locating and anchoring the vein

<< /Length 13 0 R /Type /XObject /Subtype /Image /Width 303 /Height 450 /Interpolate These veins vary in size between 6 and 15 f.style.border="none"; 2023 HealthWorks Collective. It has been estimated that 1 million health care workers sustain accidental needlesticks every year.2,3 Thousands of these workers will contract some form of hepatitis; 50-60 of them will become seropositive for HIV.4 Hollow-bore needles, the kind used for collecting blood, account for 68.5 percent of all accidental needlesticks,3 and the use of winged infusion (butterfly) sets account for 35 percent of accidental needlesticks.5 Even more alarming is that up to 92 percent of accidental needlestick injuries suffered by laboratory personnel go unreported.3 Avoiding the use of winged infusion sets and using gloves, needle disposal units and proper technique can significantly minimize the risk of injury. endstream If the typical method doesnt work, here are five tips for finding a difficult vein: Veins can be difficult for a variety of reasons. *S`II)(wxj++G~ 0 *Md90JZcwNpd)M@aJLpJ;D|8ZM :/LGLE*Xzsi_!.w~dZ+ EqcsH|wEAq/Pn #$d@ xZ/,]rG^|4'-Sl=iPN_wnPDfqtJt3&B2l4jnU!(` ^|?O~-5P7Y1:y KZ $K6oSj1O% K`P-)d!T>Pt8Pw)SVAGS{$gG#r|l9a(2zRR h#h 9Es=4^1.Ok-2V+ Hang down your arm while lying down on a bed. f.src = 'https://forms.zohopublic.com/healthservicesacademy/form/RequestCourseInformationCPTIAccelerated/formperma/SBGg-3DTNCwt65i9A6n_zU3SneyGD89SSqM_7F_nCas?zf_rszfm=1'; I have a tip to add: I always had trouble giving blood until a nurse taught me this trick. Then measure the distance of center of the spot to the start line (=a). Place a tourniquet and clean the area for 30 seconds with an alcohol wipe. x4P6coy ) % of people told us that this article helped them. WebKIMSHEAG Locating Proper Site and Anchoring Veins Terms in this set (35) Venipuncture the process of cutting into or puncturing a vein, typically for the purpose of collecting blood samples for testing of venous blood Median Cubital Vein Primary vein used for venipuncture, usually the prominent vein in the middle of the arm var iframe = document.getElementById("zf_div_SBGg-3DTNCwt65i9A6n_zU3SneyGD89SSqM_7F_nCas").getElementsByTagName("iframe")[0]; (1998). Which of the following actions should the nurse take? The bevel of the needle should be facing up and the needle should be positioned above the vein and parallel to or following its path. An important tip - take extra supplies into the patients room in case you need to attempt a second venipuncture. 7 Easy Ways to Figure Out Your Blood Type (With or Without a Test). var prevIframeHeight = iframe.style.height; You can also take a hot shower before cannulation. WebTo anchor the antecubital vein, the phlebotomist should hold the patients arm with his/her free hand. Deliver blood specimens to the laboratory promptly. PhlebotomyU is dedicated to providing our students an engaging and rewarding educational experience. Coffee, teas, caffeinated beverages, and alcohol can cause dehydration and the veins to shrink. Apply a tourniquet approximately 3-4 inches above the selected site. After an interruption, she returned to her workstation, misidentified the specimens and typed the patient incorrectly. There can be multiple reasons for difficult veins. % This cookie is set by GDPR Cookie Consent plugin. Edematous sites (swollen sites filled with serous fluid), From an IV cannula (unless permitted by your institution), Sites above an IV cannula in the same vessel, Arm with a preexisting or current blood clot, Evacuated Collection Tubes (tubes specific to labs ordered), Personal Protective Equipment (ie gloves), Bio-hazard leak-proof transportation bags. Because it looks deceptively simple, nurses, clinical nursing assistants, radiologic technologists, respiratory therapists, physicians and others are all being asked to take a stab at phlebotomy. 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Most textbooks agree that a 15-30 degree angle of insertion is optimal.6 This low angle of entry allows for a greater margin of error in judging the depth of penetration and greatly reduces the risk of passing through the vein and provoking underlying structures such as nerves, tendons and arteries. Divine has created humans in a very complex hierarchical system. Once blood flow is established, you may release the tourniquet. They should not be used for elderly patients because the skin is not as supple and does not support the veins as well. A hand vein can be anchored by a phlebotomist by using his free hand to hold the patient's hand just below the knuckles. When confronted with a problematic vein, ask the individual if there has been an area that has worked in the past. Of the three veins in the antecubital area acceptable for venipuncture, the median cubital vein (in the middle) is the vein of choice for four reasons: 1) its more stationary; 2) puncturing it is less painful to the patient; 3) its usually closer to the surface of the skin; and 4) it isnt nestled among nerves or arteries. }catch(e){} After two failed attempts, one should