When conducting your survey of the antecubital area, check both arms for the medial vein before considering one of the alternatives. If one is not prominent enough to instill confidence, default to the cephalic vein on the lateral or thumb side of the arm as a second choice.
Keep the basilic vein located on the medial or inside aspect of the antecubital area as a last resort. The proximity of underlying nerves and the brachial artery make punctures in the area of this vein highly risky. Most permanent nerve injuries and arterial nicks I see result from misguided punctures into this vein.
That is not to say the basilic vein should not be punctured. In many cases it is the prominent vein in the antecubital area. A high percentage of specimens rejected by laboratories are due to clots in lavender- or blue-stoppered tubes. A quick inversion after collection prevents a second puncture. If not inverted immediately upon filling, invert the tubes as soon as possible after the puncture.
Drawing blood from a syringe requires extra consideration to prevent clotting. The moment blood enters the barrel of the syringe the clotting process begins. If the time it takes to fill the syringe and evacuate the specimen into the tubes exceeds 1 minute, significant clotting may take place. Not only will this make it difficult to evacuate the specimen through the needle and into the tubes, but if the clots are small enough to go undetected they can affect the accuracy of the results.
Antecubital and hand veins are acceptable sites unless their use is precluded by intravenous infusions, injury or mastectomy.
Any other site should be approached with great trepidation. The anterior, or palm side, of the forearm is particularly susceptible to injury because of the close proximity of nerves and tendons to the surface of the skin and should not be considered. Foot and ankle veins can be acceptable sites for venipunctures in some facilities and on some patients. However, puncturing these veins can lead to thrombophlebitis and clot formation in patients with coagulopathies or to tissue necrosis in diabetics.
Therefore, before puncturing foot and ankle veins, make sure the facility does not have a policy against such punctures and that the physician approves of the site. There is no excuse for not completely labeling a specimen at the bedside. This means complete identification, not just temporary identifiers to remind you when you find time to label them completely later.
Patients have died as a result of mislabeled specimens. Case in point: At a small Midwestern hospital, a lab tech drew a specimen of blood to determine the blood type of a patient. She left the room without properly labeling the specimen, drew two more patients, then returned to the lab to type them all simultaneously.
After an interruption, she returned to her workstation, misidentified the specimens and typed the patient incorrectly. The patient received incompatible blood and subsequently died. Although this concept of complete and accurate specimen identification has been trumpeted loudly and clearly for decades, delayed labeling practices persist.
The bottom line is without exception: label the specimen completely at the bedside. Pulling down on the skin from below the intended puncture site with the thumb of your free hand anchors the vein and stretches the skin through which the needle will pass.
Anchoring the vein is particularly important when drawing from the cephalic or basilic veins. Stretching the skin is the single most effective way to minimize the pain of the puncture. Routinely employing this technique has two potential bonuses: your rate of successful punctures goes up and your patients thank you for considering their suffering. Not everyone can draw blood from every patient. Even those who elevate phlebotomy to an art form can have difficulty from time to time.
This is because there are veins intentionally placed in the antecubitals of the population at random for the sole purpose of keeping skillful collectors from becoming legends in their own minds. Therefore, before puncturing foot and ankle veins, make sure the facility does not have a policy against such punctures and that the physician approves of the site. There is no excuse for not completely labeling a specimen at the bedside. This means complete identification, not just temporary identifiers to remind you when you find time to label them completely later.
Patients have died as a result of mislabeled specimens. Case in point: At a small Midwestern hospital, a lab tech drew a specimen of blood to determine the blood type of a patient. She left the room without properly labeling the specimen, drew two more patients, then returned to the lab to type them all simultaneously.
After an interruption, she returned to her workstation, misidentified the specimens and typed the patient incorrectly. The patient received incompatible blood and subsequently died. Although this concept of complete and accurate specimen identification has been trumpeted loudly and clearly for decades, delayed labeling practices persist. On one ward at a large hospital, collectors scrawled patients' last names on the caps of the tubes to facilitate complete labeling at a later time.
