Wednesday, July 06, 2005
b3
KNOWLEDGE EVIDENCE QUESTIONS
UNIT B3 – OBTAIN VENOUS BLOOD SAMPLES USING INVASIVE TECHNIQUES
1
KE3
Discuss why a doctor may refer a patient for Venepuncture
Levels of certain chemical in blood can be used not only to diagnose clients but also, changes in chemial levels in blood can also show if conditions are either worsening or getting better. Phylbotomy can provide vital information about clients.
2
Describe how infection is spread
For infection to spread, there needs to be a source of that infection, a vector (some way of transfering it), a portal (a way into a new living ground) and nutritions when it gets there, be that air, water or a food source. If one of these is ilimated, then the chain of infection will be broken.
3
KE1
How may its spread be limited?
Not washing hands before and after procedure.
Dirty equipment
Not using gloves
Tourniquet used should not be used between patients
Using the same
Gloves should not be worn between two patients
each individual patient should have completely new equipment each time. deviously
4
KE4
Why is it important to clean Venepuncture sites effectively, how and when should this be carried out?
Vein are being puntured. Infection on the skin can be transferred from here to the blood stream that can be very dangerous. Inadequate use of alcohol wipes can meerly disturb the skin flora. They are only effective if they are vigourously used for 30 seconds.
5
KE5
In relation to Venepuncture, what is hazardous and non-hazardous waste? How would you dispose of each?
Hazardous
Blood stained items such as cotton wool, etcetera, should be disposed of in yellow clinical waste bins.
Non-hazardous
Packaging, etcetera, should be placed in a non-clinical waste bag - black.
6
KE6
Why is correct labelling important and what are the possible consequences of muddling samples?
It is important that correct labelling occurs because then the right sample relates to the right client and then the right treatment happens to the correct client. If encorerect labelling occurs the so can death!!!
7
KE2
Describe the legal and organisational requirements regarding health and safety and infection control when working with blood (e.g. COSHH, DoH guidelines and local policies
Protective equipment such as gloves and aprons should be worn as they have been provided by the employer for the safety of the worker.
All sharps should be disposed of in a sharps bin
All clinical waste should be disposed of in a yellow clinical waste bag
No needle should be resheathed for fear of needle stick injury.
All blood bottles should be labled by hand. Even were a sticker has been stuck on to a bottle and removed the sample will be rejected. Where hand labelling and a sticker are present, the sample will be rejected
All relevent material should be indate and in intact packaging
8
KE7
Which types of sample have particular storage and transfer requirements (e.g. temperature dependant tests) and what are the requirements?
Cold agglutinins
Must be kept at body temperature
Haematoloty: INR, APTT
Coagualtion screen
Factor Assays and Thrombophilia
Screen by arrangement (3x tubes required)
fill to the line and mix well
Attp and coag Screen must be tesed the same day.
Pediatric 1ml size from lab
Haematoloty ERS
Mix well
Chemistry Profiles: Enzymes, TFT. Lipids, CRP, rheumatolid factors, Immunoglobulins, B12, feritin, Tumour markers, Tyroid function, other hormones, PSA , Theraputic Drugs, TPI,
1 tube
Haematology: fbc, flim, Reticulocytes, Viscoscitym, Hb electrophoresis, Sickle Test IM Screen Malaria parasites
folate HbA1C, Lead porphytrin, PCR Assays
Mix well. separet tube for viscosity kept at room temperature. Paediactric tobes from lab.
Blood transfution: Crosmatch, Group and Save< Ante-nateal Group and Screen, DAG, Kleihauer
Mix well.
Chemistry: Sample requieing rapid preservation, eg, insulin
Obtain from laboratorty after consulation. Mix well
lactate
keep in the dark and and be processed within ten minutes. Prewarn the lab.
9
Why is it important to get positive confirmation of individuals identity and consent before starting the procedure?
To insure correct client is being tested
To ensure that the client is not having the consent of a client constitutes assault.
