What Is The Best Way To Avoid Reflux When Drawing Blood

Venipuncture

Venipuncture means the puncturing of a vein for the removal of a venous blood sample. In the medical office, a venipuncture is performed when a large blood specimen is needed for testing. Venipuncture can exist performed by the post-obit two methods:

The vacuum tube method is the fastest and most user-friendly of the three methods and is used most often. This method relies on the use of an evacuated tube, which is a airtight glass or plastic tube that contains a vacuum. The butterfly method is used for difficult draws, such as when a vein is small or sclerosed (hardened). This chapter presents the theory and procedure for both methods.

General Guidelines for Venipuncture

General guidelines that are common to both methods of venipuncture include whatsoever advance preparation, reviewing specimen drove and handling requirements, identification of the patient, reassuring the patient, assembling equipment and supplies, positioning the patient, applying the tourniquet, selecting a site for the venipuncture, obtaining the type of claret specimen required, and following the Occupational Rubber and Health Administration (OSHA) Bloodborne Pathogens Standard.

Get together the Equipment and Supplies

Use merely the appropriate blood tubes as specified by the laboratory directory or manufacturer's instructions accompanying a test system. Substituting blood tubes may non yield the proper blazon of specimen required or may affect the test results, equally shown past the following examples. If serum is required and a tube containing an anticoagulant is used (instead of a tube without an anticoagulant), the claret separates into plasma and cells, rather than serum and cells, and the wrong type of claret specimen is obtained, which necessitates obtaining another specimen from the patient.

The medical assistant should check each blood tube earlier use to ensure that it is not broken, chipped, cracked, or otherwise damaged. Damaged blood tubes are unsuitable for specimen collection and should be discarded. Blood tubes take an expiration appointment (Figure 31-3). The medical assistant should brand certain to cheque the expiration date on the tube to avoid using an outdated blood tube.

The medical banana must exist sure to label each blood tube. An unlabeled specimen is a cause for rejection of the specimen by an exterior laboratory. Two unique identifiers should be used to characterization the specimen. A unique identifier is information that clearly identifies a specific patient, such as the patient's name and appointment of nativity. A specimen tin be labeled by attaching a computerized bar lawmaking label to the specimen (Effigy 31-4, A). The bar lawmaking label includes (at least) ii unique patient identifiers. A specimen tin can also be labeled past handwriting the information on the label, which should include the patient'southward name and appointment of birth (two unique identifiers), the appointment and time of collection, the medical banana's initials, and whatever other information required by the laboratory (Effigy 31-4, B). The information should be printed legibly, and the medical assistant should be sure that the information is accurate to avoid a mix-up of specimens. The medical banana must too complete a laboratory request form to accompany the blood specimen. (NOTE: The medical assistant should follow the medical office policy as to when the tubes should exist labeled. Some offices prefer the tubes exist labeled earlier the specimen is drawn; other offices desire the tubes to be labeled right later on the specimen is obtained.)

Awarding of the Tourniquet

An important footstep in the venipuncture process is the application of the tourniquet. The tourniquet makes the patient'due south veins stand out so that they are easier to palpate. The tourniquet acts equally a "dam," which causes the venous blood to slow downward and pool in the veins in front of the tourniquet. This pooling of blood makes the veins more prominent so that they are more visible and can be palpated.

When applying a tourniquet, it is important to obtain the correct tourniquet tension. The tourniquet should be applied with plenty tension to irksome the venous menstruum without affecting the arterial flow. A tourniquet that is also tight obstructs both venous blood flow and arterial flow, which may result in a specimen that produces inaccurate examination results. A tourniquet that is too loose fails to crusade the veins to stand out enough to be palpated. A correctly applied tourniquet should fit snugly and non pinch the patient's skin.

Putting it All into Practice

My proper name is Dori Glover, and I work in a very decorated, fast-paced family unit practice office for ii physicians. I love my job. The physicians are great, with very different styles; the stride is fast; and the time flies by. I am constantly challenged, learning new things, coming together and helping people, and existence a part of a team that works well together.

