How To Draw Blood From An Iv
Phlebotomy Basics For Nurses
Submitted by Mary H. Nielson, DNP, APRN-BC
Phlebotomy is the procedure where a puncture is made in the vein to remove blood or infuse fluids such as saline. Every bit nurses we are very familiar with the procedure of inducing fluids, however, we are not then familiar with the process of removing blood. At some point in your nursing career, if y'all have not already done so, you lot may have to obtain blood specimens from your patients. The purpose of this commodity is to give an overview on the basics of blood drawing, such as the procedure of claret drawing with regards to patient safety, general information regarding blood specimen tubes and finally an overview of mutual lab panels.
Blood drawing technique:
Your institutions should have policies and procedures regarding phlebotomy for nursing, including preparation classes on the proper procedures for blood draw, you lot should review these procedures prior to performing whatever blood draws. Some bones concepts regarding claret describe are: the need to get together all of your equipment before starting the process, and in doing so keeping in mind non to create waste material or unnecessary use of supplies. Items you would need for a venipuncture are: a tube holder commonly called a vacutainer, a vacuum drove needle, alcohol pads, tourniquet, 2 X 2 gauze, a ring aid, all the blood tubes you may need and patient labels. If yous are drawing blood off an existing 4 line, y'all will demand an alcohol pad or appropriate cleansing agent for the port, a tube holder, a tourniquet, a needleless vacuum collection device, appropriate blood tubes, patient labels and a saline flush. The longer the IV site has been in place, the more difficult information technology may exist to obtain a blood sample. Most Four saline locks stay in place for up to 72 hours. After 72 hours at that place is a higher take a chance of infections, such as phlebitis. After the saline lock has been in for 24 hours, obtaining claret from another source would be recommended. If drawing blood from a peripherally inserted central catheter (PICC) line or key line, you will demand an booze pad or appropriate cleansing agent for the port, a tube holder, a needleless vacuum collection device, appropriate blood tubes including a waste tube, patient labels and saline flushes for each port. Follow your institutions policy and procedures on how to obtain blood samples from an Four line, PICC line or central line. The basic stride procedure includes: one. Wash your hands ii. Get together all your equipment 3. Bring equipment to patient bedside 4. Wash your hands and don your gloves 5. Verify patient with arm band, orders, and labels for blood tubes six. Explain the procedure to the patient 7. Prepare your equipment (follow your institution policy) eight. Draw the blood test in the proper order and proper blood tube (per your establishment policy) nine. Characterization each tube verifying against patients arm band 10. Cease the procedure by cleaning the patients area 11. Dispose of waste material appropriately 12. Place tubes in a biohazard bag – doff gloves 13. Wash hands 14. Send the blood to the lab, including requisition if necessary.
Patient safety - Proper Specimen Labeling
Patient prophylactic must exist a priority when drawing your patients' blood. Ensuring that yous use 2 patient identifiers for obtaining and labeling blood specimens must be done at all times. Information technology may seem like an over redundant job, especially when you lot take become familiar with your patients, but mislabeling specimens tin event in improper treatment and care for your patient. The Joint Commission's Hospital National Patient Prophylactic Goals require that you employ ii patient identifiers when providing care, treatment and services (The Joint Commission, 2013). The procedure may seem basic but to review, you lot need to have two concrete forms of ID to place the patient, the nearly commonly used are the patients arm band and the patient's labels and/or orders. In an outpatient setting the patient can verbally verify who they are using name and engagement of birth, however if the capability to provide an arm band is bachelor then the patient should receive an armband. Secondly, your data points of identification demand to include the clients name, and a number identifier, such as medical tape number, account number, date of nascence or social security number. Virtually institutions have policy'due south regarding patient identification with ii forms of identification. Follow your infirmary policy on two patient identifiers procedures. Engagement and time of specimen collection and collector'south initials, need to be written on the patient label that volition go on the sample, especially if you are drawing a specimen for type and screen and type and cross for possible blood transfusion. The specimen requisition form needs to include the same patient identifier information equally the labels on the blood specimen. If you piece of work in an outpatient setting where you send the blood to another lab, and then the post-obit information should be included on the requisition form: diagnosis, insurance data if necessary, patient location, ordering practitioner (MD, APRN, PA), the examination to be performed besides equally fourth dimension of draw showtime and stop if it is a time sensitive exam.
