venipuncture process

What is the first step of the blood collection process?

Examine the requisition form

What kind of information can we expect on a requisition form?

PT name, DOB, ID and accession numbers, test codes, healthcare provider name, special collection information, billing info

What kinds of requisition forms can be used?

Paper, electronic (bar code), or verbal in emergency situations

For emergency blood collection, what information is required to be documented?

The patients identification number and the name of the provider who verbally ordered the tests

When greeting a patient, what should you say?

Introduce yourself and state your purpose in layman’s terms

How can a blood collector obtain consent from the patient?

Identifying themselves and stating you are there to collect blood

How can a patient demonstrate informed consent for collection?

Rolling up their sleeve, extending their arm out

How do we greet sleeping patients or unconscious patients?

Sleeping patients: gently wake them and allow for orientation, greet and introduce yourself and explain your purpose

Unconscious patients: greet as usual and coordinate with a nurse or caregiver for patient identification purposes

In a psychiatric unit, what should you do to ensure comfort of the patient?

Be patient, accommodating, and place your equipment away from the patient

When a physician or clergy member is tending to a patient, should you perform blood collection? Why or why not?

It is preferred to wait UNLESS you have a STAT order

• if you have a STAT, explain your situation to the healthcare professional and obtain permission

What is the most important step of blood collection?

Ensuring you have identified the correct patient

Which two organizations require two identifiers for patients?

College of American Pathologists (CAP) and The Joint Commission (TJC)

What are the two identifiers typically used for patients?

Full name and DOB

How can you obtain the two identifiers from a patient?

Verbally asking an open ended question (Can you please state your name and DOB?) and checking the patient’s wristband

If you are using a wristband for patient ID, what is required to ensure correct information?

The wristband must be physically attached to the patient

What is a third identifier recommended by CLSI?

To show the labeled tube to the patient to confirm it is theirs

What is the advantage of RFID tags on specimens?

The data may be upgraded at anytime and allows for tracking

If a patient is missing their ID band, what should be done to confirm identity?

Have a nurse re-apply a band, or if a band cannot be placed, confirm identity through a nurse and document their name

What are some pre-analytical variables that may impact blood collection?

Diet, posture, exercise, stress, alcohol, drugs, time of day, medications

What is syncope?

fainting

How can we prevent fainting from occurring during blood collection?

sit the patient up or have them lie down if they are prone to fainting

How should an arm be positioned for blood collection?

extended downward with a support behind it, with a slight bend in the arm

How should equipment be positioned for the most efficient blood collection?

Place all equipment within arms reach, especially where your free hand can reach to

• never place equipment on a bed or food tray!

What is the most important factor in preventing healthcare associated infections?

sanitizing your hands

What are the two purposes of applying a tourniquet?

1. to occlude blood flow for easier visualization/palpitation of veins

2. to occlude venous flow for a larger sample

What is hemoconcentration?

The ratio of cellular components to plasma

What is the maximum time a tourniquet should be applied? How long must you let the arm rest before applying another tourniquet?

1 minute max, and let the arm rest for 2 minutes

Tourniquet ends should be pointed ____ from the site of collection.

away

What is the preferred site of collection?

antecubital fossa located anterior to the bend of the elbow

What is the first choice vein for collection?

Medial cubital vein

What is the second choice vein for collection?

Cephalic vein

What is the third choice vein for collection? What collection technique should be used here to avoid hematomas?

Basilic vein, use a syringe

How are veins located?

sight and touch, aka palpitation

What is palpitation used for?

size, depth, and direction of the vein

What are alternative sites of blood collection?

The back of the hand and wrist

What sites should be avoided for blood collection?

Sites of scarring, burns, brusing, edemas, prior mastectomy, IV

What size of site should be made through cleansing?

2-3 inches in diameter

After site cleansing, what should be done?

apply the tourniquet once more and ask the patient to make a fist

What should be done during needle insertion?

Use your nondominant thumb to apply anchoring to the vein for collection and pull the skin taught below the site

Insert the needle in a quick, smooth motion at 15-30 degree angle

What is the proper way to fill tubes?

Hold them at a downward angle, use your thumb to push the tube into the back of the needle

• gently twist and pull the tubes off the needle in case of resistance

• invert your tubes as well

Prior to removing a needle, what must be removed?

tourniquet

How do we remove needles?

remove the tourniquet, remove tubes from the needle, place gauze over the site, and withdraw the needle in a quick, smooth motion

After needle removal, what can be asked of a capable patient?

To place pressure on the site with gauze

After needle removal, what must be done with the needle?

engage the safety device and dispose

When are filled tubes labeled?

Only after blood collection

What information is found on a filled tube?

• Patient’s first and last names

• Patient’s identification number (inpatient) or date of birth (outpatient)

• Date and time of collection

• Collector’s initials

For winged blood collection, should a discard tube be used?

Yes