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VENIPUNCTURE USING VACUUM COLLECTION SYSTEM

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Page 1Page 2Page 3Page 4Page 5Page 6Page 7Page 8Page 9Page 10Page 11Page 12Page 13Page 14Page 15Page 16Page 17Page 18Page 19Page 20Page 21Page 22Page 23Page 24Page 25Page 26Page 27Page 28Exercise 2: Venipuncture Vacuum blood collection 13EXERCISE 2: VENIPUNCTURE USING VACUUM COLLECTION SYSTEMSkills 30 pointsObjectives1. Identify 4 potential sites for venipuncture.2. List the veins of the forearm used for venipuncture, describe where they are positioned, and list themost common ones used for routine venipuncture.3. Demonstrate concern for the safety and welfare of yourself and others by consistently usingappropriate infection control techniques.4. Demonstrate appropriate concern for your classmate by explaining the procedure.5. Describe and demonstrate the steps in the preparation of the venipuncture site.6. State the effect the tourniquet and hand squeezing has on venipuncture.7. Recognize proper needle insertion and withdrawal techniques including direction, angle, depth andaspiration.8. List the supplies necessary for performance of the venipuncture.9. List, in chronological order, the correct steps in the proper performance of a venipuncture using thevacuum blood collection system10. State the correct order of the draw.11. State the reason that the correct order of the draw must be followed.12. List six anticoagulants, the color of stopper for each and 2 laboratory tests which will be drawn intoeach.13. Perform three successful venipunctures on the artificial arm and one successful live draw withminimum stasis and trauma and no contamination.14. State the consequences of placing a tourniquet above an IV site.15. State the problems which may occur if a sample is drawn above an IV and how this will affect thequality of the laboratory samples.16. State the proper protocol when samples must be collected above an IV.17. List 6 reasons that a blood sample might be rejected by the laboratory.Revised: September 5, 2007DiscussionClinical laboratories perform blood analyses on venous blood samples collected by phlebotomy. To collecta venous blood sample, the phlebotomist pierces the vein with a hypodermic needle and draws the blood intoa syringe or uses a commercially available apparatus specifically designed for collecting venous blood, suchas the vacuum collection system. The goal of venipuncture is to obtain a blood sample from the correctpatient into the correct tube with minimal trauma. Venipuncture is an invasive procedure and requires acertain degree of skill. Vacuum Blood Collection SystemThe vacuum system consists of a double-pointed needle, a plastic holder or adapter, and a series of vacuumtubes with rubber stoppers of various colors, the colors indicate the type of additive present. Another kindof holder is available, which allows resheathing of the needle with the holder after venipuncture. BloodExercise 2: Venipuncture Vacuum collection system 14collection using the evacuated tube collection system will produce the best blood samples for analysis by thelaboratory. The blood goes from the patient directly into the appropriate test tube. Blood Collection NeedleThe Vacuum collection needle is pointed at both ends, with one end shorter than the other. The long end ofthe needle is used for insertion into the vein, the shorter end is used to pierce the rubber stopper of the vacuumtube and usually is covered by a rubber sheath. The sheath makes it possible to draw several tubes of bloodby preventing leakage of blood as tubes are changed, this is called a multi-draw needle. If the short end is notcovered with a rubber sheath, it is a single sample needle and only one tube of blood can be collected.There are several sizes of needles available, the size depends on the length and gauge of the needle that goesinto the vein. Blood collection needle lengths range from 1 to 1 ½ inches. One inch needles are used forroutine venipuncture, 1 ½ inch needles are used for patients with very deep veins. The gauge of a needle isa number that indicates the diameter of its lumen; the lumen, also called the bore, is the circular hollow spaceinside the needle. The higher the gauge, the smaller the lumen. The most frequently used gauges forphlebotomy are 20, 21 and 22.The bevel is the slanted opening at the end of the needle. the phlebotomist performs a venipuncture so thatthe bevel of the needle is facing upward when the needle is inserted into the vein. Blood collection needlescome in single use, sterile packages, either peel apart envelopes or plastic cases.HolderThe vacuum collection system holder is a plastic sleeve into which the phlebotomist screws the double pointedblood collection needle. Holders are available in two sizes, one for adult venipuncture and one for pediatricprocedures. All holders are single use, have an integral safety device which covers the needle after use andthe entire apparatus is disposed of. Blood Collection TubesBlood collection tubes are glass or plastic tubes sealed with a partial vacuum inside by rubber stoppers.Standard practice in the field is moving to the use of plastic tubes for blood collection to increase safety ofthe procedure. The air pressure inside the tube is negative, less than the normal environment. After insertingthe longer needle into the vein, the phlebotomist pushes the tube into the holder so that the shorter needlepierces the stopper. The difference in pressure between the inside of the tube and the vein causes blood to fillthe tube. The tubes are available in various sizes for adult and pediatric phlebotomies. Adult tubes havevolumes of 5, 7, 10 and 15 mL and pediatric tubes are available in volumes of 2, 3 and 4 mL. Different blood tests requires different types of blood specimens. For instance, some specimens require theaddition of an anticoagulant in the tube. The anticoagulant prevents blood from clotting, resulting in a wholeblood sample, one in which the cells are free in the plasma. If an anticoagulant is not present the blood willclot, coagulation factors present in the fluid portion of the blood cause the cellular components to clumptogether. It is of critical importance that the phlebotomist knows which type of tube to draw for each testordered. The collection of the blood in the wrong type of tube will result in the patient having to be stuckagain. In the vacuum blood collection system, the anticoagulants are already in the tubes in the precise amountneeded to mix with the amount of blood that


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