MA 202 Specimen Collection

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Author:
Shutrbug20
ID:
78691
Filename:
MA 202 Specimen Collection
Updated:
2011-04-10 19:44:04
Tags:
Venipuncture Complications
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Description:
Chapter 3 Unit 11
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  1. What can prevent access to a patient
    • Not in room - make every effort to locate by notifying nurse's station
    • STAT or Timed - draw blood at location of patient
  2. Patient ID
    • Most important procedure to verify
    • Info on req form must match ID band
    • Any discrepancies must be corrected first
    • If ID missing, have nurse install new one first
  3. List ID difficulties
    • Emergency requisitions
    • ER Collection
    • Orders telephoned into lab
    • Requisition forms picked up at site
  4. Communication Barriers with Patient
    • Sleeping / Unconscious
    • Presence of Physician / Clergy
    • Presence of Visitors
    • Apprehensive Patients
    • Language differences
    • Patient Refusal
  5. Sleeping Patients
    • Never draw from a sleeping pt
    • Wake by tapping on foot (don't startle)
  6. Unconscious Patients
    • Treat same as conscious
    • Identify self when entering room
    • Talk to patient
    • Describe the procedure
  7. Presence of Physician / Clergy
    • Do not disturb,
    • Return later
    • Unless STAT / Timed
    • Explain for intrusion and be quick
  8. Presence of Visitors
    • Ask to step out while procedure is done
    • If pt is child, ask parent to help
  9. Apprehensive Patient
    • Use distractive conversation
    • Request help from Nurse'e station
  10. Language Problems
    Request a Translator
  11. Patient Refusal
    • Explain needed for treatment / diagnosis
    • Document on req form
    • Notify health care provider
    • Never argue with patient
  12. Site Selection Problems
    Occluded (blocked)
    Sclerosed (hardened)
    • Both feel hard / cordlike and lack resiliency
    • Caused by inflammation,
    • disease,
    • chemotherapy,
    • repeated venipunctures
  13. Site Selection Problems
    Hematomas
    • No longer fresh blood
    • Painful to patient to draw
  14. Site Selection Problems
    Edematous Tissue
    • Swollen with tissue fluid
    • Contaminated with tissue fluid
  15. Site Selection Problems
    Burns / Scars
    • Difficult to palpate / see vein
    • Difficult to push needle through
  16. Site Selection Problems
    Mastectomy
    • Lymphostasis
    • Lack of lymph fluid
    • Will affect test results
  17. Difficulty Finding Vein (steps)
    • Massage upward from wrist to elbow
    • Dangle arm
    • Apply heat
    • Rotate wrist to increase Cephalic vein
    • Tap antecubital space
    • Tourniquet tighter
    • Use blood pressure cuff
    • Choose vein in hand, foot, or leg
  18. Problems Cleaning Site
    • Alcohol Tests - use povidone-iodine to clean
    • Iodine Allergy - use chlorhexidine gluconate
  19. Problems Cleaning Site
    Povidone-Iodine
    • Not used on dermal punctures
    • May elevate bilirubin, uric acid, phosphorus, potassium (BURPP) test
  20. Problems with Tourniquet Application
    • Not more than 1 minute - cause hemoconcentration
    • Petechiae - non raised red spots, too tight
    • Too Tight - no arterial pulse, complains of pinching or numbing of arm
    • Latex Allergy - must ask / verify allergy to latex - no latex bandages
  21. Syncopy Signs
    • Skin feels:
    • Cold
    • Damp
    • Clammy
  22. Emisis
    Nausea and Vomiting
  23. Pain of Stick
    • Warn patient of slight:
    • poke,
    • pinch,
    • sting
  24. Lack of Blood Flow
    • Defective tube - try another
    • Improperly positioned needle - adjust
    • Missing vein - try 2nd time
  25. Intermittent / Slow Blood Flow
    • Improper needle position
    • Collapsed vein:
    • Tube too large for vein, vacuum to great
    • Plunger pulled too fast
  26. Inadvertant Artery Puncture
    • Bright red blood
    • Spurting / pulsing blood
    • Apply pressure 5 minutes minimum
    • Label blod specimen as arterial sample
  27. Hemolized Sample
    • Plasma is red
    • Need redraw
  28. Reflux
    • Blood additive flow from tube to patient
    • Keep arm angled downward
    • Tube always below puncture site
  29. Compartment Syndrome
    • Large amount of bleeding into tissue
    • Extra fluid pressure prevents blood flow
  30. Speciment Rejection
    • No requisition form
    • Unlabeled / mislabeled specimens
    • Incompletely filled tube
    • Collection in wrong tube
    • Hemolysis

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