Phlebotomy complications
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Phlebotomy complications

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look at the complications phlebotomists may encounter and how you can fix them

look at the complications phlebotomists may encounter and how you can fix them

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Phlebotomy complications Phlebotomy complications Presentation Transcript

  • Phlebotomy Complications
  • Requisitions• ER- telephone• pick up at desk• ID-ID# might need written on requisition
  • Greeting the pt.• Asleep- wake up• Unconscious- talk to them• Psychiatric- get RN to help• Visitors- ask to step out or stay pt. choice• MD/clergy- wait unless STAT or timed test• Not in room- check nsg. station• document
  • ID• NO ID-check ankle-not ok if on bed• NO ID- RN must band• Nsg. home/pysch might not have, RN to ID• Unidentified- follow policy
  • Pt prepPreanalytical variables• Basal state- when resting, no activity• best in AM• Fasting- nothing to eat/drink x 8-10 hours
  • Diet• Fasting ??• Lipemic- blood milky/cloudy• high fat diet• Alcohol, caffeine• No chewing gum, candy while blood draw= choking
  • Posture• Should sit/lay• If pass out- standing they could fall• Change in position can affect tests
  • Other issues• Stress • Smoking• Scared-increase hormones level • May increase or• Crying child- may decrease blood tests increase levels
  • Other issues• Diurnal: • Medications:• Blood levels vary • May affect according to time of metabolism day • Meds affect many tests- MD responsibility • Herbs- affect bleeding • Document meds
  • Complications of the pt.• Apprehensive – need help to hold• Syncope- fainting• remove needle, pressure, lower to ground• apply cold compress• when awake make them stay• Seizures: take out needle, pressure, help
  • Complications of the pt. Con’t• Petichiae- indicates bleeding problem• hold site longer ( 5 minutes)• Pt refusal- their right,• notify MD• document
  • Venapuncture• Equipment: • Tourniquet Application:• Take extra tubes • Skin condition: watch• Check needle for tears • Don’t leave on more than 1 minute • Hemolysis- excessive squeezing, long-term IV, sclerosed or occluded veins
  • Site Selection• Can’t find veins: palpate• tap veins• massaging• hang down arm• apply heat• use wrist and hand• do not use veins in feet/legs•
  • Areas to be avoided• Contain thrombi• Feel hard -sclerosis• Poor circulation• Hematoma• Edema• Burns• Scarred• Mastectomy• IV site-below site
  • Cannulas and fistulasFistula• Fuse a vein & artery together
  • Cannula• special tube in chest• connects vein and artery to draw blood
  • Cleaning the site• Alcohol- routine• Betadine- sterile• Soap and water- alcohol tests
  • Examination of equipment• Check syringe –does plunger work?• Needle straight?• Everything sterile?
  • Performing venapuncture• Syringe: • Winged set (Butterfly)• Advantage: blood enters • Use for difficult sticks, hub-easy to tell if in vein small, fragile veins• Better control of suction • Advantage: better control• Disadvantage: collapse • Lower angle- 10-15 vein, needle sticks degrees• Make sure you use small • Collect with vacuatainers syringe on small veins • Disadvantage: increase sticks
  • Syringe Butterfly
  • Central Venous Access• Specific guidelines• Special training-sterile technique• 4 types: nontunneled- temporary, subclavin – tunneled-permanent, broviac, hickman – implanted- under skin, port – PICC ( Peripheral lines)- peripheral
  • PICC Line
  • Subclavin Line
  • Broviac
  • Causes of failure to obtain blood1. Resting against wall of vein- rotate needle, pull back, advance some2. Go through the vein- angle too much3. Needle rests on top of vein- angle too shallow4. Vein rolls- vein not anchored5. Vein collapses- vacutainer too big, to much pressure2 ATTEMPTS ONLY AFTER THAT REQUEST ANOTHER PHLEBOTOMIST TO DO !!!
  • Incorrect needle placement
  • Causes of hemolyzed specimens• Using a needle with gauge < 23• Using small needle with large tube• Needle not attached to syringe- cause frothing• Pull plunger back too fast• Draw from hematoma* Vigorously mixing tubes*Forcing blood into tube• Failing to allow blood to run down tube• Collect blood from IV lines• Applying tourniquet too close to site
  • Causes of hematomas• Failure to take off tourniquet prior to needle removal• Inadequate pressure to site• Bending arm while applying pressure• Excessive probing• Failure to insert needle far enough in vein• Going through the vein• Elderly- decrease vein elasticity• To Treat: remove tourniquet and needle, apply pressure and ? Ice• Find new site
  • Label tubes and bandaging arm• If no preprinted label make one.• Bandaging:• anticoagulant meds- hold site x 5 minutes• If arterial stick- hold x 10 minutes• Allergies to adhesive: use gauze• Hairy arms- no bandage• Children < 2 no bandage
  • Leaving pt.• Position as found• Rails as ordered• If they need bathroom, drink get RN
  • Reasons for rejection of specimen• Unlabeled/mislabeled• QNS• Wrong tube• Hemolysis• Lipemia• Clot in coag tube• No requisition• Contaminated specimen container