Lastly, we would like to mention body positioning, which is a fundamental but often overlooked factor in laboratory preanalytics. 6. v.10112019 . Simundic AM, Cornes MP, Grankvist K, Lippi G, Nybo M, Ceriotti F, et al. I immediately removed the tourniquet and applied pressure. Stroke with transfusions changing to hydroxyurea (SWiTCH) trial investigators. Some patients may develop Type I hypersensitivity reactions just seeing their own blood. Malingre M, Ververs T, Bos S, van Kesteren C, van Rijn H. Alcohol swabs and venipuncture in a routine hospital setting:no effect on blood ethanol measurement. If a person gets vasovagal syncope by seeing their blood, then immediately lie them down flat and lift their legs. For instance, a strenuous or prolonged fist clenching or pumping leads to the increase of extracellular potassium due to the depolarization of the skeletal muscle cells (102). The VVR is a harmless affection, which can lead to injuries due to the loss of control over body position, but which very rarely causes more severe consequences like death (56, 58). However, the risk of air embolism from vacuum tubes is being debated,3638 as the most common complication is a reduced blood flow rate because of venous obstruction during the suction.39 The required level of site-specific sterilization is similar to that for peripheral catheter insertion,9 although very strict sterilization may not be required, as the collected blood is not reinjected. Remove tourniquet 2. Could this be an indication of a medical problem? Please lie the patient on a flat surface and raise the legs. In certain trans-illuminating devices the infrared image is not directly shown, but rather it is read by the device and then projected onto the skin surface to produce a guiding pattern for the operator (86). Siegel P, Petrides PE. Only remove the tourniquet as the last amount of blood is drawn. Moreover, we recommend that regulations or guidelines for phlebotomy should include precautions regarding needle-stick injuries, the immediate treatment steps, post-exposure prophylaxis (eg, serological testing to exclude infection), vaccination or medications, and a notification system to alert the appropriate infection control center. Ditto B, Balegh S, Gilchrist PT, Holly CD.
Certified Phlebotomy Technician Skills For Your Resume And Career Ask the patient to make a fist and not pump the hand. Some healthcare facilities have pre-made kits, while others will require you to retrieve the kit yourself. Such a condition, which is defined pseudohypocalcemia (PHC), is due to the strong chelating action EDTA exerts on divalent cations and ferric iron (Fe3+). Label appropriate tubes at the bedside and place them into transport bags. The evacuated tubes system grants a higher safety for the operator and its environment because the blood specimen always circulates in a closed system (12, 13). Cook LS. When you consider some of the preliminary steps for phlebotomy collecting supplies, verifying information, preparing the patient, etc.the entire process may take anywhere from five to ten minutes. National Library of Medicine Earlobes are a good alternative because it helps in the assessment of the pH, pO2, and pCO2 of the arterial blood. Make sure that before the insertion of the cannula, the surface of the skin is cleaned as the micro-organisms present may be the reason for the contraction of phlebitis. 2zXycK*Emc#zG?"UQ Yoshida M, Shiiba S, Sago T, Nunomaki M, Harano N, Watanabe S. Comparison of pain tolerance thresholds of upper limb to identify the most appropriate venipuncture site. https://profreg.medscape.com/px/getpracticeprofile.do?method=getProfessionalProfile&urlCache=aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvMTk5ODIyMS1vdmVydmlldw==, Short-term infusion (via butterfly needle). Analgesia by cooling vibration during venipuncture in children with cognitive impairment. Wollowitz A, Bijur PE, Esses D, John Gallagher E. Use of butterfly needles to draw blood is independently associated with marked reduction in hemolysis compared to intravenous catheter. Lee H, Lee SH, Kim SJ, Choi WI, Lee JH, Choi IJ. In case of children the so called cough-trick should be used instead (64). A randomized trial of iron depletion in patients with nonalcoholic fatty liver disease and hyperferritinemia.
Phlebotomy Competency Skills Checklist Cao H, Han M, Zhu X, Liu J.
