Can You Do A Blood Draw On Thw Leg

Blood specimen collection is i of the most underestimated procedures in wellness care. Because it looks deceptively simple, nurses, clinical nursing administration, radiologic technologists, respiratory therapists, physicians and others are all beingness asked to "take a stab" at phlebotomy.

Knowledge of vein selection, the gild of draw, test-specific handling, storage and transportation requirements, anatomy of the antecubital area, safety precautions, alternative sites and other factors make phlebotomy a highly technical procedure that takes months to learn and utilise.

Like whatever other process, at that place are certain established and indisputable rules collectors should utilise in gild to consistently perform venipunctures cleanly, safely, successfully and with little or no discomfort to the patient. Some of these rules are so fundamental they could be collectively referred to equally the commandments of phlebotomy. Since 10 is a pop number for commandments, allow'south comply with tradition fifty-fifty though the list is admittedly much longer.

[dropcap]i[/dropcap] Thou shalt protect thyself from injury. Today, drawing a sample of blood tin can potentially expose the health intendance worker to at to the lowest degree twenty communicable diseases.^one Most of them are life threatening, some of them cause incurable and fatal disease, just all of them may be preventable if wellness care workers apply appropriate caution, technique and equipment.

It has been estimated that ane million health intendance workers sustain adventitious needlesticks every year.^two,3 Thousands of these workers will contract some form of hepatitis; fifty-60 of them volition become seropositive for HIV.⁴ Hollow-diameter needles, the kind used for collecting claret, account for 68.5 percent of all accidental needlesticks,^three and the use of winged infusion ("butterfly") sets business relationship for 35 pct of accidental needlesticks.⁵ Fifty-fifty 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.

[dropcap]2[/dropcap] One thousand shalt identify thy patients. This means referring to an identifying bracelet affixed to the patient or asking the patient to land his or her name. Because sedated or semi-conscious patients can reply affirmatively to any question, go beyond seeking an affirmation of their identity and asking they state their name in full.

In the example of an emergency room patient whose full identity has non been established, a temporary identifier such equally an assigned number is acceptable but should exist amended when consummate information is available. When positive identification is not possible by either of these methods, have the patient's nurse or other caregiver identify the patient and document the proper name of the person who verified the patient's identity for you. No other methods are acceptable.

[dropcap]3[/dropcap] Thou shalt puncture the skin at nearly a 15 degree bending. Most textbooks agree that a 15-30 degree bending of insertion is optimal.⁶ This depression bending of entry allows for a greater margin of mistake in judging the depth of penetration and greatly reduces the run a risk of passing through the vein and provoking underlying structures such as fretfulness, tendons and arteries. This is not to say that nosotros all must start carrying around protractors to mensurate our angles, only inserting the needle at as low an angle every bit possible minimizes the risk to the patient and facilitates a successful puncture.

As an skillful witness in cases involving injury to patients during venipuncture procedures, a majority of the nerve injuries I encounter involve an excessive angle of insertion. Injure a patient while puncturing at a steep angle and yous volition have a difficult fourth dimension disarming the jury that you are immune from the standards as set forth in the literature.

[dropcap]4[/dropcap] Thou shalt glorify the medial vein. Of the three veins in the antecubital area acceptable for venipuncture, the median cubital vein (in the middle) is the vein of selection for four reasons: 1) it'due south more stationary; 2) puncturing it is less painful to the patient; 3) it's normally closer to the surface of the peel; and iv) it isn't nestled among fretfulness or arteries.

When conducting your survey of the antecubital area, check both arms for the medial vein earlier because ane of the alternatives. If one is not prominent plenty to instill confidence, default to the cephalic vein on the lateral or thumb side of the arm as a second choice. Keep the basilic vein (located on the medial or inside aspect of the antecubital area) as a concluding resort. The proximity of underlying nerves and the brachial artery brand punctures in the area of this vein highly risky. Most permanent nerve injuries and arterial nicks I see consequence from misguided punctures into this vein. That is non to say the basilic vein should not exist punctured. In many cases it is the prominent vein in the antecubital area.

All the same, when it is not visible and/or the initial puncture is unsuccessful, probing the area subjects the patient to the potential for excruciating hurting and permanent injury more and then than probing in the expanse of the cephalic or medial veins.

[dropcap]v[/dropcap] Thou shalt invert tubes containing anticoagulants immediately subsequently drove. A high percentage of specimens rejected past laboratories are due to clots in lavender- or blue-stoppered tubes. A quick inversion afterwards collection prevents a second puncture. If not inverted immediately upon filling, invert the tubes every bit soon as possible later the puncture.

Drawing claret from a syringe requires extra consideration to prevent clotting. The moment blood enters the barrel of the syringe the clotting process begins. If the time it takes to fill the syringe and evacuate the specimen into the tubes exceeds i infinitesimal, significant clotting may accept place. Not just will this go far difficult to evacuate the specimen through the needle and into the tubes, but if the clots are small plenty to go undetected they tin can affect the accuracy of the results.

