enumeration

• 8 areas to be avoided

  damaged veins, hematoma, edema, scars, burns, tattoos, mastectomy, patients in iv therapy, obese patients, heparin and saline locks
• 4 potential pediatric venipuncture site

  medial back side of the wrist, dorsum of the foot, scalp, medial ankle
• effects of venipuncture to children

  increased sensitivity to pain, decreased capacity to cope with it, lifelong fear of needles
• 10 challenges in geriatric venipuncture

  skin changes, mental impairment, visual impairment, hearing impairment, arthritis, diabetes, coagulation problems, stroke and parkinsons disease, pulmonary function problems, patients in wheelchairs
• types of patients

  pediatric, geriatric, dialysis, hospice, home care, long-term care
• capillary puncture equipment

  lancets/incision devices, micro-collection containers/microtubes, microhematocrit tubes, capillary blood gas tubes, sealants, stirrers, magnets, warming devices, microscopic slides, plastic caps or closures,
• capillary order of draw

  blood gas specimen, slides, edta specimen, other additives specimen, serum specimen
• general site selection criteria

  warm, pink or normal color, free of cuts, scars, bruises, or rashes, not cyanotic, not infected, not edematous, not a recent previous puncture site
• puncture site should be

  central, fleshy portion of the finger, slightly to the side of the center, perpendicular to the grooves
• neonatal newborn screening

  phenylketonuria, galactosemia, hypothyroidism, cystic fibrosis
• common problems associated with routine blood specimen

  absence of feather, holes in the smear, ridges or uneven thickness, smear too thick, smear too thin, smear too long, smear too short, streaks and trials in feathered edge
• 3 phases of laboratory examination

  pre-examination, examination, post-examination
• 15 physiologic factors affecting the pre-examination phase

  age, altitude, diet, dehydration, diurnal/circadian variations, drug therapy, exercise, environmental factors, fever, intramuscular injection, jaundice/icterus, pregnancy, smoking, stress, sex
• list of problem sites for collection

  edematous area, damaged veins, hematoma, scars, burns, tattoos, mastectomy, obesity, paralysis
• patient complications and conditions

  allergies to supplies and equipment, apprehensive patients, excessive bleeding, fainting spells, nausea and vomiting, pain, petechiae, seizure/convulsion
• procedural error risks

  hematoma formation and bruising, iatrogenic anemia, infection, nerve injury, inadvertent arterial puncture, vein damage, reflex of additive
• causes of nick puncture to the nerve

  improper collection site, inserting the needle too deeply and quickly, excessive or lateral redirection of the needle, blind probing, patient startle reflex during needle insertion
• procedural error and specimen quality concerns

  hemoconcentration, hemolysis, partially-filled/over-filled tubes, specimen contamination, quantity not sufficient, wrong or expired collection tubes
• preexamination phase includes

  patient-related variables, sample collection and labelling techniques, patient preservatives/ anticoagulant, sample transport, processing and storage
• 10 common problems

  misidentifiaction of patient, mislabeling of specimen, short draws/wrong anticoagulant/blood ration, wrong tubes/wrong anticoagulatn, mixing problems/clots, hemolysis/lipemia, hemoconcentration from prolonged tourniquet time, exposure to light/extreme temperatures, impoperly timed specimens/delayed delivery of specimens to the lab, processing errors: incomplete centrifugation, improper storage, incorrect log-in