Venipuncture January 7

Venipuncture

January 7,2008

MBS 313 – check out ecollege for course outline 1 final exam Schedule is posted on his doord 6 weeks of venipuncture participation and need 4/6 draws successful 2 tubes is a successful draw then vit B 12 shots after the blood draws examinatin with partner No food in the room No liquids allowed No toes allowed either BE WELL HYDRATED Safety -- lab coat in clinic not needed in class No eating/drinking in area of collection In lab you need 3 separate fridges 1 for urine/blood/food No loose clothing and pull hair back AVOID rubbing eyes --- alcohol base in hand wash Wash hands frequently reduce infection spread Most susceptivle to staph aureus Questions to ask patient before first draw “Have you had needles before?:” “How did first draw go?” “are you immunocompromised?” not required to tell the doctor though? 5:25% of HCL or 10% bleach solution to clean up spills All sharps deposed properly (needles and anything contaiminated with blood) DON”T dispose vac container unless has blood on it TB patient or suspected TB – use N 95 pore sized mask (for patient/doctor) DO NOT wear Jewelry under gloves Re glove for each patient Do not recap needles after use with patient Can recap after inspection before patient use

Clinic LAB Manual pg 16 & 17 (about needle stick injury) Flush cold water min 10 mins if eye fluid exchanged IF Needle stick injury occurs go across street to NYPGH to get HIV test and Hep B/C test Offered Hep B vaccine right about Triple therapy HIV Prophylaxis ** only effective up to 2 hours after needle stick Retest HIV 6 mos later Retest Hep B 1mo later Both you and the person who was stuck should be tested 20% neeld sticks occur in uncovering of needles : avoid this by using one handed technique 70% after exposure abnd before disposal 7% exposure occur during surgery – dr’s nurses knick themselves Chemical exposure Total parnetral nutrition: saline/glucose/electrolytes/Pr/Lipids/vit/minerals Plastic containers are what they use but the lipids stick to containers Should be administered by glass containers – not used because of the possible breaking and contusions that can occur Chemotherapy --- possible chem. Expsure noxious exposure Hypochloric acid and carosene – issue with fumes Allergic reactions = latex gloves = elastic turnics are the only latex portion we use (do it over the shirt for the patient with latex sensitivity or allergy) Perservatives used: Sodium benozate Alcohol Vaccum tubes to remove blood = don’t collapse veins to often this way Suction is old school = collapsed veins WHOLE BLOOD: metals/hormones Hemotology, edta prevents clotting (sodium citrate), move blood back and forth, goes off tested light blue/purple tubes, test within 12 hours SERUM Most common used for blood tests Draw SST serum separteing tube Red or grey/red tube

Model top tube Blood is allowed to clot 10 cc needed Allow 10 mins ( Centrifuge and spin it 3500 rpm 15-20 mins Separate rbc from serum (on top) Hormones enzymes etc PLASMA – green top tube Fibrinogen etc Usually AC present Centrifuged to separate out SIDE EFFECTS HEMATOMA – pushed through vein on the other side Increase pressure on vv for 2-3 mins so closing off both holes with hard pressure applied once needle is removed Make it worse if not and increase circulation will make it works 2 hours after a draw NO LIFTING on Anti coagulant at least 12 hours no lifting otherwise increased vruising Forget to remove turnic before removal of needle Increase risk for hematoma = Anticoagulant patient, hemophiliacs(usually male), elderly friable vv, use butterfly on children to reduce risk of bruising and decrease movement problems Infants = use heel prick to draw blood DO NOT draw blood from jugular, can’t do it from foot either No longer recommended to bend arm at elbow dislodge of clot after its clotted Risk of clots Substances in vials = stay in tube chemicals in theer if the break (exposure issue) Latex Reaction = women make up hospital workers therefore make sense women are higher risk Anaphylaxis SHOCK symptoms: 50 or lower pulse BP: 60/40 etc ** alcohol causes breakdown of latex as well oils/vasoline/handlotion/HT/ UV 3 types of gloves on the market Nitral, vinyl, latex * see if Psoriasis Eczema Tatoos Can’t draw blood here find another site

** increase vein size push ups help and adequate hydration ** isopropal Alcohol cleaner MIN of 2 cleanses in enlarging concentric circles Moving bacteria away from site Removing big chuncks of bacteria only Need to keep doing it until the cotton comes away clean Repeated exposure to alcohol to help remove it Iodidine leaves site organe brown Ways to stop bleeding with ice Or arnica traumeel ledum After clot risk Increase hematoma risk: Anticogualnt patient on Aspirin ASA Garlic/warfarin Heparin (usually IV or subc in abdomen) Plavix (clodropil) Second possible side effect THROMBOSIS Clot in endometrial tissue damage Platlet aggregation Increase risk lower extermitiiees/don’t sit still/ 203 hours in IV Use angiocast - flexible/if line does dry ** ALWAYS make sure when inserting needle the bevel is up within VV completely envision center of vv for insertion get air in tube lost in vaccum If the needle comes out a bit then reinsert and use new vaccum tube Ways to avoid Check Px regulation Very steady with needle Thrombosis if it occurs Heparin (IV) standard of care flush Drip stops /severe pain at site Cold application after to avoid embolism min 10 mins 3rd side effect PHEBILITIS: VV inflamed due to IV therapy ¾ of hospital patients have this not blood draw RF: soln of wrong pH (ph N of blood 7.36-7.46)

Drip rate too fast, or if toto hypertonic solution, multiple infections Cancer patients S/SX of pheblitis Heat/pain @ site/ tender to touch/ IV rate is slower/ Fever TX: ABC infection (culture blood) Ice: 20 mins repeated every 20 mins Not used for 3-10 days till healed for anything Ways to avoid phebilitis Check needle size small vs large Check tonicity of solution Select site carefully More flection and movement increase risk factor (especially in elbow) of pheblitis CHOOSE WRISt if need be