seriously consider sending in someone else. try{ These are located in the fatty layer under your skin. The 2016 Infusion Therapy Standards of Practice call for no more than 2 attempts per clinician with a limit on the total number of attempts to 4. } [dropcap]2[/dropcap] Thou shalt identify thy patients. As the object falls towards the Earth again, the vertical velocity increases again in magnitude but points in the opposite direction to the initial vertical velocity. The patient received incompatible blood and subsequently died. f.style.height="352px"; However, puncturing these veins can lead to thrombophlebitis and clot formation in patients with coagulopathies or to tissue necrosis in diabetics. Position the patient and hyperextend the patients arm. The median cubital vein is used the most for its accessibility. ACNP- American College of Nurse Practitioners, Advanced Practice Nurses of the Permian Basin, Pros & Cons of Getting a Master's Degree in Nursing (MSN), Nursing Schools With the Highest Acceptance Rates, Improve knowledge and awareness of the risks associated with phlebotomy among all health workers involved in the practice, Increase safe practices and reduce blood borne virus exposure and transmission, Availability of appropriate supplies and protective equipment, Availability of post-exposure prophylaxis (PEP), Avoidance of contaminated phlebotomy equipment, Recapping and disassembling vacuum-containing tubes and holders, Reusing tourniquets and vacuum-tube holders that may be contaminated with bacteria and sometimes blood, Working alone with confused or disoriented patients who may move unexpectedly, contributing to needle-sticks. Some institutions have kits with all of the needed supplies while others will require the nurses to gather them individually. While each vein is viable for a blood draw, it is important to understand each draw sites potential risks. The anchoring system is composed of two parts: Copyright 2023 - PhlebotomyU | Website Design & SEO by, Personal Protective Equipment (PPE) for Phlebotomist. }; If you have a patient that is notorious for being a hard stick, tell the client to drink plenty of water and avoid caffeine 24 hours before the test. What is the importance of locating and anchoring the vein? Advertisement cookies are used to provide visitors with relevant ads and marketing campaigns. Difficult veins are veins that easily collapse or roll, are too thin, or are hard to find. if ( zf_ifrm_data.length == 2 ) { The proximity of underlying nerves and the brachial artery make punctures in the area of this vein highly risky. After identifying the site for the blood draw, gather the appropriate supplies needed. Superficial veins. Any, kind of error in collection of blood may lead erroneous, At the end of this activity, students must be able. Anchor 2 is most important to the phlebotomist during the blood draw. Additionally, these steps only apply to the adult and pediatric population and not neonates. } 7 How to calculate the Rf value in chromatography? Do not blow on or fan it with your hand as this will contaminate the area. Any other site should be approached with great trepidation. Phlebotomy: 5 Tips on Finding Difficult Veins | CPT1 Course To do this, position your non-dominant thumb slightly inferior to the vein and pull the skin and subcutaneous tissue downwards To learn more about our Certified Phlebotomy Technician (CPT-1) course, contact us today. Shari has worked in healthcare since 1996 and her expertise lies in acute care bedside nursing on a medical oncology floor. Venipuncture is a skill that takes time and practice to master. Anchor. She received her degree from Medcenter one College of Nursing in 2003 and her Family Nurse Practitioner Masters from the University of North Dakota in 2014. Routinely employing this technique has two potential bonuses: your rate of successful punctures goes up and your patients thank you for considering their suffering. 4 What happens if you dont use a tourniquet when drawing blood? There is usually a slight decrease in resistance when the needle enters the vein. var evntData = event.data; Start drinking plenty of water the morning of your draw, and in the waiting room before your draw. var zf_ifrm_ht_nw = ( parseInt(zf_ifrm_data[1], 10) + 15 ) + "px"; Once the vein is anchored on the arm or hand, the needle can be inserted. mount_type: "" stream I am totally not comfortable with this question. I can tell you exactly how to cut or puncture most any vein or artery in your body, but will refra Perform good hand hygiene and don appropriate PPE. window.addEventListener('click-table-loaded', function(){ The bottom line is without exception: label the specimen completely at the bedside. Collect blood in What are the three major pathways that eventually become entry points of, Jesus, James and Jane are partners who share profits and losses in the ratio of 35:25:40, respectively. Without extracting the needle from the skin, slide back a little. News and Education Editor, MSN, RN, BA, CBC. Move down the forearm looking for the basilic vein or cephalic vein. Check