Basic specimen tube information:
The following includes the basic information regarding phlebotomy tubes that are commonly used. Agreement the purpose and use of each phlebotomy tube, is essential in agreement the process of phlebotomy. All phlebotomy tubes accept a specific color top and each colour tube top corresponds to specific test to be fatigued. Also each tube may have a specific process that needs to be considered at the fourth dimension of the draw, such every bit inverting the tube or placing the tube on ice. The following is a list of normally used blood specimen tubes, and they are listed in the social club that they should be obtained. However, your institutions policy regarding tube club collection may be slightly different, so follow your institutions policies. Yellow tubes: Usually for blood cultures, these tubes needs to exist drawn first and should be inverted viii-10 times after describe. Red tubes (Serum tubes): A serum tube is commonly used for odd testing such equally drug levels. Drawn first if blood cultures are non required, there is no demand to invert these tubes. Bluish tubes: This tube contains a Citrate additive with a 9:i ratio, it is used to run clotting test. Due to the citrate additive it is so important to fill the tube to the proper amount, usually marked by a blueish line on the tube. The laboratory cannot run or report the test results if the ratio of the citrate condiment and the blood is out of proportion, equally it this will consequence in an invalid test. These tests usually demand to be run within four hours of collection. This test is the tertiary test to be fatigued and should exist inverted 3-4 times. Tiger tops/Gold tubes: These are at times referred to equally SST's (Standard serum tubes), and are used for a wide variety of testing, such as chemistry profiles (CMP, BMP), Creatine phosphokinase test (CPK), C-reactive protein and thyroid studies, they should be inverted 5 times. Dark green tubes: Contains sodium heparin, and is used for stat chemistries, at some institutions, these are non commonly used Mint green tubes: Contains lithium heparin, which is a gel separator tube that contains a clot activator to make a barrier. Testing that maybe included in these tubes would include a Creatine phosphokinase Myoglobin (CPK MB) and triponan. They would follow the standard serum tubes in the draw social club, and need to be inverted eight-x times. Lavender (purple) tubes: Has the additive EDTA, which binds calcium to prevent the blood from coagulating. Information technology is used for Consummate blood count (CBC), B-type Natriuretic Peptide (BNP), Erythrocyte Sedimentation Rate (ESR) and a glycated hemoglobin (HA1C). This tube is commonly the last tube drawn for most cases, and needs to exist inverted 8-ten times. Uncommon phlebotomy tubes Grayness tubes: This tube contains Sodium fluoride and Potassium oxalate, an enzyme inhibitor that is used to measure ammonia levels and alcohol levels. This tube must be put on ice immediately and needs to be inverted viii-x times. White tubes: Contains a plasma separator and is ordinarily used for polymerase chain reaction (PCR) assays, this tube needs to be inverted viii-ten times. Regal Blueish tubes: Used to test for heavy metals, may contain EDTA or heparin. In review if you lot are to drawing a CBC, CMP and PT/INR for your patient, you would draw a blue tube get-go (PT/INR), followed by a tiger or gilt height (CMP), followed by lavender top (CMP). Always ensure you will make full each blood tube and collect specimen per your institutional policy and process, and practise not hesitate to contact your laboratory for questions. If you specimen is not going to strait to the laboratory for testing, ensure that you refrigerate you sample. Never freeze your blood samples unless specifically directed to practise and so past the laboratory performing the examination.
Review of labs:
Dynamics of the inpatient setting dictate that laboratory exam are fatigued on the changing patient's needs. In an emergency department, outpatient clinic, private practice office or extended intendance facility full general screening panels are the most common tests ordered. These are to identity the patient'due south base line as well as identify whatever outlying conditions that may need to be addressed. The normal ranges for your blood test will exist reported out with your results for comparison. The following is a listing of general laboratory screening test including and specifics regarding the phlebotomy tube:
CBC (complete blood cell count)
A CBC is an overview of your crimson and white blood cells. The CBC may or may non accept a differential ordered. The differential is the cellular component breakdown of the WBC, and can exist ordered equally a manual or car count. In a manual differential, the cells are manually counted past a certified lab technician; an motorcar differential means that the cells are counted by motorcar.
