0:42 [Music]
0:44 good morning I'm Kristen I'm here to
0:46 draw your blood today could you please
0:48 state your name and date of birth Pat
0:53 White November 11 1986 thank you have
0:54 you had anything to eat or drink in the
0:57 last 12 hours not since 9:00 last night
1:00 Thanks do you have any questions all
1:01 right it will just take me a minute to
1:03 get everything set blood collection by
1:05 venipuncture is one of the most common
1:07 procedures performed in a healthcare
1:10 setting common but also complex
1:12 requiring knowledge and skill to assure
1:14 the accuracy and integrity of the
1:17 samples drawn and to eliminate risk to
1:19 both patient and healthcare workers the
1:21 first step is to accurately ID the
1:23 patient using at least two forms of identification
1:24 identification
1:26 does the name and date of birth on the
1:28 requisition form match what the patient
1:30 is telling you does it match what is on
1:33 the patient ID wristband as the patient
1:35 followed special orders such as fasting
1:37 prior to blood draw address the
1:39 inconsistency first with a requesting
1:42 physician or healthcare worker on duty
1:44 but if the given information does agree
1:46 it's time to prepare yourself and the
1:49 patient for a successful blood draw
1:51 using proper standard precautions the
1:54 phlebotomist washes and then Don's a
1:56 clean pair of gloves before proceeding
1:59 make sure alcohol prep pads gauze tape
2:02 the correct gauge needles and required
2:04 evacuated collection tubes are with an
2:07 easy reach for you but out of the reach
2:10 of the patient then speak reassuringly
2:12 to the patient as you position him for
2:13 the draw I'm all set here
2:18 if you'd please straighten your arm just
2:19 take a moment while I apply the
2:21 tourniquet applying a tourniquet slows
2:23 the flow of blood in the veins and
2:26 increases venous filling thus making the
2:29 veins more prominent easier to locate
2:32 and easier to enter however leaving the
2:33 tourniquet on
2:35 longer than one minute may affect
2:37 laboratory test results and should
2:40 therefore be removed and reapplied if
2:42 the procedure will take longer than 1 minute
2:43 minute
2:46 use your fingertip to palpate the
2:49 antecubital fossa to locate the median
2:51 cubital vein palpation helps determine
2:53 the direction of blood flow in the vein
2:56 to gauge the vein size and depth and to
2:59 estimate its tendency to roll it also
3:01 helps differentiate veins from arteries
3:04 unlike veins arteries have thicker
3:06 feeling walls and are more elastic to
3:08 the touch
3:11 use an alcohol prep pad to cleanse the
3:16 skin around the site in a fluid circular
3:18 motion swab from the center to the
3:21 periphery of the site being careful not
3:23 to drag the pad back across the cleanse
3:28 field let the area air dry this prevents
3:30 contamination of either the patient or
3:32 the specimen
3:35 grasp the patient's arm firmly with your
3:37 hand placing your thumb approximately 2
3:39 inches below the intended puncture site
3:42 with your thumb pull the skin taut over
3:44 the vein to help anchor it in place then
3:46 let the patient know you're ready to
3:47 make the puncture so the patient won't
3:52 startle and jump position the needle
3:55 bevel side up and line it up with a vein
3:57 position the needle so that it forms a
3:59 30 degree angle with the surface of the
4:02 arm with a single short but firm motion
4:04 swiftly insert the needle through the
4:07 skin and into the vein push the
4:09 evacuated tube onto the needle when the
4:12 needle enters the vein as the vein
4:14 aligns with a needle blood will begin to
4:17 move out of the vein up into the needle
4:19 maintain a constant slight forward
4:22 pressure on the end of the tube the
4:24 evacuated tubes are color-coded based on
4:27 their additives know the types of
4:29 additives and which color tubes are to
4:32 be drawn based on requisition as soon as
4:34 blood begins to flow into the collection
4:36 tube instruct the patient to open his
4:38 hand and remove the tourniquet from his arm
4:39 arm
4:41 removing the tourniquet allows the blood
4:43 to return to its normal rate of flow
4:45 through the vein and helps reduce
4:52 a gentle mixing by inversion at least
4:54 eight times is required to ensure that
4:56 any additives in the tube are
4:59 incorporated into the blood sample we're
5:01 almost finished here are you doing okay fine
5:04 fine
5:06 engage the safety device on the needle
5:09 and use the sharps device for proper
5:11 disposal applying pressure at the needle
5:13 entry site immediately after removing
5:15 the needle will prevent a hematoma from
5:18 forming and allow hemostasis to seal the
5:29 wound in this illustration you can see
5:32 formation of the platelet plug and the
5:34 fibrin clot applying pressure at the
5:36 needle entry site immediately after
5:38 removing the needle will prevent a
5:40 hematoma from forming and allow
5:43 hemostasis to seal the wound in this
5:45 illustration you can see formation of
5:49 the platelet plug and fibrin clot apply
5:52 the ID label on the filled evacuation
5:54 tube and store it for transport to the
5:57 lab the label must include at least the
5:59 patient's ID number full name date of
6:02 birth and today's date using standard
6:05 precautions dispose of needles in a
6:07 sharps container dispense of all other
6:10 used non sharp materials including use
6:12 gloves and gauze pads in an approved
6:15 trash receptacle and disinfect all
