Developing Phlebotomy Skills - Essay Example

Running head: developing phlebotomy skills 23rd August Introduction Venepuncture procedure entails the process of getting the intravenous access with the objective of blood sampling or for intravenous therapy. Being performed by dialysis technicians, medical practitioners, paramedics, and medical laboratory scientists among other professionals in the medical sector, venepuncture process has become one of the most used invasive health procedures. The procedure is undertaken for five key reasons. First, the medical professionals perform it in order to obtain blood that is used during the diagnostic process. The second reason is to administer medications, chemotherapy and nutrition among other elements. Thirdly, is to monitor blood levels during the treatment process. Fourthly, the medical practitioners performs the procedure in order to collect blood that is used later by the doctors during the transfusion process for example incases of accidents or a patient is need of more blood. Fifthly, the process is undertaken in order to remove blood in cases of excess red blood cells or iron. This paper seeks to discuss some of the major issues that relates to venepuncture procedure including the reactions that may occur, butterfly system and the complications associated with taking blood from a patients feet. 4 reactions that can occur during venepuncture procedure Vasovagal attack One of the major reactions that may occur during venepuncture procedure is vasovagal attack which is also referred to as vasovagal response. It is worth to note that during the process especially when an individual is undergoing phlebotomy, which means removal of the blood, some individuals experience extreme anxiety when they are being stuck with a needle. While other may hold their breaths, others may experience severe neurological response due to the fear. These responses may ultimately result to vasovagal reaction that is indicated by extreme sweating, reduced blood pressure, and fainting. During fainting response, the patient’s blood vessels dilate resulting to reduction of blood pressure and accumulation of blood in the lower part of the body (Vissers et al. 2008). Another key risk that may come up due to fainting is that the patient may sustain a fall that may result to head trauma or even a broken bone. Similarly, the fainting may some times cause fluids to enter the lungs resulting to respiratory problems especially pneumonia. According to Center for Phlebotomy Education, 2.5% of the patients that are involved in blood collection process pass out. Additionally, the center indicates that first time blood donors whose weight range between 110 to 140 pounds, they are more likely to experience vasovagal reaction. The medical practitioners are therefore advised to be prepared during the phlebotomy. For example, if they anticipate loss of consciousness during the process, they should ensure that every patient they handle is lying down or seated in a chair that is supported. Likewise, the doctors should ask the patient if they had experienced adverse reaction in the past as well as their history of passing out. In this way, they will have the ability to undertake the process without facing the challenge of vasovagal attack. Hemolysis Apart from vasovagal reaction, hemolysis is another major reaction that may occur during the venepuncture procedure. Hemolysis means the rupturing of red blood cells making their contents to be released into the fluids for example the blood plasma. In vitro hemolysis is the one that happens outside the body while the one that occurs inside the body is known as in vivo. In vitro hemolysis is mostly caused by contamination, and incorrect needle size. One of the key aspects that can cause the smashing of red blood cells is excessive suction in the hypodermic needle due to physical forces or turbulence. Similarly, if a patient collapses or it becomes difficult to find a vein, hemolysis is also like to occur (Antonopoulou and Giamarellos, 2011). One of the major implications of hemolysis is that laboratory test results may be inaccurate based on the contamination of the plasma by the hemolyzed red blood cells. For example, the hemolyzed blood has high level of potassium that makes biochemistry result to provide unreliable results. Use of poor handling of blood for example exposing it to extreme cold or heat during phlebotomy or in the blood bank, may result into in vitro hemolysis. In order to prevent hemolysis, nurses and other professionals are advised to use proper techniques of handling bloods. Infection and inflammation complication Infection and inflammation complication is another reaction that is likely to occur during the venepuncture process. According to the United States National Library of Medicine, any time when a skin is broken for example during the treatment process, there is a risk of infection. Even though it is not very common during venepuncture, cellulitis which means skin infection or inflammation has a high possibility of occurring during giving of fluids as compared to when drawing the blood. Despite the sustainable medical development that has ensured minimal death during the venepuncture procedure, cases of phlebitis are still common in some hospitals. Phlebitis refers to the inflammation of a vein (Guerra et al, 2002). However, most doctors have attained the ability of dealing with phlebitis once it