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Specimen collection cc

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  • Syringe Method: (Open Collection System) Vacutainer Method: (Closed Collection System)Radial: (45 – 60O) G 23 – 25 Brachial: (45 – 60O) G 18 – 20 Femoral: (90O)For pediatric collection: 3 ml syringe or tuberculin syringe with a 21 or 23-gauge needle; 23-gauge butterfly set is also suitable
  • Butterfly Infusion Set: Consist of a stainless steel beveled needle attached with plastic wings for the phlebotomist to grasp during the needle insertion
  • Needle Gauge: 16=Transparent 18 =Yellow 19=Brown 20=Violet 21=Green 22=Black 23=Sky blue 24=Red 25=Dark Blue 26=Orange
  • apply tourniquet below IV site
  • Never draw without consent. Charges of assault and battery could result.
  • K3EDTA: liquid form in glass tubesK2EDTA: spray-dried in plastic tubesPink: spray-dried K2EDTA
  • 3.2% = 0.105M 3.8%=0.129M
  • 3.2% = 0.105M 3.8%=0.129M
  • SPS: aids in bacterial recovery by inhibiting complement, phagocytes and certain antibioticsACD: RBC preservative
  • NCCLS Guidelines: use of plastic evacuated tubes
  • (Do not freeze whole blood.)
  • (Do not freeze whole blood.)
  • . Do not use ice cubes alone because RBCs may lyse.
  • Transcript

    • 1. BLOODSPECIMEN COLLECTION
    • 2. GENERAL CONSIDERATIONS
      “No Laboratory test can be better than its manner of specimen collection”
      PATIENT IDENTIFICATION
      PATIENT PREPARATION
      SPECIMEN IDENTIFICATION
      COLLECTION TECHNIQUE
      SPECIMEN CONTAINER
      ADDITIVES
    • 3. BloodSpecimen Collection
      PHLEBOTOMIST
      With good interpersonal skills
      Professional attitude
      Ensure Patient confidentiality
    • 4. MACROSAMPLE
      MACROSAMPLE (Venipuncture)
      Syringe Method
      Vacutainer Method
      Arterial Puncture
      Radial
      Brachial
      Femoral
    • 5. MACROSAMPLE
      Equipment Needed
      Tourniquet
      Antiseptic solution
      Syringe and needle
      Vacutainer set
      Butterfly Infusion Set
    • 6. Blood CollectionMacrosample Collection
    • 7. Blood CollectionOpen System
    • 8. Blood CollectionClosed System
    • 9. Blood CollectionClosed System
    • 10. ADVANTAGES OF VENIPUNCTURE
      allows repetition of tests/follow up
      avoids tissue juices
      can be mailed
      Fastest method from a large number of patients
      DISADVANTAGES OF VENIPUNCTURE
      • More complications may arise
      • 11. Hard to do on some patients
    • Blood CollectionMacrosample Collection
      SITES OF COLLECTION
      NB up to 18 months
      Superior Longitudinal sinus vein
      External jugular vein
      Temporal vein
    • 12. Blood CollectionMacrosample Collection
      SITES OF COLLECTION
      Older than 18 months – 3 y/o
      Femoral vein
      Long Saphenous vein
      Ankle vein
      Popliteal vein
      External Jugular vein
      Temporal vein
    • 13. Blood CollectionMacrosample Collection
      SITES OF COLLECTION
      Older than 3 y/o
      Veins on the antecubitalfossa
      Wrist vein
      Veins of the dorsal hand
      Veins of the Foot
    • 14. Blood CollectionMacrosample Collection
    • 15. Blood CollectionMacrosample Collection
    • 16. Blood CollectionMacrosample Collection
    • 17. Specimen Collection by Venipucture
      Patient Identification
      Note Isolation Restrictions
      Note Dietary Restrictions
      Reassure patient
      Position the patient
      Select venipuncturelocation
      Assemble Supplies
    • 18. Apply the tourniquet
      Cleanse the site
      Inspect needle
      Perform venipuncture
      Release tourniquet
      Withdraw needle & apply pressure
      Post Phlebotomy Procedures
      Proper disposal
      Label specimen
      Check patient
    • 19.
