Week 3: Skilled Skin Puncture and Special Collections

adult tubes hold from _______ mL of blood

3-10

pediatric tubes hold from _______ mL of blood

2-4

tubes for fingersticks or heelsticks hold ________ mL of blood or less

0.5

obtaining large quantities of blood from an infant may result in ________ or cardiac arrest

anemia

the _________________ is ideal for collection from small and fragile veins

winged infusion set

a syringe allows you to control the suction to pull blood slowly from the veins, which is particularly important for __________ and _____________ patients

elderly, pediatric

if allowable, an IV near the collection site should be off for at least ____ minutes before venipuncture

2

angle of needle insertion in hand venipuncture

10-15 degrees

venipuncture in children under 2 years of age should be limited to ____________ veins

superficial

removing more than _____% of blood from a patient at one time can lead to shock, cardiac failure, and death

10

what gauge is used for pediatric patients?

23

when using a syringe, the ___________ blood culture bottle is first

anaerobe

order of draw for vascular access devices (VADs)

1. 5 mL, discard

2. blood cultures

3. anticoagulated tubes

4. clotted tubes

what does CVC stand for?

central venous catheters

types of CVCs

1. non-tunneled or non-cuffed

2. tunneled or cuffed

3. implanted port

4. peripherally inserted central catheter (PICC)

what are non-tunneled or non-cuffed CVCs used for?

short term dwell times, during surgery

what are tunneled CVCs used for?

long term dwell times, like chemotherapy

what are implanted port CVCs used for?

long term access to the CVS, frequent IVs or chemotherapy

what are PICC CVCs used for?

can be left for weeks to months

purpose of warmed specimen

cold agglutinins

cold agglutinin

antibody that clumps RBCs when cold

examples of light sensitive specimen

1. bilirubin

2. beta carotene

3. vitamins A, B6, B12

4. folate

5. porphyrins

methods for collecting light-sensitive specimen

1. amber containers

2. foil wrapping

what samples should not be chilled?

1. electrolytes

2. prothrombin

legal/forensic specimen must have a documentation of handling, or a __________________

chain of custody

blood alcohol specimen must be documented with a _________________

chain of custody

if unable to collect after _____ attempts, get assistance from another phlebotomist

2

when should capillary collection NOT be used?

1. certain tests: blood cultures, ESR, coagulation

2. severely dehydrated patients

3. swollen sites with compromised circulation or lymphatic drainage

what does warming of the collection site do?

increases blood flow

width and depth of puncture devices

1. width = 2.5 mm maximum

2. depth = 2.0 mm maximum

maximum length of a heel stick

2.0 mm

the temperature of a warming device should not exceed _______, and should be applied for 3-5 minutes

42 C

order of collection for capillary collection

1. capillary blood gases

2. blood smears

3. EDTA tubes

4. other anticoagulant tubes

5. gray tubes

6. serum tubes

dermal puncture is performed on the ___________ surface near the fleshy center of the distal _____________ to the whorls

palmar, perpendicular

calcaneus

heel bone

dermal puncture in infants is performed on the heel, on the __________ and _________ borders only

medial, lateral

puncture _________ is the most important in determining blood flow

width

why do we wipe away the first drop of blood with capillary puncture?

contamination with tissue fluid and alcohol residue

how can blood flow be increased in capillary puncture?

1. applying and releasing firm pressure proximal to the site

2. avoid massaging

the tube must be filled with _____ minutes of puncturing the skin

2