BMP or CMP (basic metabolic profile/consummate metabolic profile)
These two tests have a variety of aliases such equally chemistry's, chem 7, chem 12. In general a BMP will include: Sodium (Na), Chloride (Cl), Potassium (Grand), Glucose, Blood Urea nitrogen (BUN), Creatinine (CR) and a Carbon dioxide (CO). A CMP includes other examination such as Calcium, Albumin, Phosphatase Alkaline, Protein total, transferase, alanine amino (ALT or SGPT) and a transferase aspartate amino (AST or SGOT). The ALT and AST are used to assess liver role.
Cholesterol screening
A lipid profile volition assess a patients cholesterol condition, these examination include total cholesterol, Low density lipoprotein (LDL), High density lipoprotein ( HDL), LDL ratio and triglycerides. Cardiac Functions When assessing for cardiac part some of the standard test are Creatine phosphokinase (CPK), CPK–MB, troponin, B-type Natriuretic Peptide (BNP). The CPK measures the Lactate dehydrogenase (LDH), of muscle expiry. An elevated CPK can be seen with muscle damage such as with motor Vehicle blow. The CPKMB is a specific isoenzyme for the cardiac musculus, but it is also constitute in skeletal muscle, and is used if the initial troponin level is abnormal (Mayo Dispensary Laboratories, 2014). CPKMB ordinarily correlates a positive upshot within v hours from first appearance of symptoms. Troponin is some other lab examination that is more than specific to appraise acute myocardial infarctions. Troponin is an enzyme that is released later on cardiac muscle death, therefore more specific for actual acute myocardial infarction (AMI). A troponin level will show positive results inside 12 hours of an AMI (Jaffe, Ravkilde, Robers, Naslund, Apple tree, Galvani, Katus, 2000). The i of import gene to recollect regarding troponin is that it may exist elevated while other cardiac enzyme markers remain negative as in a instance of unstable angina (Mayo clinic Laboratories, 2014). These lab tests are generally the standard test for heart muscle death, AMI, congested heart failure (CHF), and angina. It is important to remember that there is a time laps before the tests actually show a positive sign of elevation. The normal values of these results are CPK 52-336 u/liter. A normal CPK-MB is < 6.ii ng/ml. The normal value of a troponin outcome is < 0.10ng/ml, A B-type Natriuretic Peptide (BNP) is a exam used to aid differentiate centre failure. Other than the subjective and objective information related to heart failure a BNP examination if a definitive test for eye failure. It aids in identifying eye failure in an emergency setting only it also work equally a good indicator of the severity of heart failure, as well as response to treatment (Mayo Dispensary Laboratory, 2014). The normal value of a BNP result is < 200 pg/ml.
Inflammatory markers
A C-reactive protein is a serum protein marker used to indicate acute inflammation. This exam is ofttimes used to identify arthritis and rheumatoid arthritis. However, there may non be an peak even with clinical signs of a flare up (Mayo clinic laboratory, 2014). A C-reactive poly peptide is too existence used to help identify AMI or AMI with Coronary avenue disease (CAD), however this test is not recommended for the general population (Mayo dispensary laboratory, 2014). The normal value for the C-reactive protein is < 5mg/liter, however, you would demand to expect at you institutions special reports for cardiac values. An ESR (sedimentation rate) also exam for inflammation, and is a good base of operations line test when screening for auto immune diseases. This test take one 60 minutes to run, and non very effective in an emergency setting (Mayo clinic laboratory, 2014). Normal ranges are i-13 mm/hr for male and one-20 mm/60 minutes for female.