    • 20. Needle Insertion
    • 21. Needle Insertion
    • 22. Complications of Venipucture
      1. Immediate Local complication
      Hematoma
      Hemoconcentration
      Circulatory failure
      Syncope
      Failure of blood to enter the syringe
    • 23. Complications of Venipucture
      2. Late Local Complications
      Thrombosis
      Thrombophlebitis
      3. Delayed General Complications
      HIV
      Hepatitis
    • 24. 24
      Situations in Phlebotomy
    • 25. 25
      Situations in Phlebotomy
    • 26. 26
      Situations in Phlebotomy
    • 27. 27
      Situations in Phlebotomy
    • 28.
    • 29.
    • 30.
    • 31.
    • 32.
    • 33.
    • 34.
    • 35.
    • 36. Reasons for Specimen Rejection
      Hemolysis/Lipemia
      Clots in an anticoagulated specimen
      Nonfasting specimen when test requires fasting
      Wrong volume
      Improper transport conditions
      Discrepancies bet requisition & specimen label
      Unlabeled or mislabeled specimen
      Contaminated specimen/Leaking container
    • 37. Anticoagulants
      Anticoagulants inhibit clot formation.
      As soon as blood is removed from a vessel, activation of coagulation begins.
      Although blood drawn directly into an evacuated tube contacts the anticoagulant, it is necessary to immediately and gently invert the tube, mixing the content to prevent micro-formation.
      DEFIBRINATION
    • 38. Serum Preparation
      Tube Stoppers:
    • 39. EDTA: (Na or K)
      • K3EDTA or K2EDTA
      Tube stoppers:
      Commonly Used Anticoagulants
    • 40. Sodium Citrate:
      Tube Stoppers:
      Commonly Used Anticoagulants
    • 41. Commonly Used Anticoagulants
      HeparinTube Stoppers:
    • 42. Commonly Used Anticoagulants
      Other Tube Stoppers:
    • 43. Order of Draw
    • 44. 44
      Specimen Processing
      • Serum or plasma should be separated from cells within 2 hours of collection (unless collected in a gel separator tube).
      • 45. Allow red top tubes to clot sufficiently (20-30 minutes) before centrifugation to avoid fibrin strands.
    • 45
      Specimen Processing
      • Centrifuge 10 ± 5 minutes at 1000-1200 × g.
      • 46. Keep tubes capped during centrifugation to avoid loss of CO2, change of pH, evaporation, or aerosol formation.
      • 47. Lipemicspecimens can be ultracentrifugedto remove chylomicrons.
    • 46
      Specimen Processing
      • If analysis will be delayed more than 5 hours, serum or plasma for most tests can be capped and stored at 4°C. Some analytes should be frozen. Avoid repeated freezing and thawing.
      • 48. Specimens for lactate dehydrogenase (LD) should be kept at room temperature.
    • 47
      Specimen Processing
      • For acid phosphate, add citrate (10 mg/mL) and freeze.
      • 49. Glucose is stable in serum separator tubes for 24 hours and in sodium fluoride tubes for 24 hours at room temperature or 28 hrs at 4°C.
    • Tests Requiring a Fasting Specimen
      Fasting blood sugar
      Glucose tolerance test
      Triglycerides
      Lipid panel
      Gastrin
      Insulin
    • 50. Specimens Requiring Special Handling
    • 51. Specimens Requiring Special Handling
    • 52. Specimens Requiring Special Handling
    • 53. Open System
      Components needed :
      Blood taken transfer into ...
      Containers of different sizes
      Syringes of different sizes
    • 54. Closed System
      LabOPN1
      3 Basic Components :
      Blood flows straight into tubes ...
