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Venipuncture January 7,2008

MBS 313 – check out ecollege for course outline

1 final exam

Schedule is posted on his doord


6 weeks of venipuncture participation and need 4/6 draws successful 2 tubes is a
successful draw

then vit B 12 shots after the blood draws


examinatin with partner

No food in the room


No liquids allowed
No toes allowed either
BE WELL HYDRATED

Safety -- lab coat in clinic not needed in class


No eating/drinking in area of collection
In lab you need 3 separate fridges 1 for urine/blood/food
No loose clothing and pull hair back

AVOID rubbing eyes --- alcohol base in hand wash


Wash hands frequently reduce infection spread
Most susceptivle to staph aureus

Questions to ask patient before first draw


“Have you had needles before?:”
“How did first draw go?”
“are you immunocompromised?”
not required to tell the doctor though?
5:25% of HCL or 10% bleach solution to clean up spills
All sharps deposed properly (needles and anything contaiminated with blood)
DON”T dispose vac container unless has blood on it

TB patient or suspected TB – use N 95 pore sized mask (for patient/doctor)

DO NOT wear Jewelry under gloves


Re glove for each patient

Do not recap needles after use with patient


Can recap after inspection before patient use
Clinic LAB Manual pg 16 & 17 (about needle stick injury)

Flush cold water min 10 mins if eye fluid exchanged

IF Needle stick injury occurs go across street to NYPGH to get HIV test and Hep B/C
test
Offered Hep B vaccine right about
Triple therapy HIV Prophylaxis ** only effective up to 2 hours after needle stick
Retest HIV 6 mos later
Retest Hep B 1mo later

Both you and the person who was stuck should be tested

20% neeld sticks occur in uncovering of needles : avoid this by using one handed
technique

70% after exposure abnd before disposal


7% exposure occur during surgery – dr’s nurses knick themselves

Chemical exposure
Total parnetral nutrition: saline/glucose/electrolytes/Pr/Lipids/vit/minerals
Plastic containers are what they use but the lipids stick to containers
Should be administered by glass containers – not used because of the possible breaking
and contusions that can occur

Chemotherapy --- possible chem. Expsure noxious exposure


Hypochloric acid and carosene – issue with fumes

Allergic reactions = latex gloves = elastic turnics are the only latex portion we use (do it
over the shirt for the patient with latex sensitivity or allergy)

Perservatives used:
Sodium benozate
Alcohol

Vaccum tubes to remove blood = don’t collapse veins to often this way
Suction is old school = collapsed veins

WHOLE BLOOD: metals/hormones


Hemotology, edta prevents clotting (sodium citrate), move blood back and forth, goes off
tested light blue/purple tubes, test within 12 hours

SERUM
Most common used for blood tests
Draw SST serum separteing tube
Red or grey/red tube
Model top tube
Blood is allowed to clot 10 cc needed
Allow 10 mins (
Centrifuge and spin it 3500 rpm 15-20 mins
Separate rbc from serum (on top)
Hormones enzymes etc

PLASMA – green top tube


Fibrinogen etc
Usually AC present
Centrifuged to separate out

SIDE EFFECTS
HEMATOMA – pushed through vein on the other side
Increase pressure on vv for 2-3 mins so closing off both holes with hard pressure applied
once needle is removed

Make it worse if not and increase circulation will make it works


2 hours after a draw NO LIFTING
on Anti coagulant at least 12 hours no lifting otherwise increased vruising
Forget to remove turnic before removal of needle

Increase risk for hematoma = Anticoagulant patient, hemophiliacs(usually male), elderly


friable vv, use butterfly on children to reduce risk of bruising and decrease movement
problems

Infants = use heel prick to draw blood

DO NOT draw blood from jugular, can’t do it from foot either


No longer recommended to bend arm at elbow dislodge of clot after its clotted
Risk of clots

Substances in vials = stay in tube chemicals in theer if the break (exposure issue)

Latex Reaction = women make up hospital workers therefore make sense women are
higher risk
Anaphylaxis SHOCK symptoms: 50 or lower pulse BP: 60/40 etc

** alcohol causes breakdown of latex as well oils/vasoline/handlotion/HT/ UV

3 types of gloves on the market


Nitral, vinyl, latex

* see if Psoriasis Eczema Tatoos Can’t draw blood here


find another site
** increase vein size push ups help and adequate hydration
** isopropal Alcohol cleaner MIN of 2 cleanses in enlarging concentric circles
Moving bacteria away from site
Removing big chuncks of bacteria only
Need to keep doing it until the cotton comes away clean
Repeated exposure to alcohol to help remove it

Iodidine leaves site organe brown

Ways to stop bleeding with ice


Or arnica traumeel ledum
After clot risk

Increase hematoma risk: Anticogualnt patient on Aspirin ASA


Garlic/warfarin
Heparin (usually IV or subc in abdomen)
Plavix (clodropil)

Second possible side effect


THROMBOSIS
Clot in endometrial tissue damage
Platlet aggregation
Increase risk lower extermitiiees/don’t sit still/ 203 hours in IV

Use angiocast - flexible/if line does dry

** ALWAYS make sure when inserting needle the bevel is up


within VV completely
envision center of vv for insertion
get air in tube lost in vaccum
If the needle comes out a bit then reinsert and use new vaccum tube

Ways to avoid
Check Px regulation
Very steady with needle
Thrombosis if it occurs
Heparin (IV) standard of care flush
Drip stops /severe pain at site
Cold application after to avoid embolism min 10 mins

3rd side effect


PHEBILITIS: VV inflamed due to IV therapy
¾ of hospital patients have this
not blood draw
RF: soln of wrong pH (ph N of blood 7.36-7.46)
Drip rate too fast, or if toto hypertonic solution, multiple infections
Cancer patients

S/SX of pheblitis
Heat/pain @ site/ tender to touch/ IV rate is slower/ Fever
TX: ABC infection (culture blood)
Ice: 20 mins repeated every 20 mins
Not used for 3-10 days till healed for anything
Ways to avoid phebilitis
Check needle size small vs large
Check tonicity of solution
Select site carefully

More flection and movement increase risk factor (especially in elbow) of pheblitis
CHOOSE WRISt if need be