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phlebotomy , lesson 3 phlebotomy, Venipuncture complications, phlebotomy…

- - - - x rays
      - computed tomography CT scans
      - magnetic resonance imaging MRI scans
  - - - arterial punctures for arterul blod
  - - - thread through the blood vessel to the heart
  - - - uses x rays and high energy radiation to destroy tumors
  - - - to diagnose treatment and prognosis are determines from results
- - - - dirests the administrative functions of the laboratory
    - - direct or coordinate other functions
    - - collect specimens, run toutine tests and perform equipment maintanence
  - - - examines specimens for the presence of cancer or other diseases
    - - prepares tissues for microscopic extermination by a pathologist
    - - examines specimens for evicende of genetic disease
  - - - identifuies pathogenc organisms in specimens
- - - - hospital adminiatrator oversees the central administration
      - medical director and chief of staff oversee physicians and medical staff
  - - - cleaning
      - maintanience
      - security
      - food service
  - - - RN nursec
      - LPNs licensed practical nurse
      - PCT
        
        patient care tech
        
        unit clerk
  - - - cardiac catherterization
      - nuclear medicine
      - occupational therepy
      - pharmacy
      - physical thermpy
      - respiratory servicfdes
      - radiation therepy
      - radiology and radiology imaging
- - - - held to high standards to ensure the safety and confort of the patient.
  - - - technical knowledge
    - - good personal skills
  - - - adhere to safety and infection regulations
- - - - before calling for assistance
    - - safeguard the patients privacy
- - - - perform skills and efficietly
      - does not require supervision
    - - unquestined honedstyl and integrity are crucial
      - admitting errors is vital for the health and safety of patients
    - - if displayed toward the job can make others more positive
      - can be benificial to pateints and families
    - - be sensitive to patents concerns
      - take time to reassure anxious patients to decrease their stress
    - - besoming emotinally involved does not help patients
      - can lead to stress and burnout for the phlebotomist
      - be sympathetic and understanding
    - - affects hoe the phlebotomist is viewed
- - - - needle holder
      - double sided safety needle
      - blood collection tubes
      - gauze
      - requisition
      - alchohol preep pad
      - tourniquet
  - - - patient demographics
      - test ordered
      - test status
      - providers name
      - billing info
- - - - small laboratory found within the providers office
        
        draw blood and obtain specimens
        
        perform simple testing procedures
    - - travel
- - - - irritant contact dermatitis is a reaction to directskin contact
      - life threatening anaphylaxis in which the airway swells shit, heart rate increases, and blood pressure drop
      - food and drug administration requires labeling to indicate latex
    - - latex sensitive wear a medical alert bracelet
      - patients should also be asked about any reactions to chestnuts and fruits such as bannanas , kiwi, and avacados
- - - - alert emergency personnel if there is no responce
  - - - continue pressure until medical assistance arrives
  - - - call for professional help
      - keep the victum lying down, with legs elevated f no fracture is susspeted
      - with vommiting keep airway open byy sweeping out mouth while head is turned to side
      - keep victum warm
- - - - microorganisms are organisms that can only been seen umbder a microscope
    - - more serious infections
      - lower resistance to infection
      - noncocomial infections contracted in the hospital setting
    - - infection agents carried in blood bodily fluids and tissues
      - bloodborne exposure
        