      BD Vacutainer® Standard Holder
      BD Vacutainer®
      Multi Sampling Needle
      21G (Green), 22G (Black)
      BD Vacutainer® Evacuated Tubes
    • 55.
    • 56. Collection System - Implication to Collectors
      LabOPN1
      N&S
      Vacutainer® System
      Open System
      Manual manipulation of plunger
      Manualtransfer
      of specimen
      Closed System
      Quick & easy fill, no manipulation needed
      Auto & direct transfer of specimen
    • 57. Material Used - Collection
      N&S
      Vacutainer® System
      Disposable needle
      Evacuated specimen tube
      Reusable holder
      Disposable needle
      Non-evacuated specimen tube
      Disposable syringe
    • 58. Collection System - Implication to Collectors
      LabOPN1
      N&S
      Vacutainer® System
      Possible spillage
      Exposure to blood, contamination
      Inaccurate fill causing inaccurate blood:additive ratio
      Safety to patient and collector for good infection control
      Reduce redraw from patient - Precise vacuum preserves precise ratio
    • 59. Manual Steps
      LabOPN1
      N&S
      Vacutainer® System
      Remove needle from vein
      Remove cap from container
      Remove needle from syringe
      Transfer blood into container(s)
      Recap container(s)
      Remove tube from needle holder
      Remove needle from vein
      Additional time saving during collection is approximately 20%
      Risk of incomplete closure seal
    • 60. Collection System- Implication to Laboratory
      LabOPN1
      N&S
      Vacutainer® System
       Hemolysis redraw
      Microclots (delay in contact with additive & this is a variable factor)
      QNS redraw
      No specific color code
      Less hemolysis with full system usage
      Specimen integrity is preserved - no microclots
      Sufficient quantity
      Int’l color code - easy ID
    • 61. LabOPN1
      Evacuated System Assembly
      Screw on Needle
      Twistthe seal of the needle and remove the clear shield (cap) that covers the center-threaded section and back end of the needle. Insert the back end of the needle into the holder, and twist the needle tightly into the holder.
      CAUTION: If the seal on a needle has already been broken, the needles no longer sterile. Discard the needle in a sharps container.
    • 62. Insert Tube
      Place the first tube into the holder and partially advance it onto the needle.
      Do not fully push tube onto needle at this point, because this will break the tube's vacuum. Needle sheath on the front end is removed just prior to needle insertion.
      Once needle is in the vein, advance tube to the end of the holder. When needle fully punctures stopper, blood should begin to flow freely into tube. Lack of blood flow at this point suggest lack of tube vacuum or error in venipuncture technique.
      Pay particular attention to enlarged graphic demonstrating both partial and fully inserted needle positions.
    • 63. Butterfly
      The illustration shows a winged infusion set (butterfly) with an attached adapter for evacuated tubes.
      Inserting the needle into the vein is facilitated by pressing and holding the wings together between the thumb and forefinger.
      A Butterfly needle is useful when drawing from small, fragile, and hard-to-locate veins.
      The phlebotomist should exercise caution when using the apparatus. Because the needle is separated from the holder by the tubing, needle-stick injuries occur more easily to both patient and phlebotomist during disposal of the apparatus.
    • 64. Tourniquet
      A variety of tourniquet types are available and illustrated here. Each has advantages and disadvantages.
      Latex is commonly used because it is stretchable, does not support bacterial growth, and can be cleaned with disinfectant.
      CAUTION: Alternatives to latex must be used when patient has developed an allergy to latex. Anaphylactic shock occurs if a latex tourniquet is used.
    • 65. Gloves
      The Occupational Safety and Health Administration mandates that gloves must be worn as protection whenever blood, body fluids, or other possibly contaminated items are handled.
      The gloves should be cleaned but need not be sterile.
      Gloves protect the phlebotomist and the patient.
      Fresh gloves should be worn for each patient.