The bottom line is without exception: label the specimen completely at the bedside. Pulling down on the skin from below the intended puncture site with the thumb of your free hand anchors the vein and stretches the skin through which the needle will pass.
Anchoring the vein is particularly important when drawing from the cephalic or basilic veins. Stretching the skin is the single most effective way to minimize the pain of the puncture. Routinely employing this technique has two potential bonuses: your rate of successful punctures goes up and your patients thank you for considering their suffering.
Not everyone can draw blood from every patient. Even those who elevate phlebotomy to an art form can have difficulty from time to time. This is because there are veins intentionally placed in the antecubitals of the population at random for the sole purpose of keeping skillful collectors from becoming legends in their own minds.
After two failed attempts, one should seriously consider sending in someone else. That's professionalism. It also may be the answer to your patient's prayers. In a hospital, the only peace many patients experience is that which health care professionals bring them by their kind words, gentle technique and their smiles.
Regardless of how you think your life led you to hold a position as a health care professional, consider yourself assigned by a higher authority because of the comfort you can offer to the sick and injured in your own unique and compassionate way. You haven't been employed; you've been ordained. References 1. Jagger, J. Rates of needlestick injury caused by various devices in a university hospital. N Engl J Med, 5 , Carlsen, W.
Epidemic rages caregivers: thousands die from diseases contracted through needle sticks. San Francisco Chronicle. Pallatroni, L. Needlesticks: Who pays the price when costs are cut on safety? MLO, 30 7 , , , High profits--at what cost? Risky procedure, risky devices, risky job. Advances in Exposure Prevention, 1 1. Garza, D.
Phlebotomy handbook: Blood collection essentials. Dennis J. The 16x20 four-color graphic can be viewed and ordered at www. Post a Comment. Pages Home. The 10 Commandments of Phlebotomy. Blood specimen collection is one of the most underestimated procedures in health care. I enjoyed reading it and I hope many people will eventually consider this kind of procedure. I find it very helpful. I will share this blog post to my classmates in phlebotomy training.
I'm sure they will like it. Your contents are wonderful how to get a good job, get a job fast. Saya menghubunginya untuk meminta bantuan dan dia berkata bahwa dia akan membantu saya mendapatkan kesembuhan yang saya perlukan hanyalah mengirimnya uang ke menyiapkan obat dan setelah itu akan dikirim kepada saya melalui jasa pengiriman kurir DHL yang saya lakukan dengan sangat mengejutkan obat itu dikirimkan kepada saya dia memberi saya petunjuk untuk mengikuti cara meminumnya bahwa setelah tiga minggu saya harus pergi untuk pemeriksaan , setelah minum obat an d ikuti instruksinya setelah tiga minggu saya kembali ke rumah sakit untuk tes lain, pada awalnya saya terkejut ketika dokter mengatakan kepada saya bahwa saya negatif saya meminta dokter untuk memeriksa lagi dan hasilnya masih negatif yang sama yaitu bagaimana saya bebas dari HIV VIRUS karena kaget saya memutuskan untuk datang dan membagikan kesaksian saya sendiri kepada Anda untuk mereka yang berpikir tidak ada obat untuk HIV VIRUS yang akhirnya sembuh dan hubungi Dr Akhigbe melalui email drrealakhigbe gmail.
I have had it for 4 months now. I have told my boyfriends who I trusted about it and I have never had a bad reaction, it has affected my new relationships with Smith and people think herpes is really a minor skin irritation herpes has a long term effects on health.
The stigma attached to this virus by ignorant people is ridiculous. Most people have herpes in one form or another. Newer Post Older Post Home. Subscribe to: Post Comments Atom. Warung kami Mampir yukk. From us :. Hello from Indonesia. Samyun Wan Herbal penambah berat badan, info silahkan klik gambar. Kaca mata vision therapy Rp
0コメント