Phlebotomy document.getElementById( "ak_js_1" ).setAttribute( "value", ( new Date() ).getTime() ); 2022 LaboratoryInfo.com. World Health Organization WHO guidelines on drawing blood: best practices in phlebotomy:Press WHO. Rapid, needle-free delivery of lidocaine for reducing the pain of venipuncture among pediatric subjects. Venous stasis and whole blood platelet aggregometry:a question of data reliability and patient safety. Ask the patient to breathe slowly (deep breathing). There may be excessivebleeding in patients on aspirin or anticoagulationtherapy. Since the tube includes an additive, there is no need of dispensing the blood afterwards. In this case, the syringes needle is thought to carry the contamination after it has accidentally touched the inner side of the tube coated with the anticoagulant. Alternatively, in order to use it as an evacuated tube, the plunger can be pulled and locked before venipuncture leaving a vacuum within. The main site to draw blood is represented by the cubital fossa of the forearm, which has the shape of an isosceles triangle with the biceps forming the base, and the lateral and medial groups of the antebrachial muscles forming the sides respectively (74). Besides the blood-injury-injection phobia, the other risk factors for VVR are small body size, low estimated blood volume, poor sleep (< 6 hours), as well as the female gender and the Caucasian race (39). A retrospective analysis. This has NEVER happened before. Babiloni C, Brancucci A, Capotosto P, Del Percio C, Romani GL, Arendt-Nielsen L, et al. Egekvist H, Bjerring P, Arendt-Nielsen L. Pain and mechanical injury of human skin following needle insertions. They added an additional wrap on the site. Porphyria cutanea tarda is a disease that is characterized by uroporphyrinogen accumulation, which is related to low levels of uroporphyrinogen decarboxylase. Due to its inherently invasive nature, intravenous (IV) therapy is associated with a number of potential complications, many of which are directly relevant to patient safety (PS). government site.
Aseptic Technique: Uses, Benefits, and Complications - Healthline Heels are common sites in children. HHS Vulnerability Disclosure, Help Polycythemia vera is a clonal progressive myeloproliferative disorder that is associated with significant erythrocytosis and is characterized by the increased bone marrow production of erythrocytes, which leads to an increase in their numbers and higher blood viscosity.10 The production of white blood cells and platelets can also be increased. Superficial veins can be poorly evident to sight and palpation in some coloured or obese people, so the tourniquet must be applied several inches above the site of venipuncture in order to enhance their path by inducing venous stasis. In this context, patients who are receiving chronic blood transfusions (eg, for sickle cell anemia or thalassemia) may develop iron overload and iron deposition in various organs, which may lead to multiple organ failure.8. If the patient faints during a phlebotomy, the tourniquet should be immediately released, the needle should be removed or the catheter should be capped and appropriate treatment should be used to manage the symptoms. And dont hesitate to ask for help. Needle-free powder lidocaine delivery system provides rapid effective analgesia for venipuncture or cannulation pain in children:randomized, double-blind comparison of venipuncture and venous cannulation pain after fast-onset needle-free powder lidocaine or placebo treatment trial. With these steps, you can start to learn more about the process of phlebotomy. WebPath. endobj
Nursing. Also, consult some good hematologists. True brachial artery aneurysm following blood donation:a case report of a rare complication. We may request cookies to be set on your device. Raccomandazioni per il prelievo di sangue venoso. Tapping but not massage enhances vasodilation and improves venous palpation of cutaneous veins. Bagnasco A, Pezzi E, Rosa F, Fornonil L, Sasso L. Distraction techniques in children during venipuncture:an Italian experience. Spurious haemolysis (SH) is another common condition associated with venipuncture, and the most frequent cause of sample unsuitability (116, 117).
