M5

• The tourniquet should be placed 3 to 4 inches from the intended site.
• never apply a tourniquet over an open sore.
• In reviewing the request, the phlebotomist must

  (1) check the completeness of the required information,

  (2) verify the tests to be collected including information such as the time and date of collection,

  (3) take note of any diet restrictions or special conditions that should be followed before the actual collection,  and

  (4) determine the test status or priority of collection.
• accessioned which means that the specimen to be collected is assigned a special number that will serve as the reference number for all associated processes and paperwork.  
• Status designations

  • status priorities and procedure for each status designation
• During fasting the patient may be allowed to drink water to avoid dehydration.
• when the patient is prone to fainting, he is placed in a reclining chair, sofa or bed
• When the phlebotomist has found a vein, he should roll his finger from one side to the other to gauge its size
• Using your fingers, trace the path to determine a possible entry point.
• 1. A properly tied tourniquet has its ends pointing toward the shoulder.
• The venipuncture site should be cleaned using an antiseptic, such as 70% Isopropyl alcohol, to prevent infection or contamination. The area should cover about 2 to 3 inches diameter using a circular motion, and moving outward in concentric circular motion.
• The age of the patient, volume of blood for collection, and the size and location of the vein are factors considered in choosing the system, needle size and volume of the tube that will be used. 
• Anchor the antecubital vein by holding the patient's arm with your free hand. The fingers support the back of the arm just below the elbow. Place the thumb at least 1 to 2 inches below, but slightly on the side of the site of venipuncture, and pulling the skin towards the wrist.
• Pediatric Puncture involving children below two years old-minimize pain and trauma of the patients,& should be limited to superficial veins only. 
• challenges faced when dealing with pediatric patients

  • veins that are usually small and underdeveloped
  • considerable risk of damage could be permanent if proper procedure is not followed
  • risk of anemia.
•    Eutectic mixture of local anesthetics (EMLA) are used for pain interventions.
• EMLA comes in cream and oral form and takes about an hour to take effect and anesthetize the area.
• Several ways to restrain the movement of the patient:

  • infants are wrapped in the blankets
  • toddlers are usually held in the parent's lap
  • children: a second person usually leans over the child who is in lying position.
• Geriatric Venipuncture. Elderly patient needs special attention because they may have special conditions such as arthritis, hearing, visual and mental impairment.
•    The elderly have thinner skin and smaller muscles which causes the veins to roll easily and prone to collapse during the procedure.
•  Dialysis Patients-may request that the dorsum of their hands be used for venipuncture to preserve veins of the arms for hemodialysis access.
• DIALYSIS PATIENTS

  The phlebotomist should comply and select another site other than the arm used with arteriovenous (AV) fistula.
•  Long-term care services

  • provided to patients who cannot perform regular daily activities due to their health condition.
  • could be in their private homes or in community-based rehabilitation facilities.
• Home-Care Patients

              Home health services are for patients who need medical attention and assistance from the health professionals from time to time. 
• Hospice Patients

              Hospice care is for patients that need end-of-life care, wherein most have a prognosis of six months or less.