While performing a venipuncture for a routine blood chemical science profile (a procedure I take performed many times), I accidentally stuck myself. I could see the claret inside my glove, and I could see the patient's blood clinging to the bespeak of the needle—my middle sank. I placed the needle and holder in the sharps container and tried to keep my cool and not alarm the patient. I mentally assessed the patient. He was an older man from a rural community, but I know you cannot ever judge a book by its comprehend.

I excused myself and immediately proceeded to wash my hands thoroughly with lather and water and rinse, rinse, rinse! I then notified the physician. The physician questioned the patient regarding operations he had had in the previous year. He had undergone bypass surgery and had received 2 units of claret. Although blood is effectively screened, I idea nearly that one-in-a-zillion risk that it could have been contaminated. Thankfully, I had received the hepatitis B immunization series, but there was all the same concern regarding hepatitis C and, of course, HIV.

The patient was gracious and complied with our request to exist tested for hepatitis and HIV. The physician and I discussed the state of affairs, and we determined the adventure to be low, but he yet offered me the selection of getting the HIV postexposure prophylactic handling. This treatment is very toxic and is not something you want to receive needlessly. I declined and proceeded to look in desperation for the patient's examination results. The discussion relief hardly describes how I felt when the patient'south laboratory results came back negative!

This incident confirmed the importance of getting the hepatitis B immunization and paying attending to good technique when performing procedures involving claret.

Guidelines for Applying the Tourniquet

The following guidelines help to ensure successful awarding of the tourniquet:

i. Exercise not apply the tourniquet over sores or burned skin.

two. Place the tourniquet 3 to 4 inches in a higher place the bend in the elbow. This allows adequate room for cleansing the site and performing the venipuncture without the tourniquet getting in the way.

3. Apply the tourniquet so that it is snug, but not so tight that information technology pinches the patient's skin or is otherwise painful to the patient.

4. When applying the tourniquet, enquire the patient to clench his or her fist. This pushes blood from the lower arm into the veins and makes them easier to palpate. You can enquire the patient to clench and unclench the fist a few times; however, vigorous pumping should exist avoided because information technology could lead to hemoconcentration, which could produce inaccurate test results.

5. Never get out the tourniquet on for longer than 1 infinitesimal because this would be uncomfortable for the patient. In addition, prolonged application of the tourniquet causes the venous claret to stagnate, or puddle in one place likewise long—a condition known as venous stasis. When venous stasis occurs, the plasma portion of the blood filters into the tissues, causing hemoconcentration. Hemoconcentration is an increase in the concentration of nonfilterable blood components in the claret vessels, such every bit cherry-red blood cells, enzymes, iron, and calcium, as a result of a decrease in the fluid content of the blood. This can result in inaccurate results for a diverseness of laboratory tests.

6. Ideally, you should remove the tourniquet as before long as a good blood flow is established; notwithstanding, this may not be practical when you are beginning learning the venipuncture procedure. Removing the tourniquet may cause the needle to move such that no more claret can be obtained, and the claret has to exist redrawn. When you are learning the venipuncture procedure, it is improve to await until simply earlier the needle is removed to remove the tourniquet.

7.Always remove the tourniquet before removing the needle from the patient's arm. If the needle is removed first, the force per unit area of the tourniquet causes blood to be forced out of the puncture site and into the surrounding tissue, resulting in a hematoma. A hematoma is defined as a swelling or mass of coagulated blood caused by a interruption in a blood vessel.

viii. After utilize, wipe a tourniquet thoroughly with a disinfectant such as alcohol. Disposable tourniquets are bachelor that are thrown away after 1 utilise.

Site Option for Venipuncture

For most patients, the all-time site to utilize is the veins in the antecubital infinite (Figure 31-viii). If the patient has large, visible antecubital veins, drawing blood is easy. If the patient has pocket-size veins or veins that cannot be palpated, obtaining a claret specimen tin be quite a challenge, fifty-fifty for the most experienced medical assistant.

