Venipuncture Notecards

Front 1

Venipuncture procedure:

Back 1

Identify, assess physical, check tests and special requests, select site, prepare equipment & patient, collect sample in right container, recognize complications, assess sample, label tubes at bedside, send tubes with request to lab

Front 2

Oder Form/ Requisition
The essential elements of the requisition form are:

Back 2

Patient's surname, first name, and middle initial.

Patient's ID number.

Patient's date of birth and sex.

Requesting physician's complete name.

Source of specimen, This information must be given when requesting microbiology, cytology, fluid analysis, or other testing where analysis and reporting is site specific, Date and time of collection, Initials of phlebotomist, Indicating the test(s) requested.

Front 3

Labeling the Sample

Back 3

Patient's surname, first and middle, Patient's ID number, Date, time and initials of the phlebotomist must be on the label of each tube.

Front 4

Red Top

Back 4

no additive, blood clots, serum is seperated by centrifugation, used for chemistry, blood bank, serology, and immunology

Front 5

Gold Top

Back 5

no additive, Serum separator tube (SST) contains a gel at the bottom to separate blood from serum on centrifugation, Chemistries, Immunology and Serology

Front 6

Light Green Top

Back 6

Plasma Separating Tube (PST) with Lithium heparin, Anticoagulates with lithium heparin; Plasma is separated with PST gel at the bottom of the tube, Chemistries

Front 7

Purple Top

Back 7

EDTA, Forms calcium salts to remove calcium, Hematology (CBC) and Blood Bank (Crossmatch); requires full draw - invert 8 times to prevent clotting and platelet clumping

Front 8

Light Blue Top

Back 8

Sodium citrate, Forms calcium salts to remove calcium, Coagulation tests (protime and prothrombin time), full draw required

Front 9

Green Top

Back 9

Sodium heparin or lithium heparin, Inactivates thrombin and thromboplastin, For lithium level, use sodium heparin
For ammonia level, use sodium or lithium heparin

Front 10

Dark Blue Top

Back 10

EDTA-, Tube is designed to contain no contaminating metals, Trace element testing (zinc, copper, lead, mercury) and toxicology

Front 11

Light Gray Top

Back 11

Sodium fluoride and potassium oxalate, Antiglycolytic agent preserves glucose up to 5 days, Glucoses, requires full draw (may cause hemolysis if short draw)

Front 12

Yellow Top

Back 12

ACD (acid-citrate-dextrose), Complement inactivation, HLA tissue typing, paternity testing, DNA studies

Front 13

Yellow-Black Top

Back 13

Broth mixture, Preserves viability of microorganisms, Microbiology - aerobes, anaerobes, fungi

Front 14

Black Top

Back 14

Sodium citrate (buffered), Forms calcium salts to remove calcium, Westergren Sedimentation Rate; requires full draw

Front 15

Orange Top

Back 15

Thrombin, Quickly clots blood, STAT serum chemistries

Front 16

Light Brown Top

Back 16

Sodium heparin, Inactivates thrombin and thromboplastin; contains virtually no lead, Serum lead determination

Front 17

White Top

Back 17

Potassium EDTA, Forms calcium salts, Molecular/PCR and bDNA testing

Front 18

Pink Top

Back 18

Potassium EDTA, Forms calcium salts, Immunohematology

Front 19

Heel Stick Procedure

Back 19

Prewarm the infant's heel (42 C for 3 to 5 minutes), Clean the site to be punctured with an alcohol sponge. Dry the cleaned area with a dry cotton sponge. Hold the baby's foot firmly to avoid sudden movement, Using a sterile blood lancet, puncture the side of the heel, Make the cut across the heelprint lines so that a drop of blood can well up and not run down along the lines. Fill the capillary tube(s) or micro collection device(s) as needed. When finished, elevate the heel, place a piece of clean, dry cotton on the puncture site, and hold it in place until the bleeding has stopped.

Front 20

To protect one's self:

Back 20

always practice universal precautions, wear appropriate PPE, dispose of needles in sharps containers, follow institution's procedure if accidently punctured

Front 21

Finger Stick Procedure

Back 21

Equipment
Proper location on finger
Puncture with lancet
Drop of blood
Wipe first drop
Collecting the specimen
Specimen container

Front 22

Procedure for Vein Selection

Back 22

Palpate and trace the path of veins with the index finger. Arteries pulsate, are most elastic, and have a thick wall. Thrombosed veins lack resilience, feel cord-like, and roll easily. If superficial veins are not readily apparent, you can force blood into the vein by massaging the arm from wrist to elbow, tap the site with index and second finger, apply a warm, damp washcloth to the site for 5 minutes, or lower the extremity over the bedside to allow the veins to fill.

Front 23

Areas to avoid for venipuncture

Back 23

Extensive scars from burns and surgery - it is difficult to puncture the scar tissue and obtain a specimen.
The upper extremity on the side of a previous mastectomy - test results may be affected because of lymphedema. Hematoma - may cause erroneous test results. If another site is not available, collect the specimen distal to the hematoma. Intravenous therapy (IV) / blood transfusions - fluid may dilute the specimen, so collect from the opposite arm if possible.

Front 24

Order of Draw

Back 24

First - blood culture bottle or tube (yellow or yellow-black top)
Second - coagulation tube (light blue top). If just a routine coagulation assay is the only test ordered, then a single light blue top tube may be drawn. If there is a concern regarding contamination by tissue fluids or thromboplastins, then one may draw a non-additive tube first, and then the light blue top tube.
Third - non-additive tube (red top)
Last draw- SST, Sodium heparin, PST, EDTA, ACDA or ACDB, Oxalate/ fluoride

Front 25

Dangers of prolonged tourniquet use:

Back 25

Primary effect is hemoconcentration of non-filterable elements (i.e. proteins). The hydrostatic pressure causes some water and filterable elements to leave the extracellular space.
Significant increases can be found in total protein, aspartate aminotransferase (AST), total lipids, cholesterol, iron
Affects packed cell volume and other cellular elements
Hemolysis may occur, with pseudohyperkalemia.