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VENIPUNCTURE USING VACUUM COLLECTION SYSTEM



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EXERCISE 2 VENIPUNCTURE USING VACUUM COLLECTION SYSTEM Skills 30 points Objectives 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 Identify 4 potential sites for venipuncture List the veins of the forearm used for venipuncture describe where they are positioned and list the most common ones used for routine venipuncture Demonstrate concern for the safety and welfare of yourself and others by consistently using appropriate infection control techniques Demonstrate appropriate concern for your classmate by explaining the procedure Describe and demonstrate the steps in the preparation of the venipuncture site State the effect the tourniquet and hand squeezing has on venipuncture Recognize proper needle insertion and withdrawal techniques including direction angle depth and aspiration List the supplies necessary for performance of the venipuncture List in chronological order the correct steps in the proper performance of a venipuncture using the vacuum blood collection system State the correct order of the draw State the reason that the correct order of the draw must be followed List six anticoagulants the color of stopper for each and 2 laboratory tests which will be drawn into each Perform three successful venipunctures on the artificial arm and one successful live draw with minimum stasis and trauma and no contamination State the consequences of placing a tourniquet above an IV site State the problems which may occur if a sample is drawn above an IV and how this will affect the quality of the laboratory samples State the proper protocol when samples must be collected above an IV List 6 reasons that a blood sample might be rejected by the laboratory Revised September 5 2007 Discussion Clinical laboratories perform blood analyses on venous blood samples collected by phlebotomy To collect a venous blood sample the phlebotomist pierces the vein with a hypodermic needle and draws the blood into a syringe or uses a commercially available apparatus specifically designed for collecting venous blood such as the vacuum collection system The goal of venipuncture is to obtain a blood sample from the correct patient into the correct tube with minimal trauma Venipuncture is an invasive procedure and requires a certain degree of skill Vacuum Blood Collection System The vacuum system consists of a double pointed needle a plastic holder or adapter and a series of vacuum tubes with rubber stoppers of various colors the colors indicate the type of additive present Another kind of holder is available which allows resheathing of the needle with the holder after venipuncture Blood Exercise 2 Venipuncture Vacuum blood collection 13 collection using the evacuated tube collection system will produce the best blood samples for analysis by the laboratory The blood goes from the patient directly into the appropriate test tube Blood Collection Needle The Vacuum collection needle is pointed at both ends with one end shorter than the other The long end of the needle is used for insertion into the vein the shorter end is used to pierce the rubber stopper of the vacuum tube and usually is covered by a rubber sheath The sheath makes it possible to draw several tubes of blood by preventing leakage of blood as tubes are changed this is called a multi draw needle If the short end is not covered 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 goes into the vein Blood collection needle lengths range from 1 to 1 inches One inch needles are used for routine venipuncture 1 inch needles are used for patients with very deep veins The gauge of a needle is a number that indicates the diameter of its lumen the lumen also called the bore is the circular hollow space inside the needle The higher the gauge the smaller the lumen The most frequently used gauges for phlebotomy are 20 21 and 22 The bevel is the slanted opening at the end of the needle the phlebotomist performs a venipuncture so that the bevel of the needle is facing upward when the needle is inserted into the vein Blood collection needles come in single use sterile packages either peel apart envelopes or plastic cases Holder The vacuum collection system holder is a plastic sleeve into which the phlebotomist screws the double pointed blood collection needle Holders are available in two sizes one for adult venipuncture and one for pediatric procedures All holders are single use have an integral safety device which covers the needle after use and the entire apparatus is disposed of Blood Collection Tubes Blood 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 of the procedure The air pressure inside the tube is negative less than the normal environment After inserting the longer needle into the vein the phlebotomist pushes the tube into the holder so that the shorter needle pierces the stopper The difference in pressure between the inside of the tube and the vein causes blood to fill the tube The tubes are available in various sizes for adult and pediatric phlebotomies Adult tubes have volumes 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 the addition of an anticoagulant in the tube The anticoagulant prevents blood from clotting resulting in a whole blood sample one in which the cells are free in the plasma If an anticoagulant is not present the blood will clot coagulation factors present in the fluid portion of the blood cause the cellular components to clump together It is of critical importance that the phlebotomist knows which type of tube to draw for each test ordered The collection of the blood in the wrong type of tube will result in the patient having to be stuck again In the vacuum blood collection system the anticoagulants are already in the tubes in the precise amount needed to mix with the amount of blood that will fill the tube The color of the stopper on each tube indicates what if any anticoagulant the tube contains It is important to completely fill each tube so that the proportion Exercise 2 Venipuncture Vacuum collection system 14 of blood to chemical additive is correct otherwise the test results may not be accurate or


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