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What can cause an alteration in test results, especially for ammonia, calcium, coagulate, potassium, and protein tests?
What can cause an alteration in test results, especially for ammonia, calcium, coagulate, potassium, and protein tests?
What should you do if a patient has fainted during a venipuncture in the past?
What should you do if a patient has fainted during a venipuncture in the past?
What is a common consequence of a collection error?
What is a common consequence of a collection error?
What should you do if a patient is experiencing minor physical reactions during a venipuncture?
What should you do if a patient is experiencing minor physical reactions during a venipuncture?
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What is an example of a collection error?
What is an example of a collection error?
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Why should you ask the patient how they are feeling during a venipuncture?
Why should you ask the patient how they are feeling during a venipuncture?
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What is the importance of gauging the depth of the needle entry?
What is the importance of gauging the depth of the needle entry?
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What can cause hemoconcentration?
What can cause hemoconcentration?
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What happens when the needle is inserted too deeply?
What happens when the needle is inserted too deeply?
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What is the purpose of introducing yourself to the patient?
What is the purpose of introducing yourself to the patient?
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What is a physical complication of venipuncture that can be distressing to the patient?
What is a physical complication of venipuncture that can be distressing to the patient?
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What is the consequence of inserting the needle only partially into the vein?
What is the consequence of inserting the needle only partially into the vein?
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What is the correct order of venipuncture steps?
What is the correct order of venipuncture steps?
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What is the importance of following the direction of the vein?
What is the importance of following the direction of the vein?
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What is the purpose of washing your hands and gloving?
What is the purpose of washing your hands and gloving?
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What is the result of feeling a change in resistance during needle insertion?
What is the result of feeling a change in resistance during needle insertion?
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What is the primary reason for following the order of the draw in venipuncture?
What is the primary reason for following the order of the draw in venipuncture?
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Which of the following tubes must be filled 100% during venipuncture?
Which of the following tubes must be filled 100% during venipuncture?
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What is the purpose of the additive SPS in yellow stopper tubes?
What is the purpose of the additive SPS in yellow stopper tubes?
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What is the correct order of collection when using a syringe for blood culture bottles?
What is the correct order of collection when using a syringe for blood culture bottles?
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What is the purpose of serum tubes in venipuncture?
What is the purpose of serum tubes in venipuncture?
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Why must serum tubes be allowed to clot for 30 minutes prior to centrifugation?
Why must serum tubes be allowed to clot for 30 minutes prior to centrifugation?
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What is the purpose of the additive sodium citrate in light blue stopper tubes?
What is the purpose of the additive sodium citrate in light blue stopper tubes?
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What is the organization responsible for developing the order of the draw for venipuncture?
What is the organization responsible for developing the order of the draw for venipuncture?
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What should you do if the blood flow stops or no blood is evacuated into the collection tubes?
What should you do if the blood flow stops or no blood is evacuated into the collection tubes?
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What is a possible reason for the blood collection tubes to malfunction?
What is a possible reason for the blood collection tubes to malfunction?
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What should you ask patients to do before the start of the venipuncture procedure?
What should you ask patients to do before the start of the venipuncture procedure?
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What is a possible complication that can occur during or after a blood collection?
What is a possible complication that can occur during or after a blood collection?
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What should you do if you suspect that the vein has collapsed?
What should you do if you suspect that the vein has collapsed?
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Why is it important to check for signs or symptoms that indicate the patient is having difficulty tolerating the procedure?
Why is it important to check for signs or symptoms that indicate the patient is having difficulty tolerating the procedure?
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Why should you not repeatedly move the needle in and out, back and forth, or side to side?
Why should you not repeatedly move the needle in and out, back and forth, or side to side?
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What should you use for every attempt, even on the same patient?
What should you use for every attempt, even on the same patient?
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What can be done to help find a suitable vein for venipuncture?
What can be done to help find a suitable vein for venipuncture?
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What should you do if you do not see a flash when using a butterfly needle?
What should you do if you do not see a flash when using a butterfly needle?
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What should you do if you have transfixed the vessel?
What should you do if you have transfixed the vessel?
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What should you do if blood does not begin to flow after slightly pulling back on the needle?
