Phlebotomy Ch. 7 & 8

3 Things to keep in mind when drawing blood from a Psychiatric patient:

1) They can be unpredictable- be ready for movement or jerks. 2) Some patients may be suicidal. Watch your equipment to prevent patients from taking items they could use to harm themselves or someone else. 3) Take only the minimum amount of equipment with you into the room. It is best to leave your tray or cart outside the room.

In full term infants, what is the optimal depth of capillary puncture?

2 mm

At what age might children view medical care as punishment for bad behavior?

2-6 years old

If a patient is on blood thinners, pressure should be held on the site for at least:

5 minutes

At what age do children understand some mechanics of health (e.g. digestion, respiratory)?

6-9 years old

After excess crying, the leukocyte count does not return to normal for up to:

60 minutes

Psychosocial Needs of Pediatric Patients: Remember that it is a "child who is sick," not a ____________

"sick child"

At what age do children feel stress due to separation from familiar caregivers and changes in home routine?

0-2 years old

In premature infants, what is the optimal depth of capillary puncture?

0.85 mm

When drawing blood from these 3 types of patients, you should always ask fro assistance:

1) Children 2) Unaware patients 3) Psychiatric patients

The following tests must be performed by venipuncture: ()

1) Routine coagulation studies 2) Blood cultures 3) Lead levels 4) Test that require a significant amount of blood, such as allergy testing.

List 5 situations when capillary punctures are performed in adults:

1) Severely burned patients. 2) Oncology patients whose veins are reserved for therapeutic purposes. 3) Obese patients whose veins are too deep to locate. 4) Geriatric patients or other patients whose veins are inaccessible or very fragile. 5) Point of care testing (POCT) in a health care facility (glucose tests)

What are the 2 different principles used in the manufacture of retractable puncture devices:

1) Some devices use a blade that punctures straight down with a guillotine-type action and then tracts back into the holder. 2) The other devices use a slicing motion that produces a half-moon-type cut and then swings back into the holder.

What are the 4 causes of hemolysis?

1) The alcohol used to clean the skin was not allowed to dry. 2) The finger or heel was squeezed too vigorously in an attempt to produce greater blood flow. 3) Newborn infants have increased red cell fragility and high red blood cell (RBC) volume. 4) Blood was scraped off, instead of allowing it to flow into the micro-collection container.

An obese patient's veins are often difficult to feel through the layers of tissue. If the median cubital vein cannot be found, try the:

Veins in the hand and wrist, they should be more accessible.

The phlebotomist may not always be successful in getting the child's full cooperation, but he or she still needs to remember that ________________________________ are the best tools for a safe and successful venipuncture.

Patience & understanding

What is the correct anatomical position where a capillary puncture should be performed in adults?

The palmar surface of the distal phalanx of wither the ring or great (middle) finger.

What is the best way to restrain a child?

The parent may hold the child on his or her lap while holding the child's arm in a very straight position and restraining the rest of the child's body.

The blood from a capillary puncture is from the capillary area of the circulatory system. This blood in the capillary bed is predominantly:

Arterial

What is the best method to obtain blood from a patient with damaged or collapsing veins?

By Syringe

Venipuncture method of choice in children under 1 year old and for adults whose veins are inaccessible:

Capillary Puncture

The idea of moving the child's attention from the procedure to something else:

Distraction

The _______________________ of a new born and an infant less than 2 years old is often preferred as an alternative to a heelstick or fingerstick.

Dorsal hand vein

Adult capillary punctures are done in the:

Finger

When you puncture the finger always cut across the ________________. This technique delivers the best possible blood flow and facilitates the formation of drops of blood.

Fingerprint line

EDTA micro-collection container is ___________ to be collected by phlebotomist.

First

If an EDTA sample is required, the EDTA sample is drawn ____________ to obtain an adequate volume before the blood starts to clot.

First

In children under 1 years old, capillary punctures are done in the:

Heel

What is the most critical factor in obtaining an accurate blood sample from children?

Holding still, because fighting and crying will change the blood values.

Fluid located between the cellular components of tissue:

Interstitial Fluid

As the finger is punctured, tissue cells are damaged, and ________________ is released into the first drop. The subsequent drops are flowing due to arterial pressure

Interstitial fluid

Toward the side of the body (away from the midline of the body):

Lateral

Excessive crying of the infant can result in elevated:

Leukocyte (white blood cell - WBC) counts

Does crying cause hemolysis?

No

Should you tell a child that a fingerstick will not hurt?

No

Can a puncture be performed in a previous puncture site?

No, because of the possibility of infection.

Can you use povidone-iodine (Betadine) to clean and disinfect the puncture site?

No, it can cause an elevated potassium, phosphorous, or uric acid.

Should you use a scraping motion to collect a blood sample from the skin?

No, scraping of the blood from the surface of the skin does not allow the blood to flow into the micro-collection device. Scraping of the blood off the skin surface hemolyzes the cells. This action will spread the blood over the surface of the skin and not allow a free flow of blood.

Should children be told that the process (venipuncture) does not hurt?

No, they should be told that it will hurt a little bit and to make it easier they need to hold still.

When drawing blood from a psychiatric patient, the patient's ________ needs to be informed. They will often accompany the phlebotomist to the patient's room to help explain the procedure to the patient or to help restrain them.

Nurse

On infants and young children, the heel is the puncture site of choice. If an infant's heel is to be puncture, the site should be on the:

Plantar surface medial to a line drawn posteriorly from the middle of the great toe to the heel, or lateral to a line drawn posteriorly from between the fourth and fifth toes to the heel.

When drawing blood with a syringe, remember to:

Pull the plunger gently, only small pulls at a time. The timing between the pulls allows the vein to refill.

Warming of the puncture site can increase the blood flow _____________.

Sevenfold

Patients who are _______________________, _________________ , or __________________ cannot produce an adequate capillary puncture blood sample.

Severely dehydrated, have poor circulation (e.g. those is shock), or patients that are extremely cold.

In children 2 years or younger, venipuncture should be limited to:

Superficial veins

Limit venipuncture in children younger than 2 years old to:

Superficial veins

What is the best equipment & technique to use for venipunctures in children?

The butterfly and the use of superficial veins

A crying child not only raises your stress level but also raises:

The child's white blood cell count

When can the earlobe be used for a capillary puncture?

The earlobe is not recommended except in extreme cases, such as a severely burned patient, when no other location is available.

Before the blood sample is collected, the first drop of blood needs to be:

Wiped away

What is the best way to warm the hand ?

With a warm washcloth, warm wet heat is more efficient than a dry heat or a heat pack.