technical complications in phlebotomy

This complication arises due to the hypersecretion of histamine and histamine-like substances. Notably, a psychosomatic component, in which motivational an anticipatory cortical process toward the cause of the expected pain alters the nociceptive perception, can be recognized for the intra-procedural pain as well. 4.Guidelines. official website and that any information you provide is encrypted Such approach relies on the gate control theory of pain, according to which the transmission of peripheral nociception can be reduced by a competing concomitant mechanic stimulus incoming from the same somatic district (Figure 2) (48, 49). Prep the venipuncture site by cleansing the area with an alcohol prep pad for 30 seconds and allow it to air dry for 30 seconds. In that study, patients with HbSC who failed to achieve clinical improvement after receiving the maximum tolerated dose of hydroxyurea were offered phlebotomy and hydroxyurea, and all patients exhibited at least partial clinical improvement. It is thought that to achieve a good skill, corresponding to a rate of successful venipunctures close to 99% at first attempt, about one year of practice is necessary (132). Brenner SM, Rupp V, Boucher J, Weaver K, Dusza SW, Bokovoy J. All About the Therapeutic Phlebotomy Remove the needle from the patients arm and press down on the vessel with gauze. Hi there This review discusses therapeutic phlebotomy and the related disorders and also offers guidelines for establishing a therapeutic phlebotomy program. Why is the laboratory an afterthought for managed care organizations? Blood may be collected in a bag or in syringes. Contact us today to learn more about our programs and tuition assistance options. Next, consult a good hematologist. Health care providers should also be aware of the potential complications phlebotomy can present with and only perform when necessary. However, such complications are very rare in routine venipuncture (< 3%), except for the formation of small harmless ecchymosis which occur in 15% of phlebotomies, and have a diameter of < 20 mm in 90% of the cases (70, 73). A piston syringe is a simple device in use since the second half of the 19th century. In this regard, a device using high frequency vibrations and refrigeration has been devised for the use in children (50, 51). I will suggest doing a bleeding profile like CT, Bleeding time, PT, APTT, INR, and platelet count, including a complete blood picture. . Vacuum-venipuncture skills:time required and importance of tube order. Some people have years of phlebotomy experience but have never passed a phlebotomy program. Rombos Y, Tzanetea R, Kalotychou V, et al. This phenomenon can enhance the discrimination of the painful stimulus and in turn can magnify its intensity (60, 61). Then, insert the needle at a 15 to 30-degree angle into the vessel. This increases discomfort and distress, and thus the risk of autonomous reactions (38, 39). stream Therefore, the knowledge of anatomy, alongside with tools used to enhance their visualization, is mandatory and deserves an appropriate discussion, with the awareness that the goal is a suitable rather than a quick phlebotomy. Arterial sampling3. Sometimes permanent damage may take place to the nerve. All informations are useful for doctors, lab technicians, nurses, and paramedical staff. They should also apply a bandage or secure the cotton swab with tape. The use of interferon as a myelosuppressive agent may also provide advantages for patients with polycythemia vera.9 Other medications that reduce the platelet count are associated with decreased risks of post-phlebotomy thrombosis, although they may also increase the risk of developing leukemia.9, When a therapeutic phlebotomy program is introduced, the institution must establish guidelines and regulations for patient safety, the phlebotomy procedure, and blood disposal. Phlebotomists are trained to collect blood via venipuncture (when a needle is used to draw blood from a vein), finger pricks, or in the case of infants, heel pricks. The basic tools for venipuncture are represented by the tourniquet, the needle with the blood collection device and the stick squeezed by the patient to dilate the veins (which is no longer in use). Heels are common sites in children. [QxMD MEDLINE Link]. To help your bruise heal properly, you can: Leave the bandage on for at least 8 hours. Moreover, the evidence based medicine paradigm has codified the tricks of the trade into procedures and rules, giving precise references and guidance. Lippi G, Salvagno GL, Montagnana M, Brocco G, Cesare Guidi G. Influence of the needle bore size used for collecting venous blood samples on routine clinical chemistry testing. We would like to point out that even with evacuated tubes and hybrid systems a cross-contamination between different additives can happen if the device is not correctly used (as discussed in the last section of this paper). Various samples are collected in microtainers in different colored caps so that the identification of microtainer additives is made easier. Accessibility Comment on Blood Alcohol Concentration Using Non-Alcohol- and Alcohol-Containing Skin Antiseptics. Sorry to hear about your illness. Phlebotomy Technique: Approach Considerations, Phlebotomy, Complications Closely monitor the arm to ensure it is not applied too tight or for more than two minutes. The VVR is a harmless affection, which can lead to injuries due to the loss of control over body position, but which very rarely causes more severe consequences like death (56, 58). Inclusion in an NLM database does not imply endorsement of, or agreement with, Phlebotomy was performed by removing 350 mL of blood every 1015 days, and this procedure led to no adverse events. Phlebotomy 2 Flashcards Thank you! The main study outcome was improvement in liver damage after 2 years, according to the NAFLD activity scores. Nevertheless, if you mistakenly do penetrate the basilic vein, it will cause severe pain and bleeding. In such a device the collecting tube has a plunger which can be pulled during venipuncture to withdraw blood as in a typical syringe (Figure 1D). In this regard there are two major mechanical causes related to phlebotomy procedure: the shear stress on red blood cells flowing through a small bore needle which causes haemolysis and the needle probing of the bloodstream which damages the tissue neighbouring the venipuncture site (103-105). 