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Phlebotomy Ch.11: Lecture 2 (Problems during Collection (failure to…
Phlebotomy Ch.11: Lecture 2
Problems
lack of blood blow
can be caused by a defective tube, missing the vein, improperly positioned needle
intermittent flow indicates improper positioned needle or collapsed vein
always try to reposition or try a new tube before aborting the draw
defective tubes
always examine tubes for cracks and have spares easily accessible
Improper position
the bevel is stuck to vein wall; fix by slightly rotate needle
needle has passed through both sides of vein; fix by slowly pulling back on the needle and watch for blood to come into the tube
needle is not advanced far enough into the vein; fix by slowly advancing the needle and feel for the give of the vein and watch for blood to appear into the tube
vein was missed completely; fix by removing the tourniquet, pull needle out slightly, palpate to relocate the vein, and redirect teh needle
Problems during Collection
collapsed vein
too much vacuum on a small vein
use smaller tubes or try with a syringe
inadvertent arterial puncture
noted because of pulsating, bright red
log the specimen in as arterial because some test values will be altered
failure to collect on 1st try
guidelines allow for 2nd attempt
use a clean needle dand tube
try other arm or go below 1st attempt
if you have tried twice call for another phleb. to help
pt request
refer any pt requests to the nurse
prolonged bleeding
bleeding should stop with in 5 minutes
pts on anticoagulants may bleed longer and require more pressure
hemolysis
the destruction of RBC's results in release of hemoglobin and cellular contents into plasma
serum or plasma will appear red
many test values will be altered
the lab will have to ask for a redraw
Affects Sample Integrity
pt position
the physician may request that a pt lie down for specimen collection
reflux of anticoagulant
backflow of blood from the tube out the needle if last tube is not released before withdrawing needle
anemia
follow your facility policy on frequency and amount of blood that can be drawn
Nerve Damage
Remove needle immediately if pt has any numbness or tingling
use basilic vein as last resort
infection
follow aseptic procedure
pts should leave bandage on for at least 15 minutes post puncture
Causes of Hematoma
Excessive probing to obtain blood
Failure to insert needle into vein
inserting needle through the vein
failure to remove tourniquet before withdrawing needle
inadequate pressure after needle removal
bending the elbow while applying pressure
Comparentment Syndrome
a condition in which pressure with in the inside tissue prevents blood from flowing freely
causes: swelling, pain, may result in permanent nerve damage, burning, numbness, may be followed by paralysis distal to puncture site