Lecture Notes: Key Points on Patient Preparation and Phlebotomy Procedures

Introduction

• Instructor is attending leadership training but available via email.
• Review of material aligned with the teal green review book.
• Emphasis on daily preparation for the upcoming national exam.

Patient Preparation

• Requisition Importance
  • Must have a requisition before approaching the patient.
  • Information includes fasting requirements, medications, and patient details.
  • Don't forget to fill out the requisition with fasting hours, signature, and date.
• Patient Identification
  • Introduce yourself and confirm patient identity with two identifiers:
    • Inpatients: wristband + verbal confirmation (DOB, SSN)
    • Outpatients: physical ID + verbal confirmation.
• Evaluate Patient Understanding
  • Assess patient’s level of understanding and cognitive state before drawing blood.
  • Do not proceed if patient appears confused or disoriented.
• Patient Education
  • Explain the procedure and potential complications (fainting, nausea, pain).
  • For first-time patients, detail the entire process.

Complications and Responses

• Complications to Monitor:
  • Excessive Bleeding: Apply pressure.
  • Severe Pain: Ice if it persists; otherwise, contact a physician.
  • Lack of Sensation: Check tourniquet duration; stop draw if persistent.
  • Excessive Bruising: Apply pressure if greater than 2x2 gauze size.
  • Infection: Signs include redness and pus; avoid drawing from infected areas.
  • Patient Feeling Unwell: Advise contacting a physician if nauseated.

Drawing Procedures

• Confirming Details: Ensure fasting status through open-ended questions.
• Site Selection: Check antecubital fossa first, regardless of patient age.
• Technique:
  • Use proper angles (15-30 degrees for venipuncture, 5-15 degrees for butterfly sets).
  • Avoid drawing from areas with complications (IV lines, scars, mastectomy side).
  • Use butterfly (winged infusion set) for small or fragile veins.

Consent Types

• Express Consent: Verbal or written consent.
• Informed Consent: Patient receives information and can ask questions.
• Implied Consent: Assumed in emergency scenarios or if the patient acts as if they consent.
• Refusal Consent: Document refusals appropriately.

Order of Draw

• Standard Order:
  • Yellow, Blue, Red, Green, Lavender, Gray.
  • Capillary (fingerstick) order: Lavender, Green, Red.

Special Considerations

• Antiseptics: Isopropyl alcohol is preferred; avoid others like hydrogen peroxide.
• Blood Cultures: Requires double cleaning with small concentric circles.
• Pediatric Considerations: Use smaller tubes and winged infusion sets for children; heel sticks for infants.
• Non-blood Specimen Collection: Use sterile containers, avoid contamination.

Quality Control

• Equipment Checks: Verify daily with external controls; check expiration dates.
• Chain of Custody: Essential for forensic testing, drug testing, and other legal cases.

Emergency Situations

• Syncope: Recognize signs and respond accordingly (head between legs, cold compress).
• CPR Protocol: For unresponsive patients without a pulse, initiate CPR immediately, using AED as soon as possible.

Regulatory Bodies

• OSHA: Worker safety and health standards.
• CDC: Disease prevention and public health education.
• HIPAA: Ensures confidentiality of patient information.

Conclusion

• Continuous assessment and communication with patients are critical to ensure safety and effectiveness during procedures.
• Review important terms and concepts regularly for exam preparation.