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What can prevent access to a patient
- Not in room - make every effort to locate by notifying nurse's station
- STAT or Timed - draw blood at location of patient
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Patient ID
- Most important procedure to verify
- Info on req form must match ID band
- Any discrepancies must be corrected first
- If ID missing, have nurse install new one first
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List ID difficulties
- Emergency requisitions
- ER Collection
- Orders telephoned into lab
- Requisition forms picked up at site
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Communication Barriers with Patient
- Sleeping / Unconscious
- Presence of Physician / Clergy
- Presence of Visitors
- Apprehensive Patients
- Language differences
- Patient Refusal
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Sleeping Patients
- Never draw from a sleeping pt
- Wake by tapping on foot (don't startle)
-
Unconscious Patients
- Treat same as conscious
- Identify self when entering room
- Talk to patient
- Describe the procedure
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Presence of Physician / Clergy
- Do not disturb,
- Return later
- Unless STAT / Timed
- Explain for intrusion and be quick
-
Presence of Visitors
- Ask to step out while procedure is done
- If pt is child, ask parent to help
-
Apprehensive Patient
- Use distractive conversation
- Request help from Nurse'e station
-
Language Problems
Request a Translator
-
Patient Refusal
- Explain needed for treatment / diagnosis
- Document on req form
- Notify health care provider
- Never argue with patient
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Site Selection Problems
Occluded (blocked)
Sclerosed (hardened)
- Both feel hard / cordlike and lack resiliency
- Caused by inflammation,
- disease,
- chemotherapy,
- repeated venipunctures
-
Site Selection Problems
Hematomas
- No longer fresh blood
- Painful to patient to draw
-
Site Selection Problems
Edematous Tissue
- Swollen with tissue fluid
- Contaminated with tissue fluid
-
Site Selection Problems
Burns / Scars
- Difficult to palpate / see vein
- Difficult to push needle through
-
Site Selection Problems
Mastectomy
- Lymphostasis
- Lack of lymph fluid
- Will affect test results
-
Difficulty Finding Vein (steps)
- Massage upward from wrist to elbow
- Dangle arm
- Apply heat
- Rotate wrist to increase Cephalic vein
- Tap antecubital space
- Tourniquet tighter
- Use blood pressure cuff
- Choose vein in hand, foot, or leg
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Problems Cleaning Site
- Alcohol Tests - use povidone-iodine to clean
- Iodine Allergy - use chlorhexidine gluconate
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Problems Cleaning Site
Povidone-Iodine
- Not used on dermal punctures
- May elevate bilirubin, uric acid, phosphorus, potassium (BURPP) test
-
Problems with Tourniquet Application
- Not more than 1 minute - cause hemoconcentration
- Petechiae - non raised red spots, too tight
- Too Tight - no arterial pulse, complains of pinching or numbing of arm
- Latex Allergy - must ask / verify allergy to latex - no latex bandages
-
Syncopy Signs
- Skin feels:
- Cold
- Damp
- Clammy
-
Emisis
Nausea and Vomiting
-
Pain of Stick
- Warn patient of slight:
- poke,
- pinch,
- sting
-
Lack of Blood Flow
- Defective tube - try another
- Improperly positioned needle - adjust
- Missing vein - try 2nd time
-
Intermittent / Slow Blood Flow
- Improper needle position
- Collapsed vein:
- Tube too large for vein, vacuum to great
- Plunger pulled too fast
-
Inadvertant Artery Puncture
- Bright red blood
- Spurting / pulsing blood
- Apply pressure 5 minutes minimum
- Label blod specimen as arterial sample
-
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Reflux
- Blood additive flow from tube to patient
- Keep arm angled downward
- Tube always below puncture site
-
Compartment Syndrome
- Large amount of bleeding into tissue
- Extra fluid pressure prevents blood flow
-
Speciment Rejection
- No requisition form
- Unlabeled / mislabeled specimens
- Incompletely filled tube
- Collection in wrong tube
- Hemolysis
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