassemble an exposed, used needle with your bare hands
• Medical waste


  Special waste from health care facilities that may transmit infectious diseases if improperly treated or handled
• Medical waste disposal procedures

  1. Place biomedical waste in a bag marked with the biohazard symbol and then in a puncture-resistant leak-proof container

  2. Put all sharp instruments like needles, blades, and glass objects into special puncture-resistant containers before placing in the bag and container

  3. Do not transport, recap, bend, or break needles by hand

  4. Dispose of biomedical waste in compliance with recommended procedures like incineration, steam sterilization, burial, etc.

  
• It is not possible to directly discard potentially biohazardous items like blood or blood products and contaminated laboratory waste
• Contaminated combustible waste can be incinerated, contaminated non-combustible waste like glassware should be autoclaved before discarding
• Sharps disposal container


  Immediately after use, the blood-sampling device should be disposed of in a sharp, leak-proof, closable, puncture-proof container that is easily visible and placed within the health worker's arm's reach

  
• Shortage of sharps containers can result in increases in needle-stick injuries due to needle recapping, decanting of used sharps containers, recycling of containers, and overfilling of sharps containers
• Staff may separate a needle and syringe as a cost-saving exercise and discard the two parts in various waste systems
• Blood spillage cleanup procedure

  1. Put on gloves and gown/apron if needed

  2. Use paper towels to mop up liquid from large spills and place in infectious waste

  3. Remove as much blood as possible with wet cloths before disinfecting

  4. Flood the area with a 5000 ppm sodium hypochlorite solution for 10 minutes for cement, metal and other surfaces that can tolerate it

  5. Use a weaker 525 ppm solution and leave it in contact for longer for surfaces that may be corroded or discolored by strong bleach

  6. Prepare bleach solution fresh daily and keep it in a closed container
• Complete an incident report if an individual has been exposed to blood through non-intact skin, mucous membranes or a puncture wound
• Procedure for cleaning up broken laboratory sample

  1. Wear gloves

  2. Use tongs or a pan and brush to sweep up as much of the broken glass as possible, do not pick up with hands

  3. Discard the broken glass in a sharps container or wrap in paper and discard carefully

  4. Use paper towels to absorb as much of the body fluids as possible

  5. Wipe the area with water and detergent until visibly clean

  6. Saturate the area with 0.5% sodium hypochlorite solution

  7. Rinse off the tongs, brush and pan under running water and place to dry

  8. Remove gloves and wash hands thoroughly

  9. Record the incident in the incident book