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Questions and Answers
What is the consequence of a tourniquet that is too tight?
What is the consequence of a tourniquet that is too tight?
How long should a tourniquet be left on?
How long should a tourniquet be left on?
What should you avoid during palpation?
What should you avoid during palpation?
Why should you not select a vein that you can see but not feel?
Why should you not select a vein that you can see but not feel?
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What should you use if a tourniquet is not available?
What should you use if a tourniquet is not available?
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What happens if the tourniquet is left on for more than 1 minute?
What happens if the tourniquet is left on for more than 1 minute?
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How should you palpate the vein?
How should you palpate the vein?
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Why should you remove the tourniquet gently?
Why should you remove the tourniquet gently?
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What is the last choice for a blood collection?
What is the last choice for a blood collection?
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Why should the needle not be repositioned if the blood collection from the basilic vein is not successful?
Why should the needle not be repositioned if the blood collection from the basilic vein is not successful?
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What is the first choice for blood collection in infants up to 12 months of age?
What is the first choice for blood collection in infants up to 12 months of age?
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Why should you avoid performing a heel blood collection on an area that has a hematoma?
Why should you avoid performing a heel blood collection on an area that has a hematoma?
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What should you observe on the finger before a dermal puncture?
What should you observe on the finger before a dermal puncture?
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Why is the nondominant hand preferred for a dermal puncture?
Why is the nondominant hand preferred for a dermal puncture?
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How should a tourniquet be applied?
How should a tourniquet be applied?
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Where should the tourniquet be placed for collections in the antecubital area?
Where should the tourniquet be placed for collections in the antecubital area?
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What should be done with tubes that are expired, cracked, or have any other defects?
What should be done with tubes that are expired, cracked, or have any other defects?
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What is the OSHA requirement for adapters in venipuncture?
What is the OSHA requirement for adapters in venipuncture?
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What should you inspect tourniquets for before use?
What should you inspect tourniquets for before use?
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Why should you avoid using the arm on the affected side of a patient with a history of a mastectomy?
Why should you avoid using the arm on the affected side of a patient with a history of a mastectomy?
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What should you do if you cannot locate a vein on the patient's preferred arm?
What should you do if you cannot locate a vein on the patient's preferred arm?
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Why should you not obtain a specimen through a hematoma?
Why should you not obtain a specimen through a hematoma?
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What should you inspect individual packages of alcohol pads for?
What should you inspect individual packages of alcohol pads for?
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Why should you avoid using areas of the body covered with a tattoo for blood collection?
Why should you avoid using areas of the body covered with a tattoo for blood collection?
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What determines the equipment choices for blood collection?
What determines the equipment choices for blood collection?
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What is the most commonly used equipment for venipuncture?
What is the most commonly used equipment for venipuncture?
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What is the purpose of a phlebotomy station in an outpatient setting?
What is the purpose of a phlebotomy station in an outpatient setting?
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Why is it important to check the expiration dates of supplies?
Why is it important to check the expiration dates of supplies?
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Why is it important to ensure patient safety throughout the collection process?
Why is it important to ensure patient safety throughout the collection process?
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What is the purpose of using gauze pads in venipuncture?
What is the purpose of using gauze pads in venipuncture?
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Why should you avoid placing the phlebotomy tray on the overbed table in an inpatient setting?
Why should you avoid placing the phlebotomy tray on the overbed table in an inpatient setting?
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What is the main purpose of a phlebotomy tray or cart in an inpatient setting?
What is the main purpose of a phlebotomy tray or cart in an inpatient setting?
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What is an essential step in the venipuncture procedure?
What is an essential step in the venipuncture procedure?
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Why should you use a new pair of gloves for each patient venipuncture?
Why should you use a new pair of gloves for each patient venipuncture?
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What should you use to cleanse the skin before inserting the needle?
What should you use to cleanse the skin before inserting the needle?
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What is a crucial aspect of needle selection for venipuncture?
What is a crucial aspect of needle selection for venipuncture?
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Why is it essential to follow the order of the draw during venipuncture?
Why is it essential to follow the order of the draw during venipuncture?
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Why should you cap needles until right before the blood collection?
Why should you cap needles until right before the blood collection?
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What is a key aspect of post-procedure care in venipuncture?
What is a key aspect of post-procedure care in venipuncture?
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What should you do when reviewing the requisition before the blood collection?
What should you do when reviewing the requisition before the blood collection?
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If a tourniquet is not available, a blood pressure cuff pumped to 60 mm/Hg can be used as a substitute.
If a tourniquet is not available, a blood pressure cuff pumped to 60 mm/Hg can be used as a substitute.
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Hemoconcentration begins after 2 minutes of applying the tourniquet.
Hemoconcentration begins after 2 minutes of applying the tourniquet.
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Tendons feel spongy and bouncy during palpation.
Tendons feel spongy and bouncy during palpation.
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It is recommended to use the thumb for palpation during venipuncture.
It is recommended to use the thumb for palpation during venipuncture.
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A tourniquet should be removed slowly and forcefully after blood flow is established.
A tourniquet should be removed slowly and forcefully after blood flow is established.
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Palpation should begin with heavy pressure during venipuncture.
Palpation should begin with heavy pressure during venipuncture.
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The radial artery is close to the basilic vein.
The radial artery is close to the basilic vein.
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The ideal vein for blood collection feels hard and brittle to the touch.
The ideal vein for blood collection feels hard and brittle to the touch.
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The heel is the first choice for blood collection in adults.
The heel is the first choice for blood collection in adults.