out our list of the top non-bedside nursing careers. For hydrating your body, you should drink shakes, fluids, juices, etc. My experience has been more with IVs versus drawing blood. You can also do some warm-up exercises that will raise the temperature of your body. Intake as much water as you can. Anchor the vein by pulling the skin below the vein taut. var zf_ifrm_data = evntData.split("|"); Were committed to providing the world with free how-to resources, and even $1 helps us in our mission. Answer. d.appendChild(f); However, it does BECOME easier with practice. Question. Warn the patient that they will experience a sharp scratch. var evntData = event.data; Keep the basilic vein (located on the medial or inside aspect of the antecubital area) as a last resort. I found this very informative and helpful! These cookies ensure basic functionalities and security features of the website, anonymously. This means complete identification, not just temporary identifiers to remind you when you find time to label them completely later. Closely monitor the arm to ensure that is is not applied to tight or for more than 2 minutes. [dropcap]1[/dropcap] Thou shalt protect thyself from injury. The phlebotomist should warn the patient when the needle will be inserted so that they are not surprised. Next, locate the vein you will be using for the blood draw. When doing this, ensure that you are being gentle and have found a vein, not an artery. Difficult veins are veins that easily collapse or roll, are too thin, or are hard to find. Squeeze and release a ball repeatedly. As the body temperature rises, the blood flow increases. No other methods are acceptable. If the blood is not delivered in a timely manner it can cause hemolysis and skew the lab results. Anchoring veins To fix the issue of rolling veins, it is important to learn how to anchor a vein during a vein A quick inversion after collection prevents a second puncture. } Proper safety standards to avoid a needle stick, standards for quality care for patients and health workers, including, availability of appropriate supplies and protective equipment, availability of post-exposure prophylaxis (PEP), avoidance of contaminated phlebotomy equipment. Straighten out the arm that they're taking blood from and stick your other fist under that elbow, it pops the vein up. 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. This means referring to an identifying bracelet affixed to the patient or asking the patient to state his or her name. Once again, please be aware that these are only guidelines for blood draws and nurses should consult with the appropriate hospital personnel regarding performing this procedure on patients. Garza, D., & Becan-McBride, K. (1999). There are four common sites phlebotomists use for blood draws: median antecubital, cephalic, basilic and dorsal hand. Make it a habit to drink more water on a regular basis. Perform hand hygiene and don proper PPE. thumb is 1-2 inches below the intended site and pulling the skin toward the wrist. Our courses are designed to provide students with the skills and knowledge necessary to work in a variety of medical settings including: Hospitals, Clinical Laboratories, Clinics, Physicians Offices, Blood Banks and much more. If the antecub has already been accessed there are great options for venipuncture. What happens to the velocity of an object as it falls? This will create centrifugal force that will increase the blood flow in your arm. Starting with Anchor 1, when we watch the video, we can see the thumb on the nondominant hand of the phlebotomist is used to pull the skin taut at the draw site. 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. As an expert witness in cases involving injury to patients during venipuncture procedures, a majority of the nerve injuries I see involve an excessive angle of insertion. %PDF-1.3 So that, you would not face any difficulty in the hour of need. if ( prevIframeHeight != zf_ifrm_ht_nw ) { Norwalk, CT: Appleton & Lange. In fact, the majority of intensive care units require their nurses to possess these skills. Have the patient lower their arm and make a fist to make the veins more obvious. The point of the needle will go through the skin easier this way. wikiHow marks an article as reader-approved once it receives enough positive feedback. Youll be the first to know about nursing news, trending topics and educational resources. Learning the anatomy of the main veins and arteries in the body is essential to becoming competent in phlebotomy. WebIt is best to use a syringe or the butterfly system to take the blood. Next, identify the vein that you will be using. [dropcap]7[/dropcap] Thou shalt label specimens at the bedside. References xWMs8W# Why Are Complex Carbs Better Than Simple Carbs? Jagger, J. The phlebotomist should be positioned directly behind the needle to prevent an awkward insertion angle. })(); First, palpate the patients arm for a vein. Research at Oxford University shows that bigger, thicker needles hurt less than smaller thinner ones. To enhance students careers, meet the needs