Complications during blood collection and Treatment It is noteworthy addressing the role of alcoholic skin disinfectants for percutaneously blood drawn cultures. Cupping therapy (alone or with other interventions) may be beneficial for painful conditions, such as herpes zoster, acne, facial paralysis, cervical spondylosis, rheumatoid arthritis, brachialgia paraesthetica nocturna, carpal tunnel syndrome, acute gouty arthritis, fibrositis, fibromyalgia, persistent nonspecific lower back pain, acute trigeminal neuralgia, headaches, and migraines.46 Several thousand years ago, phlebotomy was used for both preventative and curative treatments. Limited phlebotomy technician. Needlestick injuries in blood collection staff. Phlebotomists are trained to collect blood via venipuncture (when a needle is used to draw blood from a vein), finger pricks, or in the case of infants, heel pricks. Although there can be several ways through which phlebotomy can affect the laboratory preanalytics, not all of them produce a significant bias as it can be seen in Table 2. Mastering this skill will lead to a much better experience for healthcare practitioners as well as their patients. LaboratoryInfo.com does not provide medical advice, diagnosis, or treatment. Please dont allow him to drive for another 30 minutes. Bethesda, MD 20894, Web Policies However, the first should be used to generally address any procedure which involves the iatrogenic accessioning to the vein lumen, the second for special cases in which the procedure is performed by means of a needle, and the third for vein accessioning aimed to blood collection. Your email address will not be published. With respect to PHK it should be finally remarked that tube mixing, necessary to achieve the proper preservation of the collected blood, should be performed only after the tube has been removed from the holder (111). The secondary end points were IR (as determined using the insulin sensitivity index and the homeostasis model of assessment) and systemic lipid peroxidation (plasma F2-isoprostane levels). The skin is then scratched using a sterile cupping scalpel, and then the cups are replaced to carefully draw out small quantities of blood and remove toxins. A new device to relieve venipuncture pain can affect haematology test results. Instead, if an evacuated tubes system is used, the contamination can be due to the anticoagulated blood which stains the inner needle that perforates the tube stop. However, veins at this site have a greater mobility due to the poor surrounding connective tissue, and thus they more easily roll under the needles tip or collapse, causing a missed attempt or a rupture of the vessel. The only certainty is that all the efforts made to grant the safety of the customers and the quality of the service allows phlebotomy to bridge the gap between patient and laboratory. Then, insert the needle at a 15 to 30-degree angle into the vessel.
In this regard, the order in which the tubes containing different additives are drawn is relevant to prevent contamination. The common sites are fingertips, heels, and ear lobes. Lippi G, Pavesi F, Avanzini P, Chetta F, Aloe R, Pipitone S. Development of simple equations for effective screening of spurious hemolysis in whole-blood specimens. Vincent Lopez Rowe, MD, FACS is a member of the following medical societies: American College of Surgeons, American Heart Association, American Surgical Association, Pacific Coast Surgical Association, Society for Clinical Vascular Surgery, Society for Vascular Surgery, Society of Black Academic Surgeons, Society of Black Vascular Surgeons, Southern California Vascular Surgical Society, Western Vascular SocietyDisclosure: Nothing to disclose. Hold pressure at the site for at least 5 minutes or till bleeding stops. Click to enable/disable Google Analytics tracking. Have your supplies ready! However, they do not produce any effect over the VCSA, so that small deep veins remain still hard to pierce although well visible. As for the collecting devices, it is noteworthy to mention a third kind represented by the hybrid collecting system introduced by Sarstedt in 1975 and distributed under the trade name of S-MonovetteTM (14). <>
1 0 obj
