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