Babiloni C, Brancucci A, Arendt-Nielsen L, Babiloni F, Capotosto P, Carducci F, et al. In terms of width of the venous vessel this condition corresponds to the achievement of the maximal venous cross-section area (VCSA), as it is shown by the ultrasonography imaging (84). Bose N, Kanzariya H. Role of therapeutic apheresis and phlebotomy techniques in anaesthesia and critical care. Congenital and acquired polycythemias. [ 1, 2, 3] Veins have a three-layered wall composed of an. One year previous clinical lab experience preferred. Received 2015 Aug 24; Accepted 2015 Dec 6. phlebotomy, venipuncture, laboratory testing, preanalytical phase, preanalytical variability, patient safety, evidence based medicine. Lippi G, Salvagno GL, Lima-Oliveira G, Brocco G, Danese E, Guidi GC. Alternatively, mechanical or thermal (hot or cold) stimulation of venipuncture neighbouring site can be used to relieve pain both in adults and children (47). document.getElementById( "ak_js_1" ).setAttribute( "value", ( new Date() ).getTime() ); 2022 LaboratoryInfo.com. Patients with chronic hemolytic anemia and iron overload may not tolerate phlebotomy, and both sound clinical judgment and careful monitoring are essential for managing patients who are undergoing therapeutic phlebotomy. All About the Therapeutic Phlebotomy In these studies a gross difference of 0.07 mm2, corresponding to that between a 27 G and 30 G, was enough to sensibly reduce the occurrence of pain during the skin puncture (35, 36). In case of children the so called cough-trick should be used instead (64). Dongiovanni P, Fracanzani AL, Fargion S, Valenti L. Iron in fatty liver and in the metabolic syndrome: a promising therapeutic target. Phlebotomy 1.Bloodletting - standards. It is noteworthy addressing the role of alcoholic skin disinfectants for percutaneously blood drawn cultures. Phlebotomy can be performed by nurses, medical laboratory scientists, medical practitioners, phlebotomists, dialysis technicians, and other staff. complications and considerations, equipment . Gershon RR, Pearson JM, Sherman MF, Samar SM, Canton AN, Stone PW. Marchioli R, Finazzi G, Specchia G, Masciulli A, Mennitto MR, Barbui T. The CYTO-PV: a large-scale trial testing the intensity of CYTOreductive therapy to prevent cardiovascular events in patients with polycythemia vera. Immediately lie down on the patients flat and raise the legs. The reduced compliance to venipuncture is a major issue for a phlebotomist, and demands a discussion about its management. The prolonged venous stasis, which also favours tissue hypoxia, produces a change in pH which locally affects the electrolytes balance, especially potassium (101). The wings can be bended upward becoming a handle for the needle during insertion, and then can be flattened on patients skin to stabilize the shaft once it lies within the vein (Figure 1B). Malingre M, Ververs T, Bos S, van Kesteren C, van Rijn H. Alcohol swabs and venipuncture in a routine hospital setting:no effect on blood ethanol measurement. In this regard, the needle bore size, and in turn the gauge, may be regarded as a reliable predictor of haemolysis, with 21 G needles showing half the risk of producing an unsuitable sample respect to 23 G (118). Before fainting, the person may experience symptoms like becoming light-headed, dizzy, body turning cold or the vision becoming blurry. 99. I have now developed sores (pussy) on the top of my feet; one very pussy so far. However, such complications are very rare in routine venipuncture . Outline the process of application for State certification. Fear of needles and vasovagal reactions among phlebotomy patients. Noticeably, the adoption of medical devices incorporating safety-engineered protection mechanisms is explicitly required by the European Council Directive on the prevention of sharps injury in the health care sector (Directive 2010/32/EU) (9). A randomized, controlled trial to evaluate topical anesthetic for 15 minutes before venipuncture in pediatrics. Consequently, especially with large G needles, the time blood flow spends to reach the additives is prolonged, activating platelets and leukocytes (6). Label appropriate tubes at the bedside and place them into transport bags. They added an additional wrap on the site. This chapter outlines the risks associated with unsafe phlebotomy, and summarizes best practice in phlebotomy, with the aim of improving outcomes for health workers and patients. Summarell CC, Sheehan VA. Use of hydroxyurea and phlebotomy in pediatric patients with hemoglobin sickle cell disease. Egekvist H, Bjerring P, Arendt Nielsen T. Regional variations in pain to controlled mechanical skin traumas from automatic needle insertions and relations to ultrasonography. Offered via Fremont campus online division. 