The antecubital space is the surface of the arm in front of the elbow. The antecubital veins by and large have a wide lumen and are shut to the surface of the pare, which makes them easily accessible. In addition, these veins typically accept thick walls, making them less probable to collapse. Using the antecubital space spares the patient unnecessary pain because the skin is less sensitive there than at other sites, such as the back of the hand. The medical banana should not be misled past the presence in some patients of many modest, very blue "spidery" veins that lie close to the surface of the skin. These veins are non suitable for performing a venipuncture. The antecubital veins lie beneath these veins.

The best vein to utilise in the antecubital space is the median cubital. The median cubital is a prominent vein in the middle of the antecubital space and does not roll (see Figure 31-eight). At times, however, the median cubital vein cannot be used, for example, when it lies deep in the tissues and cannot be palpated or is scarred from repeated venipunctures.

The cephalic and basilic veins are located on opposite sides of the antecubital space and provide an alternative site when the median cubital vein is unavailable. The cephalic vein is located on the thumb side of the antecubital space, and the basilic vein is located on the piddling finger side of the antecubital infinite. The disadvantage of these "side" veins is that they tend to curl or movement abroad from the needle, escaping puncture. To forestall rolling, house pressure should be applied below and to the side of the vein to stabilize information technology as the needle is inserted.

The brachial artery likewise is located in the antecubital space, simply it lies deeper in the tissues. This is the avenue that is used to measure blood pressure. Earlier performing a venipuncture, palpate for the presence of this artery. In contrast to a vein, an artery pulsates, is more elastic, and has a thicker wall than a vein. If the brachial artery is inadvertently punctured, the patient feels more than the usual amount of pain, and the claret is bright blood-red and comes out in pulsing movements. If this situation occurs, the tourniquet should be removed and then the needle. Force per unit area with a gauze pad should be applied for four to 5 minutes.

Guidelines for Site Selection

Specific guidelines should exist followed to facilitate the option of a skillful vein:

1. Ensure that the lighting is acceptable. Good lighting facilitates inspection of the veins.

2. Ensure that the veins "stand out" as much every bit possible. Earlier locating a venipuncture site, always apply the tourniquet, and take the patient make a fist. This combination makes the veins more than prominent.

three. Examine the antecubital veins of both artillery. The best site to perform a venipuncture varies with each individual. The patient may have larger veins in 1 arm than in the other. It is advisable to ask the patient whether he or she has had a venipuncture before. Nearly adults have had previous venipunctures and know which of their veins are best to apply and which should be avoided. Listen to and evaluate information offered by the patient.

iv. Use inspection and particularly palpation to select a vein. A vein does not accept to be seen to be a proficient pick. If you cannot see a vein, palpation alone can be used to locate information technology. A vein feels similar an elastic tube that "gives" nether the pressure of the fingertips.

5. Ever palpate for the median cubital vein (middle vein) first. It commonly is bigger, is anchored better, bruises less, and poses the smallest run a risk of injuring underlying structures (due east.g., nerves and arteries) than the other veins. Because of this, if the patient's median cubital vein cannot exist seen but still can be palpated, it should exist used as the offset option when selecting a vein. If the median cubital vein is skillful in both arms, select the i that appears the fullest. The cephalic vein located on the pollex side is the next best vein choice because information technology does non gyre and trample as hands as the basilic vein. The basilic vein, located on the piddling finger side of the antecubital space, is the to the lowest degree desirable venipuncture site in the antecubital space. Branches of the median nervus may lie close to this vein in some individuals. In addition, the basilic vein lies in shut proximity to the brachial avenue. Both of these conditions pose a adventure of injury to underlying structures when blood is drawn from the basilic vein.

