ROUTINE VENIPUNCTURE WITH A SYRINGE
6. Complete the procedure
Finish the procedure as in steps 18 to 20 of Procedure 9-1.
AVOID THAT ERROR!
The waiting room at Consolidated Medical Services is filled, with
seven outpatients still waiting for draws and more patients likely to arrive at any moment. Phlebotomist Tomas Sanchez knows the efficient functioning of the laboratory depends on him, and he is working quickly to clear the backlog. He seats his next pa- tient, checks her ID against the requisition, prepares his tubes,
applies the tourniquet, and swabs the site with alcohol. Moments later, he blows on the site to remove the last traces of liquid, then inserts the needle. The samples obtained, he finishes with the patient and labels the tubes. “Next!” What did he do wrong, and what should he have done?
WHAT WOULD YOU DO?
You must not draw blood from the patient. Drawing from the wrong patient can lead to incorrect diag- nosis or treatment and may even lead to death of the patient. It can also get you fired and subject you to legal action. Although it seems likely the patient is the one you were expecting, there is a slight chance he is not—it is possible that two patients with the same name and similar dates of birth are both patients at the hospital and the ID numbers are in error. Find a nurse to determine where the error arose. You must resolve the discrepancy before you draw.
AVOID THAT ERROR!
AVOID THAT ERROR!
Ms. Campos has fainted, fortunately remaining on the bed rather than falling to the floor and risking severe injury.
Sylvia should have insisted that the patient lie back in the bed, with enough support to prevent movement should she
Tomas blew on the site, potentially contaminating it with bacteria or viruses from his mouth. Despite the need for rapid turn-
faint. Had Ms. Campos refused, Sylvia should have con- tacted the nurse. That is exactly what she must do now, to make sure the patient is safe and has not been injured during syncope.
around, he should have waited for the site to air-dry before proceeding with the draw.
PROCEDURE 9-2—cont’d
Venipuncture With a Syringe
STUDY QUESTIONS
See answers in Appendix F.
1. What is the most important aspect of any phlebotomy procedure?
2. Describe how to properly identify a patient.
3. What information is typically on a requisition form?
4. List the steps you should perform when requisitions are received.
5. Define hemoconcentration.
6. Name three veins in the antecubital area suitable for venipuncture.
7. Explain why the median cubital vein is the first choice for venipuncture.
8. Describe how veins, arteries, and tendons feel when palpating them.
9. What techniques can you use to help locate a vein?
10. Define hematoma.
11. Describe the correct position of the patient’s arm after withdrawing the venipuncture needle.
12. Explain the correct procedure for labeling blood tubes.
13. List the information a phlebotomist must look for on a requisition slip.
14. Explain the reasoning behind preparing the patient before you wash your hands and put on gloves.
15. Describe the purpose of an ABN, and the phlebotomist’s role in their use.
CERTIFICATION EXAMINATION PREPARATION
See answers in Appendix F.
1. Which is a purpose of the requisition?
a. Identifying the patient
b. Determining the specimens to be collected
c. Allowing the equipment necessary for the collection to be gathered
d. All of the above
2. Which vein is often the only one that can be palpated in an obese patient?
a. Median b. Cephalic c. Basilic d. Iliac
3. Upon entering a patient’s room, you should first a. assemble your equipment.
b. put on your gloves.
c. introduce yourself.
d. identify the patient.
4. Which vein lies close to the brachial artery?
a. Cephalic b. Median cubital c. Basilic d. Iliac
5. At what angle should a venipuncture needle penetrate the skin?
a. 10 to 15 degrees b. 15 to 30 degree c. 30 to 40 degrees d. 45 degrees
6. Which information must match on the patient’s ID band and the requisition?
a. DOB b. ID number c. Patient’s name d. All of the above
7. When should the tourniquet be removed from the arm in a venipuncture procedure?
a. After the needle is withdrawn b. As the needle is withdrawn c. Before the needle is withdrawn d. The tourniquet should not be removed
8. Tourniquets should be placed _____ inches above the venipuncture site.
a. 1 to 2 b. 2 to 3 c. 3 to 4 d. 4 to 5
9. The following can occur if the tourniquet is left on the patient too long:
a. nerve damage.
b. hemoconcentration.
c. occluded radial pulse.
d. hematoma.
10. Hematomas can be caused by
a. removing the tourniquet after removing the needle.
b. withdrawing the needle before removing the last tube.
c. withdrawing the needle too quickly.
d. removing the tourniquet before remov- ing the needle.
11. An increase in the ratio of formed elements to plasma is called
a. hemolysis.
b. petechiae.
c. hemoconcentration.
d. hematoma.
12. Small red spots on the skin are referred to as a. hemolysis.
b. petechiae.
c. hemoconcentration.
d. hematoma.
13. If you are asked to perform a venipuncture on an inpatient who is not wearing an ID band, you should
a. identify the patient by asking his or her name, and perform the venipuncture.
b. ask the patient’s nurse to attach a new ID band before proceeding.
c. notify the physician.
d. refuse to perform the venipuncture.
14. Which vein is the first choice for venipuncture?
a. Basilic b. Median cubital c. Cephalic d. Iliac
15. During the venipuncture procedure, the tourniquet should stay on no longer than
a. 30 seconds.
b. 45 seconds.
c. 1 minute.
d. 2 minutes.
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