PNC 2 SKILLS - Using Venipuncture to Collect a Venous Blood Sample

The nurse is caring for a client who needs venipuncture. The client has IV fluids running in the left forearm. The client asks where the nurse will perform the venipuncture. What is the best response by the nurse? A. "Anywhere in the right arm." B. "Anywhere above the IV in the left arm." C. "Anywhere in the left arm." D. "Anywhere below the IV in the left arm."

"Anywhere in the right arm." Rationale: Performing a venipuncture in the same extremity where IV fluids are running can affect the accuracy of the sample. Therefore, the nurse should attempt venipuncture in the client's right arm, not on the arm with the IV.

The nurse is caring for a female client who needs venipuncture. The client has a history of breast cancer. What is an important assessment question for the nurse? A. "Have you had chemotherapy?" B. "Have you had a mastectomy?" C. "Have you had a recent fever?" D. "Have you been diagnosed with anemia?"

"Have you had a mastectomy?" Rationale: Venipuncture is not recommended in the extremity located on the same side as the previous mastectomy, due to the increased risk of lymphedema. The opposite extremity should be used if possible. Previous chemotherapy should not have a bearing on current venipuncture. Anemia should not affect venipuncture. Recent fever would not preclude regular venipuncture procedure.

A nurse is attempting to enlarge the veins of a client before venipuncture. Which techniques are appropriate? Select all that apply. A. Lightly tap the skin over the vein. B. Leave the tourniquet in place for up to 5 minutes before attempting venipuncture. C. Ask the client to make a fist. D. Apply a warm compress to the limb before applying the tourniquet. E. Lower the client's arm before applying the tourniquet.

-Lightly tap the skin over the vein. -Ask the client to make a fist. -Apply a warm compress to the limb before applying the tourniquet. -Lower the client's arm before applying the tourniquet. Rationale: To help distend the client's veins, the nurse should have the client make a fist, tap the skin over the vein lightly several times. Lower the client's arm to allow blood to pool in the veins before applying the tourniquet, or apply warm compresses for about 10 minutes before applying the tourniquet. The tourniquet should remain in place no more than 60 seconds to prevent injury, stasis, and hemoconcentration, which may alter results.

The nurse is preparing to perform venipuncture to obtain a venous blood sample. Place the following steps in the correct order.

1)Clean client's skin with antimicrobial swab 2)Reapply a tourniquet 3 to 4 in (3.75 to 10 cm) above the puncture site. 3)Hold the client's arm in a downward position. 4)Insert the needle, bevel up, at a 15-degree angle. 5)Release tourniquet when blood flows into collection tube. 6)Apply gentle pressure to the puncture site. Rationale: Cleaning the client's skin reduces the risk for transmission of microorganisms. Use of a tourniquet increases venous pressure to aid in vein identification. Holding the client's arm down facilitates inserting the needle. Positioning the needle at the proper angle reduces the risk of puncturing through the vein. Tourniquet removal reduces venous pressure and restores venous return to help prevent bleeding and bruising. Applying pressure to site after needle removal prevents injury, bleeding, and extravasation into the surrounding tissue, which can cause a hematoma.

A nurse needs to obtain a venous blood sample from a term neonate. On the basis of recent research, which is the method of choice for collecting this client's sample? A. Heel lance B. Finger lancet C. Venipuncture with standard needle D. Venipuncture with butterfly needle

Venipuncture with butterfly needle Rationale: Recent research indicates that venipuncture, when performed by a skilled phlebotomist, appears to be the method of choice rather than a heel lance, which is more painful. The nurse should use butterfly needles, as appropriate, for obtaining blood from infants and small children. A finger lancet is used to obtain a capillary blood sample for glucose testing in adults.