Lima-Oliveira G, Salvagno GL, Danese E, Brocco G, Guidi GC, Lippi G. Contamination of lithium heparin blood by K2-ethylenediaminetetraacetic acid (EDTA): an experimental evaluation. These regulations emphasize patient education regarding intra- and post-phlebotomy symptoms and consent, and include training for staff regarding how to manage adverse effects and infections, how to reach the target blood vessel, venous phlebotomy techniques, patient safety, and basic cardiopulmonary resuscitation.35, Patient factors, such as age, sex, weight, comorbidities, overall health status, and the likelihood of compliance, should be considered when prescribing a phlebotomy regimen.8 Zubair8 has described various criteria for initiating therapeutic phlebotomy, which include ferritin levels of >200 ng/mL for ages of <18 years (regardless of sex), ferritin levels of >500 ng/mL for women who are not pregnant but are of childbearing age, and ferritin levels of >300 ng/mL for men who are >18 years old. The .gov means its official. A study of 178 consecutive vasovagal syncopal reactions from the perspective of safety. This phenomenon can enhance the discrimination of the painful stimulus and in turn can magnify its intensity (60, 61). official website and that any information you provide is encrypted Salvagno G, Lima-Oliveira G, Brocco G, Danese E, Guidi GC, Lippi G. Lima-Oliveira G, Lippi G, Salvagno GL, Brocco G, Gaino S, Dima F, et al. Bronchospasm leads to an asthmatic attack. However, various complications may also arise from blood collection. Therapeutic phlebotomy is the optimal treatment for this disease, and hydroxychloroquine treatment is a good alternative.20 In these cases, phlebotomy should be repeated every 2 weeks until the Hb levels are <20 ng/mL.21 Other studies have suggested that erythrocytapheresis is an alternative to phlebotomy.22. If you log out, you will be required to enter your username and password the next time you visit. If the patient feels sharp electric pain, immediately remove the needle. Lippi G, Salvagno GL, Montagnana M, Brocco G, Cesare Guidi G. Influence of the needle bore size used for collecting venous blood samples on routine clinical chemistry testing. An overview on venipuncture is provided in Table 1. The tourniquet application causes the inner pressure of the vein to increase artificially. Valenti L, Fracanzani AL, Dongiovanni P, et al. Comparison of 4 analgesic agents for venipuncture. Fainting during the collection of the blood: Presentation (sign/symptom) of the patient: There may be various types of complications of blood collection. Thus, non-alcoholic disinfectants would prevent the false-positive testing regardless of the correctness of the venipuncture procedure. Thus, the patients overall iron levels are reduced, which makes therapeutic phlebotomy the preferred treatment for blood disorders in which the removal of RBCs or serum iron is the most efficient method for managing the symptoms and complications.9 There are currently three major indications for therapeutic phlebotomy: hemochromatosis, polycythemia vera, and porphyria cutanea tarda. This happens due to low blood pressure. Wollowitz A, Bijur PE, Esses D, John Gallagher E. Use of butterfly needles to draw blood is independently associated with marked reduction in hemolysis compared to intravenous catheter. Seimiya M, Yoshida T, Sawabe Y, Sogawa K, Umemura H, Matsushita K, et al.
(PDF) Complications of venepuncture The patient will have a typicalpictureof hypersensitivityreaction type 1. I will suggest that as the patient feels pain and tingling, please take out the needle immediately if there is damage to the nerve, as the nervous system does not regenerate. Phlebotomy is a technique in which a needle is temporarily inserted into a vein to provide venous access for venous blood sampling. Sometimes permanent damage may take place to the nerve. For example, at Unitek College, students in our Medical Assisting program must demonstrate the application of adult and pediatric phlebotomy, venipuncture, and capillary blood collection. Fingerstick sampling. They are mainly represented by the dorsal surface of the hand, where veins lay superficially because of the poor connective tissue and muscles. The risk of a hematoma can be reduced by applying pressure to the drawing site, and pressure and ice should be used to slow the bleeding if a hematoma occurs. Hence, there was no bleeding and the patient is fine. Different modalities of painful somatosensory stimulations affect anticipatory cortical processes:a high-resolution EEG study. 