Chapter 8 Lesson Plan - Lippincott Williams &...

Phlebotomy Essentials (6e)

Lesson Plan

Chapter 8 — Venipuncture Procedures

Goals of the Lesson:

Cognitive: Students will be able to perform venipuncture on a variety of patients, including infants and children, elders, and incapacitated patients. They will be able to perform venipuncture using ETS, butterfly, and syringe procedures.Motor: Students will be able to accurately review and accession test requests; approach, identify, and prep patients; collect specimens; and label and transport specimens.Affective: Students will understand the importance of interaction with the patient and will be able to assess and have an approach for handling difficult situations and patients.

Learning Objectives. The lesson plan for each objective starts on the page shown below:

Objective 8-1: Demonstrate knowledge of each venipuncture step from the time the test request is received until the specimen is delivered to the lab, and define associated terminology........................................................................................................8-2Objective 8-2: Describe how to perform a venipuncture using ETS, syringe, or butterfly, list required patient and specimen identification information, describe how to handle patient ID discrepancies, and state the acceptable reasons for inability to collect a specimen......................................................................................................................................................................8-7Objective 8-3: Identify challenges and unique aspects associated with collecting specimens from pediatric and geriatric patients.....................................................................................................................................................................................8-16Objective 8-4: Describe why a patient would require dialysis and how it is performed, and exhibit an awareness of the type of care provided for long-term care, home care, and hospice patients.........................................................................................8-16

You Will Need:

Suggested list of classroom materials and teaching aids for Chapter 8:8-2 Computer and manual requisition forms8-3 Simulated physicians’ lab orders 8-4 Sample requisition; simulated ID bands

Specimen collection equipment; tourniquets; venipuncture equipment; vein-locating device; artificial arm; Venipuncture Procedure Evaluation form; Transfer Device Procedure Evaluation formCLSI Document: Accuracy in Patient and Sample Identification [CLSI GP33-A] Wayne, PA

Page 8-1© 2016 Wolters Kluwer. All rights reserved.

Key Terms

accessionanchorarm/wrist bandASAPbar codebedside mannerDNR/DNAREMLAfastinghospiceID band/braceletID cardMR numberneedle phobianeedle sheathNPOpalpatepatencypatient IDpreop/postoprefluxrequisitionstat

Phlebotomy Essentials (6e)Chapter 8 — Venipuncture Procedures

CLSI Document: Procedures for the Collection of Diagnostic Blood Specimens by Venipuncture; Approved Standard, 6th Edition [CLSI H3-A6] Wayne, PA



Objective 8-1a: Demonstrate knowledge of each venipuncture step from the time the test request is received until the specimen is delivered to the lab, and define associated terminology.

Lecture Outline — Objective 8-1a Figures, Tables, and Features

Resources and In-Class Activities

Outside Assignments/ Evaluation Instructor’s Notes

Content Text PPt

Key Terms listed on p. 209 209 NA All tables and figures are available in the Image Bank on the IRC.

NA Outside AssignmentsSRCAudio Glossary of key termsFlashcards of key terms

EvaluationWBMatching 8-1: Key Terms and Descriptions

Legend: PPt: PowerPoint; IRC: Instructor Resource Center (found at http://thepoint.lww.com/McCall6e); SRC: Student Resource Center (found at http://thepoint.lww.com/McCall6e); WB: Workbook.


http://thepoint.lww.com/McCall5e)



Objective 8-1b: Describe the test request process, identify the types of requisitions used, and list the required requisition information.

Lecture Outline — Objective 8-1b Figures, Tables, and Features



Content Text PPt

Step 1: Review and accession test request Initiation of the test request

o By physician or designated healthcare professional

o Required requisition information (Box 8-1)

o Several formats Manual (Fig. 8-1)

— becoming more for backup

Computer (Fig. 8-2) Bar code

Receipt of test request by the lab (Fig. 8-3) — reqs must be reviewed for completeness, verify what is needed

210–229

6-10 Figures

8-1: A manual requisition.p. 211

8-2: A computer requisition with bar code.p. 212

8-3: Computer requisitions printing at a terminal in the laboratory.p. 213

Boxes

8-1: Required Requisition Informationp. 210

In-Class ActivitiesDiscussionHave students examine and compare various types of computer and manual requisitions. Have students practice filling in required information on several types of requisitions.