125 p. Lippi G, Caputo M, Banfi G, Buttarello M, Ceriotti F, Daves M, et al. Phlebotomy | Medical Assistant | Medical Assistant Program However, antiemetic drugs are not generally recommended as a pretreatment for phlebotomy.9. Diarrhea. While drawing blood, avoid the basilic vein which is near the brachial artery and several other nerves. The impact of phlebotomy in nonalcoholic fatty liver disease: a prospective, randomized, controlled trial. Application of pressure on straight arm for 5 minutes. Use a smaller needle relative to the veins depth. All material on this website is protected by copyright, Copyright 1994-2023 by WebMD LLC. <>/ExtGState<>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> Influence of the needle bore size on platelet count and routine coagulation testing. Please dont leave the patient alone and dont allow them to drive for another 30 minutes. Venipuncture Complications and Special Situations. 15 Experts Clarify Overused And Often Misunderstood Tech Buzzwords - Forbes Lippi G, Salvagno GL, Montagnana M, Brocco G, Guidi GC. Next, consult a good hematologist. Among the wide range of a medical assistant's responsibilities, drawing blood is among the most essential. Limited phlebotomy technician. Therefore, due to the gross difference of 0.2 mm2 in their respective cross-section area, the 23 G needle, which pierces an area of about 0.32 mm2, can be regarded as naturally more comfortable and less painful than the larger 21 G. Nonetheless the reduced inner diameter of smaller G needles limits the blood flow, and slows the withdrawal of blood. [QxMD MEDLINE Link]. Phlebotomy. Phlebotomy Technician. Learning Outcomes List the duties of a phlebotomist. Sickle cell disease (SS or SA variants) may benefit from phlebotomy alone or in combination with hydroxyurea.7 This is because phlebotomy decreases the bloods viscosity by reducing the Hb levels and the mean corpuscular Hb concentration, which subsequently reduces the HbS polymerization that is observed during sickle cell disease.23 Bouchar et al23 reported that frequent phlebotomies reduced hospitalization duration and lowered Hb levels without any adverse events, although only patients with high Hb levels were likely to benefit from phlebotomy. Due to the connecting tubing the void volume of the collecting device is increased. Nonalcoholic fatty liver, steatohepatitis, and the metabolic syndrome. Like any other skill, phlebotomy requires time and practice to get it right. Reflux of anticoagulant Put in order the steps for removal and disposal of the needle during venipuncture. Vacuum-venipuncture skills:time required and importance of tube order. Thank you for uploading useful article. However this is a very rare consequence occurring in about 1: 25,000 individuals undergoing blood donation (78). Step-by-Step Guide to Phlebotomy Estes JW. Palpation allows phlebotomist to recognize the vessel elasticity, depth and consistency of the surrounding tissues. Flawless phlebotomy: becoming a great collector. Attach the needed tubes or syringes to remove the proper volume of blood. Tell the patient to relax their hand if in a fist 3. This is another rare complication of blood collection. Interestingly, it is not possible to say whether such a coincidence between length of training and fall in the rate of VVR may come from the actual experience gained by the operator in promptly accessing suitable veins, or rather be due to the psychological effect exerted on patients by an experienced-looking phlebotomist. Alternatively, in order to use it as an evacuated tube, the plunger can be pulled and locked before venipuncture leaving a vacuum within. Clemson University - Center for Corporate Learning . Ships . Nonetheless, mechanical stress on cells can similarly induce an increase of blood potassium through a membrane leakage. Insertion of winged butterfly device. Another treatment option is deferoxamine (an iron-chelating medication), which is capable of binding up to 85 mg of iron per 1 g of medication; this treatment can reduce the iron load by 250 mg/500 mL.34 Deferoxamine may be beneficial for patients who cannot tolerate phlebotomy. Hi, Is it normal to have lump and redness around puncture site? Safety and efficacy of a needle-free powder lidocaine delivery system in pediatric patients undergoing venipuncture or peripheral venous cannulation:randomized bouble-blind COMFORT-004 trial. official website and that any information you provide is encrypted On palpation, the vein should be soft and bouncy, it should refill after being depressed, and it ideally should