10
KE8
Describe effective ways of getting positive identification.
Appropriate identification must be
obtained wherever possible by the patient
verbally confirming their full name,
address and date of birth. Information on
in-patient identification wrist bands must
correspond to this. Check hospital number
on request form with in-patient notes
and/or identification wrist band. If the
patient is not wearing an identification
wristband, or it is illegible or contains
insufficient detail, the blood sample must
not be taken.
If the request form is not fully completed
to include clinical details the blood sample
must not be taken.
11
KE10
Describe the contra-indications and changes in behaviour and condition, which indicate that the procedure should be stopped, and advice sought. (e.g. allergies, skin problems, incorrect presentation such as non – fasting.)
The client may consent verbally and then, by behavieour imply they they do not want the proecure done. this could invodlve moving an amr just before the needle is incernted. if this persists, then the client should be asked if they want the test in the first place.
Allergies,
Any allergies should be discovered prior to commencement of the procedure. An which directly effect the procedure should be identified and any remedial action taken. For example, if a client is alergic to latex, then non-latex glove should be worn for the procedure. Client is alergic to micropore tape then another type of tape should be used.
Skin problems,
If the client has skin problems at a prospective venepuncture site, then an alternative stie should be investigated and adivice sort.
Incorrect presentation such as non – fasting
The procedure should be postonted until the correct condtions are implace.
12
KE12
What sites may you choose for Venepuncture and why.
the veian cubital veins
the cephalic vein
basilic vein
the metacarpal veins )only used when other sites are not accessible
13
KE13
What factors would you consider when choosing the best site to use (including the individuals own preference)
Previous experience of client
Accessiblity
Degree of tortuousness of veins
client contsent and ability to co-operate
lack of infection
14
KE14
What factors can affect the quality of the sample (e.g. prolonged use of a tourniquet)
Type of needle used. If the lumen is too small, then this can affect the sample. Also, the cells can be affected if a "butterfly" needle is used
15
KE15
Describe how you would prepare individuals for Venepuncture; include how their personal preferences may effect their preparation.
Check client identity and confirm by checking name band and asking for verbal verificaion if possible
Explain procdure and gain an informed conscent.
ensue the cleitn is comfotable.
Assess veins and determ which to use
Supprot lim comfortable invovling clinet to maximise comfoft here.
16
KE16
Describe the steps you would take to detect suitable veins
Appy a bouniquet above the site for inspection and visually inpsect the vein
palpate the vein
17
KE17
Describe the possible concerns individuals may have in relation to Venepuncture and blood sampling.
Is is going to hurt?
yes it is. Clients have the right to be told that this is the case. It is important that they are tol that the pain should be transitarty. If a particular needl phobia is in place, then skin-numbing cream can be prescribed.
How do they know if is my sample?
All samples are labed and placed in a labled form. this reduced the risk of mixing up samples.
18
KE18
What is likely to cause discomfort to individuals during and after the collection of blood samples? Describe how such discomforts can minimised. E.g. applying correct pressure to tourniquet and puncture site to avoid bruising)
Applying the tourniquet too hard can restrict arterial blood flow. To test if this has not occured, palpation of the radial pulse should be carried out.
Insertion of the needle will cause pain. In needle phobia or minors, skin numbing cream can be applied prior to procedure.
19
KE19
What remedial action can be taken if there are problems in obtaining blood?
If a client's veins collapse or are not very prominent, soaking the site in warm water can cause vasodilation thus fascilitating the procedure.
Aterial puncture
If this occurs:-
remove needle
apply pressure to site unit bleeding ceases.
explain what has happened
if there is contieneued pain, increase swelling or bruising, seek medical advice.
20
KE20
Why are anticoagulants added to blood samples and why is it important to collect the right volume of blood when it is to be mixed with anti-coagulant?