3 = Able to perform with supervision. It is commonly referred to as fainting or passing out. In that study, patients with HbSC who failed to achieve clinical improvement after receiving the maximum tolerated dose of hydroxyurea were offered phlebotomy and hydroxyurea, and all patients exhibited at least partial clinical improvement. Particular behavioural techniques can be applied against VVR. Epicranial needles are made of stainless-steel, and differ in the length and gauge (G) of the shaft, with smaller values indicating larger diameters (4). can be found in the World Health Organization (WHO) issue on blood draw, as well as in the Clinical and Laboratory Standards Institute (CLSI) H3-A6 issue (91, 92). Elevated serum potassium values:the role of preanalytic variables. WHO Library Cataloguing-in-Publication Data WHO guidelines on drawing blood: best practices in phlebotomy. Moreover, a 23 G needle could be as safe as a 21 G if handled correctly, whereas smaller bore size than 23 G needle should be avoided or used in very rare and extreme circumstances (104). Clinical Technician I. Alternatively, an equivalent combination of relevant education and/or experience. Prss-Ustn A, Rapiti E, Hutin Y. Estimation of the global burden of disease attributable to contaminated sharps injuries among health-care workers. Gil Z Shlamovitz, MD, FACEP Professor of Clinical Emergency Medicine, Keck School of Medicine of the University of Southern California; Chief Medical Information Officer, Keck Medicine of USC Sensu strictu, it indicates the practice of causing a loss of blood (bloodletting) for therapeutic purposes (1). Attach the needed tubes or syringes to remove the proper volume of blood. After the procedure, its recommended that the patient drink water and eat something. One good source of related information is the practice criteria of the American Association of Blood Banks.35 Furthermore, regulations for phlebotomy are also provided in Standard 66 of Practice Criteria III from the Infusion Nursing Standards of Practice that were established by the Infusion Nurses Society. They should also apply a bandage or secure the cotton swab with tape. One famous example is George Washington (former President of the US), who died after losing 1.7 L of blood during treatment for acute epiglottitis.3, Phlebotomy using inserted needles differs from wet cupping therapy (Al-hijamah).4 During Al-hijamah, local suction is created at the selected areas using special cups, which are subsequently removed after several minutes. Phlebotomy tools of the trade: part 2: surveying the antecubital area. Advise the patient to look after redness, pain, swelling, or tenderness. Newborn Screen. One year previous clinical lab experience preferred. Diarrhea. How to Become a Phlebotomist In these studies a gross difference of 0.07 mm2, corresponding to that between a 27 G and 30 G, was enough to sensibly reduce the occurrence of pain during the skin puncture (35, 36). 2 = Need Training. Sorry to hear about your illness. No, it looks like the inflammatory process has started. When do you usually get symptoms after such incident? Although in the large part of individuals the running pattern of superficial veins appears well evident in this region, the path and distribution can be irregular and may require a careful inspection before attempting the needle insertion.
Best practices in phlebotomy - WHO Guidelines on Drawing Blood - NCBI Venipuncture Complications and Special Situations. The frequency of these complications is very low and can be nullified if proper training is provided to the nurses. In this review, we examine the major indications for therapeutic phlebotomy and provide guidelines for phlebotomy, its effects and specific treatments, and additional information that may help facilitate the use of therapeutic phlebotomy for South Korean patients. We would finally advise that to effectively reduce contamination, the phlebotomists hands hygiene (washing and wearing gloves) is essential as much as the patients appropriate skin cleansing. sharing sensitive information, make sure youre on a federal [Full Text]. George Washington and the doctors: treating Americas first superhero. Antiseptic solution application. Schreiber S, Cozzi G, Rutigliano R, Assandro P, Tubaro M, Cortellazzo Wiel L, et al.
