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Phlebotomy Ch.11: Lecture 1 (Problems: Cleaning Site (Hemoconcentration…
Phlebotomy Ch.11: Lecture 1
Complications
locating pt
if pt is not in his/her room check at the nurses station
if the pt is in another area and the test is stat/timed you should go to that area
identifying pt
the info on the requisition must match info on armband exactly before drawing blood
resolve any discrepancy before collecting specimen
Do Not draw from a pt without armband
some facilities may also require special armband for blood bank specimens
sleep or unconscious patients
never draw blood from sleeping pt's
gently wake before proceeding
follow procedure and talk to the unconscious pt
they may still be able to hear you even if they can't respond
presence of physician/ clergy
unless it is stat/timed test return at a later time and document
if test is stat/timed announce yourself and wait for permission to enter
presence of visitors
greet visitors as would a pt
you may ask them to step out while you collect your specimen
sometimes family may be helpful if pt is a child
Apprehensive pts
good communication skills can help to put a nervous pt at ease
if you suspect that you may still have difficulty: ask for assistance from family member or nursing staff
language problems
for non-english speaking pts you may need a translator
you may also want to demonstrate to the pt what you are going to do
if pt extends arm, you will know that he/she understands what you need to do
pt refusal
pt does have the right to refuse
try to reason for the refusal
tell pt that tests are needed for tx
if pt still refuses report to nurse and supervisor then document it
Problems: Selected Site
occulated (blocked) or sclerosed veins
veins will feel hard and have no bounce
these veins may be susceptible to infection or produce erroneous test results because of impaired blood flow
Hematomas
can be caused by going through a vein, having the bevel only partly in the vein, or fail to apply enough pressure post puncture
they can obstruct blood flow and thereby after test results if specimen is collected from that area
edematous tissue
arm may be swollen due to accumulation of tissue fluid or from Iv that infiltrated into tissues
collected here can alter test results due to contamination with tissue fluid
burns or scars
these sites are susceptible to infection and may be painful to the pt and difficult to penetrate
mastectomies
collection on the side of the mastectomy can cause lymphostasis or accumulation of lymph fluid if a tourniquet is used on that arm
the pt has higher risk of an infection
avoid areas of disruption in skin: lesions, rashes, recent tattoos, not healed stitches
Finding vein tips
always check both arms
massage the arm from wrist to elbow
dangle arm in downward position
apply heat with infant heel warmer
rotate the wrist to check cephalic vein
use a BP cuff
use an alternative site such as the hand, foot, or leg with butterfly or winged infusion set
Hand collection using a WIS
position the pt's hand and apply the tourniquet
insert needle
choose the largest and straighest vein
anchor the vein with your nondominant hand
insert needle into vein using the wings in an up position with bevel up with a 10-15 degree angle
a flash of blood will appear in tubing when the vein is entered
gently thread needle into the lumen of the vein to stabilize
hold the needle in place with one hand while using the other to handle tubes and collect the sample
Finish collection
release the tourniquet when the first tube is filled
remove the needle and activate safety device
Attend to pt: apply direct pressure to puncture
Dispose of WIS into sharps container if using ETS, dispose of assembly intact
is using syringe- use needleless transfer device to transfer the sample and then dispose of the assembly intact
Problems: Cleaning Site
pt allergic to alcohol may require use of povidone iodine or chlorhexidine gluconate
alcohol is not used to clean skin for a blood alcohol test
DO NOT use povidone iodine for dermal puncture because it may elevate test results
Hemoconcentration
alteration in the ratio of formed elements in the blood
plasma and smaller elements filter into the tissues when the tourniquet is on longer than one minute which leaves a concentration of larger elements in blood
increase values are seen in proteins, RBC's, enzymes, iron, calcium, K, lactic acid
can also be caused by fist pumping, occulated veins, or dehydration
Petechiae
small, non-raised red spots on the skin of a pt with a capillary wall or platelet disorder
by the tourniquet being too tight- pt will complain of numbness or tingling in arm
loosen and begin again
Latex allergy
all pts must be asked whether they have a latex allergy
use non-latex gloves and tourniquet
use non-latex bandages
syncope
fainting
remove tourniquet and needle immediately
apply pressure and document
call for help and stay with pt
Seizures
remove tourniquet and needle immediately
apply pressure and document
stay with pt and call for help
do not put anything in the pt mouth as to cause injury
pain
warn the pt prior to stick
Nausea and Vomit
vomiting= emesis
provide a wet washcloth and emesis basin
Hematoma
swelling of tissue around site as it fills with blood
remove tourniquet and needle immediately apply pressure and a cool compress