What should you do if blood does not begin to flow after slightly pulling back on the needle?
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What can cause blood flow to unexpectedly stop during venipuncture?
What can cause blood flow to unexpectedly stop during venipuncture?
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How many times is it generally accepted to retry phlebotomy?
How many times is it generally accepted to retry phlebotomy?
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What should you do if the patient expresses any indication of pain?
What should you do if the patient expresses any indication of pain?
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What should you do if you cannot find a suitable vein?
What should you do if you cannot find a suitable vein?
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Additive carryover from one evacuated tube to another can cause test results to be accurate.
Additive carryover from one evacuated tube to another can cause test results to be accurate.
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The order of the draw was developed by the Clinical and Laboratory Standards Institute (CLSI) to worsen the quality of blood tests.
The order of the draw was developed by the Clinical and Laboratory Standards Institute (CLSI) to worsen the quality of blood tests.
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Serum tubes must be filled 100% during venipuncture.
Serum tubes must be filled 100% during venipuncture.
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The additive SPS in yellow stopper tubes is used to perform coagulation tests.
The additive SPS in yellow stopper tubes is used to perform coagulation tests.
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Anaerobic tubes are collected first when using a syringe for blood culture bottles.
Anaerobic tubes are collected first when using a syringe for blood culture bottles.
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Serum tubes are used to perform bacterial studies.
Serum tubes are used to perform bacterial studies.
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Hemoconcentration can cause an alteration in test results, especially for glucose, sodium, and chloride tests.
Hemoconcentration can cause an alteration in test results, especially for glucose, sodium, and chloride tests.
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As a phlebotomist, you can completely prevent syncope from occurring during a venipuncture.
As a phlebotomist, you can completely prevent syncope from occurring during a venipuncture.
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Collection errors can only occur due to the patient's physical reactions during the venipuncture.
Collection errors can only occur due to the patient's physical reactions during the venipuncture.
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Minor physical reactions, such as dizziness, nausea, and sweating, are usually serious and require immediate medical attention.
Minor physical reactions, such as dizziness, nausea, and sweating, are usually serious and require immediate medical attention.
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If a patient is pumping their fist, it is okay to proceed with the venipuncture without stopping them.
If a patient is pumping their fist, it is okay to proceed with the venipuncture without stopping them.
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The phlebotomist should only stay with the patient until they have finished the venipuncture procedure.
The phlebotomist should only stay with the patient until they have finished the venipuncture procedure.
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A swift entry always increases the risk of hematoma during venipuncture.
A swift entry always increases the risk of hematoma during venipuncture.
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Inserting the needle at an angle perpendicular to the vein helps prevent missing the vessel.
Inserting the needle at an angle perpendicular to the vein helps prevent missing the vessel.
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Feeling a change in resistance during needle insertion indicates that the needle is in the surrounding tissue.
Feeling a change in resistance during needle insertion indicates that the needle is in the surrounding tissue.
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Inserting the needle too deeply can cause the vein to collapse.
Inserting the needle too deeply can cause the vein to collapse.
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Gently pushing the ETS tube in place should be done after the needle is inserted to a point where it only partially penetrates the vein.
Gently pushing the ETS tube in place should be done after the needle is inserted to a point where it only partially penetrates the vein.
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Positioning the patient's arm in a slightly bent, upward position is recommended for venipuncture.
Positioning the patient's arm in a slightly bent, upward position is recommended for venipuncture.
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Assembling the needed equipment before introducing yourself to the patient is the correct order of steps.
Assembling the needed equipment before introducing yourself to the patient is the correct order of steps.
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Washing your hands and gloving after positioning the patient's arm is the correct order of steps.
Washing your hands and gloving after positioning the patient's arm is the correct order of steps.
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Study Notes
Venipuncture Order of the Draw
- The order of the draw is crucial to prevent additive carryover from one evacuated tube to another, which can affect blood test results.
- The correct order of the draw is: blood culture bottles or yellow tube stopper, light blue, serum tubes, and then other tubes.
- Blood culture bottles or yellow tube stopper contain the additive SPS and are used for bacterial studies.
- Light blue tubes contain the additive sodium citrate and are used for coagulation tests, and must be filled 100%.