be well supported by the surrounding tissue. VENIPUNCTURE PROCEDURE The venipuncture procedure is complex, requiring both knowledge and skill to perform. Peripheral Blood Smears. Todos los estudiantes admitidos deben leer, escribir y entender ingls (todos los cursos en la escuela son dictados en ingls y no prestamos servicios de traduccin). By an adaptor it is possible to collect the blood directly in tube in which the required additive is already included. Here's how skin punctures is used on certified phlebotomy technician resumes: Draw blood from capillaries by dermal puncture, such as heel or finger stick methods. Since the tube includes an additive, there is no need of dispensing the blood afterwards. During blood drawing, when you feel a burning sensation on your forearm radiating to your wrist is needle touching a nerve. Schneeberg NG. Dontleave the patients untilthere is a complete stoppageof the blood from the venipuncture site. Aseptic Technique: Uses, Benefits, and Complications - Healthline Patients with significantly elevated initial ferritin levels (1,000 ng/mL) should have their serum ferritin levels monitored every 23 months, and Hb levels should be checked during each phlebotomy visit. For instance, in all but four states, phlebotomists arent required to obtain a phlebotomy certificate or license to draw blood. Then, insert the needle at a 15 to 30-degree angle into the vessel. For instance, a strenuous or prolonged fist clenching or pumping leads to the increase of extracellular potassium due to the depolarization of the skeletal muscle cells (102). Ask the patient to make a fist and not pump the hand. New ways to deal with known preanalytical issues:use of transilluminator instead of tourniquet for easing vein access and eliminating stasis on clinical biochemistry. History of bloodletting by phlebotomy. Theaverage time to acquire blood for three tubes was between 26 and 44 seconds. Usichenko TI, Pavlovic D, Foellner S, Wendt M. Reducing venipuncture pain by a cough trick:a randomized crossover volunteer study. Wayne, PA, USA, 2007. The best way to prevent nerve damage is to make sure that along with choosing the most prominent vein, you penetrate the needle properly into the vein. Comparison of 4 analgesic agents for venipuncture. Intravenous catheterization is a widely used invasive procedure, with applications in both ambulatory and hospital settings. To help your bruise heal properly, you can: Leave the bandage on for at least 8 hours. For removing blood to combat high levels of iron or red blood cells. Phlebotomy Test Study Guide Flashcards | Quizlet Inspection and especially palpation represent the basic approach to identify the site for venipuncture (Figure 5) (74). I have had several blood draws in the past couple weeks and my blood squirts and gushes out after the needle withdrawl, all over me , the floor and the wall! Another complication of phlebotomy is needle-stick injuries among health-care workers (HCWs). Careers, Unable to load your collection due to an error. Nonetheless, in recent times some authors have proposed an indirect assessment of haemolysis in whole blood samples using the automated cell blood count parameters to compute suitable and reliable indexes (123, 124). Hence, the insertion depends on an indirect mode of action, and how the handler directs the needle. Hematoma: Hypersensitivity Reaction: Infections: Pain due to nerve involvement: Phlebitis: Sepsis: Skin puncture: Presentation (sign/symptom) of the patient: Treatment Complications during blood collection and Treatment There may be various types of complications of blood collection. Transfer of blood from syringe to vacuum tube. Local anaesthetics, like lidocaine or prilocaine, have been successfully introduced to relieve the intra-procedural pain in children and in adults (40-42). (Help! An official website of the United States government. Your email address will not be published. Sulaiman RA, Cornes MP, Whitehead SJ, Othonos N, Ford C, Gama R. Effect of order of draw of blood samples during phlebotomy on routine biochemistry results. Position the patient and hyperextend the patients arm. HbSC exhibits significantly different pathophysiology, compared to hemoglobin SS, as HbSC does not sickle and instead causes cellular dehydration that potentiates the sickling of hemoglobin SS. Phlebotomy Technique: Approach Considerations, Phlebotomy, Complications National Library of Medicine The main collecting devices are the piston syringe and the evacuated-tube system (4). Phlebotomy is when someone uses a needle to take blood from a vein, usually in your arm. Please lie the patient on a flat surface and raise the legs. All . To