13 Types of Phlebotomy Certifications | Indeed.com There was no bleeding and the patient is fine. Spurious haemolysis (SH) is another common condition associated with venipuncture, and the most frequent cause of sample unsuitability (116, 117). To acquire blood samples for diagnostic purposes. 6. v.10112019 . Lippi G, Salvagno GL, Brocco G, Guidi GC. After drawing blood, the pierce in the rubber stop is resealed when the tube is removed from the holder, thus preventing the sample from leaking out. <>/ExtGState<>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> 1 North Main Street, 7th Floor, . Alcohol exerts its strong disinfectant activity by denaturing proteins, thus it has a broad range of antimicrobial activity except for spores. However this is a very rare consequence occurring in about 1: 25,000 individuals undergoing blood donation (78). In conclusion, the evidence that we have reviewed indicates that phlebotomy is safe and provides good efficacy with relatively low costs, although further studies are needed to improve the treatment guidelines for phlebotomy. Lippi G, Salvagno GL, Montagnana M, Franchini M, Guidi GC. Lima-Oliveira G, Lippi G, Salvagno GL, Montagnana M, Picheth G, Guidi GC. Insertion of needle (bevel up). Summarell CC, Sheehan VA. Use of hydroxyurea and phlebotomy in pediatric patients with hemoglobin sickle cell disease. The evaporation shortens the duration of this antiseptic effect, nonetheless this is enough to prevent the bacterial carryover due to the skin piercing (28). Immediately lie down on the patients flat and raise the legs. This procedure holds significant importance as it helps in the prognosis of many diseases. However, a volume of >2 units (>1 L) should be cleared by the requesting physician, and no more than 12 units should be removed during a 24-hour period. Phlebotomy, which dates back to the age of ancient Greece, has gained experience through the evolution of medicine becoming a fundamental diagnostic tool. Cubital fossa venipuncture sites based on anatomical variations and relationships of cutaneous veins and nerves. If the blood testing demands different additives, this system allows switching between multiple tubes without interrupting the blood withdrawal. The chance of its occurrence is 12.3%. Therapeutic phlebotomy: a review of diagnoses and treatment considerations. Phlebotomy is a technique in which a needle is temporarily inserted into a vein to provide venous access for venous blood sampling. The site is secure. These regulations emphasize patient education regarding intra- and post-phlebotomy symptoms and consent, and include training for staff regarding how to manage adverse effects and infections, how to reach the target blood vessel, venous phlebotomy techniques, patient safety, and basic cardiopulmonary resuscitation.35, Patient factors, such as age, sex, weight, comorbidities, overall health status, and the likelihood of compliance, should be considered when prescribing a phlebotomy regimen.8 Zubair8 has described various criteria for initiating therapeutic phlebotomy, which include ferritin levels of >200 ng/mL for ages of <18 years (regardless of sex), ferritin levels of >500 ng/mL for women who are not pregnant but are of childbearing age, and ferritin levels of >300 ng/mL for men who are >18 years old. We would finally advise that to effectively reduce contamination, the phlebotomists hands hygiene (washing and wearing gloves) is essential as much as the patients appropriate skin cleansing. In all those circumstances, the onset of pain is delayed respect to phlebotomy, and in some cases it can require a vascular surgery intervention (71, 72). In the past phlebotomy was essentially a therapeutic resource to cure many ailments, whereas nowadays it is the diagnostic basis which medicine relies on to approach most of the known diseases (1, 2). Collecting blood is the primary objective of venipuncture. Phlebotomy can be performed by nurses, medical laboratory scientists, medical practitioners, phlebotomists, dialysis technicians, and other staff. This is because phlebotomy teams typically make rounds at specific times in most hospital settings. Does the nerve heal after? Created by Ashyia20 Terms in this set (19) A phlebotomy technician should invert anticoagulant tubes to prevent which of the following complications? Not adequate pressure was applied after the venipuncture. Venipuncture is the intravenous suction of blood using a syringe. Certified phlebotomy technician 2. There are several complications resulting from VP such as pain and fear; hematoma; thrombosis, infection, nerve damage, arterial puncture, vasovagal reactions, and also rare events. The occurrence of VVR, which is one of the mostly feared complications follows a negative trend decreasing to a minimum in about one year (132). Topographic anatomy of the cubital fossa (cross-section at the elbow); vessels: CV) cephalic vein; RA) radial artery; BV) basilic vein; tendons: ) biceps brachii tendon; ) triceps brachii tendon); nerves: a) lateral antebrachial cutaneous nerve; b) medial antebrachial cutaneous nerve; c) median nerve; d) ulnar nerve; e) posterior lateral antebrachial nerve; f) radial nerve; muscles and bones: 1) brachioradialis; 2) brachialis; 3) pronator tenes; 4) trochlea (humerus); 5) olecranon (ulna); 6) anconeus. Share cases and questions with Physicians on Medscape consult. Thank you for uploading useful article. eLearning Program Information Page 1 of . Replacement fluids should also be prescribed for patients who cannot tolerate the rapid loss of plasma, and this prescription should clearly specify the type, amount, infusion rate, and infusion time (before, during, or after the procedure).

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