ALERTStrictly adhere to guidelines for hand hygiene, standard precautions, and site preparation to minimize the risk of a health care–associated infection.undefined#ref15">15 Show
Signs of nerve injury include severe, unusual or shooting pain, tingling or numbness, or a tremor in the arm. If the patient complains of any of these symptoms during venipuncture, withdraw the needle immediately.2 Don appropriate personal protective equipment (PPE) based on the patient’s signs and symptoms and indications for isolation precautions. OVERVIEWInfection control standards must be followed when obtaining a blood specimen. Appropriate safety devices should always be used and blood-borne pathogen standards should be followed to minimize the risk of exposure to blood-borne pathogens.16 The use of safer needleless devices, such as those with a reliable integrated safety feature, is recommended.16 Venipuncture requires an aseptic, no-touch technique.8 Veins used for venipuncture should be repeatedly assessed for infiltration, extravasation, infection, and phlebitis using standardized scales.11,12,13 Pain, burning, stinging, erythema, warmth, and subcutaneous swelling should be reported to the practitioner. Venipuncture with a syringe requires the nurse to exert aspiration pressure against the syringe plunger. This method involves inserting a hollow-bore needle attached to a syringe into the lumen of a large vein to obtain a blood specimen. A hollow-bore straight needle or winged-butterfly needle with a short length of tubing is connected to an appropriate-size syringe. After blood is drawn into the syringe, the needle is withdrawn from the patient’s vein while a safety device is engaged and then detached from the syringe. The syringe is then connected to a blood-transfer device housing a rubber-sheathed needle with a Luer lock. The rubber-sheathed needle housed in the collection barrel is used to puncture the rubber top of a vacuum test tube. Once punctured, the vacuum in the blood collection tube extracts a set volume of blood from the syringe. The correct amount of blood required by the laboratory must be drawn into each blood collection tube to ensure accurate laboratory test results and decrease the patient’s risk of anemia.10 Some blood collection tubes contain fixative agents that require an exact amount of blood in the collection tube. Blood collection tubes without fixative agents allow variable amounts of blood. Some laboratory tests require less blood than others; the minimum amount needed for a required laboratory test should be confirmed with the organization’s laboratory.10 Some fixatives are more likely to contaminate other blood specimens when blood collection tubes are sequentially engaged in the rubber-sheathed needle. Knowing the prescribed laboratory order of the blood specimens into the collection tubes is essential.17 The sequence of collecting blood specimens is different when using a syringe and transfer device than when using a vacuum-extraction blood collection system. Blood specimens should be transported to the laboratory immediately after collection per the organization’s practice.17 Some blood specimens may require special storage or handling, such as being placed on ice, refrigerated, or frozen.17 Because limited venous access may be a life-threatening complication of venipuncture, maintaining the patient’s vein’s integrity is essential. A patient with veins that may collapse or become injured from the vacuum pressure may require an alternative method of blood specimen collection or the use of a smaller syringe. In addition, a patient whose veins may be difficult to locate because of unusual anatomy, trauma from repeated phlebotomy, or edema may also require an alternative method of blood specimen collection. Tourniquets should be used with caution. If a tourniquet is deemed necessary, the nurse should not apply the tourniquet for longer than 1 minute.10 Prolonged tourniquet application can cause stasis and hemoconcentration.10 Infection control standards require that tourniquets be single use.7 Contamination from Staphylococcus aureus from reused tourniquets is a common finding.18 When preparing a specimen label, the nurse should confirm the patient’s identifying information per the organization’s practice. A laboratory cannot process a mislabeled blood specimen or one that does not arrive in a timely manner. Errors in any aspect of blood sampling may require repeat samples, placing the patient at risk for blood loss and venous injury. Accuracy in obtaining, labeling, and handling blood specimens reduces the need for redrawing specimens. Venipuncture can be painful, and the patient may experience anxiety or fear before the procedure. In some cases, just the appearance of a needle is frightening. A calm approach and skilled technique may help limit a patient’s aversion to venipuncture. Anxiety may be assuaged by communicating with the patient about how to help relieve the patient’s concerns. Appropriate laboratory tubes should be obtained before the home visit. If needed, the laboratory should be called so that the proper tubes and the volume required to process the specimens can be confirmed. EDUCATION
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REFERENCES
ADDITIONAL READINGSO’Grady, N.P. and others. (2011, updated 2017). Guidelines for the prevention of intravascular catheter-related infections, 2011. Centers for Disease Control and Prevention. Retrieved June 28, 2021, from https://www.cdc.gov/infectioncontrol/pdf/guidelines/bsi-guidelines-H.pdf *In these skills, a “classic” reference is a widely cited, standard work of established excellence that significantly affects current practice and may also represent the foundational research for practice. Elsevier Skills Levels of Evidence
What is the maximum time the tourniquet should be left in place?Tourniquets should generally remain inflated less than 2 hours, with most authors suggesting a maximal time of 1.5 to 2 hours. Techniques such as hourly release of the tourniquet for 10 minutes, cooling of the affected limb, and alternating dual cuffs may reduce the risk of injury.
What is the maximum time a tourniquet should be left on quizlet?A tourniquet should not be applied for more than one minute. Leaving a tourniquet on for prolonged periods may cause stasis or hemoconcentration affecting lab test values.
How far should the tourniquet be from the venipuncture site?Apply the tourniquet 3-4 inches above the selected puncture site. Do not place too tightly or leave on more than 2 minutes (and no more than a minute to avoid increasing risk for hemoconcentration).
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