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Site Selection - Site problems
burns, tattos, scars they are hard to palpate and penetrate, impaired circulation, painful
Site problems - damaged veins
schlerosed or thrombosed - difficult to penetrate, impaired circulation, may yield bad lab results
Obseity site problems
veins too deep and difficult to palpate, tourn. may not fit, use blood pressure cuff.
What to do when drawing an obese patient
two creases in the anticubital area, may find median cubital vein there. may turn arm so hand is prone to find cephalic vein, cephalic vein is usually the vein of choice
IV therapy pts problems. NEVER DRAW ABOVE IV SITE BECAUSE:
blood sample may be contaminated with IV fluids (drugs) If not other site is available draw below IV site.
Follow facility protocol for drawing below an IV - 7 steps
Turn off IV for 2 min, tourn below IV (distal), choose site distal to IV, look for vein other than one with IV, Discard first 5 cc of blood (10 for coag tests), notify RN when done, document
VAD patient procedures
Only done by trained personnel, discard first 5cc of blood, do not draw from this for coag tests because lines are flushed with heparin
CVAD is used for what?
line in main artery or vein, flushed with heparin to prevent thrombosis, must discard first 5cc of blood to remove contamination, do not use for coag testing
Lavender tube tests (anything that has to do with counting blood cells & their characteristics)
CBC, WBC, RBC, Hemoglobin, Hematocit, Platelets, sed rate, Retic count, differential (slide made to look at cells)
Blue tube blood tests (anything that has to do with coagulation studies)
PT, PTT, d-dimer, DIC panel, Fibrinogen, Factor Assays
Green tube tests
STAT (cause blood does not clot so it can be processed quicker), electrolytes (sodium, potassium, chrloride, CO2), basic metobolic panel (BUN, creat, electrolytes, Ca) Ammonia (must be on ice)
MI Panel (heart attack) this is a stat test that will be done in a green tube, Lipid Panel , Liver panel, Nutrition, basal metabolic panel, comprehensive metablic panel, renal panel, electrolytes, diabetes, thyroid.
PST or green tubes are used for STAT testing because
it is ready for testing sooner. SST tubes you must waitfor it to clot before spinning in a centrifuge
Other common chemistry tests
amylase, lipase, ammonia (NH3), iron, enzymes, uric acid, drugs of abuse (ETOH), therapeutic drugs, hormones, tumor markers
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