6:19 contaminated surface areas you've just
6:20 completed a successful blood draw
6:23 providing a sample that can be processed
6:26 for analysis fortunately most blood
6:28 draws are completed in an entirely
6:30 professional skilled and successful
6:35 manner most but not all poor technique
6:38 poor judgment lack of knowledge loss of
6:41 concentration and undue haste all are
6:43 factors that can negatively impact the
6:46 integrity of a sample or worse that can
6:48 create undue stress and pain for the
6:51 patient or cause a patient physical harm
6:53 let's take a look
6:55 failure to align the needle perfectly
6:57 with a vein and failure to insert the
7:00 needle at a 30 degree angle can result
7:02 in the needle missing its mark poor technique
7:03 technique
7:05 that will require an unwelcome second
7:08 needle stick inserting the needle at too
7:11 steep or too shallow an angle and not
7:13 lining up precisely with a vein are two
7:16 common reasons for missing the vein
7:19 to the patient that usually means only
7:20 one thing
7:24 further anxiety and discomfort but it
7:26 can have other consequences as well
7:29 serious complications are most likely to
7:32 arise when targeting the basilic vein
7:35 with its close proximity to nerves which
7:37 can be permanently damaged or the
7:39 brachial artery which could be nicked
7:42 even with a proper angle the appropriate
7:46 needle size must be used ready you're
7:47 only gonna feel very small pinch this
7:50 time huh it is acceptable to use a
7:52 smaller needle called a butterfly
7:54 however it should be noted that
7:57 butterflies are a larger gauge needle 23
8:00 to 25 gauge and therefore have a smaller
8:04 bore size a large gauge straight needle
8:07 25 gauge in this case may make piercing
8:09 the vein more certain but as you can see
8:12 the smaller bore size can cause the red
8:16 blood cells to lyse while it appeared to
8:17 the healthcare professional that this
8:20 blood draw was successful it's clear
8:22 once the sample is centrifuged that the
8:24 choice of needle gauge was a poor one
8:27 the selection compromised the integrity
8:30 of the sample aside from these two
8:32 examples of invisible errors there are
8:34 many visible signs that a healthcare
8:36 professional may not be following
8:38 standard precautions that ensure a
8:40 quality blood draw as well as a
9:09 all right you're good to go
9:12 that's it yeah I just need to put some
9:32 what about this oh you gonna go good to go
9:33 go
9:36 not necessarily failure to apply
9:37 pressure on the puncture site
9:39 immediately following removal of the
9:41 needle can cause bleeding from the vein
9:44 into the space around it forming a
9:46 hematoma a collection of blood under the
9:49 skin surface that will become bruised in
9:52 appearance and painful to the touch
9:55 there are many times of course when a
9:57 single blood draw involves more than the
9:59 collection of a single sample you may be
10:02 required to collect as many as 10 tubes
10:05 in a single draw and this requires even
10:07 greater skill and careful planning to
10:13 two keys to a successful multiple tube
10:15 draw must occur in the planning stage
10:18 you need to determine which gauge needle
10:20 will be appropriate for all tests being
10:23 requested and you need to plan the order
10:25 of the draw to assure the integrity of
10:29 all samples but your technique should
10:32 remain the same let's take a few moments
10:35 to review position the needle bevel side
10:37 up and line it up with a vein position
10:39 the needle to form a 30 degree angle
10:41 with the surface of the arm with a
10:44 single short but firm motion swiftly
10:45 insert the needle through the skin and
10:48 into the vein push the evacuated tube
10:50 onto the needle when the needle enters
10:52 the vein as the vein aligns with a
10:54 needle blood will begin to move out of
10:57 the vein up into the needle maintain a
11:00 constant slight forward pressure on the
11:02 end of the tube to prevent release of
11:03 the shutoff valve
11:06 as soon as blood begins to flow into the
11:09 collection tube instruct the patient to
11:11 open his hand and remove the tourniquet
11:12 from his arm
11:14 removing the tourniquet allows the blood
11:16 to return to its normal rate of flow
11:17 through the vein and helps reduce
11:20 bleeding at the puncture site when
11:22 performing a multi tube draw it is
11:24 important to follow the correct Hospital
11:27 mandated order of draw blood cultures
11:30 are always drawn first however in a
11:33 routine venipuncture a light blue tube
11:35 should be drawn first followed by a red
11:39 top gold green lavender and great we're
11:40 almost done here this is the last tube I
11:43 need to draw when will I know the
11:45 results I'm kind of anxious about them
11:47 your samples will go over to the lab
11:49 today and your doctor will notify you
11:51 after the results are in you don't see
11:53 them no I don't the samples that we draw
11:55 today are tested by laboratory
11:57 professionals who relay those results
11:59 directly to the physician my
12:01 responsibility is to assure the quality
12:04 of the samples I draw so that the
12:06 results your doctor receives are both
12:09 accurate and meaningful the level of
12:11 quality and integrity of the samples the
12:13 laboratory receives is dependent upon
12:15 the level of skill knowledge and
12:18 professionalism of the phlebotomist a
12:21 big responsibility but one that can make
12:23 a real difference in the lives of your patients
