What Are The 7 Areas That Need To Be Avoided During A Blood Draw

Blood specimen collection is one of the most underestimated procedures in health intendance. Because it looks deceptively elementary, nurses, clinical nursing administration, radiologic technologists, respiratory therapists, physicians and others are all being asked to "take a stab" at phlebotomy.

Knowledge of vein option, the lodge of draw, test-specific handling, storage and transportation requirements, anatomy of the antecubital area, safety precautions, alternative sites and other factors make phlebotomy a highly technical procedure that takes months to learn and utilize.

Like whatsoever other procedure, there are certain established and indisputable rules collectors should apply in order to consistently perform venipunctures cleanly, safely, successfully and with piddling or no discomfort to the patient. Some of these rules are then fundamental they could exist collectively referred to equally the commandments of phlebotomy. Since 10 is a popular number for commandments, permit'south comply with tradition even though the list is admittedly much longer.

[dropcap]1[/dropcap] Thou shalt protect thyself from injury. Today, drawing a sample of blood can potentially betrayal the health care worker to at to the lowest degree xx communicable diseases.¹ Most of them are life threatening, some of them cause incurable and fatal disease, but all of them may be preventable if health care workers apply appropriate caution, technique and equipment.

It has been estimated that one million health intendance workers sustain adventitious needlesticks every year.^2,3 Thousands of these workers will contract some class of hepatitis; 50-60 of them volition become seropositive for HIV.^iv Hollow-bore needles, the kind used for collecting blood, account for 68.5 pct of all accidental needlesticks,³ and the apply of winged infusion ("butterfly") sets account for 35 percent of accidental needlesticks.⁵ Even more alarming is that up to 92 pct of adventitious needlestick injuries suffered by laboratory personnel become unreported.³ Fugitive the use of winged infusion sets and using gloves, needle disposal units and proper technique tin significantly minimize the risk of injury.

[dropcap]2[/dropcap] Thou shalt identify thy patients. This ways referring to an identifying bracelet affixed to the patient or request the patient to state his or her name. Because sedated or semi-witting patients can respond affirmatively to any question, get across seeking an affirmation of their identity and request they state their name in full.

In the case of an emergency room patient whose full identity has not been established, a temporary identifier such as an assigned number is acceptable but should be amended when complete information is available. When positive identification is non possible by either of these methods, have the patient's nurse or other caregiver identify the patient and document the proper name of the person who verified the patient'due south identity for yous. No other methods are acceptable.

[dropcap]3[/dropcap] Thou shalt puncture the skin at about a xv degree angle. Most textbooks agree that a 15-30 caste angle of insertion is optimal.^vi This low bending of entry allows for a greater margin of error in judging the depth of penetration and profoundly reduces the risk of passing through the vein and provoking underlying structures such as nerves, tendons and arteries. This is not to say that we all must start conveying effectually protractors to mensurate our angles, just inserting the needle at as low an bending as possible minimizes the risk to the patient and facilitates a successful puncture.

Every bit an expert witness in cases involving injury to patients during venipuncture procedures, a majority of the nerve injuries I see involve an excessive bending of insertion. Hurt a patient while puncturing at a steep angle and y'all will accept a difficult time convincing the jury that y'all are immune from the standards as set forth in the literature.

[dropcap]four[/dropcap] Thou shalt glorify the medial vein. Of the three veins in the antecubital expanse acceptable for venipuncture, the median cubital vein (in the middle) is the vein of choice for four reasons: 1) it's more stationary; 2) puncturing it is less painful to the patient; 3) it's usually closer to the surface of the skin; and iv) it isn't nestled among nerves or arteries.

When conducting your survey of the antecubital area, cheque both arms for the medial vein before because ane of the alternatives. If ane is not prominent enough to instill confidence, default to the cephalic vein on the lateral or thumb side of the arm as a second choice. Keep the basilic vein (located on the medial or inside aspect of the antecubital area) as a last resort. The proximity of underlying nerves and the brachial artery make punctures in the area of this vein highly risky. Nearly permanent nerve injuries and arterial nicks I see result from misguided punctures into this vein. That is not to say the basilic vein should not exist punctured. In many cases it is the prominent vein in the antecubital area.

However, when it is not visible and/or the initial puncture is unsuccessful, probing the area subjects the patient to the potential for excruciating pain and permanent injury more than so than probing in the area of the cephalic or medial veins.

[dropcap]5[/dropcap] Thou shalt invert tubes containing anticoagulants immediately after collection. A high percentage of specimens rejected past laboratories are due to clots in lavander- or blue-stoppered tubes. A quick inversion afterwards collection prevents a second puncture. If not inverted immediately upon filling, capsize the tubes as soon as possible after the puncture.

Drawing claret from a syringe requires extra consideration to prevent clotting. The moment claret enters the barrel of the syringe the clotting procedure begins. If the time it takes to fill the syringe and evacuate the specimen into the tubes exceeds 1 minute, significant clotting may take place. Not only will this make it difficult to evacuate the specimen through the needle and into the tubes, simply if the clots are pocket-sized enough to go undetected they tin bear upon the accurateness of the results.

