Книга_3777_Библиотеки_им_академика_М_И_Перельмана

CHAPTER 4 Blood Collection Equipment

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Figure 4-11 Microcollection tubes. See color insert.

Figure 4-12 Unopette blood diluting unit. See color insert.

Delmar/Cengage Learning

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PART 2 Blood and Urine Collection

SUMMARY

One of the most important tasks for the phlebotomist is to learn how to use blood-drawing equipment properly. Experience will help the phlebotomist to choose the right equipment for each patient’s unique situation. Phlebotomists will continually be exposed to re ned equipment that can be utilized to get the best specimen with the least amount of trouble for the patient.

REVIEW ACTIVITIES

1. Gauze is made of ______________________________________

_____________.

2. Gauze should be placed on the ______________________ rather

than on another surface when preparing to perform a venipuncture, in order to _______________________________________ ___________________________.

3. A tourniquet is used to __________________________________

_____________.

4. A tourniquet should be cleaned and decontaminated frequently

because ______________________________________________ ____________________.

5. Alcohol preps are used to ________________________________

_____________.

6. The size of the needle for a venipuncture is chosen based on

_____________________________________________________ ___________________.

7. The three types of needles used most often by the phlebotomist

are: a. b. c.

8. The two parts of a syringe are:

a. b.

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CHAPTER 4 Blood Collection Equipment

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9. Identify the additive in the following color-coded collection

tubes: a. Lavender b. Blue c. Green d. Red-brown e. Gray f. Pink g. Yellow

DISCUSSION QUESTION

1. You go to Room 606 to draw the patient in bed 1. You also have

lab orders to draw the patient in bed 2. The patient in bed 1 is an 80-year-old male with very small, fragile veins. The patient in bed 2 is a 20-year-old male with large, healthy veins. Why is it important to know the function and qualities of the equipment in your collection tray?

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“Our highly sophisticated

and well-controlled

laboratory technology is

useless if the specimens

presented for analysis

are already riddled with

error because of faulty

identi cation or poor

collection techniques.

Proper specimen collection

and specimen handling are

of the utmost importance,

for today, errors are

more likely to occur in

these areas than during

the laboratory procedure

itself.”

—National Committee

for Clinical Laboratory

Standards (1989)

Collection by Routine Venipuncture

After studying this unit, it is the responsibility of the learner to be able to:

1. Organize a workload by stat, timed, ASAP, and routine orders.

2. Explain the importance of accurately identifying the patient.

3. Write the process for patient identi cation for outpatients and

inpatients.

4. Describe the process taken should the patient not have an inpatient or

outpatient identi cation armband.

5. Demonstrate the positioning of the patient for venipuncture.

6. Demonstrate and explain the process of venipuncture site selection.

7. Demonstrate appropriate venipuncture technique on an injectable

training arm.

8. Demonstrate appropriate venipuncture technique on a fellow student.

9. List the appropriate order of draw when using the evacuated collection

system.

10. List the rationale for each step of the venipuncture procedure.

11. Demonstrate on an injectable training arm the appropriate steps in

performing a venipuncture with the butter y winged infusion set.

12. List the appropriate order of draw when using the syringe/butter y

collection.

13. Explain the rationale for using a butter y/syringe rather than the evacuated

collection system.

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antecubital in front of the elbow

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ASAP as soon as possible

aseptic free from infection

basilic vein prominent vein of the forearm

located on the inside edge of the antecubital fossa

cephalic vein prominent vein in the forearm

utilized for venipuncture

edematous swollen due to an accumulation of

excess  uid in the tissue

hematoma a swelling or mass of blood, usually

clotted, in an organ or tissue, caused by a ruptured blood vessel due to injury

hemoconcentration increased localized blood

concentration of molecules such as cells, proteins, and coagulation factors

lymphostasis lack of  uid drainage in the lymph

system; stoppage of lymph  ow

median cubital vein vein in the antecubital area

that is most commonly used for venipuncture

routine collection orders collected per individual

laboratory policy

stat at once, immediately; from the Latin statim

thrombosed occluded, or blocked, by a blood clot

timed collection orders collected at a speci ed

collection time

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V

PART 2 Blood and Urine Collection

enipuncture is the most frequently used method for obtaining a

blood sample for diagnostic testing. Because test results are highly

dependent on the quality of the specimen, the phlebotomist must

perform the venipuncture procedure at a high level of skill. In

addition to providing the laboratory with high-quality blood speci-

mens, the phlebotomist must also deliver a high-quality venipunc-

ture to the patient. The procedure must be performed so as to

cause minimal trauma to the patient.