monitor levels of various blood components. Therefore, the authors suggested that dual therapy using hydroxyurea and phlebotomy may be an effective approach for patients with HbSC who do not experience improvement with hydroxyurea alone. Venipuncture is the process by which you can collect blood directly from the vein. Lillo R, Salinas M, Lopez-Garrigos M, Naranjo-Santana Y, Gutierrez M, Marin MD, et al. 3 0 obj Their distribution and connections can be classified into four types (I to IV), according to the dominance of CV or BV with respect to the calibre of the vessel (Figure 3) (75). Available at http://library.med.utah.edu/WebPath/TUTORIAL/PHLEB/PHLEB.html. Phlebotomy, which dates back to the age of ancient Greece, has gained experience through the evolution of medicine becoming a fundamental diagnostic tool. Remove tourniquet 2. Because these cookies are strictly necessary to deliver the website, you cannot refuse them without impacting how our site functions. Reducing the incidence of pseudohyperkalemia by avoiding making a fist during phlebotomy:a quality improvement report. No, it looks like the inflammatory process has started. Age seems to be a main determinant in this context, with younger individuals showing higher self-related and phlebotomist-related anxiety (56). The adults can show an anxious behaviour with respect to phlebotomy, and in about 2% of the cases a clear phobia toward needles (defined as trypanophobia) can be recognized. "Digital transformation" is a buzzword that is often overused and misunderstood. Phlebotomy might be erroneously considered a very simple and brief task to undertake. Prep the venipuncture site by cleansing the area with an alcohol prep pad for 30 seconds and allow it to air dry for 30 seconds. Bethesda, MD 20894, Web Policies Seimiya M, Yoshida T, Sawabe Y, Sogawa K, Umemura H, Matsushita K, et al. 1 0 obj Therapeutic phlebotomy is the optimal treatment for this disease, and hydroxychloroquine treatment is a good alternative.20 In these cases, phlebotomy should be repeated every 2 weeks until the Hb levels are <20 ng/mL.21 Other studies have suggested that erythrocytapheresis is an alternative to phlebotomy.22. However, the avoidance to use alcoholic solutions for blood alcohol test seems to be quite controversial, since some authors have shown that swabbing the venipuncture site with 70% isopropyl alcohol or ethanol does not significantly alter the blood alcohol level (23-25). Influence of hemolysis on routine clinical chemistry testing. Lippi G, Pipitone S, Gennari D, Franchini M. Identification of spurious hemolysis in anticoagulated blood with Sysmex XE-2100 and Siemens Advia 2120. In this regard there are two major mechanical causes related to phlebotomy procedure: the shear stress on red blood cells flowing through a small bore needle which causes haemolysis and the needle probing of the bloodstream which damages the tissue neighbouring the venipuncture site (103-105). Also, consult some good hematologists. Its a good idea to take an extra set of supplies into the exam room as you might need to perform more than one procedure. However, the thickness and consistency of skin layers, and thus the resistance opposed to needle penetration, determine the painful sensation as well (37). Performed dermal punctures using micro collection tubes and pipettes. Grab the patient's lower arm (below the site of puncture) firmly to draw the skin taut and anchor the vein from rolling. Lima-Oliveira G, Salvagno GL, Danese E, Brocco G, Guidi GC, Lippi G. Contamination of lithium heparin blood by K2-ethylenediaminetetraacetic acid (EDTA): an experimental evaluation. The only certainty is that all the efforts made to grant the safety of the customers and the quality of the service allows phlebotomy to bridge the gap between patient and laboratory. [QxMD MEDLINE Link]. A needle is placed in a large blood vessel, typically in the elbow crease, to remove blood. Blood collection staff education in the prevention of venepuncture failures and donor adverse reactions:from inexperienced to skilful staff. In contrast, the specimen of those who are above the age of 6 months is collected by finger sticks. Phlebotomy 2 Flashcards It is a rare complication of venipuncture. The evacuated tubes system grants a higher safety for the operator and its environment because the blood specimen always circulates in a closed system (12, 13). Sorry to hear about your illness. Therefore the quality of the specimen, which rules the laboratory preanalytics, is crucial to ensure patient safety (95, 96). Newborn Screen. Noteworthy, it has been shown to increase the compliance to venipuncture also in children with