osteomyelitis
if a bone is punctured you can cause a bone infection which requires long term IV therapy
vein occlusion
chemotherapy and IV drug abuse can block the veins
hematoma
blood that has seeped into the tissue makes a blood tumor (lump). can occur because the bevel is not completely (partially) in the vein or the needle has gone through the vein. stop the procedure immediately and apply pressure to the site
syncope
cold, damp, clammy skin, dizziness, black dots in the vision, hearing becomes distant, fainting is the end result. this patient should be lying down when blood is drawn.
syncope first aid
remove tourniquet, needle, lay patient down, apply a cool compress
hemoconcentration
can occur when a tourniquet is left on too long because the cells cannot pass the area but the fluid can. This would cause incorrect readings especially for Hct.
petechiae
small pinpoint bruises causes by a too tight tourniquet resulting from ruptured capillaries
collapsed veins
if the syringe is drawn too quickly or the vacuum is to strong for a small vein
hemolysis
rupture of red blood cells causing a release of hemoglobin and pink tinged serum. test results will be grossly incorrect
increased swelling and hematoma
if tourniquet is left on after removal of the needle, not enough pressure to the site after needle removal, or heat is applied immediately after phlebotomy
mastectomy
never use this side of the body for phlebotomy because there can be lymphostatis or decreased lymph flow due to removal of the lymph nodes. venipuncture here would increase the potential for infection and alter the chemical composition of the blood which
thrombosis
a solid mass derived from blood constituents (clot) that would occlude (clog) the vessel
edema
an abnormal accumulation of fluids in the intercellular spaces causing puffiness of the tissue which would make it difficult to palpate (feel) the veins
neurologic complications
a sharp tingling sensation. It is more likely if venipuncture is done over the basilic vein because the brachial nerve lies beneath
obesity
veins are difficult to visualize and palpate because the patient has so much adipose (fat) tissue
failure to draw
Occurs when the needle is not deep enough or is too deep, no vacuum in the tube, the needle bevel is against the vein wall, sclerosed veins
damaged, sclerosed or occluded veins
blood does not flow well through these veins. They are scarred and feel hard on palpation. this can happen to chemotherapy patients and IV drug abusers. Though you can feel the veins they are usually so damaged that you can't get a needle into the middle
petechia
Small red spots can occur if the tourniquet is too tight or the patient has a coagulation abnormality.
burned or scarred areas
Difficult to palpate (feel), may be sensitive, more susceptible to infection
sclerosis
scarred, hardened, and stiff veins that feel cord-like and is caused by extensive IV and drug use and elderly
*use another vein for venipuncture if possible
phlebitis
inflammation of a vein as a result of repeated venipuncture on that vein
thrombophlebitis
inflammation of a vein with formation of a clot
septicemia
systemic infection associated with the presence of pathogenic organism introduced during venipuncture
usually because the area wasn't cleaned properly
hemolysis
breaking of RBC's membrane which releases free hemoglobin into the circulating blood
Usually a result of mechanical damage due to poor technique
What can cause specimen contamination and hemolysis during capillary collections?
excessive milking of the finger- contaminates the specimen with skin and tissue cells
How can a hematoma be prevented after collection?
After the needle is removed, apply appropriate pressure to venipuncture site until the bleeding stops
*never have patient bend the arm
Which of the following personal protection equipment (PPE) must a phlebotomist use when performing a skin puncture or venipuncture?
Gloves
Most tubes containing additives should be inverted how many times?
5-8
How many inches above the site should a tourniquet be placed?
2-4