6. Thoroughly appraise the patient'southward veins. To assess a vein every bit a possible site for venipuncture, place one or 2 fingertips (index and middle fingers) over it and printing lightly, and so release pressure level. Do not employ your pollex to palpate the vein because it is not as sensitive as the index finger. To exist suitable for a venipuncture, the vein should experience round, firm, elastic, and engorged. When you depress and release an engorged vein, it should spring back in a rounded, filled state.

7. Make up one's mind the size, depth, and direction of the vein. When a suitable vein has been located, it should exist palpated thoroughly and advisedly to determine the direction of the vein and to judge the size and depth of the vein. Palpate and trace the path of the vein several times by rolling your index finger back and forth over the vein to determine its size. Audit and palpate the vein for problems. Some veins that appear suitable at kickoff sight feel pocket-size, hard, bumpy, or flat when palpated.

8. Map the location of the site. After locating an acceptable vein, mentally "map" the location of the puncture site on the patient's arm with "skin marks." This technique is particularly helpful if the vein cannot be seen, simply only palpated. The puncture site may exist located on or next to a peel marking, such as a freckle, a small wrinkle, or a pigmented expanse.

nine. Do not leave the tourniquet on for longer than 1 minute. When first learning the venipuncture procedure, y'all may demand to perform numerous assessments of the patient'due south arms to locate the best vein. After each assessment, remove the tourniquet for approximately 2 minutes to allow normal circulation of the blood to occur. This prevents patient discomfort and hemoconcentration, which can pb to inaccurate results for a variety of laboratory tests.

ten. If a practiced vein cannot be constitute, the following techniques can be employed to make the veins more prominent:

Alternative Venipuncture Sites

If it is incommunicable to locate a suitable vein in the antecubital infinite, alternative sites are available, including the inner forearm, the wrist area above the thumb, and the dorsum of the paw (Figure 31-nine). These alternative veins are smaller and accept thinner walls than the antecubital veins and should be used for venipuncture but when all possibilities for obtaining the claret specimen at the antecubital site have been considered. If the medical assistant is able to palpate a small vein in the antecubital space, information technology may exist possible to obtain blood there using the butterfly method of venipuncture.

The hand veins, in particular, should exist used simply as a concluding resort. The veins of the paw have a trend to gyre because they are non supported by much tissue and are close to the surface of the skin. This makes them more than difficult to stick. In addition, an abundant supply of nerves is nowadays in the hands, which makes this procedure more uncomfortable for the patient. Mitt veins tend to have thin walls, which makes them more susceptible to collapsing, bruising, and phlebitis. In some patients, however, particularly the obese and the elderly, the mitt veins may be the only attainable site.

OSHA Prophylactic Precautions

The OSHA Bloodborne Pathogens Standard presented in Affiliate 17 must exist carefully followed during the venipuncture process to avoid exposure to bloodborne pathogens. The following OSHA requirements employ specifically to the venipuncture procedure and to separation of serum from whole claret (see after):

ane. Wear gloves when it is reasonably anticipated that yous will have paw contact with blood.

2. Avoid hand-to-mouth contact, such as eating, drinking, or applying makeup, while working with blood specimens.

3. Wearable a face up shield or mask in combination with an middle protection device whenever splashes, spray, splatter, or droplets of claret may be generated.

four. Perform all procedures involving blood in a manner so as to minimize splashing, spraying, splattering, and generating aerosol of blood.

5. Bandage cuts and other lesions on the easily before gloving.

half-dozen. Sanitize hands equally soon as possible after removing gloves.

7. If your hands or other skin surfaces come in contact with blood, wash the expanse every bit soon as possible with soap and h2o.

8. If your mucous membranes (due east.g., eyes, nose, mouth) come in contact with blood, flush them with water equally soon as possible.

nine. Do non bend, break, or shear contaminated venipuncture needles.

10. Practise not recap a contaminated venipuncture needle.

11. Locate the sharps container as close as possible to the area of use. Immediately after use, place the contaminated venipuncture needle (and plastic holder) in the biohazard sharps container.