When blood leaves the body, the clotting proecess is initisated. Anticoagulent in the bottom of sample bottles help to stop this from happening. There is a specific vacumm in each tube which, in theory, attracts a specific volume of blood. Thus, there needs to be a speicif ammount of anticoagulanant in the bottom of the tube as to not excessively anticoagulate or allow haemolysation to occur.
21
Describe the dressings needed for the different types of puncture sites.
For younger clients, an ordinary sticking plaster may suffice. However, where skin is more friable such as in elderly clients, the lint free dressing secured with tape may be the dressing of choice.
22
Describe how you would apply dressings.
A lint free dressing should be held in place for two minutes then secured with tape once bleeding has ceased. The elbow should be kept straight as this helps to reduce bruising.
23
KE21
What advice would you give individuals on caring for the site? (Ke21)
keep the dressing on for 24 hours at least. keep dry and clean.
24
KE23
How would you recognise the common adverse reactions which individuals may have (e.g. fainting, bruising) What action would you take if they occurred.
Bruising and /or haematoma
This can occur when the needle has venetrated the posterier wall of the vein possibly due to the insertion angle being lower than 30 degrees. the needlw shoud be reomved and pressure applied and until the cessation of bleeding. The limb should be elevated, an ice pack should be applied then a pressure dressing should be applied.
Fainting
Place client's head between legs if feeling faint. encouage client to lie down. The use of a butterfly may be helpful. this should be secured if the client should need medication. Assistance should be summoned.
25
Describe how you would recognise an arterial puncture
Excessive pain on needle insertion. The punctured vessel has a pulse.
26
KE24
What action would you take if the above occurs.
The needle shoud be at once removed. Bleeding, which can be perfuse, should be stemmed by the application of pressure until it's cessation
27
KE25
What equipment and materials are needed for venous sampling, and how would you check and prepare them (including protective clothing for the worker and/or the individual.
Please note that all equipment must be checked that it has not been used before, is clean, within intact packaging, where appropriate and is within date, where appropriate.
Tourniquet
Clean tray
Vacutainer needle and holder (Refer to Becton Dickinson Vacutainer Systems Venous Access
Guide for needle size and alternative equipment.)
Sharps container (
This needs to be assembled at correctly, the relevant information (date assembled, location, the name of the person who assembled the bin) needs to be displayed on the bin. The bin must not be excessively full. If the bin is more than three-quarters full, it should be sealed, signed that it has been sealed and placed in the designated area where it will be collected for incineration.)
Cotton wool balls
Blood specimen tubes (refer to Vacutainer tube guide, the request form or phone the laboratory
to ensure correct specimen tubes are used, and specific storage conditions fulfilled).
Specimen request forms
Non sterile low protein powder free latex gloves
Pillow to support limb
Plastic apron (for the Worker and optional for the client)
a bowl of warm water to aid the vasodilation of limb is necessary
28
How would you maintain confidentiality whilst transporting blood samples (i.e. from patients home to the surgery)
Confidentiality is very important at all times. Blood samples I used for testing for certain diseases such as HIV and hepatitis as well as many sexually transmitted diseases. The client may not wish all and sundry to know that they are being tested for such conditions. It is therefore important that all blood samples have their names and any tests that pertain to covered. The forms used within the trust fall back on themselves, hiding the identity and reason for the tests required. When taking Blood, it is important that the accompanying form is stuck down as to not allow the name of the patient to be read nor what tests have been taken.
29
How would you deal with any spillages of blood?
the excess is soaked up using disposable paper towles. neat milton solution is then poured on the top of these.
30
Describe the procedure you would follow if you sustain a needlestick injury
Immediately a needle stick injury is incurred, the site should be encouraged to bleed over a sink so that the workers own bloodstream helps to flush away the blood of the individual who had the needle used upon them. Once the needle stick site has been bled like this, it should then be covered by waterproofed plaster. If required, the individual who has been stuck can request to have blood taken and stored for future reference should the client who hadn't even used upon them have any blood borne diseases.
An incident report form should be completed. Occupational health should be informed also.