    • 66. Cart and Tray
      Carts and trays are examples of devices used to store / carry equipment. They should contain all the equipment required to properly perform phlebotomy.       
      Cart
      Tray
    • 67. Antiseptics
      The venipuncture site must be thoroughly cleansed prior to puncture. Isopropylalcohol (70%) is commonly used.
      Alcohol wipes usually come in individually wrapped prep pads.
      When opened, the pad should be fully saturated with alcohol; if it is not, discard the pad and open another.
      Isopropylalcohol is not a disinfectant, e.g., iodine. If tubes are being drawn for blood culture, cleansing of the site must be done using a disinfectant. Follow the laboratory's standard operating procedure for blood culture draws.
    • 68. Gauze
      Clean 2" x 2" gauze pads are used to place pressure over the venipuncture site once the needle is removed.
      Do not use cotton. It tends to stick to the wound site.
      Do not remove gauze too soon. The clot that is forming may be disturbed and bleeding may restart. 
    • 69. Bandages
      Use an adhesive bandage to cover the site once bleeding has ceased.
      Use paper, cloth, or knitted tape over a folded gauze square for patients who are sensitive to adhesive bandages.
      To prepare a gauze pad, fold the gauze in half, and then in half again to form a square. Place this over the puncture site and secure in place with tape.
    • 70. Disposals
      Discard contaminated needles in a designated container referred to as a "sharp container“
      A variety of containers are manufactured. They provide for safe removal of the needle from the holder whether an evacuated tube system or syringe is used.
      They must be rigid, puncture-resistant, leak-proof, disposable, and easily sealed when full.They should have a locking lid which does not permit entry into the container.
      They are usually red, bright orange, or yellow, and must be labeled "BIOHAZARD".
    • 71. Site selection in Arm
      The highlighted area shows the antecubitalfossa where the major veins used for venipuncture are located.
      • Choose one that is bouncy or resilient, large enough to support good blood flow, and well-anchored by tissue.
      • 72. Median cubital vein is the first choice because it is large, well-anchored, least painful, and least likely to bruise.
    • Site selection in Arm
      Cephalic vein is the second choice. It is large, but not as well anchored and is more painful when punctured than the median cubital.
      Basilic vein is the third choice. It is generally easy to palpate, but not well anchored. It lies near the brachial artery and the median nerve, either of which could accidentally be punctured.
    • 73. Avoiding the Median Nerve
      Avoid major nerves.
      Hitting a patient's nerve with a needle can cause sharp and immediate pain.
      The patient may also experience an involuntary reflex action, pulling the arm away from the needle.
      Arteries, which can be detected by a pulse, should not be used for routine blood collection.
      To avoid inadvertently puncturing an artery, do not select a vein that overlies or is close to an artery.
      As seen in the diagram, both the median nerve and the brachial artery lie close to the basilic vein.
      Excessive or blind probing while performing a venipuncture can lead to permanent injury of the nerve or artery that may result in legal action.
    • 74.
    • 75. Site selection in Hand
      Hand or wrist veins may be used when antecubitalfossa veins are unsuitable or unavailable.
      Phlebotomist must use extra care to anchor them.
      These veins have a narrow diameter, it may be necessary to use a small gauge needle and small volume evacuated tubes.
      Use of a butterfly apparatus may enhance success and make the procedure less painful.
    • 76. Site selection in Foot
      The last resort for blood collection is from the foot veins after the arm veins have been determine unsuitable.
      Always check with the hospital policy before this type of sampling is carried out.
    • 77. Inappropriate Sites for Venipuncture
      Arms on side of Mastectomy
      Edematous areas
      Hematomas
      Arm in which blood is being transfused
      Scarred areas
      Arms with cannulas, fistulas or vascular grafts
      Arm above IV lines
    • 78. Assemble Equipment
      Prior to initiating venipuncture, gather all equipment needed.
