Hello Steemit users

Hope you all will be safe and sound. As a medical lab technologist i'am going to share toady about Order of the Draw.

Order of the Draw

1. Sterile/Blood cultures
2. Blue coagulation tube
3. Red
4. Other additives

• Green
• Lavender
• Gray

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Patient Identification

• It is vitally important that the phlebotomist correctly identifies the patient.
• Do not offer the patient a name to respond to.
• All hospitalized patients have an identification arm band with their name, hospital identification number and other pertinent information.
• Always compare the laboratory test request slip name and ID number with the name and ID number on the patient's hospital arm band.
• If there is any discrepancy, do not draw the patient's blood.
• For an out-patient, verify the patient's identity by having the patient give you additional identifying information such as a social security number, date of birth or address.

Preparation

• wash or disinfect his or her hands
• Identify patient
• Introduce yourself, state your mission
• "Have you ever had your blood drawn before?"
• If no, explain the procedure
• Choose the appropriate tubes for the tests requested Tourniquet Application
• Apply appro ximately 3-5 inches above antecubital fossa.
• If the skin appears blanched above and below the tourniquet it is too tight.
• If your finger can be inserted between the tourniquet and the patient's skin it is too loose.

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Palpate

• After tourniquet application have patient clench fist.
• Feel for a vein that rebounds (bounces) when pushed or tapped on.
• PALPATE any potential vein to help determine size, direction and depth. A slight rotation of the arm may help to better expose a vein that may otherwise be hidden.

Vein Selection

• Choose the veins that are large and accessible.
• Large veins that are not well anchored in tissue frequently roll, so if you choose one, be sure to secure it with the thumb of your nondominant hand when you penetrate it with the needle.
• Avoid bruised and scarred areas.

Can’t Feel the Vein?

Tricks to Help Distend Veins:

• Have the patient "pump" the hand 3 times.
• Don't overdue it because over-pumping can create hemoconcentration.
• Have the patient dangle arm below the heart level for 1-3 minutes.
• Warm the area with a hot pack or warm, moist cloth heated to approximately 42°C.
• If all else fails, consult another technician for their opinion and/or intervention.

Veins for Venipuncture

Veins used for drawing blood

1. Median cubital vein - first choice, well supported, least apt to roll
2. Cephalic vein - second choice
3. Basilic vein - third choice, often the most prominent vein, but it tends to roll easily and makes venipuncture difficult.

Source

Median Cubital – first choice

• This vein is located in the antecubital fossa. (the area of the arm in front of the elbow)
• Well anchored vein, usually large and prominent.
• Very few problems. Offering the best chance for a close to painless puncture, as there are few nerve endings close to this vein.

Cephalic Vein-Second Choice

• Cephalic vein which is located on the upper or shoulder side of the arm.
• This vein is usually well anchored.
• The cephalic vein may lie close to the surface. A low angle of needle insertion must be used to avoid possible spurting or blood forming a drop at the puncture site. (15°).

Basilic Vein-Third Choice

• Located on the underside of the arm.
• In many patients this vein may not be well anchored and will roll, making it difficult to access with the needle.
• Syringe draw should be considered as it gives the phlebotomist more control over a rolling vein. Pooling of blood and hematoma formation possible.
• The basilic vein is close to the brachial artery so there is more risk of hitting an artery. Exercise caution when drawing from this area. Additionally, this area is often more sensitive, thus a stick is slightly more painful for the patient.

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Cleansing the Site

• After selecting a vein, clean the puncture site with a cotton ball saturated with 70% isopropyl
  alcohol or prepackage alcohol swabs. Rub the alcohol swab in a circular motion moving outward from the site (concept of this technique is to prevent sterile site from contamination). Use enough pressure to remove all perspiration and dirt from the puncture site.
• Discreetly look at the swab when finished, if it appears excessively dirty repeat the cleansing process with a fresh alcohol swab. After cleansing do not touch the site, if the vein must be repalpated the area must be cleansed again. Some experts allow cleansing of the index finger before repalpating but this technique is debatable.