UNIT B3 – OBTAIN VENOUS BLOOD SAMPLES USING INVASIVE TECHNIQUES
1
KE3
Discuss why a doctor may refer a patient for Venepuncture
Levels of certain chemical in blood can be used not only to diagnose clients but also, changes in chemial levels in blood can also show if conditions are either worsening or getting better. Phylbotomy can provide vital information about clients.
2
Describe how infection is spread
For infection to spread, there needs to be a source of that infection, a vector (some way of transfering it), a portal (a way into a new living ground) and nutritions when it gets there, be that air, water or a food source. If one of these is ilimated, then the chain of infection will be broken.
3
KE1
How may its spread be limited?
Not washing hands before and after procedure.
Dirty equipment
Not using gloves
Tourniquet used should not be used between patients
Using the same
Gloves should not be worn between two patients
each individual patient should have completely new equipment each time. deviously
4
KE4
Why is it important to clean Venepuncture sites effectively, how and when should this be carried out?
Vein are being puntured. Infection on the skin can be transferred from here to the blood stream that can be very dangerous. Inadequate use of alcohol wipes can meerly disturb the skin flora. They are only effective if they are vigourously used for 30 seconds.
5
KE5
In relation to Venepuncture, what is hazardous and non-hazardous waste? How would you dispose of each?
Hazardous
Blood stained items such as cotton wool, etcetera, should be disposed of in yellow clinical waste bins.
Non-hazardous
Packaging, etcetera, should be placed in a non-clinical waste bag - black.
6
KE6
Why is correct labelling important and what are the possible consequences of muddling samples?
It is important that correct labelling occurs because then the right sample relates to the right client and then the right treatment happens to the correct client. If encorerect labelling occurs the so can death!!!
7
KE2
Describe the legal and organisational requirements regarding health and safety and infection control when working with blood (e.g. COSHH, DoH guidelines and local policies
Protective equipment such as gloves and aprons should be worn as they have been provided by the employer for the safety of the worker.
All sharps should be disposed of in a sharps bin
All clinical waste should be disposed of in a yellow clinical waste bag
No needle should be resheathed for fear of needle stick injury.
All blood bottles should be labled by hand. Even were a sticker has been stuck on to a bottle and removed the sample will be rejected. Where hand labelling and a sticker are present, the sample will be rejected
All relevent material should be indate and in intact packaging
8
KE7
Which types of sample have particular storage and transfer requirements (e.g. temperature dependant tests) and what are the requirements?
Cold agglutinins
Must be kept at body temperature
Haematoloty: INR, APTT
Coagualtion screen
Factor Assays and Thrombophilia
Screen by arrangement (3x tubes required)
fill to the line and mix well
Attp and coag Screen must be tesed the same day.
Pediatric 1ml size from lab
Haematoloty ERS
Mix well
Chemistry Profiles: Enzymes, TFT. Lipids, CRP, rheumatolid factors, Immunoglobulins, B12, feritin, Tumour markers, Tyroid function, other hormones, PSA , Theraputic Drugs, TPI,
1 tube
Haematology: fbc, flim, Reticulocytes, Viscoscitym, Hb electrophoresis, Sickle Test IM Screen Malaria parasites
folate HbA1C, Lead porphytrin, PCR Assays
Mix well. separet tube for viscosity kept at room temperature. Paediactric tobes from lab.
Blood transfution: Crosmatch, Group and Save< Ante-nateal Group and Screen, DAG, Kleihauer
Mix well.
Chemistry: Sample requieing rapid preservation, eg, insulin
Obtain from laboratorty after consulation. Mix well
lactate
keep in the dark and and be processed within ten minutes. Prewarn the lab.
9
Why is it important to get positive confirmation of individuals identity and consent before starting the procedure?
To insure correct client is being tested
To ensure that the client is not having the consent of a client constitutes assault.
10
KE8
Describe effective ways of getting positive identification.