occurs on their patients. Another serious complication that may occur during the process is sepsis. This refers to a serious infection in the blood especially for the patients whose immune system is compromised. Such individuals includes the old people, patients who are experiencing disorders in their immune system as well as the people who aim at suppressing their immune system by use of drugs. Some of the notable symptoms of sepsis include flushed skin, hyperventilation, high fevers, low blood pressure, increased heart rate, swelling, and alteration of mental status. Two ways of treating the sepsis condition includes use of antibiotics and intravenous fluids. In cases where the replacement of the fluid is not adequate to achieve appropriate blood pressure, providers of health care services can use vasopressors. As indicated by United States National Library of Medicine, doctors and medical practitioners should ensure that before venepuncture procedure is undertaken and pricking the skin is, the site should be well cleaned. Bleeding complications Excessive bleeding is another possible complication that may arise during the venepuncture procedure. According to the medical center in the University of Maryland, there are some cases after venepuncture where a patient will breed longer than in normal cases. Bleeding complications are mostly found in the people who experiences particular condition for example hemophilia. Other individuals who have high risk of experiencing excessive bleeding includes those who are taking blood thinners as well as aspirin among other drugs. While other may bleed profusely, other patients tend to develop hematoma under their skin. Hematoma refers to the accumulation of blood outside the blood vessels (Sharp and Mohammad, 1998). One of the key ways through which hematoma may occur is during when a heparin, is provided through the intramuscular route. Mostly hematoma slowly dissolves however in some cases they may indicate no change or continue to grow. For instance, a person who gets an injury on his or her thumb may experience hematoma that may cover one of the fingers within duration of one week. Notable effect of hematomas in the cases they are slow absorbed is that they can make blood cells that are broken as well as the hemoglobin pigment to be deposited in the connective tissue thus making the customer to experience more pain. Question 2: Butterfly system During the venepuncture process, phlebotomist can use various methods. The two major includes the Vacutainer system and butterfly system. The butterfly system entails the process of using a butterfly set, a specialized device that is used in performing the venepuncture. The set consists of 2 flexible wings, from front to rear, hypodermic needle, transparent tubing that measures 20 to 35 cm, and a connector. It is vital to note that skin punctures as well as phlebotomy among young infants are processes that require to be performed by trained phlebotomist especially on how to collect blood and deal with pediatric patient. In order to be successful in collecting blood specimen from pediatric patients, it is imperative for an individual to have adequate skills in the filed of phlebotomy. Additionally, one should be able to follow the laid down instruction especially when assembling the equipment that are used in the process. Besides being an expert, one should be knowledgeable about the psychological development of a pediatric as well as the use of proper interpersonal skills. In this way, he or she will be in a position to create a strong positive relationship with his or her patient, an aspect that will make the patient to trust the professional. Butterfly system is mostly used on young children who have fragile veins or being thin. The two main supplies that are required in the butterfly system include the butterfly wingset and the syringe. The first major reason as to why the use of butterfly system is recommended is that it provides an opportunity of precise placement. This is made possible since the needle is closely grasped once the butterfly is held by its wings between the index finger and the thumb. Based on the unique design that is used in the butterfly set, it is possible to insert the needle at a shallow angle. The second advantage of butterfly system is that since the transparent tubing is flexible in nature, it is possible for it to reach more body surface as well as tolerating more movement from the patient. The third advantage is that the system can be used in special cases where other methods cannot be applied. For example, the winged set can be applied in the cases that indicates fragile veins, patient who expects tremors as well as uncontrolled movement, and in PAXgene tube collections. This implies that the system is able to handle quite a number of challenges that are experienced by the phlebotomist during their duties. For any venepuncture procedure to be successful while using the butterfly system, it is mandatory for the person undertaking it to be aware of how the system works. Some of the information that should be included in the blood collection form includes patient names, medical record number, date of birth, and race and sex. Once the information is put in the laboratory information system, a label that is referred to as LIS order number is generated. LIS order number is the one that is used by the phlebotomist to identify the patient. It is the duty of the