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3. Venipun;kl;kl;l;l;l;l;l;l;cture (6).pptx
- 2. Learning Objectives 2 List the equipment necessary to collect blood by venipuncture. Identify the types of additives used in blood collection tubes. Identify the color coding associated with each type of additive. Describe the principle behind the order of draw for evacuated tubes. Describe proper bedside manner during venipuncture. Explain the importance of proper patient identification. Describe how to prepare patients for venipuncture. Describe each step in the venipuncture procedure. List the 5 pieces of information that should be on the label of all specimens.
- 3. Venipuncture Equipment 3 Tourniquets Alcohol Needles Tube holder Collection tubes Sharps container Pen Gauze Bandages Gloves ? ??????? ? ???????? ? ??????? ? ????????? ?????? ? ????????? ???????? ? ???????? ????????? ??????? ? ????? ? ??????? ? ?????????? ? ????????
- 4. Tourniquet 4 A tourniquet is applied in order to make veins more prominent Prevents blood flow out of the arm, causing the veins to bulge Types ? Latex – most common, inexpensive, disposable ? Velcro-closure – made of elastic and velcro, not easily cleaned ? Buckle-closure – made of elastic and a buckle, not easily cleaned ? Blood pressure cuff – pressure should be maintained below patient’s diastolic pressure ? ????????? ?????? ??????? ??????? ????? ???????????? ?????? ? ????????? ???? ?????? ?????? ?????? ????????? ???????? ????? ?????? ????? ? ??????? ? – ?????? ????????????? ???????? ????????? ????? C ?????????? ??????? ????????? ? – ??????? ???????? ??????? ??????? ????? ?????????? ?????? ?????? ???? ???????? ???????? ?????? ? - ?????? ???? ??????? ????????? ??????? ???????? ?????? ???? ????????? ?????? ???????? ? - ????? ?????? ????? ?????? ???? ????? ??????? ????? ???????? C ?????????? ??????????? ???????
- 5. Antiseptics 5 Alcohol is most commonly used Povidone-iodine is used for blood culture collection Chlorhexidine may be used if the patient is allergic to iodine ? ?????????? ???????? ???? C ?????????? ? ?????? ??????? ??????????? ???????? ?????? C ????????? ? ???????????????? ????????? ?????? ???? ??????? ???????? ????? ?????
- 6. NEEDLES 6 ? Point – sharp, enters the skin with minimal pain ? Bevel – the needle is cut at angle at the end, makes it non-coring ? Shaft – different lengths, usually ? - 1 ? inches ? Gauge – the diameter of the needles lumen, the smaller the number, the larger the lumen ? Butterfly – winged infusion set ? C ???????? ??????? ???C??????? ???? ????? ???C????? ???C?????? ??????? ? - ????? ???C???? ???C????? ???? ???CC??????? ?????CC????? ???????? ???C C???? ????C C???????? ??????? ????? ? - ??????? ???????? - ? ?????? ????????? 1 ? ?????? ? - ????? ????????? ?????? ??????C????? ???C?????? ????? ????? ???????? ???C??? ????????? ? - ???????? ???C????????
- 7. Tube Holder 7 Tube holder is used for multisample needles and evacuated tubes so that tubes can be changed safely ? ???????? ??????? ????????? ?????? ????????? ????? ?????? ?????? ????????? ??????????? ????????? ??????? ?????????? ???????
- 8. EVACUATED TUBES 8 ? Used with multisample needles so that multiple tubes can be collected with one venipuncture ? Blood is collected directly into the tube ? Evacuated tubes fill with blood automatically because of a vacuum inside the tube, fills the tube to the precise amount ? Tubes have various additives, indicated by the color of the top ? ???????? ????? ???? ??????????? ????? ?????? ?????? ????????? ???????? ?????? ???????? ???????? ???????? ? ???? ???????? ?????? ????? ????? ????????? ? ??????? ????????? ?????????? ??????? ?????? ?????? ?????? ?????? ?????????????? ????????? ????????? ??????? ?????????? ????????? ? ???????? ????? ?????????? ???????