      Place the necessary evacuated tubes in the proper sequence for specimen collection.
      A sharps container should be easily accessible for immediate needle disposal following completion of the venipuncture.
    • 79. Wash Hands
      The most important means of preventing and controlling the spread of infection is proper hand washing:
      Remove watch and rings
      Without touching the sink, wet hands under warm, running water. Apply soap and work up a lather, rubbing hands together to create friction for at least 15 seconds.
      Rinse hands in a downward motion from wrists to fingertips.
      Repeat steps 2 and 3.
      Dry hands with a clean paper towel
      Turn the faucet off with another clean paper towel.
    • 80. Apply Gloves
      OSHA regulations require the wearing of gloves during phlebotomy procedures.
      A new pair of gloves must be worn for each patient. When donning gloves, pull them over the cuff of protective clothing.
    • 81. Position Patient
      A patient should be either seated or lying down while having blood drawn.
      The patient's arm should be firmly supported and extended downward in a straight line from the shoulder to the wrist.
      Ensure patient's hand is closed, which makes the veins more prominent.
      Do not ask the patient to pump his / her hand.
    • 82. Correct arm positioning:
      Allows gravity to help veins enlarge.
      Helps assure the specimen collection tubes fill from the bottom up to prevent reflux and additive carryover between sample tubes.
    • 83. Tie Tourniquet
      Position tourniquet under the arm 3-4 inches above the intended venipuncture site, with each hand grasping one side of the tourniquet.
      Apply and maintain tension. Without rolling or twisting the tourniquet, bring the two sides together.
      Cross one side over the other and securely tuck a portion of the upper side under the lower side.
      Note that the loop is below the tourniquet band and the free ends (flaps) of the tourniquet are pointing away from the venipuncture site. This prevents it from the interfering with the site of needle entry.
      The flaps should be positioned so they can easily be grasped with one hand. Gently pulling on the flaps releases the tourniquet.
    • 84. Apply Tourniquet
      Apply tourniquet to increase pressure in the veins and aid in vein selection.
      When correctly placed on the patient's arm, it should be tight enough to slow venous flow without affecting arterial flow. It should feel slightly tight to the patient, allowing more blood to flow into than out of the area.
      The veins enlarge, making them easier to palpate and penetrate with a needle.
      Ideally, never leave a tourniquet on the patient longer than one minute. Tourniquets left on longer may alter test results.
      Do not apply a tourniquet over an open sore.
      Do not apply a tourniquet to the arm on the side of a recent mastectomy.
    • 85. Select Site
      Venipuncture is most commonly performed in the anticubitalfossa area of the arm where the median cubital, cephalic, and basilic veins lie fairly close to the surface.
      Use the tip of the index finger to palpate (examine by feel) the vein. This helps determine the size, depth, and direction of the vein.
      Select vein that is easily palpated, large enough to support good blood flow, and well-anchored or fixed by surrounding tissue.
    • 86. Cleanse site
      Clean venipuncture site with antiseptic to help prevent microbial contamination to the specimen and patient.
      Start at the center of the site and move outward in ever widening, concentric circles. Failure to follow this procedure may re-introduce dirt and bacteria.Use sufficient pressure to remove surface dirt and debris.
      Repeat the process with a fresh alcohol prep pad if the site's is still dirty.
      Let the site air dry (30 - 60 seconds) prior to beginning the venipuncture.
      Do not wipe, blow on, or fan the site, as these actions may re-introduce contaminations.
      For blood culture draws, refer to the laboratory's standard operating procedure for instructions.
    • 87. Insertion Angle
      Insert the needle at a 15-30 degree angle when penetrating the skin and the vein.
    • 88. Insertion Angle
      Above picture: Bevel of the needle is fully inserted within the lumen of the vein within 15-30 degree angle.
      Middle picture: Needle angle is too steep. If needle advances further into the vein, it may penetrate completely through the vein to tissue.
