requisitions and computerized or addressograph labels for patient 2% Chlorexidine with 70% alcohol wipes (CHG/alcohol)

Transcription

1 PURPOSE Prcedure fr btaining a peripheral bld sample via venipuncture. POLICY STATEMENTS Bld sampling requires a prescriber s rder indicating bld samples t be drawn. The chice f site and prcedure (venepuncture, finger-prick r heel-prick) will depend n the vlume f bld needed fr the prcedure and the type f labratry test t be dne. Patient immbilizatin is crucial t the safety f the pediatric and nenatal patient underging capillary r peripheral bld sampling, and t the success f the prcedure. A helper is essential fr prperly immbilizing the patient fr the prcedure. SITE APPLICABILITY Sunny Hill Health Centre fr Children. PRACTICE LEVEL/COMPETENCIES In rder t perfrm peripheral bld sampling via venipuncture, the Registered Nurse must demnstrate knwledge and understanding f: relevant anatmy and physilgy (vasculature) infectin cntrl prcedures (Rutine infectin cntrl practices) health and safety (Bld and Bdy Fluid Expsure Cntrl Plan) cmmunicatin and infrmed cnsent the prcedure: chice f vein btaining samples cllectin devices cmpleting the prcedure handling, labelling and transprting specimens Relevant cmpetencies develped thrugh educatin, preceptrship and clinical practice. EQUIPMENT requisitins and cmputerized r addressgraph labels fr patient 2% Chlrexidine with 70% alchl wipes (CHG/alchl) NOTE: if ding newbrn screening, nly use 70% alchl wipes fr cleansing skin prir t cllectin (ther disinfectants may interfere with screening analysis) glves (Use nn sterile glves unless patient is immuncmprmised r if drawing bld cultures, then use sterile glves) apprpriate winged bld cllectin set r winged infusin set needle (butterfly) (23 r 25 Gauge) and vacutainer hlder r syringe(s) apprpriate vacutainers (bld tubes) r syringes bld gas syringe if needed bld transfer device if syringe used fr cllectin turniquet band aid if needed ice pack if needed - Ice pack may be required because sme tests require that bld specimens be cled immediately after cllectin t slw dwn metablic prcesses which may alter test results (e.g. glucse). PROCEDURE 1. DETERMINE if lcal anesthetic cream applicatin is apprpriate and apply if needed. Ratinale Tpical anesthetic cream must be applied fr a specific time perid in rder t be effective CC BC Children s Hspital Child & Yuth Health Plicy and Prcedure Manual Page 1 f 5

2 2. REFER t Bldwrk Test and Tubes quick reference guide r the Department f Pathlgy elab Handbk t determine apprpriate bld tubes and vlumes and any special handling instructins. Fr bld culture instructins, REFER t Bld Culture Cllectin Prtcl and recmmended bld vlumes fr bld cultures chart t determine type f bttles and ptimal vlume f bld t add t each bttle. 3. IDENTIFY patient by cmparing patient name, birthdate (DOB), and MRN n requisitin and labels t patient identiband. Reslve any demgraphic discrepancies prir t cllectin. When pssible, ask patient/family fr name and DOB. Facilitates cmpletin f task in timely manner. Failure t crrectly identify patients prir t prcedures may result in errrs. 4. EXPLAIN prcedure t patient/family. Evaluates and reinfrces understanding f previusly taught infrmatin and cnfirms cnsent fr prcedure. 5. WARM the site prir t puncture if necessary. Warming will increase bld flw in the area apprximately seven fld. Primarily arterial flw ver venus is increased in the capillaries when the area is warmed. 6. PERFORM hand hygiene and PREPARE Rutine infectin cntrl practices; reduces equipment using aseptic technique. transmissin f micrrganisms. 7. POSITION patient cmfrtably and restrain as necessary. See Psitining fr Cmfrt pster fr examples f psitining fr prcedures. OBTAIN help f secnd nurse as needed. Lessens chance f patient mving during insertin prcedure, which might lead t venus perfratin. 8. GLOVE. Prtects clinician frm ptential bld expsure. 9. APPLY turniquet abut 2" abve site and LOCATE apprpriate vein fr venipuncture: Turniquet prmtes venus distentin by bstructing venus return. palpate and trace path f veins several times with finger The vein selected shuld be large, readily accessible, and sufficiently clse t the surface t be palpated. avid arteries: pulsatile, mre elastic and thicker walls avid thrmbsed veins: lack resilience, rll easily d nt allw the turniquet t remain in place fr mre than 1 minute NOTE: d nt apply turniquet if drawing bld fr lactate, ammnia r CPK. 10. CLEANSE venipuncture site with CHG/alchl wipe using frictin fr secnds and ALLOW t air dry. 11. PERFORM venipuncture: STABILIZE selected vein using the nndminant hand t gently stretch the skin belw the intended puncture site PENETRATE skin at a degree angle Decreases risk f infectin. Skin cntact with chlrhexidine/alchl shuld be fr secnds t achieve maximum antiseptic effectiveness. Air drying is essential t increase efficacy f chlrhexidine. Facilitates smther needle entry. CC BC Children s Hspital Child & Yuth Health Plicy and Prcedure Manual Page 2 f 5

