NMED1117 The Functions of a Phlebotomist

1. Review section 7.1 and perform a search for information regarding unsuccessful venipuncture:
2. do a search for other related links

• google.com
• enter “failed venipuncture” or “unsuccessful venipuncture”
• choose a representative sample of documents that deal with the procedure for failed or unsuccessful venipuncture

1. ii) review any procedural documentation from your clinical site if available or another clinical site

2. Answer the following question (essay format):

“Describe how you would proceed from this point of the venipuncture procedure. Cite all references, including clinical reference site.

Answer:

One of the key functions pertaining to the functions of a phlebotomist, is the act requiring the retrieval of blood from the concerned patient (Lima-Oliveira et al., 2014). As opined by the Center for Disease Control and Prevention, almost one out of a group of three individuals is considered to be obese, with the likelihood that these statistics will increase to double the numbers in the future (Skinner & Skelton, 2014). The prevalence of obesity, often results in difficulty in the performance of drawing blood from the concerned patient, as outlined in the above study (Al-harosh & Shchukin, 2017). The following paragraphs of the essay, highlight the key steps which can be taken, in the management of a failed venipuncture pertaining to an obese client.

One of the key reasons pertaining to a failure in the process of drawing of blood, may be wrong positioning of the concerned needle, due to misconducts in needle insertion or an incidence of the absence of vacuum in the required tube. In such situations, the act is required to be repeated, by gentle removal of the needle following by its repositioning. The concerned phlebotomist, must not dig for the veins or harm the obese patient in the process. In the situation of suspected loss of vacuum in the concerned tube, additional or novel tubes may be utilized for careful repetition of the act (de Freitas Floriano et al., 2018).

In the situation of the concerned obese patient highlighted in the case study, the patient seems to possess veins which are deeply in the body, resulting in difficulty of the phlebotomist to locate and palpitate. In such situations, alternative techniques may be implemented, since further repositioning may lead to the destruction of red blood cells and the resultant release of factors concerning blood coagulation. Alternative methods like a finger stick may be used for the obese patient. This would involve sterilization of the concerned site topically, using disinfectants, followed by piercing with a sterile lancet. The blood so produced in the form of a large droplet, may then be collected with the aid of a capillary tube (Grebely et al., 2017).

In the likely event of a failed venipuncture as observed in the case of an obese patient, a tourniquet may be used, which is bandage based device, using principles of compression and constriction, in order to control, regulate and direct the flow of blood to the concerned area for the purpose of withdrawal. However, tourniquets have a reputation for causing considerable loss of comfort in the concerned patient and may not work if the patient is excessively obese. In such situations, alternative methods such as a blood pressure cuffs may be utilized, which have been reported to cause led discomfort in the patient (Balakrishnan et al., 2016).

However, in the light of failure pertaining to the withdrawal of blood despite utilization of the above methods, alternative methods may be used for the purpose of the same in the obese patient of the case study. This would involve usage of warm compression techniques. The concerned phlebotomist may use heat which can further aid in withdrawing of the blood, and lead to greater visibility of the required vein. If the blood withdrawal process of the concerned obese patient is rescheduled for another day, the phlebotomist may request him to wear warm clothes pertaining the purpose of the same (Drew, Bennett & Littlejohn, 2015).

Often the key reasons pertaining to the failure to withdraw blood during venipuncture of an obese patient, is wrong positioning. In such situations, the concerned patient in the case study, may be instructed to completely extend the arms, which aids in repositioning of the veins to arrive in close proximity to the skin. Further methods would involve requesting the patient to relax and clarifying which positions have been used, if the patient has engaged in blood withdrawal in the recent past (Jung et al., 2018).

Hence, to conclude, the occurrences of failed venipuncture is not uncommon during the act of withdrawal of blood in an obese patient. With respect to the obese patient highlighted in the case study, a number of alternative methods may be used by the concerned phlebotomist, based upon the level of comfort experienced by the patient. However, irrespective of the type of method used in the event of a failed venipuncture, it of utmost importance for the phlebotomist to utilize gentleness in repositioning of the needles, in order to avoid potential bleeding and harm to the concerned patient.

References

Al-harosh, M. B., & Shchukin, S. I. (2017). Peripheral vein detection using electrical impedance method. Journal of Electrical Bioimpedance, 8(1), 79-83.

Balakrishnan, V., Wilson, J., Taggart, B., Cipolla, J., & Jeanmonod, R. (2016). Impact of phlebotomy tourniquet use on blood lactate levels in acutely ill patients. Canadian Journal of Emergency Medicine, 18(5), 358-362.

de Freitas Floriano, C. M., Avelar, A. F. M., & Peterlini, M. A. S. (2018). Difficulties Related to Peripheral Intravenous Access in Children in an Emergency Room. Journal of Infusion Nursing, 41(1), 66-72.

Drew, B., Bennett, B. L., & Littlejohn, L. (2015). Application of current hemorrhage control techniques for backcountry care: part one, tourniquets and hemorrhage control adjuncts. Wilderness & environmental medicine, 26(2), 236-245.

Grebely, J., Lamoury, F. M., Hajarizadeh, B., Mowat, Y., Marshall, A. D., Bajis, S., ... & Gorton, C. (2017). Evaluation of the Xpert HCV Viral Load point-of-care assay from venepuncture-collected and finger-stick capillary whole-blood samples: a cohort study. The lancet Gastroenterology & hepatology, 2(7), 514-520.

Jung, D. E., Lee, H. C., Yoon, H. K., & Park, H. P. (2018). The effects of ipsilateral tilt position on right subclavian venous catheterization: study protocol for a prospective randomized trial. Trials, 19(1), 292.

Lima-Oliveira, G., Lippi, G., Salvagno, G. L., Picheth, G., & Guidi, G. C. (2014). Phlebotomist labelling primary blood tubes for clinical laboratory tests: an important step to medical diagnostics. Journal of Medical Diagnostic Methods, 3, e111.

Skinner, A. C., & Skelton, J. A. (2014). Prevalence and trends in obesity and severe obesity among children in the United States, 1999-2012. JAMA pediatrics, 168(6), 561-566.