12. Place blood specimens in containers that forbid leakage during collection, treatment, processing, storage, transport, and shipping.

thirteen. Handle all laboratory equipment and supplies properly and with intendance as indicated by the manufacturer. For instance, await until the centrifuge comes to a complete stop before opening information technology.

14. Exercise not shop food in refrigerators where testing supplies or specimens are stored.

15. If you are exposed to blood, report the incident immediately to your md-employer.

Vacuum Tube Method of Venipuncture

The vacuum tube method is frequently used to collect venous blood specimens. This method is considered ideal for collecting blood from normal healthy antecubital veins that are adequate in size to withstand the pressure of the vacuum in the evacuated tube. Procedure 31-1 outlines the venipuncture vacuum tube method. The vacuum tube system consists of a collection needle, a plastic holder, and an evacuated tube (Figure 31-11). One commercially available vacuum tube arrangement is the Vacutainer Organization (Becton Dickinson, Franklin Lakes, NJ).

Procedure 31-1   Venipuncture—Vacuum Tube Method

Upshot

Perform a venipuncture using the vacuum tube method.

Equipment/Supplies

1.Procedural Step. Review the requirements for collecting and handling the blood specimen as ordered by the physician. Sanitize your hands.

ii.Procedural Step. Greet the patient and introduce yourself. Identify the patient past asking the patient to state his or her total name and date of nascency. Compare this data with the demographic information in the patient's chart. If the patient was required to gear up for the exam (eastward.k., fasting, medication brake), determine whether he or she has prepared properly. If the patient has not followed the patient preparation requirements, notify the physician for instructions on handling this situation.

Principle. It is important to confirm that you accept the correct patient to avert collecting a specimen on the incorrect patient. The patient must prepare properly to obtain a high-quality specimen that would lead to authentic test results.

3.Procedural Stride. Assemble the equipment. Select the proper evacuated tubes for the tests to be performed. Check the expiration date on the tubes. Characterization each tube using i of the post-obit methods: (a) attaching a computer bar lawmaking label to each tube to be drawn and labeling information technology with your initials, or (b) manually labeling each tube with the patient's name and engagement of nascence, the date, and your initials. If the specimen is to be tested at an exterior laboratory, complete a laboratory request grade. (NOTE: Follow the medical office policy as to when the tubes should be labeled. Some offices prefer that tubes exist labeled before the specimen is drawn; other offices want the tubes to be labeled right subsequently the specimen is drawn.)

Principle. Outdated tubes may no longer comprise a vacuum, and, as a effect, they may not be able to draw blood into the tube. Proper labeling of blood specimens avoids a botch of specimens.

4.Procedural Step. Ready the vacuum tube system. Remove the cap from the posterior needle using a twisting and pulling motility. Insert the posterior needle into the minor opening on the plastic holder. Screw the plastic holder onto the Luer adapter, and tighten it deeply.

Principle. An unsecured needle tin can fall out of its plastic holder.

v.Procedural Step. Open up the sterile gauze package, and lay information technology flat to permit the gauze pad to rest on the within of its wrapper. Position the evacuated tubes in the correct lodge of draw. If the evacuated tube contains a powdered additive, tap the tube just below the stopper to release any additive adhering to the stopper.

Principle. If an additive remains trapped in the stopper, erroneous test results may occur.

6.Procedural Step. Place the first tube loosely in the plastic holder.

seven.Procedural Step. Explain the process to the patient, and reassure the patient. Perform a preliminary cess of both arms to make up one's mind the best vein to utilize. It too is helpful to ask the patient which arm has been used in the past to obtain blood.

Principle. Venipuncture is often a frightening feel for the patient, and reassurance should be offered to reduce apprehension.

8.Procedural Footstep. Utilise the tourniquet. Position the tourniquet 3 to 4 inches above the curve in the elbow. The tourniquet should be snug but not tight. Ask the patient to clench the fist of the arm to which the tourniquet has been applied.

