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Phlebotomy Ch. 11
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- 1Factors that Prevent Access to the Patient~locating patient
~identifying patient
~sleeping or unconscious patient
~presence of a physician, clergy or visitors
~apprehensive patients
~language problems
~patient refusal - 2Problems in Site selection~occuluded (blocked vein)
~hematomas
~edematous tissue
~mastectomies
~areas with rashes, cuts, fresh tattoos, unhealed wounds - 3Difficulty Finding a Vein~always check both arms
~massage arm from wrist to elbow
~dangle arm downward
~apply heat
~use a blood pressure cuff
~use an alternative site such as hand, foot, or leg with butterfly infusion set - 4Hand Collection with WIS~position patients hand and apply tourniquet
~insert needle in the largest straight vein
~anchor vein and insert needle with bevel up
~collect the sample
~finish collection and attend to patient
~sharps in bin - 5Problems Associated with the Cleaning Site~patient is allergic to alcohol
~cannot use alcohol for a blood alcohol test
~do not use povidone iodine for dermal punctures - 6Problems Associated with Tourniquet Application~hemoconcentration: alters the ration of cellular elements in blood
~petechiae: small red spots on the skin
~tourniquet too tight
~latex allergy - 7Complications During Collection~syncope: fainting
~seizure
~pain
~nausea and vomitting
~hematoma
~lack of blood flow
~defective evacuated tubes
~improperly positioned needle - 8Improperly Positioned Needle~bevel is stuck to the vein wall
~needle has passed through both sides of the vein
~needle is not far enough into the vein
~vein is missed completely - 9Complications During Collection~collapsed vein
~inadvertent arterial puncture
~failure to collect on the first try - 10Problems in Completing the Procedure~patient requests: refer any patient requests to the nurse
~prolonged bleeding: bleeding should stop within 5 minutes - 11Factors that Affect Sample Integrity~hemolysis: the destruction of RBC's
~releases hemoglobin & cellular contents into plasma
~serum/plasma will appear red
~will alter tests & labs will have to ask for a redraw - 12Causes of Hemolysis~too small of a needle
~small needle with a large vacuum tube
~too much shaking of tube - 13Factors that Affect Sample Integrity~Patient positioning: dr may request patient lay down for procedure
~Reflux of anticoagulant: backflow of blood from the tube out the needle if the last tube is not released before withdrawing needle - 14Tests Affected by Patient Positioning~cell counts, hemoglobin, protein, albumin, bilirubin, calcium, enzymes, triglycerides and cholesteral
- 15Long Term Complications Associated with Venipuncture~Anemia: follow facilities policy
~Nerve Damage: remove the needle immediately if the patient feels any numbness/tingling
~Infection: follow aseptic procedures, patient should leave bandaid on for at least 15 min - 16Causes of Hematomas~excessive probing to obtain blood, failure to insert needle into vein, inserting needle through vein, failure to remove tourniquet before withdrawing needle, inadequate pressure after needle removal, and bending elbow to apply pressure
- 17Compartment Syndrome~a condition in which pressure within the tissue prevents blood from flowing freely
~causes swelling, pain, and may result in permanent nerve damage
~pain, burning, and numbness may be followed by paralysis distal to puncture site - 18Specimen Rejection~no requisition form, unlabeled or mislabeled specimens, incompletely filled tube, defective tube, collection in the wrong tube, hemolysis, clotted blood in anticoagulanted specimen, contaminated specimens and containers, improper special handling
- 19Specimen Recollection~site not properly cleaned, use of the wrong antiseptic, incomplete drying of antiseptic, powder from gloves, microscopic clots in an anticoagulated specimen, contaminated specimens and containers, improper special handling
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- phlebotomy Fichas sobre Phlebotomy Ch. 11, creado por Kelly-Ann Jordan el 20/06/2019.
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- Kelly-Ann Jordan
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