medical practitioner undertaking the procedure to ensure that the information provided by the parents or the guardian are true. Some of the basic roles that the phlebotomist should undertake after receiving the LIS number include using the venipuncture site selection guidelines to come up with the best site for the venipuncture procedure and determining the appropriate sample size. Once the patient is identified which is the first step, the phlebotomist will need to assemble the materials needed at the patient’s bedside and this becomes the second step. During the assembling of the equipments used in the butterfly equipment, it is essential for the users to follow strictly the laid down instructions. For example, the phlebotomist must first wash his or her hands with soap and water. Alternatively, Microsan® can be used. This is followed by wearing a new pair of gloves which must not be reused. The next step is to remove the adapter from the butterfly set, breaking the seal of the syringe, attaching the syringe to the butterfly set at the adapter and finally selecting the microcontainers that the medical personnel need during the procedure. Key equipment used includes tourniquet, butterfly needle, cotton balls, tape, disposable vacutainer holder, alcohol prep pads, appropriate vacutainer tubes, lab requisition, LIS labels, and sharp disposal container. The third step is to ensure total immobilization of the site. This entails providing support to the patient for example by ensuring that it he or she is a child he is held by the parent or the guardian for the venipuncture to be effective. During this step, the medical personnel should provide praise for bravely as a way of motivating the patient. The fourth step is to apply the tourniquet. This should be secured in a tight manner to ensure effective palpation of the vein. The fourth step is to clean the venipuncture site in a circular manner using alcohol. The fifth stage is to allow the area to dry. While in this stage, it is appropriate for the phlebotomist to explain to the patient that it will hurt but not for a long time. In this way, the patient will trust the phlebotomist. The sixth step is to anchor the vein and insert the needle. The butterfly needle should be properly rotated to ensure the bevel is up. The seventh step is to collect the proper amount of blood and then releasing the tourniquet. The seventh stage is to put the specimen in the microcollection tubes. During this stage, the winged infusion set should be removed from the syringe. The eighth stage is to apply pressure after withdrawing the needle. For a child, it is important that before leaving the room, the venipuncture has stopped bleeding since small infants cannot apply significant amount of pressure. The final stages includes careful disposal of the needle, checking the site to ensure that the bleeding has stopped, application of gauge bandage, cleaning up of the supplies used in the process and finally labeling of the tubes. Question 4: Reasons and complications of taking blood sample from hands or feet of a patient It is essential to note that in normal cases blood samples are taken from arms. Mostly, the phlebotomist uses the median cubital vein based on its significant size as compared to other veins. Being an anchored vein, median cubital reduces the possibility of feeling pain among the patients. Other veins that are used if the median cubital is damaged or it is not felt are cephalic and basilica veins. However, the basilica vein is the last option while cephalic vein is the second option. In some cases, phlebotomist may be required to take blood samples from hands or the feet of the patient. One of the notable reasons as to why this can be necessary is when none of the veins found within the antecubital fossa area is felt. Additionally, due to an injury or intravenous placement in antecubital fossa, the phlebotomist may use the hand veins. Even though the hand veins are close to the surface, they are prone to rolling and constant movements making it to be painful for the patient. In order to ensure effective drawing of the blood while using hand veins, phlebotomist are advised to anchor the veins using their own hands and holding the veins at their places during the blood drawing process. Even though the phlebotomist is at liberty to use the hand veins, feet and ankles veins are not allowed to be used without the approval of a physician. This is based on the fact that such veins are not easily located and the potential of blood clot is very high. Complications associated with taking blood from a patients feet Thrombophlebitis One of the key complications that arise if feet veins are punctured is Thrombophlebitis. This entails inflammation of the veins. Notable symptoms that are indicated by individuals with Thrombophlebitis include pain in the affected parts, cord like veins, skin redness, and swelling of the ankles and foot. Some of the major risk factors that cause the complication include an injury on the vein, regular blood clotting, and reduced flow of blood in the veins. Even though travelling for a long duration of time in airplane or cars, can result into Thrombophlebitis, is specifically caused by superficial thrombophlebitis which entails damages of the skin surface and veins that are located in the feet. Similarly, any damage of the larger veins that are located in the feet, a situation referred to as deep venous thrombosis