Endocrinology markers
There are several specific tests to monitor a patient'due south endocrine system. A few of the nigh commonly seen are the Thyroid Stimulating Hormone (TSH), glucose level and Hemoglobin Adult 1C type examination (HA1C). The TSH with Gratuitous T4 volition measure a patient'due south thyroid role. A TSH measures the specific thyroid stimulating hormone, while the Costless T4 will give a proficient index of the overall thyroid part. Normal ranges for TSH is 0.3-5.0 mIU/Fifty while normal ranges for Free T four are v.0-12.5 ug/dl. To monitor a patient for diabetes or pre diabetic state, you would check a fasting glucose which should be below 99 mg/dl. A hemoglobin A1C (HA1C) is also checked. This test give an over view of what the average blood glucose level in a person was for the last 3 months. It will non identify highs and lows of a person boilerplate blood carbohydrate, just it will give the average. Besides every bit the daily finger stick testing, an HA1C should be done on diabetic patients approximately every three months, and lab test volition be reported out with the HA1C along with a corresponding glucose levels range.
Other markers
Kidney function are measured past the BUN and Creatinine, the Glomular filtration charge per unit (GFR), and tin also be measured by a Cystatin C level. The cysteine C is a test that measures a protein inhibitor used to identify kidney function and correlates to the kidneys glomular filtration charge per unit. High values indicate a low GFR and low values indicates high GFR. The Cystatin C is not affected by infection or inflammation, and then information technology is a more than reliable marking used to appraise kidney function, specially in the elderly and malnourished. The normal ranges are 0.59-0.91 mg/L. Finally, there are basic cancer markers used to cancer screening. Two of the most common are the CEA and PSA. The CEA (carcinoembryonic antigen serum) is a general screening test for patients who may have or be at risk for colorectal cancer, breast cancer, gastrointestinal tract, liver, lung and ovarian cancers. Normal CEA ranges are < 3 ng/mL, whatsoever value grater than 20 ng/ml is strongly suggestive of cancer. The PSA (prostate specific antigen) is more specific for the prostate gland. The normal ranges tin can vary per historic period, and screening recommendations have too varied over the years, simply should be washed if patients have urogenital complaints.
References
The Joint Commission (2013). National Patient Safety Goals Effective January 1, 2014. Retrieved from: http ://www.jointcommission.org/assets/1/half-dozen/HAP_NPSG_Chapter_2014.pdf Mair J, Artner-Dworzak Eastward, Dienstl A., Lechleitner, P., Morass, B., Smidt, J., Wagner, I., Wettach, C & Puschendorf, B. (1991) Early detection of acute myocardial infarction past measurement of mass concentration of creatine kinase-MB. American Journal of Cardiology. 68:1545-1550 Jaffe, A., Ravkilde, J., Robers, R., Naslund, U., Apple, F., Galvani, Thousand, & Katus, H. (2000) It'south time for a change to a troponin Standard. Apportionment: Journal of the American Heart Clan. 102: 126-1220 Mayo dispensary, (2014). Mayo clinic laboratories Test ID: TPNT troponin T, serum. Retrieved from: http ://world wide web.mayomedicallaboratories.com/test- catalog/Clinical+and+Interpretive/82428 Mayo clinic, (2014). Mayo clinic laboratories Test ID: CKMB Creatine Kinase (CK) MB isoenzyme,Serum. Retrieved from: http ://www.mayomedicallaboratories.com/test- itemize/Clinical+and+Interpretive/82429 Mayo clinic, (2014). Mayo clinic laboratories Test ID: BNP P-type natriuretic peptide (BNP) plasma. Call up from http ://www.mayomedicallaboratories.com/examination- itemize/Clinical+and+Interpretive/83873 Mayo dispensary, (2014). Mayo clinic laboratories C-reactive protein test. Retrieved from http ://www.mayoclinic.org/tests-procedures/c-reactive-protein/basics/definition/prc- 20014480 Maryo clinic, (2014) Test and Procedures sed charge per unit. Retrieved from: http ://www.mayoclinic.org/tests-procedures/sed-rate/basics/definition/mainland china-20013502 Blood book, (2013). Blood test results – normal ranges. Retrieved from: http ://www.bloodbook.com/ranges.html Mayo medical laboratories interpretive paw book Rochester, Minnesota.
Source: https://rn-journal.com/journal-of-nursing/phlebotomy-basics-for-nurses
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