cognitive impairment (52). government site. Therefore, we propose an approach for laboratory professionals by including all the criticalities proper of this craft. Before Therefore, the insertion depends on a direct mode of action, as the needle is handled regardless of the collecting device. These regulations emphasize patient education regarding intra- and post-phlebotomy symptoms and consent, and include training for staff regarding how to manage adverse effects and infections, how to reach the target blood vessel, venous phlebotomy techniques, patient safety, and basic cardiopulmonary resuscitation.35, Patient factors, such as age, sex, weight, comorbidities, overall health status, and the likelihood of compliance, should be considered when prescribing a phlebotomy regimen.8 Zubair8 has described various criteria for initiating therapeutic phlebotomy, which include ferritin levels of >200 ng/mL for ages of <18 years (regardless of sex), ferritin levels of >500 ng/mL for women who are not pregnant but are of childbearing age, and ferritin levels of >300 ng/mL for men who are >18 years old. Haemolysis can be readily detected by visual inspection after sample centrifugation, and directly quantified through a spectrophotometric reading even at low concentration. http://creativecommons.org/licenses/by-nc/3.0/. Not adequate pressure was applied after the venipuncture. Once the patient is able to walk, he or she can be transferred to a monitoring area and have a light meal with liquids, although alcoholic or caffeinated beverages should be avoided for several hours after the phlebotomy. As a consequence, the patient experiences anxiety and thus a reduced compliance to venipuncture. Therapeutic phlebotomy is currently indicated for the treatment of hemochromatosis, polycythemia vera, porphyria cutanea tarda, sickle cell disease, and nonalcoholic fatty liver disease with hyperferritinemia. Phlebotomy. The main site to draw blood is represented by the cubital fossa of the forearm, which has the shape of an isosceles triangle with the biceps forming the base, and the lateral and medial groups of the antebrachial muscles forming the sides respectively (74). In the past phlebotomy was essentially a therapeutic resource to cure many ailments, whereas nowadays it is the diagnostic basis which medicine relies on to approach most of the known diseases (1, 2). % Lippi G, Salvagno GL, Brocco G, Guidi GC. Rombos et al24 demonstrated that weekly phlebotomy improved the duration, frequency, and severity of pain crises and suggested that regular phlebotomies were associated with a considerable placebo effect. Healthcare professionals commonly use aseptic technique when. Reducing reactions to blood donation with applied muscle tension:a randomized controlled trial. Such a device has been shown to be well tolerated, significantly reducing the pain in 4 to 18 years old children, as well as considerably increasing the opportunity of a successful procedure (odds ratio 3.05, 95% confidence interval 1.03 - 9.02) (51). It also addresses the issues concerning medical aspect of venipuncture, like the practical approach to the superficial veins anatomy, as well as the management of the patients compliance with the blood draw. Thereby, the clinical, technical and practical issues are treated with the same relevance throughout the entire paper. The evidence-based paradigm has changed and evolved medical practice. Conversely, the so-called winged or butterfly has its own body provided with a pair of wing-like flexible tabs and PVC tubing that connects to the collecting device. Indeed, the burden of preanalytical issues is well known to laboratorians, but sometimes it is underestimated by the phlebotomists which are rather focused on the immediate patient management. Better keep the patient in the lab until you are sure there is no bleeding. Following our reasoning on preanalytics issues, we would like to point out that any deviation from the correct blood drawn procedure should be always reported to the laboratory. Click on the different category headings to find out more. It also ensures the quality of many lab tests avoiding the mechanical stress of the blood components produced by the dispensing, and ensuring to fill the tube with the appropriate quantity of blood for the required additive. Kiyoyama T, Tokuda Y, Shiiki S, Hachiman T, Shimasaki T, Endo K. Isopropyl alcohol compared with isopropyl alcohol plus povidone-iodine as skin preparation for prevention of blood culture contamination. The .gov means its official. The care taken to recognize the most appropriate site to insert the needle is a key to determine the successful outcome of the procedure