      Lower picture: Needle angle is too shallow, causing bevel to rest on the wall of the vein. Needle may be partially in the lumen and partially in tissue, resulting in hematoma formation. Insert needle at a 15-30 degree angle when penetrating the skin and the vein.
    • 89. Insert Needle
      Grasp patient's arm with thumb on top and fingers wrapped to the back.
      Pull skin taut below the intended venipuncture site with thumb, anchoring vein to keep it from moving or rolling.
      Using a smooth motion, quickly insert the needle, bevel up.
      Stop needle advancement when a slight decrease in resistance is felt, signaling entry into the vein.
      Advance tube onto needle to the end of holder
      Use thumb to push tube while index and middle fingers grasp flanges of tube holder. Blood should begin to flow into tube.
      Release tourniquet as soon as possible, depending upon blood flow. Ideally, do not leave tourniquet on for more than one minute.
    • 90. Fill Tube
      Maintaintube in a downward position so that blood and any tube additive it contains does not touch the needle.
      Fill tube until vacuum is exhausted and blood flow stops.
      Remove tubes from holder by applying pressure against flanges of tube holder with thumb and index finger while using a slight twist to remove the tube.
      Hold needle steady as tubes are removed and inserted.
      If tube contains an additive, invert it gently several times after removal to mix the blood and additive. Additional mixing can be performed while other tubes are filling.
    • 91. Remove Needle
      Release tourniquet prior to removing needle. Ensure patient's hand is open
      After the last tube is removed from holder, hold a clean gauze pad in position over the entry site. Gently and quickly remove needle from the arm.
      It is necessary to apply pressure to the site to prevent leakage of blood and possible hematoma formation.
      As soon as needle is fully withdrawn, but not before, apply pressure firmly to the puncture site using a gauze pad.
      If the patient is alert, ask him / her to continue to apply pressure until bleeding has stopped.
      Keep arm extended and preferably raised; arm should not be bent as this increases the risk of hematoma formation.
    • 92. Dispose Needle
      Discard contaminated needles in a container referred to as a "sharp container"
      Never cut, bend, break, or recap needles.
      A variety of containers are manufactured. They provide safe removal of the needle from holder when using an evacuated tube system.
      Place needle in the proper slot in the lid, and turn it clockwise until it unscrews from the holder.
      Do not attempt to remove needle with your fingers. If needle doe not separate from the holder, throw the entire unit away in a sharps container.
      Proper Needle Disposal
      Improper Needle Disposal
    • 93. Label Tube
      Always verify information on tube labels. All identifiers on the labels must be accurate.
      Label tubes after they are drawn, while the patient is still present, to reduce the risk of specimen misidentification.
      If additional information must be added to the label (e.g., fasting, time to draw), write with ink, never pencil.
      Never:
      Label tubes prior to venipuncture
      Leave an inpatient room before labeling the tubes
      Dismiss an outpatient before labeling is completed.
    • 94. Transport Tube
      When transporting tubes through public hallways, place them in a secondary container to minimize the risk of leakage and spillage.
      The secondary container must be clearly labeled "BIOHAZARD.“
      Once the tubes are in the container, seal it before transport.Securely attach paper requisition(s) to the secondary transport container.