[dropcap]6[/dropcap] 1000 shalt attempt to collect specimens just from an acceptable site. Antecubital and mitt veins are adequate sites unless their utilise is precluded by intravenous infusions, injury or mastectomy. Any other site should be approached with nifty trepidation.

The anterior, or palm side, of the forearm is specially susceptible to injury because of the close proximity of fretfulness and tendons to the surface of the pare and should non exist considered.

Foot and ankle veins tin exist acceptable sites for venipunctures in some facilities and on some patients. However, puncturing these veins tin can lead to thrombophlebitis and clot formation in patients with coagulopathies or to tissue necrosis in diabetics. Therefore, before puncturing foot and talocrural joint veins, make sure the facility does not have a policy confronting such punctures and that the physician approves of the site.

[dropcap]7[/dropcap] M shalt characterization specimens at the bedside. There is no alibi for not completely labeling a specimen at the bedside. This means complete identification, non just temporary identifiers to remind y'all when you find time to characterization them completely later.

Patients have died every bit a result of mislabeled specimens. Case in point: At a small Midwestern hospital, a lab tech drew a specimen of blood to determine the blood type of a patient. She left the room without properly labeling the specimen, drew two more patients, then returned to the lab to type them all simultaneously. After an interruption, she returned to her workstation, misidentified the specimens and typed the patient incorrectly. The patient received incompatible blood and later died.

Although this concept of complete and accurate specimen identification has been trumpeted loudly and conspicuously for decades, delayed labeling practices persist. On one ward at a large infirmary, collectors scrawled patients' last names on the caps of the tubes to facilitate complete labeling at a later time. The bottom line is without exception: label the specimen completely at the bedside.

[dropcap]8[/dropcap] Thou shalt stretch the peel at the puncture site. Pulling down on the skin from beneath the intended puncture site with the thumb of your free hand anchors the vein and stretches the skin through which the needle volition pass. Anchoring the vein is peculiarly important when drawing from the cephalic or basilic veins. Stretching the peel is the unmarried most effective manner to minimize the pain of the puncture.

Routinely employing this technique has two potential bonuses: your rate of successful punctures goes up and your patients thank you for considering their suffering.

[dropcap]9[/dropcap] K shalt know when to quit. Not everyone tin depict blood from every patient. Even those who elevate phlebotomy to an art form can accept difficulty from fourth dimension to fourth dimension. This is because there are veins intentionally placed in the antecubitals of the population at random for the sole purpose of keeping skilful collectors from becoming legends in their own minds. Afterwards ii failed attempts, one should seriously consider sending in someone else. That's professionalism. It also may be the answer to your patient'southward prayers.

[dropcap]10[/dropcap] K shalt care for all patients every bit if they are family. In a infirmary, the only peace many patients feel is that which wellness intendance professionals bring them by their kind words, gentle technique and their smiles. Regardless of how y'all think your life led you to hold a position as a health care professional person, consider yourself assigned by a higher authority because of the comfort yous can offering to the sick and injured in your own unique and empathetic manner. You lot haven't been employed; yous've been ordained.

Readers may purchase the author's "10 Commandments of Phlebotmy" poster through the Eye for Phlebotomy Educational activity. The sixteen×twenty iv-colour graphic tin be viewed and ordered at http://www.phlebotomy.com/affiche.htm

Phlebotomy-Related Spider web Sites

• Center for Phlebotomy Education
  http://www.phlebotomy.com/
• Q-Probes: Phlebotomy
  http://www.cap.org/html/lip/benchmarks/phlebotomy_toc.html
• Welcome to the Needle Phobia Page
  http://world wide web.webcom.com/cfsc/needles.html
• Evaluation of Safety Devices for Preventing Percutaneous Injuries Amongst Health Care Workers During Phlebotomy Procedures
  http://thebody.com/cdc/phlebot.html

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References

1. Jagger, J. (1998). Rates of needlestick injury caused past various devices in a academy hospital. N Engl J Med, 319(5), 284-288.
2. Carlsen, W., & Holding, R. (1998, April 13). Epidemic rages caregivers: thousands die from diseases contracted through needle sticks. San Francisco Chronicle.
3. Pallatroni, Fifty. (1998). Needlesticks: Who pays the price when costs are cut on safety? MLO, 30(7), xxx-31, 34-36, 88.
4. Carlsen, Due west., & Property, R. (1998, April 14). High profits–at what cost? San Francisco Chronicle.
5. Jagger, J. Risky procedure, risky devices, risky job. Advances in Exposure Prevention, 1(1).
6. Garza, D., & Becan-McBride, One thousand. (1999). Phlebotomy handbook: Blood collection essentials. Norwalk, CT: Appleton & Lange.

Source: https://www.elitelearning.com/resource-center/laboratory/the-10-commandments-of-phlebotomy/

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