is also a major disorder that is associated with Thrombophlebitis. During the diagnosis of the Thrombophlebitis condition, the medical practitioners make frequent checks on various aspects such as skin condition, pulse, temperatures, and blood pressure. In this way, the medical personnel are in a position to notice the reaction of their patients during the treatment process. Key methods that are used as the way of treatment include medications such as thrombolytics, analgesics, and anticoagulant among others. Once a patient experiences Thrombophlebitis, medical professionals can advise them on various issues. For example, they are informed to reduce the pressure in the affected areas thus decreasing the possibility of further damage. Additionally, the patient can under surgical removal of affected vein can be undertaken in some cases even though the surgery it is rarely needed. Coagulation Related to Thrombophlebitis, Coagulation is another complication that is a complication associated with taking blood from a patients feet. This refers to a situation where the patient blood changes into a gel. Some of the notable activities that are involved in coagulation include adhesion, accumulation of platelets, and fibrin maturation. In case a vein is damaged, coagulation begins immediately resulting to more complications especially when blood is being drowned. Major problems that emerge from coagulation include thrombosis, and hemorrhage among others. Notable factor disorders for coagulation are the hemophilias that includes the three types namely hemophilia A, hemophilia B, and hemophilia C. While hemophilia A and B are more likely to occur, hemophilia C is rarer. Based on the scientific developments that have happened in the 20th century, a number of biochemical factors were largely invented. These include factor VII, factor V, factor VI, and factor VIII among others. Based on the problems that may occur that may occur due to the blood clotting in the case a vein is damaged, the number of deaths is likely to occur. Based on the extensive research in the developed countries, the problem of blood clotting has now been effectively addressed once a patient seeks medical attention in a timely manner. On their part, the medical professionals under the regulations in the filed have counteracted such complication by not allowing getting bloods from the feet of the patients. Tissue necrosis in diabetics Tissue necrosis is another complication that if not addressed, it can easily lead to death. The complication which entails dying of large number of body tissues occurs once in the case a person with chronic health problem experiences an injury or an infection. For example, if in the process of drawing blood for the feet an internal injury occurs on the vein, possibly resulting to affecting the blood circulation, there may be occurrence of disruption in the cell membranes. There are five major distinctive types on necrosis. The first one is coagulative necrosis. This entails the formation of gel-like substances in the cells that have died. One of the major causes of coagulative necrosis is protein denaturation. Some of the major areas that coagulative necrosis can affect includes adrenal glands, kidney and the heart. The second type is the colliquative necrosis. This entails digestion of the cells that have died resulting to a mass liquid which is viscous in nature. The third type of necrosis that can affect the diabetics is the fat necrosis. Fat necrosis affects tissues that have fat components for example the pancreas. Based on its cause, each type of necrosis has different type of treatment. Notable ways of treating this complication includes debridement, which means the removal of the tissue that is dead, taking antibiotics, and discontinuing the use of bases or pharmaceutical drugs that react with the body tissues. Conclusion Based on the above discussion, it is clear that during venepuncture process, there are major reactions that may occur thus causing more problems to the patient. These include vasovagal attack, hemolysis, infection and inflammation complications, and bleeding complications. This implies that medical professionals undertaking the venepuncture procedure must ensure that they cautiously undertake maximum care to avoid such reactions. Being one of the methods of undertaking venepuncture procedure, Butterfly system has three major advantages which includes precise placement, it is possible for it to reach more body surface due to the fact that transparent tubing is flexible in nature, and lastly it can be utilized in special cases where other methods cannot be applied. Complications associated with taking blood from a patient’s feet include Thrombophlebitis, Coagulation, and Tissue necrosis in diabetics. To deal with such problems and attain a successful venepuncture, it is essential for extensive training of medical personnel to undertake the process. References Antonopoulou, A and Giamarellos EJ. 2011. Immunomodulation in sepsis: state of the art and future perspective. Immunotherapy 3 (1): 117–28. Guerra MJ, Vaz MJ, and Silva O. 2002. Adverse reactions of blood donation. Servir. 2002; 50:232–5. [PubMed]. Sharp MK and Mohammad SF. 1998. Scaling of hemolysis in needles and catheters. Ann Biomed Eng 24 (5): 88–97. Vissers D, et al. 2008.Fainting and hemolysis during blood sampling in youngsters: prevalence study. Int J Nurs Stud. 2008 May: 45 (4):60-64. Read More