and reduces the risk of injuries. Therapeutic phlebotomy is the best choice for initial therapy, and one of its key treatment objectives is to reduce the risk of these thrombotic events.8 This is because patients with polycythemia vera have an increased risk of thrombotic events, such as cerebrovascular disease, cardiovascular disease, and arterial or venous thromboembolism. Cook LS. government site. Incorrect order of draw could be mitigate the patient safety:a phlebotomy management case report. Even though many hospitals employ phlebotomy teams, it can be very beneficial for some Medical Assistants to learn these skills. J Med Case Rep 2014;2014:613921. When you consider some of the preliminary steps for phlebotomy collecting supplies, verifying information, preparing the patient, etc.the entire process may take anywhere from five to ten minutes. Warnes CA, Williams RG, Bashore TM, Child JS, Connolly HM, Dearani JA. Thank you! However, such complications are very rare in routine venipuncture (< 3%), except for the formation of small harmless ecchymosis which occur in 15% of phlebotomies, and have a diameter of < 20 mm in 90% of the cases (70, 73). (Click here to see our full list of Medical Assisting duties and responsibilities). Advise the patient to look after redness, pain, swelling, or tenderness. Sajid MI. WebPath. Lippi G, Blanckaert N, Bonini P, Green S, Kitchen S, Palicka V, et al. official website and that any information you provide is encrypted All informations are useful for doctors, lab technicians, nurses, and paramedical staff. One famous example is George Washington (former President of the US), who died after losing 1.7 L of blood during treatment for acute epiglottitis.3, Phlebotomy using inserted needles differs from wet cupping therapy (Al-hijamah).4 During Al-hijamah, local suction is created at the selected areas using special cups, which are subsequently removed after several minutes. Fingerstick sampling. In case of hypersensitivity reaction, give antihistamines. Noteworthy, the effect that the shift in plasma volume has on hematocrit is regarded as postural pseudoanemia for the consequence it has on haematological testing (131). Kessler CS, McGuinn M, Spec A, Christensen J, Baragi R, Hershow RC. n]?(~ Keep the pressure for as long as you are sure that there is no bleeding. If you log out, you will be required to enter your username and password the next time you visit. Therapeutic phlebotomy: a review of diagnoses and treatment considerations. This is a rare complication after blood collection. The needles can have a retractile, sliding or a safety shield system to secure the blood shaft once extracted from the patients skin (8). This in turn reduces the painful sensation to a small pinch (35-37). Marchesini G, Bugianesi E, Forlani G, et al. Although the colour-code scheme was devised to help the operator in recognizing the additive within the tube, the broad heterogeneity in the scheme adopted by the various manufacturers and the lack of standardization resulted in a serious issue (11). Wollowitz A, Bijur PE, Esses D, John Gallagher E. Use of butterfly needles to draw blood is independently associated with marked reduction in hemolysis compared to intravenous catheter. Ensure you have received a physicians order to draw blood. National Library of Medicine 3.Needlestick injuries - prevention and control. How I treat hemochromatosis. Ph Imbalance Hemolysis Hemoconcentration Specific Gravity Imbalance Hemolysis- destruction of red blood cells A new device to relieve venipuncture pain can affect haematology test results. [Full Text]. A phlebotomist is a person responsible for drawing blood from patients for lab tests, transfusions, or donation. Alternatively, the simpler distraction which can be obtained by playing with toys, viewing cartoons or listening to music can also be used, in order to successfully contrast the enhancement of the intra-procedural pain perception (65-68). After drawing blood, the pierce in the rubber stop is resealed when the tube is removed from the holder, thus preventing the sample from leaking out. Your submission was successful. An overview of systematic reviews of clinical evidence for cupping therapy. Bio-hazard leak-proof transportation bags. However, conflicting results were observed in a more recent prospective randomized controlled trial that investigated the effect of phlebotomy with lifestyle advice among patients with NAFLD.33 The primary end points were hepatic steatosis (as quantified using magnetic resonance imaging) and liver injury (as measured using levels of alanine transaminase and cytokeratin-18).
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