- Serum tubes may contain no additive or a clot activator, and must be allowed to clot for 30 minutes before centrifugation.
Hemoconcentration and Physical Reactions
- Hemoconcentration can occur when a tourniquet is applied too long or the patient excessively pumps their fist, causing blood flow stagnation and altering test results.
- To prevent hemoconcentration, remove the tourniquet before the 1-minute time limit and ask the patient to stop pumping their fist if necessary.
- Minor physical reactions (sweating, dizziness, nausea) can occur during or after venipuncture, but are usually not serious and resolve without treatment.
- Be aware of these reactions as they may indicate a complication of the blood collection.
Collection and Processing Errors
- Collection errors can be more common than physical complications and can have serious consequences.
- Examples of collection errors include misidentification of the patient, improper site selection and preparation, using the wrong tube, incorrect order of the draw, underfilling the tubes, failure to invert the tubes, and mislabeling of specimens.
Performing Venipuncture
- The correct order for venipuncture steps includes introducing yourself to the patient, identifying the patient, having the patient sit or lie down, washing your hands and putting on gloves, assembling the needed equipment, and positioning the patient's arm.
- Use a new needle for every attempt, even on the same patient, and do not repeatedly move the needle in and out, back and forth, or side to side if blood flow stops or no blood is evacuated into the collection tubes.
- If blood flow stops or no blood is evacuated, try another tube, and if necessary, perform another puncture.
Complications and Patient Care
- Complications can occur during or after venipuncture, including syncope, nerve damage, and hemoconcentration.
- Ask patients to let you know if they are having any problems during or after the venipuncture, and be aware of signs or symptoms that indicate the patient is having difficulty tolerating the procedure.
- Know how to identify and address these complications to minimize the chance of a negative outcome for the patient.
Venipuncture Order of the Draw
- The order of the draw was developed by the Clinical and Laboratory Standards Institute (CLSI) to improve the quality of blood tests and standardize the order of blood tube collection.
- The order is important because the use of a double-sided needle results in additive carryover from one evacuated tube to another during blood collection, which can cause test results to be altered.
Blood Culture Bottles and Yellow Tube Stopper
- Blood culture bottles come in sets of aerobic and anaerobic, with the anaerobic tube collected first when using a syringe, and the aerobic tube collected first when using a butterfly needle.
- The yellow stopper tube contains the additive SPS and is used to perform bacterial studies.
Light Blue Tubes
- The light blue stopper tube contains the additive sodium citrate and is used to perform blood collections for coagulation tests.
- Light blue tubes must be filled 100%.
Serum Tubes
- Serum tubes have different stopper colors (red, gold, speckled red and gray, or red and black) and may contain no additive or a clot activator.
- Serum tubes must be allowed to clot for 30 minutes prior to centrifugation.
- Serum tubes are used to perform chemistry blood collections.
Hemoconcentration
- Hemoconcentration can cause an alteration in test results, especially for ammonia, calcium, coagulate, potassium, and protein tests.
- It can be prevented by removing the tourniquet prior to the 1-minute time limit and asking the patient to stop pumping their fist.
Physical Reactions
- Minor physical reactions (diaphoresis, dizziness, nausea) can occur during or after a venipuncture, but these are often not serious and usually go away without treatment.
- Be aware that these reactions can be an indication that the patient is experiencing a complication of the blood collection.
Collection/Processing Errors
- Collection errors can be more common than physical complications and can have serious or fatal consequences.
- Examples of collection errors include misidentification of the patient, improper site selection and preparation, using the wrong tube, incorrect order of the draw, underfilling the tubes, failure to invert the tubes, and mislabeling of specimens.
Syncope
- Ask the patient whether they have ever fainted during a venipuncture.
- If so, have them lie down, and proceed with the collection cautiously.
Venipuncture Steps
- Introduce yourself to the patient.
- Identify the patient using at least two identifiers.
- Have the patient sit or lie down.
- Wash your hands, and don gloves.
- Assemble the needed equipment.
- Position the patient's arm in a slightly bent, downward position.
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Description
Learn about the standardized order of blood tube collection, developed by CLSI to improve blood test quality and prevent additive carryover.