This chapter will cover the procedure involved in collecting a blood sample by performing a routine venipuncture. A routine venipuncture assumes that the blood will be drawn from one of the three prominent veins in the the elbow; the median, the

phalic

lection system or the syringe/butter y collection system. Because venipuncture is an invasive procedure, it must be performed in an

aseptic manner, free from the possibility of infection.

and demonstrate expertise in venipuncture technique at all times. Because the student will experience a learning curve, the  rst several venipunctures may be unsuccessful. The venipuncture may not produce a blood sample, the needle may come out of the puncture prematurely, or a hematoma may be produced. These complicating factors will be addressed at the conclusion of the chapter.

hands-on, experience that will provide the phlebotomist with the opportunity to become pro cient in performing blood collections by venipuncture. Venipuncture is a skill, and it must be practiced.

tures under the guidance of an instructor. An injectable training arm is an excellent tool to use when attempting the  rst few venipunctures. It allows the phlebotomist to practice tying the tourniquet, to become familiar with handling the equipment, and to commit to memory the steps in the collection process. Once phlebotomy students feel comfortable with the injectable arm, they may progress to practicing on a fellow student or an instructor. After an appropriate skill level is reached, the phlebotomy

veins. The veins will be punctured using the evacuated col-

The phlebotomist must collect high-quality blood samples

While classroom instruction is necessary, it is empirical, or

The phlebotomy student should perform all initial venipunc-

antecubital area which is in front of

median cubital, and the median ce-

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CHAPTER 5 Collection by Routine Venipuncture

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99

student may have the opportunity to obtain blood from a patient under an instructor’s guidance.

As previously mentioned, it is very important that the patient receive a venipuncture that is performed in an efficient, aseptic, and relatively painless manner. The preliminary steps to performing the puncture are important and must be carried out in a consistent manner.

ORGANIZATION OF WORKLOAD

Prioritize Orders

Collection orders are usually prioritized according to stat, timed, ASAP, and routine orders. Should the phlebotomist have multiple collections to perform, the orders must be placed in the proper order of collection.

Stat, or urgent, orders are to be collected immediately and the specimens

delivered to the lab immediately. Stat orders have priority in collection over all other orders. They will always be drawn  rst. orders must be collected as close to the speci ed collection time as possible. After stats, timed collections are ranked next in priority designated

ASAP

(as soon as possible) should be given third priority.

Routine collections receive last priority, and should be collected per

individual laboratory policy

.

Timed collection

. Orders

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Review the Collection Requisition

Before greeting a patient or entering a patient’s room, review the collection order for the name of the patient, the test(s) ordered, the collection priority, and additional collection instructions or comments. Being prepared beforehand will establish an atmosphere of con dence. Check the collection tray or your work area beforehand as well as the patient’s room to make sure the appropriate equipment is available. Be sure to check for special comments on the collection order or for posted instructions in the patient’s room. Being alert to special considerations concerning the patient’s condition (for example, the patient who may be blind, deaf, or unable to speak English) will help you to be more sensitive to the patient’s needs. It will also allow you to appear more professional and well prepared.

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PART 2 Blood and Urine Collection

INTERACTING WITH THE PATIENT

Greet the Patient

Address the patient with a pleasant tone of voice and a smile. Introduce yourself by  rst name. In a hospital setting, state your purpose in being in the patient’s room. If the patient is sleeping, attempt to wake the patient up before you continue with the collection process. The patient may ask questions concerning the tests that have been ordered. Instruct the patient to direct such questions to the physician. If the patient should be unconscious, always address the patient using the same manner and protocol as if he were awake.

Identify the Patient

Absolute identi cation of the patient is mandatory for every collection. You must ensure accurate identification of the patient and the blood samples throughout the collection process. Failure to do so may result in serious consequences for the patient.

Inpatients

Compare the patient’s identi cation bracelet with the collection order form. Compare the patient’s name, identification number, and date of birth. The identi cation bracelet must be attached to the patient’s body. A bracelet taped to the bed is not suf cient. Report any discrepancies or any patients without bracelets to the appropriate person. Do not collect any blood samples until the patient has been absolutely identi ed.