        accidental needlestick
        
        contact with mucous membranes
        
        contact with contaminated equiptment or surfaces
        
        droplet transmission
      - chain of infection
        
        infection spreads following chain of infection
        
        break the chain and the infectious process is broken
        
        six components in chain
        
        1 infectious agent or miroorganism
        
        patients wound infection
        
        2 reservoir
        
        ptient with wound
        
        3portal of exit
        
        wound opening
        
        4 mode of transmission
        
        debris on phlebotomists ungloved hand
        
        5, portal of entry
        
        small cut on phlebotomists hand
        
        6 susceptible host
        
        the phlebotomist
        
        means of transmission
        
        contact
        
        most frequent
        
        direct or indirect
        
        droplets
        
        particles from a source
        
        larger and propelled a short distance
        
        airborne
        
        nuclei of droplet
        
        dust particle
        
        common vehicle
        
        contaminated food or water
        
        contaminated equiptment
        
        vector
        
        mosquito carryin malaria
        
        tick carrying lyme disease
  - - - standard percautions
        
        hand hygiene
        
        use of PPE
        
        use of sharps sontainers
        
        respiratory hygiene
        
        cough etiquette
    - - existing potential exposure
      - engeneering and practice controls
      - hepatitis B vaccine
      - post exposure follow up
      - training and communication
      - record keeping
      - evaluation of accidental exposures
    - - wash hands with antimicrobial soap
      - use alcohol based sanitizer
      - hand hygiene
        
        before and after entering patients room
        
        before an after gloving
        
        before procedures
        
        after removing PPE
        
        anything that provides a barrier
        
        fluid resisitant gowns or labcoats
        
        masks
        
        respirators
        
        face sheilds
        
        goggles
        
        shoe covers
        
        gloves
        
        large droplet exposure fluid impermeable gon gloves and mask
        
        blood or body fluid splash potential goggles and mask
        
        airborne exposure N95 masks or respirators
        
        x=change
        
        when soiled or after contact with potentially infectious material
        
        never cut the finger tips off
        
        after contract with contaminated equipment
        
        before and after break
        
        before leaving the laboratory
        
        after shift
- - - - if normal status then wait till later
  - - - in not stat or timed test, return later
        
        if stat or timed introduce yourself and respectfully state reason for interuption
    - - for all test folow the same procedure
    - - leave room if physician arrives unless stat or timed test
    - - ask for a few minutes to complete draw
- - - - butterfly needle
  - - - blood seeping under tissue or skin
        
        stop and chose different puncture site
        
        caused by needle going through or not far enough ion vien
        
        insufficient pressure on site
        
        excessive probing with needle
    - - swelling
  - - - cold dampo and clammy skin
      - beeds of sweat on forheadd
    - - remove the needle and tourniquet
      - apply pressure on site
      - have a patient lower head between their knees
  - - - remove the needle and tourniquet
      - apply pressure to site
      - follow facility protocol
    - - provide emesis basin
      - ask patient to breath slowly and deeply
  - - - defecive tube
      - improper position of needle
      - collapsed vein
      - what to do?
        
        use a new tube
        
        gently advance or retract the needle and redirect
        
        only repea blood drawonce with new needle and tube
        
        may need to be completed on opposite arm using butterfly or syringe
    - - puncture of artery
      - anticoagulation therapy
      - what to do?
        
        if ertery is punctured complete the draw
        
        apply pressure for 10 minutes
        
        mark sample as srterial blood when applicabe
        
        apply pressure for 5 minutes or longer for patients on anticoagulation therepy
- - - - invert tubes gently
      - do not shake
      - pull back syringe plunger slowly and carefully
      - use proper supplies and equipment
    - - affects sample integrity
      - can result from lwaving tourniqut in place for longer than 60 seconds
      - can cause higher than normal potassium
  - - - low hemoglibin and hematocrit
      - caused by repeat blood tests
    - - bleeding into surrounding tissue
        
        occure with ehemophilia or coagulation therepy
    - - needle contacts nerve
      - idicated by shooting pain or numbness in arm
    - - caused by lack of aseptic proceduresk
- - - - patient identification
        
