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Phlebotomy Ch.12: Lecture 2 (Vascular Access Devices (VAD's)…
Phlebotomy Ch.12: Lecture 2
Geriatric Pt's
physical changes
skin less elastic, layers thinner, and bruising is more likely with veins closer to surface
blood vessels are less elastic and may be narrow
loss of muscle mass leads to "loose skin"
loss of muscle mass allows veins to move if not properly anchored
Common disorders
Hearing Loss
make sure to speak slowly while looking at pt
Difficulty Speaking
due to parkinson's or a stroke; understanding may not be affected
Arthritis
make straightening the arm difficult; always check with pt first
Anticoagulation therapy
increased risk of prolonged bleeding, bruising, and cooperation issues
Dementia or mental/ impairment
can cause identification problems and cooperation issues
Vascular Access Devices (VAD's)
are inserted into vein or an artery and is used to administer med's, fluids, monitor bp, or draw blood
CVC
central venous catheter
are most common
implanted port
has self-sealing septum located under skin, which reduces chance of infection
PICC
peripherally inserted central catheter
located in upper arm and not usually suitable for blood draw aspiration
Arterial Line
inserted commonly in the radial artery for monitoring bp or blood gas testing
heparin lock
temporary line inserted into peripheral vein used to administer med or draw blood
arteriovenous (AV) shunt
artificial connection between a vein and an artery
used for dialysis only
Do Not draw blood/ perform procedure's that could impair circulation from an arm that has AV shunt
external/ cannula
can be used for drawing blood
internal/ fistula
cannot be used for drawing blood and the arm is never used for any phleb. procedure
Drawing from VAD's
use sterile syringes no longer than 20 cc
lines are flushed with heparin or saline
always discard first sample-the amount depends on size of catheter
order of draw
blood cultures
anticoagulant tubes
serum tubes
Blood collecting issues
pt identification due to dementia
always check ID bracelets or get verification from family or staff
limit blood loss; poor circulation may make dermal puncture unsuitable
apply adequate pressure to reduce bruising
warming the site helps locate the vein
anchoring is essential to limit vein rolling
use smaller gauge needles or butterflies
Extended draws for periods of time
use routine venipuncture sites
use smaller gauge needles/butterflies
use alternative sites like hand
always hold adequate pressure after the venipuncture to give veins best chance to repair
Do Not draw from sites that are damaged already
Drawing from pt with IV
if possible draw from other arm
for IV's in both arms, have nurse turn off IV for 2 min
select site below IV and draw off 5 ml discard before collecting specimens to be used for testing
document that blood was drawn below on IV and identify the IV solution
NEVER draw above an IV