Troubleshooting & Phlebotomy Complications PDF

Trouble Shooting and Phlebotomy Complications Siti Balkis Budin MD (UKM), MSc (Ulster UK) PhD (UKM)  VENIPUNCTURE SITE SELECTION TO BE AVOIDED: SMHE can't see feel the vein 1. Extensive scars from burns and surgery - it...

Trouble Shooting and Phlebotomy Complications Siti Balkis Budin MD (UKM), MSc (Ulster UK) PhD (UKM)  VENIPUNCTURE SITE SELECTION TO BE AVOIDED: SMHE can't see feel the vein 1. Extensive scars from burns and surgery - it is difficult to puncture the scar = tissue and obtain a specimen. to surgical operation remove breast 2. The upper extremity on the side of a previous mastectomy - test results may be affected because of lymphedema. = hematoma if still visible Take blood above the wein 3. Hematoma - may cause erroneous test results. If another site is not available, collect the specimen distal to the hematoma. 4. Edematous extremities - tissue fluid accumulation alters test results. 1. Drawing from intravenous lines - Drawing from an intravenous line may avoid a difficult venipuncture, but problems. The line must be flushed first. When using a syringe inserted into the line, blood must be withdrawn slowly to avoid hemolysis. Loading… 2. Cannula/fistula/heparin lock. In general, blood should not be drawn from an arm with a fistula or cannula without consulting the attending physician.  - Bulging vein : Lower angle bigger angle Deep vein : Loading… about 1-1. 5 cm  Missed Hit & running Vein Approach the vein in the same direction the vein is running. Mark the direction For running vein, need to anchor the skin Phlebotomy in Geriatric  GERIATRIC PHLEBOTOMY TIPS In elderly, skin commonly becomes thinner and looser; the muscles also become smaller, causing veins to roll easier. become less elastic easily injured or collapse during butterfly needle a venipuncture. use  Recommended tips for GERIATRIC PHLEBOTOMY RECOMMENDED TIPS APPLICATION OF THE TOURNIQUET Elderly patients are prone to bruising Loading… Place the tourniquet over the patient’s sleeve of the patient shirt sleeve if drawing an arm vein. Do not apply the tourniquet too tightly as it could cause injury or collapse the vein. The tourniquet should remain tied for no more than one minute at a time. LOCATING THE BEST VEIN  The veins in the arm may not be the best GERIATRIC PHLEBOTOMY RECOMMENDED TIPS Elderly patients’ veins have a tendency to move or “roll” very easily (running vein). Gently pull the skin taut and anchor the vein using thumb Puncture the vein in a quick, smooth motion. Insert the needle at a decreased angle since the veins are close to the surface of the skin. Choose a straight section of the hand vein –avoid any “intersection” or “V” where a vein branches into another vein Prevent bruises or hematoma Apply pressure on the site for three to five minutes or until the bleeding has stopped. Bandaging the site Older patients more sensitive to standard adhesive bandages.  Avoid using adhesive bandages Phlebotomy in Paediatric Preparing the child and parent skin Restrain the child anesthetic - numb for surface Pain alleviation: topical anethetic EMLA time reducer -short  2 < years old Dorsal Hand Vein Technique The dorsal hand technique is appropriate for neonates and infants who are younger than 2 years old. A 23g Butterfly Blood Collection Set attached to a 3-5 ml syringe is preferred when performing a dorsal hand venipuncture. buttertus 23 gange 3-5 Me Syringe Heel Stick for Infant COMPLICATIONS OF PHLEBOTOMY  HEMATOMA Hematoma Formation Is the Most Common Complication of Venipuncture This type of complication is caused by blood leaking into the tissues during or after venipuncture after failure to penetrate the vein properly during insertion Causes of haematoma formation after venipuncture are small fragile veins, needle too large, excessive probing to find vein, removing the needle prior to releasing the tourniquest, needle going all the way through the vein, needle only partially entering the vein allowing leakage, applying pressure to gauze before the needle is removed  To avoid haematoma formation from venipuncture, puncture only the uppermost wall of the vein just under the skin, remove the tourniquets before removing the needle, use the major superficial veins, make sure the needle fully penetrates the uppermost wall of the veins because partial puncture may allow blood to leak into the tissue just under the skin and apply pressure to the puncture site  localized - ANS reaction > - syncope/fainting It is caused because of rapid fall in the blood pressure and it is an autonomic nervous system reaction usually based on fear Fear and phobia may occur in some patients on seeing the needle.  Petechiae & Excessive Bleeding : tiny spotsbleeding Skin on Petechiae may be due to coagulation problems or abnormalities The patient may bleed excessively after blood collection; make sure bleeding stops prior to leaving the patient. Excessive bleeding after venipuncture can occur In-patient on anticoagulants, on drugs such as aspirin medication or drugs that decrease the number of platelets The patient should not be left alone until bleeding has stopped.  Others Complications Allergies The patient may be allergic to the cleaning agent or other solutions used to disinfect the site therefore ask for any allergy. Some patients have latex allergy. Iatrogenic Anemia -hospital-acquired anemia When large volumes of blood are taken for diagnostic purpose Arterial Puncture When this occurs, the needle should be removed immediately and pressure applied over the site. Thrombosis Thrombus is a solid mass derived from blood clot constituents in the vessels that is a clot  Thrombus may partially or fully occlude a vein or artery making venepuncture Loading…