Principle. The combined effect of the force per unit area of the tourniquet and the clenched fist should cause the antecubital veins to stand up out so that authentic choice of a puncture site can exist made.

9.Procedural Step. With a tourniquet in identify, thoroughly assess the veins of first ane arm and then the other to decide the best vein to utilise.

10.Procedural Step. Position the patient'southward arm. The arm with the vein selected for the venipuncture should be extended and placed in a straight line from the shoulder to the wrist with the antecubital veins facing anteriorly. The arm should be supported on the armrest by a rolled towel or by having the patient place the fist of the other hand under the elbow.

Principle. This position allows like shooting fish in a barrel access to the antecubital veins.

11.Procedural Pace. Thoroughly palpate the selected vein. Gently palpate the vein with the fingertips to determine the direction of the vein and to estimate its size and depth. Never exit the tourniquet on an arm for longer than 1 minute at a time. (NOTE: If you need to perform several assessments to locate the all-time vein, the tourniquet must be removed and reapplied afterward a 2-infinitesimal waiting period.)

Principle. Leaving the tourniquet on for longer than 1 minute is uncomfortable for the patient and may alter the test results.

12.Procedural Step. Remove the tourniquet and cleanse the site with an antiseptic wipe. Cleansing should be done in a circular movement, starting from the inside and moving away from the puncture site. Let the site to air-dry; after cleansing, do non touch the area, wipe the area with gauze, or fan the area with your hand. Place the remaining supplies within comfortable reach of your nondominant paw.

Principle. Using a circular move helps carry strange particles away from the puncture site. The site must exist allowed to air-dry to allow the alcohol enough fourth dimension to destroy microorganisms on the patient's peel. Remainder alcohol entering the blood specimen can cause hemolysis, leading to inaccurate exam results. In improver, balance alcohol causes the patient to experience a stinging sensation when the puncture is made. Touching or fanning the expanse causes contamination of the puncture site, and the cleansing process must be repeated. Items used during the procedure should be positioned and so that you exercise not have to reach over the patient and possibly move the needle, resulting in hurting, injury, or both.

xiii.Procedural Stride. Reapply the tourniquet. Apply gloves. If you are using a needle with a prophylactic shield, rotate the shield astern toward the holder (refer to Figure 31-13, A). Remove the cap from the needle using a twisting and pulling motion. Hold the vacuum tube organisation by placing the thumb of the dominant mitt on pinnacle of the plastic holder and the pads of the first iii fingers underneath the holder and evacuated tube. The needle should exist positioned with the bevel facing upwardly. Position the evacuated tube and so that the label is facing downward.

Principle. Gloves provide a bulwark against bloodborne pathogens. Positioning the needle with the bevel up allows easier entry into the skin and the vein, resulting in less hurting for the patient. With the characterization facing downward, you would be able to observe the claret equally information technology fills the tube, which allows you to know when the tube is full.

14.Procedural Step. Ballast the vein. Grasp the patient'due south arm with the nondominant hand. Your thumb should be placed 1 to two inches below and to the side of the puncture site. Using your thumb, draw the pare taut over the vein in the direction of the patient's hand.

Principle. The thumb helps hold the skin taut for easier entry and helps stabilize the vein to exist punctured. Placing the thumb to the side keeps it out of the way of the vacuum tube setup, then that you tin can maintain a 15-degree bending when inbound the vein.

15.Procedural Stride. Position the needle at a 15-degree angle to the arm. Rest the backs of the fingers on the patient's forearm. Ensure that the needle points in the same management as the vein to be entered. The needle should be positioned and so that it enters the vein approximately inch below the identify where the vein is to be entered.

Principle. An angle of less than 15 degrees may cause the needle to enter above the vein, preventing puncture. An bending of more than 15 degrees may cause the needle to become through the vein past puncturing the posterior wall. This could result in a hematoma.

Source: https://nursekey.com/phlebotomy/

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