        two methods required
        
        include spelling of name
        
        caregiver or family member may provide
      - vein selection
        
        antercubital fossa veins are priority
        
        sites that may not be used
        
        lateral or palmor surface of wrist
        
        infected site
        
        arm with fistula
        
        limbs on same side as mastectomy
        
        lower extremities
      - sites to avoid
        
        extensive scarring or healed burnes
        
        hematoma
        
        above or below IV or VAD
        
        inflammed sites
        
        inflamed tattooe
        
        edematous sites
        
        extermites affected by stroke or injury
      - cleaning puncture
        
        use back and forth friction
        
        use pad with 70% isopropyl alcohol
        
        alcohol disinfects area
        
        some tests prohibit alcohol use
        
        consult local policy
      - blood pressure cuff
        
        used as tourniquet
        
        requires training
        
        check patients blood pressure
        
        inflate cuff to below patients diastolic pressure
        
        blood pressure 120/80
        
        inflate cuff to 70 mmHg
      - anchoring a vein
        
        use thumb of non dominant hand
        
        draw the skin taut to anchor 1-2 inches below puncture site
        
        ensure thumb does not impede needle insertion
        
        using finger above vein can lead to accidental needlestick
      - making a fist
        
        may kae vein more prominent
        
        do not pump the fist
        
        elevated blood potassium oncentration
      - accidental puncturing an artery
        
        stop procedure immediately
        
        remove tourniquet
        
        apply direct forceful pressure for 5 minutes
        
        notify nursing staff or physician
        
        suspected arterial puncture
        
        rapid forming hematoma
        
        bright red blood surgars into tube
      - labeling the specimen
        
        perform in front of patient
        
        compare labels to ID band and show labled specimens to patient
        
        proper labeling is critical
- - - - strip of latex or non latex
        
        used to find vein
      - dispose of single use only
        
        only exeption is if starilized
      - never leave in place for moere than one minute
  - - - used to clean living tissue
      - 70% isopropyl alcohol is commonly used as antiseptic
  - - - blood cultires
      - arterial punctures
      - alcohol levels
    - - chlorhexidine gluconate
      - benzalkonium chloride
    - - do not fan or blow on the area
      - remove tourniquet while drying
- - - - larger used in blood bank 16-18 gauge
        
        smallest needles 23 gauge used for small fragile veins
      - larger the number the smaller the diameter
  - - - elderly or pediatric patient
- - - - blood tyoe
      - blood count
      - horemone levels
      - metal levels
  - - - sodim
      - potassium
  - - - complete blood count CBC
      - prothrombin time PT
  - - - aticoagulants prevent clotting
      - EDTA prevents platelets from clumping
      - clot activators promote blood clotting
    - - serum separator tubes SST contain a polymer gel
      - separates plasma from serum
      - do not use expired tubes
      - dispose of in biohazard container
    - - pale yellow topped sterile tubes always draw first
        
        used for blood cultues
        
        additives is SPS which is an anticoagulant
        
        whole blood specimen is inverted 8-10 times
      - light blue topped tubes draw next
        
        used for coagulation studies
        
        additive is sodium citrate which is an anticoagulant
        
        plasma specimen is inverted 3-4 times
      - red topped tubes draw next
        
        used for serum and chemistry
        
        no chemical additive
        
        serum specimen is inverted 5 times
      - gold or red-grey toped tubes are drawn next
        
        used for serum tests
        
        contains silicone to enhance clot fomation
        
        serum separator tubes SST are inverted 5 times
      - green topped tubes drawn next
        
        used ofor STAT and chemistry tests and can be used for arterial blod gases ABG
        
        additive is heparin which s anticoagulant
        
        plasma specimen is inverted 8-10 times
      - lavender topped tube drawn next
        
        used for hematology tests
        
        aditive is EDTA which is anticoagulant to prevent platlets from slumping
        
        whole blood speciment in inverted 8-10 times
      - grey topped tubes are drawn last
        
        used for chemistry tests especially glucose tests lactic acid measurements and alcohol levels
        
        additives are potassium oxalate of sodium fluoride and potassium oxalate or heparin
        
        inverted 8-10 times
    - - whole blood
        
        yellow lavender tubes
      - serum
        
        red, red speckled and gold tubes
      - plasma
        
        blue, green, and grey
  - - - yeloow green, lavender, grey
    - - red, red spekled tubes
    - - light blue tubes
    - - yellow
      - light blue
      - red
      - gold red speckled
      - green
      - lavander
      - grey
      - yolanda loves red golden grapes like gary
- - - - ahort tunr around time
      - state doe immediatly
      - fasting or times test
  - - - names
      - dob
      - hospital ID nunmber
- - - - introduce yourself
      - identify patient
      - verify preparation in applicable
      - explain the procedure and get verbal concent
      - apply touniquet
      - select site by palation
      - remove tourniquet if longet than 60 seconds
      - select supplies
      - apply gloves
    - - used for fragile veins
      - controlled blood draw
      - blood transfer device used