- Examines requisition form
- Greets patient and states procedure to be done
- Identifies patient verbally
- Examines patient's ID band
- Compares requisition information to ID band
- Selects correct tubes and equipment for procedure
- Washes hands
- Puts on gloves
- Positions patient's arm
- Applies tourniquet
- Identifies vein by palpation
- Releases tourniquet
- Cleanses site and allows it to air dry
- Assembles equipment
- Reapplies tourniquet
- Does not touch puncture site with unclean finger
- Removes needle cap and examines the needle
- Anchors vein below puncture site
- Smoothly enters appropriate vein at an angle with bevel up
- Does not move needle when changing tubes
- Collects tubes in correct order
- Mixes tubes promptly
- Fills tubes completely
- Releases tourniquet within 1 minute
- Removes last tube collected from holder
- Covers puncture site with gauze
- Removes the needle smoothly and applies pressure
- Activates any safety feature
- Disposes needle in the sharps container with the safety device activated and attached to the holder
- Labels tubes
- Confirms labeled tube to the patient ID band or has patient verified that the information is correct
- Examines puncture site
- Applies bandage
- Disposes used supplies
- Removes gloves and washes hands
- Thanks patient
- Converses appropriately with patient during the procedure
Showing posts with label phlebotomy. Show all posts
Showing posts with label phlebotomy. Show all posts
Wednesday, January 23, 2019
Evaluation on Evacuated Tube System CHECKLIST
Monday, April 17, 2017
Phlebotomy 101: How to get blood from babies? Part 1
What's difficult in blood extraction of the babies is that their veins are still thin. You can not always use 3cc syringe to get the baby's blood from the arm. If possible, one should pull the plunger slowly so as to prevent the vein from collapsing. There should be an assistant to hold the baby's arm to secure the vein. Take note, the baby's veins are still movable and their skin tends to stretch.
THE SOLUTION...
To get blood samples for tests like CBC, Total and Direct Bilirubin for babies and the like, a passive blood collection technique called DRIPPING may be applied.
HOW TO DO DRIPPING
1. First and foremost, nursery rooms especially neonatal ICUs limit hand contacts to their babies. And for this reason, we should observe proper hand hygiene by washing our hands with soap and dry it thoroughly with a tissue/paper towel. Also, prepare the things you need. In our hospital, it is a policy to leave the warding trays outside the nursery rooms and bring only the things you only need.
2. It is an option whether you put gloves or not. As for me, I don't wear gloves until I have found the right vein for dripping.
4. One of the ways to obtain a successful extraction is the way you hold the baby's hand. In order for you to easily squeeze the hand as the blood drops, make a circle around the baby's hand.
5. Clean the site: inner to outer motion. In this manner you can see your chosen vein clearly. Let it dry.
4. Taut the baby's skin. Hold it firmly. A 23-gauge needle can be used. As you insert the sterile needle (bevel up), don't let air get into it. Shallow angle of insertion at first then insert deeper until blood coming from the vein of choice comes to the needle's hub.
5. SQUEEZING TECHNIQUES...
As soon as the blood drops, squeeze the baby's hand gently by letting your index finger massage the baby's hand downward. This is to facilitate the blood to drop in the microtainer tube that you're holding in your other hand. It is advised to observe a 3-second interval after squeezing to avoid needle dislodge and to allow more blood to drop in the tube.
6. In case you observe any clots in the hub, gently remove it by using an alcohol swab. This should be removed immediately or else the blood flow will stop. Also, when you notice the blood stops dropping, adjust the needle inward or outward. Do it gently.
7. After collecting the right amount of blood. Cap all the microtainers and remove the needle with a cotton ball immediately covering the puncture site. Apply pressure for 1 minute then put a plaster.
8. Dispose the sharps in the sharps container and make sure the baby's bed is clean before leaving.
Dripping might be time-consuming but I personally prefer doing it than the syringe method. I hope this helps...
Stay tuned for my Part 2 of neonatal phlebotomy tips!
Thursday, March 2, 2017
Phlebotomy 101: How to extract difficult veins? Must-see tips!
I think none of us phlebotomists would want to stick a needle twice. If only the patient knows how we tried our best to get his blood once. BUT...We can't avoid having patients with difficult veins and because of this, we might fail to extract some of them. As a result, patients will get angry and all we have to do is to sigh and act like we never heard them.
But then, we're just humans. We're not perfect thus we make mistakes. Letting go might be hard but just like in getting blood where you think it's hopeless and it's hurting, maybe it's best to just pull it out. Well, if you want to know how I deal my patients in situations like these, then this might be of help for you. I tell you a secret: All extractions starts with setting the patient in a good mood before we stick the needle in them.
TRICKS TO ASSURE THE PATIENT...