Appropriate identification must be
obtained wherever possible by the patient
verbally confirming their full name,
address and date of birth. Information on
in-patient identification wrist bands must
correspond to this. Check hospital number
on request form with in-patient notes
and/or identification wrist band. If the
patient is not wearing an identification
wristband, or it is illegible or contains
insufficient detail, the blood sample must
not be taken.
If the request form is not fully completed
to include clinical details the blood sample
must not be taken.
11
KE10
Describe the contra-indications and changes in behaviour and condition, which indicate that the procedure should be stopped, and advice sought. (e.g. allergies, skin problems, incorrect presentation such as non – fasting.)
The client may consent verbally and then, by behavieour imply they they do not want the proecure done. this could invodlve moving an amr just before the needle is incernted. if this persists, then the client should be asked if they want the test in the first place.
Allergies,
Any allergies should be discovered prior to commencement of the procedure. An which directly effect the procedure should be identified and any remedial action taken. For example, if a client is alergic to latex, then non-latex glove should be worn for the procedure. Client is alergic to micropore tape then another type of tape should be used.
Skin problems,
If the client has skin problems at a prospective venepuncture site, then an alternative stie should be investigated and adivice sort.
Incorrect presentation such as non – fasting
The procedure should be postonted until the correct condtions are implace.
12
KE12
What sites may you choose for Venepuncture and why.
the veian cubital veins
the cephalic vein
basilic vein
the metacarpal veins )only used when other sites are not accessible
13
KE13
What factors would you consider when choosing the best site to use (including the individuals own preference)
Previous experience of client
Accessiblity
Degree of tortuousness of veins
client contsent and ability to co-operate
lack of infection
14
KE14
What factors can affect the quality of the sample (e.g. prolonged use of a tourniquet)
Type of needle used. If the lumen is too small, then this can affect the sample. Also, the cells can be affected if a "butterfly" needle is used
15
KE15
Describe how you would prepare individuals for Venepuncture; include how their personal preferences may effect their preparation.
Check client identity and confirm by checking name band and asking for verbal verificaion if possible
Explain procdure and gain an informed conscent.
ensue the cleitn is comfotable.
Assess veins and determ which to use
Supprot lim comfortable invovling clinet to maximise comfoft here.
16
KE16
Describe the steps you would take to detect suitable veins
Appy a bouniquet above the site for inspection and visually inpsect the vein
palpate the vein
17
KE17
Describe the possible concerns individuals may have in relation to Venepuncture and blood sampling.
Is is going to hurt?
yes it is. Clients have the right to be told that this is the case. It is important that they are tol that the pain should be transitarty. If a particular needl phobia is in place, then skin-numbing cream can be prescribed.
How do they know if is my sample?
All samples are labed and placed in a labled form. this reduced the risk of mixing up samples.
18
KE18
What is likely to cause discomfort to individuals during and after the collection of blood samples? Describe how such discomforts can minimised. E.g. applying correct pressure to tourniquet and puncture site to avoid bruising)
Applying the tourniquet too hard can restrict arterial blood flow. To test if this has not occured, palpation of the radial pulse should be carried out.
Insertion of the needle will cause pain. In needle phobia or minors, skin numbing cream can be applied prior to procedure.
19
KE19
What remedial action can be taken if there are problems in obtaining blood?
If a client's veins collapse or are not very prominent, soaking the site in warm water can cause vasodilation thus fascilitating the procedure.
Aterial puncture
If this occurs:-
remove needle
apply pressure to site unit bleeding ceases.
explain what has happened
if there is contieneued pain, increase swelling or bruising, seek medical advice.
20
KE20
Why are anticoagulants added to blood samples and why is it important to collect the right volume of blood when it is to be mixed with anti-coagulant?
When blood leaves the body, the clotting proecess is initisated. Anticoagulent in the bottom of sample bottles help to stop this from happening. There is a specific vacumm in each tube which, in theory, attracts a specific volume of blood. Thus, there needs to be a speicif ammount of anticoagulanant in the bottom of the tube as to not excessively anticoagulate or allow haemolysation to occur.