of healthcare providers and improve patient care by providing high quality, cost effective phlebotomy education through industry leading curriculum, current technology and extensive hands on experience. By clicking Accept All, you consent to the use of ALL the cookies. Label appropriate tubes at the bedside and place them into transport bags. Emails full of tips, news, resources and advice will be sent your way soon. After doing so, your patients will thank you and your self-confidence will greatly increase. Some of these rules are so fundamental they could be collectively referred to as the commandments of phlebotomy. Phlebotomy equipment can be organized in all the following except: A. infant cradle pads B.trays C. drawing station D.Mobile workstations. The cephalic vein runs along the radial side of the forearm. N Engl J Med, 319(5), 284-288. How many failed attempts at venipuncture are allowed? It also reduces their chances of falling and injuring themselves if they do pass out. This will disrupt your sleep and youll have to go to the washroom again and again and youre more likely to suffer from insomnia. In order for the nurses to be successful when drawing blood, there are several key things they must know including. Complications include pain, swelling, skin sores, varicose veins, post-thrombotic syndrome, amputation, pulmonary embolism and death. Insert the needle at a 15 to 30-degree angle into the vessel. Performing venipunctures without tourniquets is not an option. How much does a English bull terrier cost? Insert the needle in at a 15 to 30 degree angle and then hold it still while collecting blood. The cookie is set by GDPR cookie consent to record the user consent for the cookies in the category "Functional". In most instances, however, it is a matter of the patient being dehydrated. 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. Grab the patients lower arm (below the site of puncture) firmly to draw the skin taut and anchor the vein from rolling. One of the steps requires the phlebotomist to anchor the Anchor the vein from below with your non-dominant hand by gently pulling on the skin distal to the insertion site. The median cubital vein runs between the muscles and may be clearly visible as a blue bulge in the inside of your elbow. Analytical cookies are used to understand how visitors interact with the website. } Dorsal hand veins are often the last resort for phlebotomists, but they can be successful. 2 0 obj Intermittent IV bolus, 200 mL. Differentiate a good vein from a bad vein. [dropcap]4[/dropcap] Thou shalt glorify the medial vein. Two other names Guidelines: To hold the needle, grasp the plastic wings between your thumb and first finger. The hepatic veins arise from the core vein central liver lobulea subsection of the liverand drain blood to the IVC. f.style.height="352px"; Measure the distance of the start line to the solvent front (=d). Thats professionalism. Course Hero is not sponsored or endorsed by any college or university. The time of day may also influence difficult veins ability to be drawn from. In reality, anyone can have difficult veins, which may require more assistance for blood draws. Insert the needle through the skin at a 30-degree angle or less, with the bevel facing upwards. Thanks to all authors for creating a page that has been read 689,873 times. His/Her fingers should support the back of the arm slightly below the elbow. Most permanent nerve injuries and arterial nicks I see result from misguided punctures into this vein. Drawing blood from this area does pose a greater likelihood of the vein rolling or collapsing because it is difficult to anchor. Alcohol is better than iodine because if the iodine gets into the blood it can alter values that the lab may be looking for. The warm pack or water bottle should be put on the area before it is disinfected. Phlebotomy teams generally only make rounds at specific times in hospital settings, therefore, if a lab test is ordered immediately it could be the responsibility of the nursing staff to draw the specimen. After assembling the appropriate equipment, follow the next steps to perform a proper venipuncture. Anchor 2 maintains the device as steady as possible, which allows the phlebotomist to exchange one tube with another without the needle being inadvertently pulled from the arm. Lets explore some tips and tricks that help in locating the difficult veins. Looking for a change beyond the bedside? It is composed of so many LEDs that make veins visible. 26. In addition, the veins themselves become more fragile. It is the most frequent procedure performed by a phle- botomist and the most important step in this proce- dure is patient identification. {"smallUrl":"https:\/\/www.wikihow.com\/images\/thumb\/b\/b4\/Draw-Blood-from-Hard-to-Hit-Veins-Step-1.jpg\/v4-460px-Draw-Blood-from-Hard-to-Hit-Veins-Step-1.jpg","bigUrl":"\/images\/thumb\/b\/b4\/Draw-Blood-from-Hard-to-Hit-Veins-Step-1.jpg\/aid9214-v4-728px-Draw-Blood-from-Hard-to-Hit-Veins-Step-1.jpg","smallWidth":460,"smallHeight":345,"bigWidth":728,"bigHeight":546,"licensing":"