Venipuncture Procedure

Use at least two patient identifiers when providing care. Double checking of ID bands and ID/Driver’s license of patient if possible. Using labels to mark all materials /items needed for the procedures. A two person check off procedure must be implemented. Items requiring labeling include: patient records, signed consents, and all assessments, diagnostic tests and x-rays. Also included should be any item that is needed for the procedure (blood products, devices, and equipment). Using a matching system, so that all items in the procedure area are matched to the patient. The matching system must be completed by a minimum of two staff members. These staff members should include a qualified staff member, nursing staff involved in the procedure, recovery room staff, and discharge staff.

This procedure is done by making a small puncture in the groin or a small incision in the chest.

Intervention Procedure: Following the diagnostic portion of the procedure, the left femoral vein was accessed under ultrasound guidance with a 21 gauge thin wall needle. A double lumen 4 -French (5 cm in length) was placed percutaneously into the left femoral vein by modified Seldinger technique with guide-wire exchange. Blood was withdrawn from all lumens and flushed with normal saline. The catheter was sutured in place and a sterile dressing was applied over the site prior to removal of drapes.

Pt requires IV discontinuation d/t: pain / infiltration / expiration of indwelling time frame. Discontinue 22 gauge IV catheter from L hand. Cannula intact. Pressure held for 3 minutes, assess for continue blood loss, none noted. 2 x 2 gauze dressing with paper tape

The steps to do a central line are as follows: Set up materials needed for the procedure, check the patients charts, lay them down with a roll under their back to expose the chest. Swab the chest with antiseptic, inject the anesthetic lidocaine, then use a syringe and puncture a hole near the clavicle. Next use the guidewire to find your way through the veins to the heart, and using that follow it in with the central line. The last step is suture it in place and clean up. (12)

Sterilize and prepare the patient's genital area. You have wipe the patient's genital area with disinfectant soaked cotton swabs, to remove any debris. Repeat step if needed. For female patients, be sure to clean the labia and urethral meatus (the outside of the opening of the urethra located above the vagina). For the men clean the urethral opening on the penis. When you finish wiping down the patient, lay down surgical drapes around the genitals, leaving yourself enough work

Write up a phlebotomy venipuncture procedure that you can use for the rest of the year and beyond. You may use textbooks, the internet, videos, pictures, and other laboratory procedures as examples. Make sure your procedure is in your own words and is easy to read and understand for use in a clinical setting. Please take a look at other Standard Operating Procedures (SOPs) in order to see an appropriate format for writing laboratory procedures. This will be a “living document” that will change and grow once you learn and experience more situations that will give you more “tricks” to utilize in the art of phlebotomy.

After a suitable vein has been visualized and the venipuncture site thoroughly cleansed, the needle is then placed into the patient’s vein for blood collection. Difficulties can arise if a needle is not fully inserted or if it went entirely through the vein and a hematoma will be the result. (Morgan, 2005) Hematomas are bruises due to the collection of blood from veins or arteries in the surrounding tissues. (Garza, 2010) Sticking a fragile vein, excessive probing of the needle if the vein is initially missed, and failure to remove the tourniquet before removing the needle are some other ways a hematoma can develop during a venipuncture procedure. (Garza, 2010) When needles are incorrectly inserted into a vein, blood is allowed to escape, forming a bruise. (Garza, 2010) If at any time this should happen, the phlebotomist should immediately end the procedure by first removing the tourniquet, then the needle, and apply firm pressure to cease the blood flow. (Morgan, 2005) Improper needle placement can also cause neurological damage. With deep insertion of a needle, hitting the nerve behind the vein is likely. (Garza, 2010) Radiating or shooting pain and sometimes numbness has been reported by patients in these situations. (Garza, 2010) Phlebotomist should always insert needles with care to avoid any injury to the

Peripheral IV catheterization is a painful and potentially anxiety-provoking procedure for the patients. The interventions to reduce the pain caused by venipuncture were explored in the past decades (Oman, 2014). The majority of the studies reviewed in this summary included one level 1 evidence of meta-analyses (Oman, 2014), three level 2 evidences of randomized controlled trials (Beck, 2011; Deguzman, 2012; Kahre, 2011) and one level 3 evidence of controlled trials without randomization (Levitt , 2013). Many studies have demonstrated that 1% lidocaine intradermal injection before IV insertion can reduce the pain significantly (Oman, 2014). Kahre and his colleagues’ study indicated bacteriostatic normal saline (BNS) group had lower pain score

Proper patient identification in hospitals has been an issue for many years, especially when it comes to blood specimen collection. Laboratory specimens being mislabeled are a everyday cause of harm to patients including repeat diagnostic procedures; repeat phlebotomy; delays in necessary surgical procedures; a performing unnecessary surgical procedures (Dunn and Moga, 2010). This is not only costly, but it is very stressing to patients and medical staff. The biggest concern is the possibility of making a fatal error when it comes to specimen collection. Without proper patient identification this risk increases substantially. Wallin, Sodberg, Van Guelpen, Stenlund, Grankvist, and Brulin (2009) state that critical errors in patient identification for blood testing occurs in up to one per 1000 specimens or procedures and misidentified specimens cause 160,000 adverse events every year in America.

Medical staff will clean and shave your groin or arm for the insertion of the catheter. A local numbing agent will be administered, but you will be awake during the procedure. Medicines for anxiety could be given if patient is having trouble relaxing during the exam. Next, a small catheter will be inserted into an artery. The doctor then uses x-rays to guide the catheter to the area of interest. Once the catheter is in place, dye will be inserted through tube. This allows for visualization of your blood vessels. Very minimal movement will be aloud during this exam to ensure safety and high quality images. This procedure could last one to two hours. If this is a planned procedure and not an emergency, this is normally only scheduled in the

Physicians needed a way to get to the veins of their patients quickly, so several tools were fabricated over the centuries, ensuring a swift puncture; even some punctures with a measurable degree of incision. These tools consisted of lancets and scarifications, which opened the vein; then there were cupping cups and leeches, which allowed a more localized draw from the capillaries. Davis and Apel state, "in the eighteenth century, delicate mechanical spring lancets and scarifications were invented to replace the simpler thumg lancets and fleams." Lancets are surgical knives that bore the greatest amount of liquid; creating an opening approximately one-fifth of an inch. Spring-loaded lancets were the easiest to use because they made consistent cuts whose cuts varied depending on the skill of the physician. Scarificators were brass boxes with a lever on top that released a set of blades which snapped out of slits on the base; offering a consistent depth and length of an incision. Cupping cups were heated while placed on the patients skin. As the cup cooled on the skin, a vacuum type of energy

Surgery normally consists either of saphenofemoral ligation (where a cut is made at the top of the groin above the main varicose vein) or short saphenous ligation, with or without stripping, and phlebectomies (removal of the vein). Alternatively, varicose veins can be treated by sclerotherapy, an injection treatment which shrinks the blood vessel, although this has been associated with a high recurrence rate.

Scrub the site of the puncture with a alcohol pad. Use a circular scrubbing motion, from inside to outside only. Cover a wide area around the selected site, 3 to 4 inches. This may have to be repeated depending on the cleanliness of the patient. Cleansing the site prevents chemical or microbial contamination of specimen and patient. Do not touch this area again. Let the area air dry. Do not blow on or fan the area. The alcohol should be allowed to dry to avoid hemolysis and/or burning sensation when the venipuncture is performed. It is better to use syringes if veins are small. butterfly collection sets are also available and useful if multiple tubes are needed. If a syringe is used, move the plunger up and down in the barrel once or

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