21
Describe the dressings needed for the different types of puncture sites.
For younger clients, an ordinary sticking plaster may suffice. However, where skin is more friable such as in elderly clients, the lint free dressing secured with tape may be the dressing of choice.
22
Describe how you would apply dressings.
A lint free dressing should be held in place for two minutes then secured with tape once bleeding has ceased. The elbow should be kept straight as this helps to reduce bruising.
23
KE21
What advice would you give individuals on caring for the site? (Ke21)
keep the dressing on for 24 hours at least. keep dry and clean.
24
KE23
How would you recognise the common adverse reactions which individuals may have (e.g. fainting, bruising) What action would you take if they occurred.
Bruising and /or haematoma
This can occur when the needle has venetrated the posterier wall of the vein possibly due to the insertion angle being lower than 30 degrees. the needlw shoud be reomved and pressure applied and until the cessation of bleeding. The limb should be elevated, an ice pack should be applied then a pressure dressing should be applied.
Fainting
Place client's head between legs if feeling faint. encouage client to lie down. The use of a butterfly may be helpful. this should be secured if the client should need medication. Assistance should be summoned.
25
Describe how you would recognise an arterial puncture
Excessive pain on needle insertion. The punctured vessel has a pulse.
26
KE24
What action would you take if the above occurs.
The needle shoud be at once removed. Bleeding, which can be perfuse, should be stemmed by the application of pressure until it's cessation
27
KE25
What equipment and materials are needed for venous sampling, and how would you check and prepare them (including protective clothing for the worker and/or the individual.
Please note that all equipment must be checked that it has not been used before, is clean, within intact packaging, where appropriate and is within date, where appropriate.
Tourniquet
Clean tray
Vacutainer needle and holder (Refer to Becton Dickinson Vacutainer Systems Venous Access
Guide for needle size and alternative equipment.)
Sharps container (
This needs to be assembled at correctly, the relevant information (date assembled, location, the name of the person who assembled the bin) needs to be displayed on the bin. The bin must not be excessively full. If the bin is more than three-quarters full, it should be sealed, signed that it has been sealed and placed in the designated area where it will be collected for incineration.)
Cotton wool balls
Blood specimen tubes (refer to Vacutainer tube guide, the request form or phone the laboratory
to ensure correct specimen tubes are used, and specific storage conditions fulfilled).
Specimen request forms
Non sterile low protein powder free latex gloves
Pillow to support limb
Plastic apron (for the Worker and optional for the client)
a bowl of warm water to aid the vasodilation of limb is necessary
28
How would you maintain confidentiality whilst transporting blood samples (i.e. from patients home to the surgery)
Confidentiality is very important at all times. Blood samples I used for testing for certain diseases such as HIV and hepatitis as well as many sexually transmitted diseases. The client may not wish all and sundry to know that they are being tested for such conditions. It is therefore important that all blood samples have their names and any tests that pertain to covered. The forms used within the trust fall back on themselves, hiding the identity and reason for the tests required. When taking Blood, it is important that the accompanying form is stuck down as to not allow the name of the patient to be read nor what tests have been taken.
29
How would you deal with any spillages of blood?
the excess is soaked up using disposable paper towles. neat milton solution is then poured on the top of these.
30
Describe the procedure you would follow if you sustain a needlestick injury
Immediately a needle stick injury is incurred, the site should be encouraged to bleed over a sink so that the workers own bloodstream helps to flush away the blood of the individual who had the needle used upon them. Once the needle stick site has been bled like this, it should then be covered by waterproofed plaster. If required, the individual who has been stuck can request to have blood taken and stored for future reference should the client who hadn't even used upon them have any blood borne diseases.
An incident report form should be completed. Occupational health should be informed also.
# posted by alanpjack @ 1:46 AM 