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A tourniquet should be placed directly above the venipuncture site.
A tourniquet should be placed directly above the venipuncture site.
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The middle and index fingers on the dominant hand are the best choices for dermal puncture.
The middle and index fingers on the dominant hand are the best choices for dermal puncture.
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A tourniquet should be applied tightly to obstruct the vein.
A tourniquet should be applied tightly to obstruct the vein.
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All tubes with defects or expiration must be reused after proper inspection.
All tubes with defects or expiration must be reused after proper inspection.
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Tourniquets can be used multiple times without inspection.
Tourniquets can be used multiple times without inspection.
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Alcohol pads can be reused if they are not damaged.
Alcohol pads can be reused if they are not damaged.
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A patient's arm with a tattoo is a safe choice for blood collection.
A patient's arm with a tattoo is a safe choice for blood collection.
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A tourniquet should be applied loosely to avoid discomfort.
A tourniquet should be applied loosely to avoid discomfort.
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A patient with a history of a mastectomy should have their affected arm used for blood collection.
A patient with a history of a mastectomy should have their affected arm used for blood collection.
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Palpation should start on the arm that the patient does not prefer.
Palpation should start on the arm that the patient does not prefer.
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A tourniquet should be removed quickly to avoid discomfort.
A tourniquet should be removed quickly to avoid discomfort.
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Study Notes
Preparing for Venipuncture
- When applying a tourniquet, it should be tight enough to assist in finding the vein but not so tight that it slows or stops blood flow, and it should be removed quickly and easily, within 1 minute after application.
- If a tourniquet is not available, a blood pressure cuff pumped to 40 mm/Hg can be used as an alternative.
- The tourniquet should be placed approximately 3 to 4 inches above the antecubital area for collections in that region, or above the wrist bone for dorsal hand collections.
Observing and Palpating
- When palpating, start from the middle of the antecubital region and move towards the outside of the arm, using light pressure and a single finger (preferably the index or second finger of the non-dominant hand).
- Veins feel spongy and bouncy, while tendons feel hard and should be avoided.
- Avoid veins that feel hard, as they may be sclerosed or scarred.
- Select a vein that is well-anchored, feels spongy and bouncy, is straight, and is easy to access with a needle.
Selecting and Preparing the Site
- Observe the patient's arm for any factors that can affect the blood collection, such as tattoos, scarring, or hematoma.
- Ask the patient which arm they prefer to use for the collection, and start palpation on that arm.
- Avoid using the arm on the affected side of a patient who has a history of a mastectomy, and avoid areas with tattoos or hematoma.
- Check the requisition to know what supplies are needed, and gather all necessary supplies before the blood collection.
Tourniquet Application and Removal
- Tourniquets can be for single or multiple use, and should be inspected for contamination, cracks, or excessive wear before each patient.
- Remove the tourniquet gently, as the needle will still be in the vessel.
- Discard or reuse tourniquets as the facility requires.
Equipment Selection
- The evacuated tube system (ETS) is the most commonly used equipment for venipuncture.
- Equipment used for ETS includes gloves, isopropyl alcohol swabs or pads, and gauze pads.
- Gloves should be new and well-fitting, and should be used for each patient venipuncture.
- Isopropyl alcohol swabs or pads should be used to cleanse the skin before inserting the needle, and should be discarded after each use.
- Gauze pads should be disposable and used to provide pressure to aid in clotting and to cover the venipuncture site.
Objectives
- Upon completion of this chapter, you should be able to determine the appropriate supplies and equipment needed for the requested collection, verify the quality of the supplies and equipment, select the appropriate collection site, apply and remove the tourniquet, prepare the collection site, and perform proper insertion and removal techniques for venipuncture.
Applying a Tourniquet
- Apply the tourniquet so that removal is quick and easy, and remove it once blood flow is established, no longer than 1 minute after application.
- A tourniquet that is too tight can slow or stop blood flow and cause patient discomfort.
- If a tourniquet is not available, a blood pressure cuff pumped to 40 mm/Hg can be used.
Palpation
- Start palpating from the middle of the antecubital region and move outward, using light pressure and the very tip of the index or second finger of the nondominant hand.
- Veins feel spongy and bouncy, while tendons feel hard and should be avoided.
- Avoid palpating with the thumb and do not select a vein that can be seen but not felt, as it may be a superficial vessel.
Choosing a Vein
- The ideal vein is well-anchored, feels spongy and bouncy, is straight, and is easy to access with a needle.
- The basilic vein is the last choice due to the proximity of the radial nerve and brachial artery.
- Never reposition the needle if an attempt to collect blood from the basilic vein is unsuccessful.
Special Considerations
- For infants, use the heel for blood collection up to 12 months of age, avoiding areas with hematomas, recent access, or cuts/scratches.
- For dermal puncture in children or adults, use the middle and ring fingers of the nondominant hand, avoiding areas with scarring, cuts, or calluses.
Tourniquet Maintenance
- Inspect multiple-use tourniquets for contamination, cracks, or excessive wear before each use.
- Dispose of single-use tourniquets after use and multiple-use tourniquets with defects or contamination.
Site Selection and Preparation
- Observe the patient's arm for factors that can affect blood collection, such as tattoos, scarring, or hematomas.
- Ask patients about their preferred arm for collection and avoid using the arm affected by a mastectomy or covered with a tattoo.
- Check individual packages of alcohol pads for rips or tears, and dispose of any defective or dry pads.
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Description
Learn about the proper application and removal of a tourniquet during a blood draw, including the importance of avoiding hemoconcentration and ensuring accurate results.
