The Venipuncture From an Arm Vein
The Venipuncture From an Arm Vein
The Venipuncture From an Arm Vein
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22 So You’re Going to Collect a Blood Specimen: An Introduction to Phlebotomy<br />
Hospitalized patient not in bed<br />
Have the patient sit at a small table where the elbow c<strong>an</strong><br />
be placed on a hard surface, or in a position in which the<br />
arm c<strong>an</strong> be placed across the bed. If necessary, put a small<br />
pillow or a roll of towels under the extended arm to<br />
support it.<br />
Outpatient/ambulatory patient<br />
Ask the patient to sit in a chair designed for phlebotomy<br />
or at a small table where the elbow is placed across a hard<br />
surface. This will ensure that there is sufficient support<br />
for the arm. This support will help prevent the patient<br />
from pulling the arm back when the needle is inserted<br />
into a vein. For inf<strong>an</strong>ts or small children, have a second<br />
individual, such as a parent, hold the arm of the child<br />
firmly so that the arm will not jerk suddenly when the<br />
needle is inserted into the vein.<br />
Home visits<br />
Tourniquet<br />
Pillow<br />
Follow the same principles outlined above. Do not place<br />
your equipment on or near food. Ensure patient safety<br />
since there may not be <strong>an</strong>y help available if the patient<br />
faints (see pages 36–37).<br />
Some patients may have fragile bones<br />
or restrictions to phlebotomy sites due<br />
to recent surgeries. Make certain to<br />
obey <strong>an</strong>y signage that warns the<br />
phlebotomist against potential injuries<br />
to the patient from phlebotomy.<br />
Hospitalized patient in bed<br />
Make sure the patient is in a position<br />
where the arm is easy to access for<br />
venipuncture. Place the blood<br />
collection tray where it is readily<br />
available but is not in d<strong>an</strong>ger of being<br />
upset by the patient. Never put your<br />
equipment on the patient’s bed.<br />
Never label tubes prior to collection.<br />
Never leave <strong>an</strong>y equipment in the<br />
room.<br />
Before phlebotomy, always ask<br />
patients if they are taking<br />
<strong>an</strong>ticoagul<strong>an</strong>ts or if they have <strong>an</strong><br />
inherited blood clotting problem.<br />
Patients who are taking medicine to<br />
prevent their blood from clotting<br />
(ie, <strong>an</strong>ticoagul<strong>an</strong>ts such as coumadin,<br />
heparin, or aspirin) or patients who<br />
have inherited a blood clotting<br />
abnormality (eg, hemophilia) may<br />
continue to bleed from the punctured<br />
vein. If this bleeding is not stopped,<br />
blood may accumulate within the tissues<br />
of the arm, specifically in the enclosed<br />
area of the arm that surrounds the<br />
muscle. This bleeding c<strong>an</strong> lead to<br />
compartment syndrome, a condition<br />
in which the blood accumulates in a<br />
contained space within the arm such<br />
that the pressure produced c<strong>an</strong> interfere<br />
with blood flow <strong>an</strong>d may injure the<br />
muscle. This is a rare but very serious<br />
complication <strong>an</strong>d requires <strong>an</strong><br />
emergency surgical procedure to open<br />
the compartment, relieve the pressure,<br />
<strong>an</strong>d stop the bleeding.