VENEPUNCTURE: PHLEBOTOMY nSHAN KESHRI nClinical Sessions 2010 n n aka BLOOD COLLECTION INDICATIONS nDiagnostic: n •Obtain blood sample for analysis. • n (e.g. systemic problems – Fe anemia, glucose DM, INR, infections, cholesterol, immunology, liver enzymes/ function) n INDICATIONS nTherepeutic: n •treat Polycythemia Vera (elevated RBC volume aka hematocrit) • •treat hemochromatosis (dangerously high iron levels) •Donation for transfusion n CONTRAINDICATIONS nLow oxygen levels in blood (hypoxemia) n RISKS nInfection n nnegligible if sterile environment, proper use/disposal of needles, and proper management of samples. n n n nHitting a nerve or artery (arterial stab) n remove needle and apply pressure SIDE EFFECTS nSome pain, possible bruising n nFainting and light headed (vaso-vagal) n nExcessive bleeding n nHaematoma (blood acc. under skin) n nIron deficiency anemia (in therapeutic phlebotomy) n n ALTERNATIVES nNo real alternative to phlebotomy, however there are various different sites on the body that could be used. n nSee Method. n nNever attempt more than twice: •Refer patient back. PROCEDURE Think Action & Rationale! WHAT are you doing? WHY are you doing it? At every step know: WASH HANDS EQUIPMENT: Sterile Tray with: nPair of gloves nTourniquet nAlcohol wipes nGauze nVACUTAINER barrel and Needle nBlood bottles (color coded according to additive e.g. anticoagulant or preservative) n nRULES OF ASEPSIS STEP 2: CHECK PATIENT DETAILS n nAsk full Name, DOB, Gender and compare with blood request form! n nCheck blood form has been signed by the requesting doctor n nIf special requirements, check patient has complied, e.g. fasting! n nHave you had blood taken before? (preferred vein) n n Put Gloves on. Ensure patient is in a relaxed position. FIND A SUITABLE VEIN (Palpation: bouncy & large & superficial) n90% used – Anterior Cubital Fossa, n – Median Cubital vein, Cephalic, Basilic Vein n nBack of hand- Cephalic (housemans) vein n n n n n nFeet, Central Line, Peripheral Venous line, Femoral stab (groin harder to disinfect) nAttach VACUTAINER needle to barrel. n n n n nApply tourniquet 2 fingers above anterior cubital fossa. (increases pressure) n n Inform patient ‘this may feel a little tight’. nDisinfect skin with alcohol wipes. n n n n n nRemove cap from needle. n n nWarn Patient of Sharp Scratch. n nStretch skin and insert needle at 15-30 degrees parallel into the vein n (bevel edge of needle facing up) n 15-30 degrees nIntroduce VACUTAINER bottle into the barrel. n n n n n nAllow blood to collect. It will automatically stop filling when full. n nNB: Different colour bottles contain different additives and anti-coagulants etc! n nAmount drawn depends on indication (see request form) n n nHowever normally 5-25 ml is enough. nFIRST Remove blood BOTTLE n nTHEN remove TOURNIQUET n nLASTLY, swiftly remove NEEDLE n nSafely dispose needle to sharps bin immidiately –NEVER RESHEATH!! nApply gauze to puncture site for 1 minute, with some pressure. n n n nRemove gloves and wash hands n MANAGEMENT nInvert blood bottle to ensure blood mixes with the additives in specimen bottle Label blood bottle: nPatient Name n nIdentification Number n nDate & Time …etc n nDocument in patient record. n nSend to Pathology lab for analysis. WASH HANDS OLD UK / CURRENT CZ METHOD nMONOVETTE SARSTEDT VACUUM TUBES n nPull syringe to create vacuum, then slot into needle. n nWhen full, snap off handle To Prevent Heamatoma! nPuncture only the uppermost wall of the vein n nEnsure needle fully penetrates uppermost wall of the vein. (Partial penetration may allow blood to leak) n nRemove tourniquet before removing needle (decreases pressure) n nUse major superficial veins n nApply pressure to the puncture site n Protect Yourself! (in addition to what has been mentioned) nChange gloves between patients. n nClean up spills with disinfectant. n nDo not break, or recap needle. n (avoid accidental needle puncture or splashing of contents) n Protect Yourself! (in addition to what has been mentioned) nIn Event of being pricked with needle: • •Remove and dispose of gloves. • •Squeeze puncture site to promote bleeding. • •Wash area well with soap and water. • •Record the patient’s name and ID number. • •Follow institution’s guidelines regarding treatment and follow-up. • •NB Prophylactic zidovudine following blood exposure to HIV has shown effectiveness. n SUMMARY nTourniquet nAntiseptic wipe nPalpate nInsert n.... but be gentle! n n nDon’t forget Safety and Communication. VIDEO THANKYOU FOR LISTENING http://www.youtube.com/user/vanitagoss#p/a/u/1/9V_5Dgr9ozM