In this regard the paper describes devices, tools and procedures in the light of the most recent scientific findings, also discussing their impact on both quality of blood testing and patient safety. The antecubital fossa contains four veins (see the images below). Required fields are marked *. Sulaiman RA, Cornes MP, Whitehead SJ, Othonos N, Ford C, Gama R. Effect of order of draw of blood samples during phlebotomy on routine biochemistry results. There is a leak of blood from the site of the venipuncture site. Blood collection staff education in the prevention of venepuncture failures and donor adverse reactions:from inexperienced to skilful staff. The patient may feel a sharp pain and tingle due to the involvementof the nerve. Phlebotomists are considered to have occupational exposure to blood borne pathogens. SomeEMTs and paramedics may also perform venipuncture, and inveterinary medicine, the procedure is usually performed byveterinariansorveterinary technicians. Venipuncture is the intravenous suction of blood using a syringe. Anticipatory electroencephalography alpha rhythm predicts subjective perception of pain intensity. 2.Phlebotomy - standards. The needle and the blood collection device represent the tools that have undergone a considerable evolution through the years, and which will be discussed in detail later on. Influence of hemolysis on routine clinical chemistry testing. Lippi G, Salvagno GL, Montagnana M, Brocco G, Guidi GC. Lateral antebrachial cutaneous nerve injury induced by phlebotomy. Keep the pressure for as long as you are sure that there is no bleeding. Intravenous catheterization is a widely used invasive procedure, with applications in both ambulatory and hospital settings. Deliver blood specimens to the laboratory promptly. Cellulitis is more likely to occur when fluids are given than during a blood draw. However, there is no mathematical formula that can tell which is the right vein, the right needle, the right angle and the right force that will give the perfect blood draw. 19 (49):55-65; quiz 66. 1.Bloodletting - standards. I weighed 18 bls more than I did on hosp discharge a week ago and have eaten very little because I have had an infected, tender tooth. Since these providers may collect personal data like your IP address we allow you to block them here. Although the colour-code scheme was devised to help the operator in recognizing the additive within the tube, the broad heterogeneity in the scheme adopted by the various manufacturers and the lack of standardization resulted in a serious issue (11). Therefore, the knowledge of anatomy, alongside with tools used to enhance their visualization, is mandatory and deserves an appropriate discussion, with the awareness that the goal is a suitable rather than a quick phlebotomy. However, it should be noticed that the effectiveness of larger bore needles could be mitigated by the choice of the venipuncture site, and that such a lower estimated risk of haemolysis would be reliable only when the phlebotomy is performed on large veins of the antecubital fossa (119). In such a system the plunger is absent, and the barrel is replaced by a plastic or glass tube sealed with a rubber stop provided with preformed vacuum (10). Venipuncture sampling2. It appears that the device used to collect blood is the strongest independent predictor of hemolysis in blood samples drawn in the emergency department (ED). The pain or intra-procedural discomfort is a major factor in phlebotomy compliance, and depends on the mechanical force that the needle exerts on the skin to penetrate it, given the veins wall has no nociceptive innervations. A typical condition is in case of a missed first attempt which requires a searching by needle probing of the bloodstream. Improving quality in venipuncture site and vein selection, and also in venipuncture technique may help in lowering complications. (accessed on 1/5/2023), Complete this form and our Admissions department will contact you shortly with more information. Lima-Oliveira G, Lippi G, Salvagno GL, Montagnana M, Manguera CL, Sumita NM, et al. The use of interferon as a myelosuppressive agent may also provide advantages for patients with polycythemia vera.9 Other medications that reduce the platelet count are associated with decreased risks of post-phlebotomy thrombosis, although they may also increase the risk of developing leukemia.9, When a therapeutic phlebotomy program is introduced, the institution must establish guidelines and regulations for patient safety, the phlebotomy procedure, and blood disposal. For drawing blood by venipuncture, a needle with hollow shaft is used (Figure 1A) (3). Depending on the location (i.e. The site is secure. Certified phlebotomy technician 2. 2 0 obj
Bacon BR, Adams PC, Kowdley KV, Powell LW, Tavill AS. If it happens, give some antiallergic medication. Therefore, phlebotomists should be well acquainted with the possibility of needle-stick injuries and blood-borne pathogen exposure, and take appropriate measures to avoid these injuries and exposures. The chance of its occurrence is 12.3%. Complications during blood collection and Treatment: Syncopy during Blood collection, Complications during blood collection and Treatment: Type 1 Hypersensitivity mechanism.
Holy Trinity Westfield Nj Mass Schedule,
Articles T