[dropcap]6[/dropcap] M shalt attempt to collect specimens merely from an acceptable site. Antecubital and hand veins are adequate sites unless their use is precluded by intravenous infusions, injury or mastectomy. Whatever other site should be approached with great trepidation.

The inductive, or palm side, of the forearm is especially susceptible to injury because of the close proximity of nerves and tendons to the surface of the peel and should not be considered.

Foot and talocrural joint veins tin exist acceptable sites for venipunctures in some facilities and on some patients. Notwithstanding, puncturing these veins can atomic number 82 to thrombophlebitis and clot formation in patients with coagulopathies or to tissue necrosis in diabetics. Therefore, before puncturing foot and ankle veins, make sure the facility does not accept a policy against such punctures and that the physician approves of the site.

[dropcap]7[/dropcap] Thou shalt characterization specimens at the bedside. There is no excuse for not completely labeling a specimen at the bedside. This means complete identification, not just temporary identifiers to remind yous when you observe fourth dimension to label them completely afterwards.

Patients have died as a effect of mislabeled specimens. Case in point: At a modest Midwestern infirmary, a lab tech drew a specimen of blood to determine the blood blazon of a patient. She left the room without properly labeling the specimen, drew two more patients, and then returned to the lab to type them all simultaneously. Afterward an intermission, she returned to her workstation, misidentified the specimens and typed the patient incorrectly. The patient received incompatible blood and subsequently died.

Although this concept of complete and accurate specimen identification has been trumpeted loudly and clearly for decades, delayed labeling practices persist. On i ward at a big hospital, collectors scrawled patients' last names on the caps of the tubes to facilitate complete labeling at a later time. The lesser line is without exception: label the specimen completely at the bedside.

[dropcap]8[/dropcap] Thou shalt stretch the peel at the puncture site. Pulling downwards on the skin from below the intended puncture site with the thumb of your free hand anchors the vein and stretches the skin through which the needle will pass. Anchoring the vein is particularly important when drawing from the cephalic or basilic veins. Stretching the skin is the single most effective mode to minimize the pain of the puncture.

Routinely employing this technique has two potential bonuses: your rate of successful punctures goes up and your patients thank you for considering their suffering.

[dropcap]nine[/dropcap] Thou shalt know when to quit. Not everyone can draw blood from every patient. Even those who elevate phlebotomy to an art form tin have difficulty from fourth dimension to time. This is because there are veins intentionally placed in the antecubitals of the population at random for the sole purpose of keeping skillful collectors from becoming legends in their own minds. Later on two failed attempts, one should seriously consider sending in someone else. That's professionalism. It also may exist the answer to your patient'south prayers.

[dropcap]10[/dropcap] Thou shalt care for all patients every bit if they are family. In a infirmary, the only peace many patients experience is that which wellness intendance professionals bring them by their kind words, gentle technique and their smiles. Regardless of how you think your life led you to hold a position equally a health intendance professional, consider yourself assigned by a higher authorisation because of the comfort you can offer to the sick and injured in your own unique and compassionate way. Y'all haven't been employed; you've been ordained.

Readers may purchase the author's "Ten Commandments of Phlebotmy" poster through the Center for Phlebotomy Education. The 16×20 iv-color graphic can be viewed and ordered at http://world wide web.phlebotomy.com/poster.htm

Phlebotomy-Related Web Sites

Center for Phlebotomy Education
http://www.phlebotomy.com/
Q-Probes: Phlebotomy
http://www.cap.org/html/lip/benchmarks/phlebotomy_toc.html
Welcome to the Needle Phobia Page
http://www.webcom.com/cfsc/needles.html
Evaluation of Condom Devices for Preventing Percutaneous Injuries Among Health Intendance Workers During Phlebotomy Procedures
http://thebody.com/cdc/phlebot.html

References

Jagger, J. (1998). Rates of needlestick injury caused by various devices in a university hospital. N Engl J Med, 319(5), 284-288.
Carlsen, W., & Holding, R. (1998, Apr 13). Epidemic rages caregivers: thousands die from diseases contracted through needle sticks. San Francisco Chronicle.
Pallatroni, L. (1998). Needlesticks: Who pays the price when costs are cut on safety? MLO, 30(7), 30-31, 34-36, 88.
Carlsen, W., & Holding, R. (1998, Apr xiv). High profits–at what cost? San Francisco Chronicle.
Jagger, J. Risky process, risky devices, risky job. Advances in Exposure Prevention, 1(ane).
Garza, D., & Becan-McBride, G. (1999). Phlebotomy handbook: Blood collection essentials. Norwalk, CT: Appleton & Lange.