Lesson 5

• Venipuncture


  Complex procedure that requires both knowledge and skill
• Most important step in venipuncture procedure

  • Proper patient identification
• Essential steps for successful venipuncture collection procedure


  1. Review and accession test request

  2. Approach, identify, and prepare patient

  3. Verify diet restrictions and latex sensitivity

  4. Sanitize hands

  5. Position patient, apply tourniquet, and ask patient to make a fist

  6. Select vein, release tourniquet, and ask patient to open fist

  7. Clean and air-dry the site
• Test requisition


  A form on which test orders are entered
• Types of test requisition

  • Manual
  • Computerized
  • Bar-coded
• Test status or collection priority

  • Stat
  • Med Emerg
  • Timed
  • ASAP
  • Fasting
  • NPO
  • Preop
  • Postop
  • Routine
• Stat


  Immediately (from Latin statim) - test results are urgently needed on critical patients
• Med Emerg


  Same as stat
• Timed


  Collect at a specific time - tests for which timing is critical for accurate results
• ASAP


  As soon as possible - test results are needed soon to respond to a serious situation, but patient is not critical
• Fasting


  No food or drink except water for 8-12 hours prior to specimen collection - to verify patient has fasted and eliminate diet effects on tests
• NPO


  Nothing by mouth (from Latin nil per os) - prior to surgery or other anesthesia procedures
• Preop


  Before an operation - to determine patient eligibility for surgery
• Postop


  After an operation - to assess patient condition after surgery
• Routine


  Relating to established procedure - used to establish a diagnosis or monitor a patient's progress
• 1. Way ID


  The patient's verbal ID statement, a check of the ID band/Identification Bracelets, and a visual comparison of the labeled specimen with the patient's ID band before leaving the bedside
• Latex sensitivity


  Ask patient if he/she has sensitivity to latex
• Tourniquet


  A properly tied tourniquet with the ends pointing toward the shoulder to prevent them from contaminating the blood collection site
• According to the CLSI, when a tourniquet is used during preliminary vein selection, it should be released and reapplied after 2 minutes
• Studies have shown that reusable tourniquets have the potential to transmit bacteria, including methicillin-resistant-Staphylococcus aureus
• Edema


  Water retention - may cause diluted blood
• Cyanotic areas


  Areas with lesser oxygen
• Scarred areas


  Thinner area, stretchmarks - collagen is ruptured
• Burned or tattooed areas


  May cause infection
• Heavily calloused area


  Area to be avoided for venipuncture
• Traumatized areas or site with hematoma


  Area to be avoided for venipuncture

  
• Sclerosed or thrombosed veins


  Example: varicose veins - area to be avoided for venipuncture
• Intravenous lines in both arms

  Stop IV fluid for 10-15 minutes but don't remove - extract in lower than IV line

  
• Arms with arteriovenous shunt or fistula


  If extracted here, sample will be a mixture of artery and venous blood

  
• Cast/s on arm/s


  Area to be avoided for venipuncture
• Mastectomy


  Removal of breast - left breast is surgically removed, then don't extract blood on left arm because breast has a lot of lymph nodes
• Lymph nodes


  Filters bacteria or virus flowing in blood stream, house of WBC, expands and asks help from WBC - decreased levels of RBC if extracted in this area
• Hematomas


  Area to be avoided for venipuncture

  
• Arteriovenous shunt/fistula


  Area to be avoided for venipuncture
• Patient's arm with an intravenous (IV) line

  Area to be avoided for venipuncture

  
• Procedure for vein selection

  1. Palpate & trace path of veins with index finger

  2. If a suitable vein cannot be found, massage the arm from wrist to elbow and apply warm, wet towel to the site for a few minutes
• Cleaning the venipuncture site

  Clean the site with a circular motion, starting at the point where you expect to insert the needle, and moving outward in ever-widening concentric circles until you have cleaned the entire area
• BC


  • Decreased levels of RBC if extracted in this area
• HEMATOMAS


  Decreased levels of RBC if extracted in this area
• ARTERIOVENOUS SHUNT/FISTULA


  Decreased levels of RBC if extracted in this area