I think one of the things to keep a patient comfortable is to show to them that you really know what you're doing, Make an impression that you can be trusted. Sometimes, a patient might ask: Are you a sharpshooter? Are you the senior phleb? To gain trust, you must be confident and set a positive attitude that you can do it. Always act like you're an expert. VEIN ASSESSMENT IS VERY IMPORTANT. Do not haste and take your time in finding the right vein. Just with that manner, the patient will understand that you are really taking time and didn't take him for granted. If must, communicate to them but not to the extent of being talkative (I usually ask them if their lab tests are on a monthly or weekly basis and later they do the talking).
WHAT IF IT REALLY FAILED...
Based on my experience, patients tend to understand why the extraction went wrong when you explain to them what happened and also the mood that you set for them can be helpful. So, the next thing you gonna do is to convince him/her to extract again.
If the patient is already angry, it is best to keep calm. Don't contest the patient's high temper. Deal them in a professional way. Don't argue. Why not try these options for yourself?
Option 1: See if there's a basilic or cephalic vein in that arm.
- Although median cubital vein is ideal but sometimes you need to consider other veins as well such as the cephalic vein in which obese ones have more palpable cephalic vein.
Option 2: Find vein in the other arm.
- Go try palpate the patient's other arm. You may find a vein there. As what I've said, take your time. Mostly, palpable veins are located in the dominant arm so it is helpful to ask if the patient is right-handed or left-handed.
Option 3: Look for a vein in the dorsal hand of the patient
- If there's no hope to find a vein in both arms, we can get blood in patient's dorsal hand if they allow it. Sometimes, I'm surprised how some people have palpable veins on their hands while they're having deep and thin veins in the arm.
Option 4: Use small-gauge needle or a butterfly
- An assessment of what to use when extracting blood can help you achieve a one-stick only goal. Take note that thin veins can't stand bigger gauge needles as the vein will collapse upon insertion. Butterfly method is advisable if the veins are thin and superficial or if you're going to extract in the dorsal hand.
Option 5: Ask help from a senior phlebotomist
- Only and only if the patient insisted..but if not, why not try your best? It's not always your senior will come and rescue you. Show to your senior that you made an effort and at least you've tried. If it still failed for the second time, allow the senior to do the job.
PLEASE STAY TUNED FOR AN UPDATE OF MY PHLEBO TIPS
But then, we're just humans. We're not perfect thus we make mistakes. Letting go might be hard but just like in getting blood where you think it's hopeless and it's hurting, maybe it's best to just pull it out. Well, if you want to know how I deal my patients in situations like these, then this might be of help for you. I tell you a secret: All extractions starts with setting the patient in a good mood before we stick the needle in them.
I think one of the things to keep a patient comfortable is to show to them that you really know what you're doing, Make an impression that you can be trusted. Sometimes, a patient might ask: Are you a sharpshooter? Are you the senior phleb? To gain trust, you must be confident and set a positive attitude that you can do it. Always act like you're an expert. VEIN ASSESSMENT IS VERY IMPORTANT. Do not haste and take your time in finding the right vein. Just with that manner, the patient will understand that you are really taking time and didn't take him for granted. If must, communicate to them but not to the extent of being talkative (I usually ask them if their lab tests are on a monthly or weekly basis and later they do the talking).
WHAT IF IT REALLY FAILED...
Based on my experience, patients tend to understand why the extraction went wrong when you explain to them what happened and also the mood that you set for them can be helpful. So, the next thing you gonna do is to convince him/her to extract again.
If the patient is already angry, it is best to keep calm. Don't contest the patient's high temper. Deal them in a professional way. Don't argue. Why not try these options for yourself?
Option 1: See if there's a basilic or cephalic vein in that arm.
- Although median cubital vein is ideal but sometimes you need to consider other veins as well such as the cephalic vein in which obese ones have more palpable cephalic vein.
Option 2: Find vein in the other arm.
- Go try palpate the patient's other arm. You may find a vein there. As what I've said, take your time. Mostly, palpable veins are located in the dominant arm so it is helpful to ask if the patient is right-handed or left-handed.
Option 3: Look for a vein in the dorsal hand of the patient
- If there's no hope to find a vein in both arms, we can get blood in patient's dorsal hand if they allow it. Sometimes, I'm surprised how some people have palpable veins on their hands while they're having deep and thin veins in the arm.
Option 4: Use small-gauge needle or a butterfly
- An assessment of what to use when extracting blood can help you achieve a one-stick only goal. Take note that thin veins can't stand bigger gauge needles as the vein will collapse upon insertion. Butterfly method is advisable if the veins are thin and superficial or if you're going to extract in the dorsal hand.
Option 5: Ask help from a senior phlebotomist
- Only and only if the patient insisted..but if not, why not try your best? It's not always your senior will come and rescue you. Show to your senior that you made an effort and at least you've tried. If it still failed for the second time, allow the senior to do the job.
PLEASE STAY TUNED FOR AN UPDATE OF MY PHLEBO TIPS
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