    • 95. Blood taken and transferred to
      Syringes of different sizes
      Containers of different sizes
      Blood collection: Open System
    • 96. Holder
      Evacuated tube
      Needle
      Blood collection: Closed System
    • 97. Blood collection: Closed System
      How it works
    • 98. Transparent Needle Hub
      BD Vacutainer FLASHBACK NEEDLE
    • 99. Black- G22x1”
      Green- G21x1”
      BD Vacutainer FLASHBACK NEEDLE
    • 100. BD Vacutainer FLASHBACK NEEDLE
    • 101. Do not eat or drink in the area of blood collection,transportation or specimen processing and analysis
      Do not apply cosmetics anytime during blood collection,transportation or processing and analysis
      Wash hands before and after eating, drinking and before and after using the restrooms
    • 102. No long necklaces, large and or dangling earrings or loose bracelets during any type of blood collection, transportation or processing and analysis
      Remove laboratory coat or smock used during blood collection or other patient care activities before going to an area where coffee breaks or meals are taken
    • 103. Wear gloves for all blood collection and every skin puncture
      Wash hands before and after putting on gloves
      Use a new, clean pair of gloves for each procedure – use non-latex gloves
      Wear a laboratory coat, a gown or a smock during blood collection. Remove garment and leave it at the facility for appropriate cleaning and disinfecting
    • 104. Wear eye and face protectors if blood and body fluid splashing is anticipated
      Follow procedure for disposing of blood collection items
      Decontamination of tourniquets and trays after use is highly recommended
    • 105. Never recap a needle by hand
      Use safety lancets with self –retracting blade
      Disposed of sharps, needles, blades and others in a puncture resistant container
    • 106. for safer blood collection and reliable test results.
    • 107. Blood CollectionMacrosample Collection
      PROCEDURAL STEPS
    • 108. Introduction to Patient
      Greet Patient
      Introducing yourself by name
      Describe the procedure to be performed, providing reassurance to the patient.
    • 109. Patient Identification
      Ask an outpatient to state his/her full name, spell the last name, and state his/her date of birth.
      Verify the requisition (order) and samples labels, if applicable, have the same identifiers.
    • 110. Patient Identification
      Check inpatient's identification band to verify the name and hospital identification number match the order.
      If the patient is not wearing an identification band, DO NOT perform the venipuncture.
      Correct identification of patient is critical. Blood test results collected from a mis-identified patient will be linked to the wrong patient, and may put the health of two patients at risk.
    • 111. Assemble Equipment
      Prior to initiating venipuncture, gather all equipment needed.
      Place the necessary evacuated tubes in the proper sequence for specimen collection.
      A sharps container should be easily accessible for immediate needle disposal following completion of the venipuncture.
    • 112. Position Patient
      Seated or lying
      The patient's arm should be firmly supported and extended downward in a straight line from the shoulder to the wrist.
      Ensure patient's hand is closed, which makes the veins more prominent.
    • 113. Tie Tourniquet
      3-4 inches above the intended venipuncture site,
      Apply and maintain tension. Without rolling or twisting the tourniquet, bring the two sides together.
      Cross one side over the other and securely tuck a portion of the upper side under the lower side.
      The loop should be below the tourniquet band and the free ends (flaps) of the tourniquet are pointing away from the venipuncture site.
      The flaps should be positioned so they can easily be grasped with one hand.
    • 114. Site Selection
      Cubital vein
      Cephalic vein
      Basilic vein
      Avoid major nerves (can cause sharp and immediate pain; involuntary reflex action)
      Avoid arteries which can be detected by a pulse.
      Do not select a vein that overlies or is close to an artery.
      Avoid excessive or blind probing while performing a venipuncture
    • 115. Cleanse site
      Clean venipuncture site with antiseptic
      Let the site air dry (30 - 60 seconds) prior to beginning the venipuncture.
      Do not wipe, blow on, or fan
    • 116. Needle Insertion
    • 117. Fill Tube
    • 118. Remove Needle
    • 119. Dispose Needle
      Proper Needle Disposal
      Improper Needle Disposal
    • 120. Label Tube
    • 121. Transport Tube
      When transporting tubes through public hallways, place them in a secondary container to minimize the risk of leakage and spillage.
      The secondary container must be clearly labeled "BIOHAZARD.“
      Once the tubes are in the container, seal it before transport.Securely attach paper requisition(s) to the secondary transport container.
    • 122.
    • 123. Tube Guide
    • 124. LabOPN1
    • 125. LabOPN1
    • 126. LabOPN1
    • 127. LabOPN1
    • 128.
    • 129. Order of Draw

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