- 9. Tube Additives 9 Additive is designed to function optimally with the amount of blood required to fill the tube ? Anticoagulants – prevent blood from clotting ? EDTA – ethylenediaminetetraacetic acid, chelates calcium ? Used for hematology, CBC and differential ? Heparin – prevents conversion of prothrombin to thrombin ? Ammonium, lithium, and sodium heparin ? Used for chemistry ? Sodium citrate – binds calcium ? Used for coagulation, PT, PTT ? Potassium oxalate – binds calcium ? Used for glucose testing ? ??????? ????????? ???????? ??????? ???? ?????? ?????? ???? ???????? ??????? ????? ????????? ?????? ?????????? ? – ???? ?????? ?????? ???????? ???????? ???????? ? EDTA - ??????? ?????? ????????? ????? ??????????? ?????? ??????????? ? ??? ?????? ???????? ???C ????????? CBC ???????? ? - ?????????????? ??????? ?????? ??????????? ????????? ????? ? ???????????? ??????????? ??????????? ?????????? ? ?????????? ???????? ? - ??????????? ?????? ?????????? ??????? ? ????????? ???????? PT? PTT ? - ?????? ???????????? ????????? ??????????? ? ?????????? ????????? ????????
- 10. Tube Additives 10 Antiglycolytic agents – inhibits glycolysis ? Sodium fluoride ? Glucose stability is preserved for 24 hours ? Commonly used in combination with potassium oxalate Clot activator – enhances coagulation ? Glass or silica ? Provides more surface area for platelet activation ? Used for chemistry Thixotropic gel separator – Forms a barrier between serum and cells after centrifugation ? Used for chemistry ? – ??????? ??????? ????????? ????????? ??????? ?????? ?????? ? ?????????? ???????? ? ?????????? ?????? ????? ???????? ????? ?????? 24 ?????? ? ???? ???????? ???? ??????????? ?????? ???????????? ????????? ? - ?????? ?????? ?????? ???????? ?????? ? ?????????? ???? ???????? ? ???????? ?????? ??????? ??????? ?????? ????????? ????????? ? ?????????? ???????? ? - ???????????? ??????? ??????? ?????? ?????????? ??????? ????? ???????????? ?????? ????????? ??????? ????? ? ?????????? ????????
- 11. Order of Draw 11 One multisample needle is used to fill all of the tubes Additive from one tube can be transferred to the next, so there is a specific order of draw ? Blood culture tubes ? Light blue ? Red ? Green ? Lavender ? Gray ? Other tubes ? ???????? ?????? ????????? ????? ?????????? ?????? ?????? ????????? ? ????????? ???????? ????? ?????? ????????? ????? ?????? ??????? ???? ?????? ?????? ?????? ????????? ??????? ?????? ??????? ? ?????? ??????? ???????? ? ?????? ?????? ? ?????? ? ?????? ? ???????? ? ??????? ? ?????? ????????
- 12. Performing venipuncture 12 Obtain test requisition – patient identification, tests ordered Patient contact – gently knock, slowly open the door, greet the patient ? “Good morning, my name is Michelle, I am here to collect a blood sample for some tests you doctor has ordered.” Proper patient identification is the first in many steps in collecting a quality specimen ? Inpatient: Armband – name and medical record number, if the armband is not on the patient, do not draw the blood, ask the nurse to attach a new armband before drawing the specimen ? Outpatient: Please state your name and date of birth Wash hands and put on gloves ? – ??????? ?????????? ????? ????? ???????? ?????????? ???????????? ????????? ?????? ? - ??????? ?????? ????????? ????????? ??????? ????? ??????? ??????? ??????? ??????? ???????? ? " ????? ????? ???????? ?????? ???????? ?????? ????? ???????? ???? ?????? ?????? ".??????? ??????? ?????? ???????????? ? ???? ???????? ???????? ????????? ???? ???? ???????? ???? ???????? ???????? ???????? ??????? ?????? ????? ???? ????????? ? - : ??????? ?????? ?????? ????????? ???????? ????? ???? ????? ???????? ??????? ?????? ?????? ????? ????????? ????? ?????? ?????? ??????? ????????? ???? ??????? ??????? ???????? ????? ????? ??????? ?????? ? : ?????? ????? ?????? ?????????? ????????? ???????? ????????
