Arterial puncture is when the needle in inserted into an artery rather than a vein. Show
This rarely happens and our nurses are trained to deal with this complication: however, it is important that if there are any changes you follow the advice below. If you are experiencing any of the following symptoms:
1: Raise your arm and apply firm pressure. 2: Go immediately to the Accident and Emergency department at your nearest hospital, ask someone to take you or dial 999 and take this information with you. 3: Show the A&E doctor the letter you'll have been given at your donation session - it will look like this leaflet. 4: Continue to raise your arm and apply firm pressure over the site of needle entry on your way to hospital. You must not use this arm to donate blood in the future. BruisingIt is likely that a bruise will appear after this has happened. The bruise may look dramatic and some people can find this worrying, especially if it appears away from the donation area. Bruises will disappear with time but this may take several weeks. It is normal for bruises to spread out before fading. If you do experience a bruise the following advice may help during the first 36 hours after the bruise appeared. Treat your bruise with RICE!Rest - allow time for the bruise to heal. Protect the bruise by avoiding heavy lifting, e.g. at the gym or carrying heavy shopping, and only light, gentle movement is recommended. After 36 hours return to normal activity. Ice - do not place directly on the skin but under a cloth. Compression - pressing on the point where the needle was inserted when a bruise has appeared may reduce the size of the bruise which is forming. Elevation - if possible, raise your arm above the level of your heart when at rest. If you require pain relief take paracetamol (according to manufacturer’s instructions) but avoid aspirin and ibuprofen for the first 24 hours. After 36 hours contrast bathing may help reduce any swelling. This requires putting a cold cloth on the affected area for 10 minutes followed by a warm cloth for 10 minutes and repeating this several times, ending with a cold cloth. Further informationIf you are worried or require further information you can obtain advice by ringing our donor helpline on 0300 123 23 23 BLOOD COLLECTION:ROUTINE VENIPUNCTURE AND SPECIMEN HANDLINGObjectives for the tutorial:
VENIPUNCTURE PROCEDUREThe venipuncture procedure is complex, requiring both knowledge and skill to perform. Each phlebotomist generally establishes a routine that is comfortable for her or him. Phlebotomists are considered to have occupational exposure to blood borne pathogens. The performance of routine vascular access procedures by skilled phlebotomists requires, at a minimum, the use of gloves to prevent contact with blood. Airborne precautions may be considered to provide a level of safety against infectious diseases such as tuberculosis, influenza, and COVID-19. Precautions include a medical grade face mask. With risk for blood spatter a face shield provides protection. A face mask reduces risk for blood culture specimen contamination. Laboratory coats or work smocks are not typically needed as personal protective equipment during routine venipuncture, but an employer must assess the workplace to determine whether certain tasks, workplace situations, or employee skill levels may result in an employee's need for laboratory coats or other personal protective equipment to prevent contact with blood. It is an employer's responsibility to provide, clean, repair, replace, and/or dispose of personal protective equipment/clothing. As part of presenting a professional appearance, an institutional dress code may include wearing of a laboratory coat or smock. Patient identification is critical for safety. At least two patient identifiers, such as name and date of birth, are needed. Label collection tubes after identification of the patient. Interruptions and distractions during medical encounters and procedures should be avoided. Several essential steps are required for every successful collection procedure:
ORDER FORM / REQUISITIONA requisition form must accompany each sample submitted to the laboratory. This requisition form must contain the proper information in order to process the specimen. The essential elements of the requisition form are:
An example of a simple requisition form with the essential elements is shown below: LABELING THE SAMPLEA properly labeled sample is essential so that the results of the test match the patient. The key elements in labeling are:
Automated systems may include labels with bar codes. Examples of labeled collection tubes are shown below: EQUIPMENT:THE FOLLOWING ARE NEEDED FOR ROUTINE VENIPUNCTURE:
ORDER OF DRAWBlood collection tubes must be drawn in a specific order to avoid cross-contamination of additives between tubes. The recommended order of draw for plastic collection tubes is:
NOTE:Tubes with additives must be thoroughly mixed. Erroneous test results may be obtained when the blood is not thoroughly mixed with the additive. Transferring a sample from one collection tube to another or mixing blood from different collection tubes must be avoided. PROCEDURAL ISSUESPATIENT RELATIONS AND IDENTIFICATION: The phlebotomist's role requires a professional, courteous, and understanding manner in all contacts with the patient. Greet the patient and identify yourself and indicate the procedure that will take place. Effective communication - both verbal and nonverbal - is essential. Proper patient identification MANDATORY. If an inpatient is able to respond, ask for a full name and always check the armband or bracelet for confirmation. For an inpatient DO NOT DRAW BLOOD IF THE ARMBAND OR BRACELET IS MISSING. For an inpatient the nursing staff can be contacted to aid in identification prior to proceeding. An outpatient must provide identification other than the verbal statement of a name. Using the requisition for reference, ask a patient to provide additional information such as a birthdate. A government issued photo identification card such as a driver's license can aid in resolving identification issues. If possible, speak with the patient during the process. The patient who is at ease will be less focused on the procedure. Always thank the patient and excuse yourself courteously when finished. PATIENT'S BILL OF RIGHTS: The Patient's Bill of Rights has been adopted by many hospitals as declared by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). The basic patient rights endorsed by the JCAHO follow in condensed form are given below. The patient has the right to:
VENIPUNCTURE SITE SELECTION: Although the larger and fuller median cubital and cephalic veins of the arm are used most frequently, the basilic vein on the dorsum of the arm or dorsal hand veins are also acceptable for venipuncture. Foot veins are a last resort because of the higher probability of complications. Certain areas are to be avoided when choosing a site:
PROCEDURE FOR VEIN SELECTION:
PERFORMANCE OF A VENIPUNCTURE:
PHLEBOTOMY PROCEDURE ILLUSTRATED:
PERFORMANCE OF A FINGERSTICK:
FINGERSTICK PROCEDURE ILLUSTRATED:
ADDITIONAL CONSIDERATIONS:To prevent a hematoma:
To prevent hemolysis (which can interfere with many tests):
Indwelling Lines or Catheters:
Hemoconcentration: An increased concentration of larger molecules and formed elements in the blood may be due to several factors:
Prolonged Tourniquet Application:
Patient Preparation Factors:
REASONS FOR CANCELING A LABORATORY TESTA test that has been ordered may be cancelled due to problems unrelated to drawing the specimen, and these are the most common causes for cancellations:
A test may be cancelled due to a technical problem in the specimen collection process:
SAFETY AND INFECTION CONTROLBecause of contacts with sick patients and their specimens, it is important to follow safety and infection control procedures. PROTECT YOURSELF
PROTECT THE PATIENT
TROUBLESHOOTING GUIDELINES:IF AN INCOMPLETE COLLECTION OR NO BLOOD IS OBTAINED:
IF BLOOD STOPS FLOWING INTO THE TUBE:
PROBLEMS OTHER THAN AN INCOMPLETE COLLECTION:
BLOOD COLLECTION ON BABIES:
HEELSTICK PROCEDURE ILLUSTRATED:
PEDIATRIC PHLEBOTOMY:
COLLECTION TUBES FOR PHLEBOTOMY
ReferencesGiavarina D, Lippi G. Blood venous sample collection: Recommendations overview and a checklist to improve quality. Clin Biochem. 2017;50(10-11):568-573. Kiechle FL. So You're Going to Collect a Blood Specimen: An Introduction to Phlebotomy, 13th Edition (2010), College of American Pathologists, Northfield, IL. Dalal BI, Brigden ML. Factitious biochemical measurements resulting from hematologic conditions. Am J Clin Pathol. 2009 Feb;131(2):195-204. Lippi G, Salvagno GL, Montagnana M, Franchini M, Guidi GC. Phlebotomy issues and quality improvement in results of laboratory testing. Clin Lab. 2006;52(5-6):217-30. Lippi G, Blanckaert N, Bonini P, Green S, Kitchen S, Palicka V, Vassault AJ, Mattiuzzi C, Plebani M. Causes, consequences, detection, and prevention of identification errors in laboratory diagnostics. Clin Chem Lab Med. 2009;47(2):143-53. Occupational Safety and Health Administration, United States Department of Labor. https://www.osha.gov/laws-regs/standardinterpretations/2007-10-26 and https://www.osha.gov/OshDoc/data_BloodborneFacts/bbfact03.pdf (Accessed June 13, 2022). Phelan MP, Reineks EZ, Berriochoa JP, Schold JD, Hustey FM, Chamberlin J, Kovach A. Impact of Use of Smaller Volume, Smaller Vacuum Blood Collection Tubes on Hemolysis in Emergency Department Blood Samples. Am J Clin Pathol. 2017;148(4):330-335. Sanders AM, Agger WA, Gray AM, Fischer CM, Kamprud EA. Use of hair nets and face masks to decrease blood culture contamination rates. Diagn Microbiol Infect Dis. 2019;95(1):15-19. doi: 10.1016/j.diagmicrobio.2019.04.001. Uman LS, Birnie KA, Noel M, et al. Psychological interventions for needle-related procedural pain and distress in children and adolescents. Cochrane Database Syst Rev. 2013 Oct 10;(10):CD005179. doi: 10.1002/14651858.CD005179.pub3. Valenstein PN, Sirota RL. Identification errors in pathology and laboratory medicine. Clin Lab Med. 2004;24(4):979-96, vii. World Health Organization. WHO guidelines on drawing blood: best practices in phlebotomy. https://www.ncbi.nlm.nih.gov/books/NBK138650/pdf/Bookshelf_NBK138650.pdf (Accessed June 13, 2022) And for our furry friends: Joslin JO. Blood Collection Techniques in Exotic Small Mammals. Journal of Exotic Pet Medicine. 2009;18(2):117-139. Which of the following is the best indication that you have accidentally punctured an artery quizlet?Which of the following is the best indication that you have accidentally punctured an artery? A patient complains of marked pain when you insert the needle. The pain radiates down his arm and does not subside.
Which instance may lead you to suspect that you have accidentally punctured an artery?Which instance may lead you to suspect that you have accidentally punctured an artery? The blood pulses into the tube.
Which of the following statements most accurately describes capillary puncture blood?Phlebotomy final test. Which symptoms would a patient with a high degree of jaundice typically have?Signs and Symptoms
Jaundice usually appears first on the face and then moves to the chest, belly, arms, and legs as bilirubin levels get higher. The whites of the eyes can also look yellow.
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