3 with the bevel facing up ADVANCE needle int the vein RELEASE wings r lightly hld wing t keep the needle in place while drawing bld NOTE: Venipuncture may be attempted twice by ne individual. After a secnd unsuccessful attempt a clleague with the relevant cmpetencies shuld be asked t attempt a third venipuncture. If the 3rd venipuncture is unsuccessful, cntact the physician. 12. COLLECT bld by inserting bld cllectin tubes int vacutainer hlder in the fllwing rder: 1. bld cultures 2. Na Citrate blue tp (cagulatin studies) 3. red tp 4. heparin green tp (chemistries) 5. EDTA tube lavender tp (hematlgy, transfusin medicine) 6. grey tp 7. all ther REMOVE each tube when desired vlume is cllected. ensure patient's hand is pen ensure patient is nt "pumping" their hand OR cllect bld by aspirating int syringe and transfer bld int tubes using a bld transfer device. NOTE: if drawing bld gases, attach bld gas syringe t tubing and aspirate desired amunt f bld befre cllecting ther specimens. 13. MIX each tube immediately after drawing bld int it. Gently invert each tube 10 times. 14. REMOVE turniquet when the cllectin is almst finished r when the bld flw is gd. 15. ACTIVATE safety feature and then REMOVE needle. PLACE a gauze pad ver puncture site and APPLY pressure fr at least 1 minute until bleeding has stpped. 16. APPLY band aid r gauze with tape t puncture site. ADVISE patient/caregiver t keep bandage n fr at least 15 minutes. 17. LABEL specimen tubes at the patient's bedside. Label must include MRN, first and last name, date f birth, date and time sample drawn and RN initials. May use cmputerized r addressgraph labels if available except fr Grup and Screen and Crssmatch.* NOTE : *Grup & Screen and Crssmatch cllectin prcedure: Natinal Standards fr safe transfusin practice require Patient's hand shuld be pen and nt pumping t reduce the amunt f venus pressure as muscles relax. When using a winged bld cllectin set fr venipuncture and a cagulatin (citrate) tube is the first specimen tube t be drawn, a discard tube is t be drawn first. The discard tube must be used t fill the bld cllectin set tubing s dead space with bld but the discard tube des nt need t be cmpletely filled. This imprtant step will ensure maintenance f the prper bld-t-additive rati f the bld specimen. The discard tube shuld be a nnadditive r a cagulatin tube. Ensures the bld cells are mixed with additives in the tubes. Reduces bleeding when the needle is withdrawn. Activating the safety feature befre needle remval decreases risk f needlestick injury. The gauze is applied t stp bleeding and prevent infectin. Pressure is required t help prevent bruising. Ensures crrect labeling f specimens and requisitins. CC BC Children s Hspital Child & Yuth Health Plicy and Prcedure Manual Page 3 f 5

4 specimen labeling at the bedside Cnfirm patient identificatin - name, DOB, MRN n patient ID band matches with the requisitin. Reslve any discrepancies prir t cllectin. When pssible, ask patient his/her name and DOB. Specimen MUST be hand labelled at bedside nly by the persn wh cllected the specimen. Cmputer generated labels are nt t be used. Label must cntain patient name, DOB, MRN, date and time f cllectin and RN initials. Sign requisitin and recrd date and time f cllectin. Nte: signing requisitin cnfirms yu have crrectly identified the patient. 18. COMPLETE apprpriate labratry requisitins indicating the site where bld sample was btained, RN initials, and date and time. On the transfusin medicine requisitin: sign, date and time the requisitin in the apprpriate space. Yur signature MUST include full last name, and first name r first initial. Persn wh cllects sample must be the persn wh signs the requisitin. NOTE : Fr bld cultures, indicate patient's weight n requisitin. 19. REMOVE equipment and DISPOSE apprpriately. Rutine infectin cntrl practices; reduces 20. PLACE specimens inside transprt bags and seal. transmissin f micrrganisms. PLACE requisitin in utside pcket, REMOVE glves, PERFORM hand hygiene and ARRANGE fr transprt f specimen(s) t lab. NOTE: fr specimen transfers frm Sunnyhill Health Centre fr Children, transprt t the lab is dne by taxi. Fr instructins n arranging transfer, see appendix B. DOCUMENTATION DOCUMENT n apprpriate recrd(s): prcedure and time venipuncture site used site cnditin befre and after insertin needle type, gauge and length number f attempts and by whm samples drawn patient cmments r hw patient tlerated prcedure any ther pertinent actins r bservatins REFERENCES Appld, K. (2009). Slving Phlebtmy Prblems. Cntinuing Educatin Tpics & Issues BC Children's Hspital MLA Phlebtmy: Venipuncture Plicy and Prcedure. Draft versin 1.16, December 5, Vancuver. Authr. CC BC Children s Hspital Child & Yuth Health Plicy and Prcedure Manual Page 4 f 5

5 Bishp, T. (2009). Venepuncture. Practice Nurse. 37(12): Huff, L., Hamlin, A., Wlski, D., McClure, T., Eliades, A.B., Weaver, L.and Shelestak, D. (2009). Atraumatic care: EMLA cream and applicatin f heat t facilitate peripheral venus cannulatin in children. Issues in Cmprehensive Pediatric Nursing. 32(2): CLSI (frmerly NCCLS) Prcedures fr the Cllectin f Diagnstic Bld Specimens by Venipuncture; Apprved Standard Sixth Editin, CLSI Dcument H3-A6, Vl. 27 N. 26. Wayne, PA: Clinical and Labratry Standards Institute; WHO Guidelines n Drawing Bld. Best Practices in Phlebtmy, Chapter 6: Pediatric and nenatal bld sampling. CC BC Children s Hspital Child & Yuth Health Plicy and Prcedure Manual Page 5 f 5