Outpatients

Ask the patient to state his or her name and birth date. Compare the stated information with the collection order form. Report any discrepancies to the appropriate person. Do not collect a blood sample until discrepancies have been corrected. Some health care facilities issue the patient a temporary identi

cation armband. Verify that the armband contains correct information.

Unidenti ed Emergency Patients

A temporary means of identifying the patient must be established. The temporary identi

cation must be attached to the patient’s body

. Do not collect any blood samples until some identi cation has been attached to the patient.

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CHAPTER 5 Collection by Routine Venipuncture

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Verify Diet Restrictions and Time Requirements

Some tests have requirements, such as fasting or a special diet prior to collection of a blood sample. A timed collection should be collected at the speci ed time. Should any of the diet or time requirements be neglected, accurate test results will not be ensured. Do not collect a blood sample if such requirements have not been met. Report discrepancies to the appropriate person. Should a decision by the appropriate person be made to collect a specimen even though the specimen requirements have not been met, collect the sample and document the discrepancy in the appropriate manner.

Position the Patient

The patient should be positioned so as to be comfortable before the venipuncture is performed. In addition, the patient must be positioned to facilitate comfortable collection for the phlebotomist.

Inpatients

Raise or lower the patient’s bed so that it will be at a comfortable level for you when performing the venipuncture. The bed should be at a level that will not create a strain on your back. Have the patient lie on his or her back in a comfortable position. Ask the patient to hyperextend the arm in a straight line from shoulder to wrist. The hand should be lower than the shoulder. A pillow placed under the elbow makes a nice support for the arm. Lower the bed railing only on the side of the bed where you will need to stand. Do not remove any patient restraints. Should the patient be comatose or unable to change position, ask for assistance from the patient’s nurse. Do not place the collection tray on the patient’s bed; the patient may inadvertently knock the tray off the bed.

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Outpatients

The patient should be seated in the drawing chair. Have the patient extend the arm to form a straight line from the shoulder to the wrist. The arm should not be bent at the elbow. The arm rest attached to the drawing chair should support the patient’

s arm. Most drawing stations have a bed where a blood draw can be performed. Use this bed if you think the patient might faint.

Reassure the Patient

Explain the procedure to the patient. Explain that the pain will be brief. Instruct the patient to remain as relaxed and calm as possible. If the

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PART 2 Blood and Urine Collection

patient appears to be frightened and anxious, have him or her focus on breathing slowly and deeply.

PREPARING FOR THE VENIPUNCTURE

Select the Venipuncture Site

By making a preliminary assessment of the best veins in the patient’s arms, you will be able to determine the most appropriate equipment for performing the venipuncture. An assessment of the veins will determine whether an evacuated system or a syringe setup will be more appropriate. In addition, you will be able to determine needle size. A preliminary assessment will also identify any need to preheat the puncture site if the blood vessels require dilating. The most frequently used veins for venipuncture are the super cial veins located in the forearm and hand. Please refer to Figure 5-1.

The larger median cubital and cephalic veins are used most often. An alternative choice may be the take great care in selecting the basilic vein for venipuncture, as the vein lies in close proximity to the median nerve and the brachial artery dentally nicking the nerve or the artery may cause serious consequences for the patient. However, other veins in the anterior surface of the forearm, as well as in the wrist and hand, are acceptable sites for venipuncture, provided that the selected site has no scarring, hematoma, burn, or edema. The veins on the palm side of the wrist should not be used. Tendons and nerves lie close to the veins, and may be accidentally injured while performing a venipuncture. The venipuncture site should also preferably not be on the side of a mastectomy or on the arm receiving intravenous therapy. There are, however, precautions that may be taken if it is necessary to obtain a blood specimen from a site in either of these two cases. These special considerations will be discussed later in this chapter. If the potential venipuncture site involves any of these conditions, you must try to select a different site.

The phlebotomist should depend primarily on touch and not sight in locating and selecting a vein for venipuncture. A healthy vein will feel “bouncy” to the touch when it is palpated. A will not provide an adequate blood sample, feels cordlike and has no spring or bounce. Applying a tourniquet and closing the patient’s hand into a  st will cause the veins to  ll and become more prominent. Do not pump the  st. Opening and closing the  st rapidly can cause localized

hemoconcentration, resulting in inaccurate test results.

basilic vein. Beginning students should

. Acci-

thrombosed vein, which

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