- 13. PERFORMING VENIPUNCTURE 13 Reassure the patient – your patient may be worried, let them know it will be brief and there will be a small amount of pain, do not tell the patient it won’t hurt Position the patient – patient should be seated or lying down, do not draw blood while a patient is standing, support the arm with a pillow or the patients fist Check for fasting or medication requirements Assemble your equipment – alcohol, needle, tube holder, tubes, gauze
- 14. Performing venipuncture 14 Apply the tourniquet – 3-4 inches above the venipuncture site ? Make and “X” around the patient’s arm with the tourniquet ? Pull the lower side taught and tuck it in from the top, at the center of the “X” ? Do not pull it through as if making a knot ? Tourniquet should not be left on more than 1 minute ? hemoconcentration – increase in ratio of formed elements to plasma altering test results ? Hemolysis – red cells are destroyed, alters test results ? Petechiae – small pinpoint bruising – if tourniquet is too tight ? ??????? ????? ????????? ???? 3 - 4 ???????? C ??????? ?????? ????? ??????? ? " ??????? ?????? X " ?????? ????? ????????? ?????????? ???????? ? ???? ?????? ???????? ???????? ?????? ????????? ???? ????????? ????? ???????? " ??????? ??????? ???? X " ? ?????? ?????? ????? ???? ????? ??????? ???? ? ???? ??????? ????????? ????? ??????? ???? ??????? ??????? ? - ????????? ?????? ??????? ?????? ??????? ?????? ????? ?????????? ????? ????????? ?????????? ??????? ??????? ????? ? – ????????? ??????? ????? ?????? ???????? ?????????? ??????? ??????? ?????????? ? - - C ????????? ??????? ??????? ??????? ?????????? ?????? ????????? ?????? ?????
- 15. Performing venipuncture 15 Vein selection ? Median cubital – first choice ? Cephalic – second choice ? Basilic – third choice Palpate the vein – with index finger, gently push up and down to determine depth and direction of vein ? Veins are bouncy ? Tendons are firm ? Arteries have a pulse ? ???????? ???????? ? –? ? ??????? ???????? ????????? ???????? ? - ???????? ???????? ?????? ? – ???????? ?????????? ??????????? ? - ??????? ?????? ?????? ?????????? ?????? ?????????? ???????? ???? ???????? ???????? ????? ???????? ???????? ? ??????? ????????? ? ??????? ????????? ? ????? ????? ??????????
- 16. Performing venipuncture 16 Clean the site – in a circular motion, spiraling out from the puncture site, do not blow on the area Clean Examine the needle – ensure it is not barbed or blunt Examine Anchor the vein – below the venipuncture site with your nondominant hand Anchor Hold the tube holder with your thumb on top Hold Ensure the needle is bevel up Ensure
- 17. Performing venipuncture 17 Enter the vein in one quick fluid motion at a 15-30 degree angle Push tubes on to the needle in the tuber holder Remove the tourniquet after blood flow is established Allow tube to fill, remove the tube from the needle and invert 5-8 eight times to mix the additive and the blood Collect tubes in the proper order of draw Once all tubes are full, remove the last tube and withdraw the needle from the vein ???????? ??????? ??????? ??????? ??????? ???????? ?????? 15 - 30 ?????? ????????? ?????? ???? ?????????? ???????? ????? ?????????? ????C ?????? ?????? ?????? ???? ???????? ????? ????????? ???????? ???? ???????? ???????? ???? ????????? ?????? ???? ????????? ????????? ?????? 5 - 8 ????????? ???????? ?????? ?????? ??????? ??????? ???????? ?????????? ?????????? ????? ???????? ???? ???????? ??????? ???????? ????????? ???????? ???? ??????????? ?????? ???????? ???????
- 18. Perfor ming Venipuncture 18 Label Label the tubes at the patient’s bedside with 5 pieces of information ? Patient name/Medical record number/ Date/Time/Phlebotomist’s initials Apply Apply bandage after bleeding has stopped Dispose While holding pressure, dispose of the needle in the sharps container Apply Apply gauze to the site and hold pressure for a minute or two
- 19. Performing Venipuncture 19 Remove gloves and wash hands Remove Thank the patient, smile Than k Deliver specimen to the laboratory Deliver
Editor's Notes
- #13: Hol, ne