Materials

Computer and manual requisition forms (Figs. 8-1 and 8-2 from IRC Image Bank)

Outside AssignmentsWBSkills Drill 8-1: Requisition Activity






Objective 8-1c: List and define test status designations, identify status priorities, and describe the procedure to follow for each status designation.

Lecture Outline — Objective 8-1c Figures, Tables, and Features



Content Text PPt

Common Test Status Designations (Table 8-1) Status/priority STAT

o Firsto Immediate

ly collect, test and report Med emerg

o Firsto Same as

STAT Timed

o Secondo Collect as

close to possible to requested time

ASAPo Second or

third, depending on testo Follow

protocol for type of test Fasting

o Fourtho Verify

patient has fasted; check what to do if no

NPOo N/Ao Prior to

surgery or other anesthesia procedures

212-213

Tables

8-1: Common Test Status Designationsp. 214

In-Class ActivitiesIRCCritical Thinking Question

Outside AssignmentsWBKnowledge Drill 8-4: Common Test Status Designations






Content Text PPt

Preopo Second or

third, depending on testo To

determine if patient is okay for surgery

Postopo Second or

third, depending on testo To assess

patient condition Routine

o Noneo To get

diagnosis or monitor progress

Accessioning the test request "Record in the order

received"






Objective 8-1d: Describe proper “bedside manner” and how to handle special situations associated with patient contact.

Lecture Outline — Objective 8-1d Figures, Tables, and Features



Content Text PPt

Step 2: Approach, identify, and prepare patient Approaching the patient

o Look for signs (Fig. 8-4) — on door or behind bed, info. re: the patient

o Entering a patient's room

o Physicians and clergy

o Family and visitors

o Unavailable patient

o Identifying yourself — who, why there; get consent if student

o Obtaining consent

o Bedside manner

Handling special situations o The patient

is asleep — gently awaken

o The patient is unconscious — speak to patient

o A physician or member of the clergy is with the patient — don’t interrupt, come back later, unless for STAT or timed specimen

213-215

11-14 Figures

8-4: Two examples of warning signs. A. No blood pressures or venipuncture in right arm. B. Fall-colored leaves symbolizing fall precautions.p. 215

In-Class ActivityDiscussionHave students role play handling various patient contact situations.

ResourcesCLSI Document: Procedures for the Collection of Diagnostic Blood Specimens by Venipuncture; Approved Standard, 6th Edition [CLSI H03-A6] Wayne, PA

NA



o Family or visitors are with the patient — ask them to step outside

o The patient is not in the room — check at nurses station, follow protocol


-8© 2016 Wolters Kluwer. All rights reserved.




Objective 8-2a: Describe how to perform a venipuncture using ETS, syringe, or butterfly, list required patient and specimen identification information, describe how to handle patient ID discrepancies, and state the acceptable reasons for inability to collect a specimen.

Lecture Outline — Objective 8-2a Figures, Tables, and Features



Content Text PPt

Patient identification Most important step in

specimen collection Verify patient’s name and

date of birtho Ask

patient Check identification bracelet

(Figs. 8-5; 8-6) 3-way ID: verbal

verification, ID band, comparison of labeled specimen to ID band

ID discrepancieso If

discrepancies — find patient’s nurse first

o If ID band is missing — check ankle, see patient’s nurse, never draw blood if ID on IV pole or night table

Missing ID: check ankle/check with nurse

Emergency room ID procedures

Identification of young, mentally incompetent, or non-English-speaking patients — ask nurse

Neonates & other infants Outpatient ID

216–218

12 Figures

8-5: A. A phlebotomist at bedside checking patient identification band. B. Closeup of a typical identification bracelet.p. 216

8-6: An example of a special 3-part ID band used for unidentified ER patients.p. 218

In-Class ActivitiesDiscussionCompare identification on sample requisitions with information on ID bands worn by students.

IRCCritical Thinking QuestionVideo: “Introductory and Identification Processes Required Prior to Blood Specimen Collection”

Materials

Sample requisition Simulated ID bands

Resources

CLSI Document: Accuracy in Patient and Sample Identification [CLSI GP33-A] Wayne, PA

NA



Objective 8-2b: Describe how to prepare patients for testing, how to answer inquiries concerning tests, and what to do if a patient objects to a test.

Lecture Outline — Objective 8-2b Figures, Tables, and Features



Content Text PPt

Preparing the patient Bedside manner — gain

patient trust and confidence, put patient at ease

Explain the procedure o Patient

inquiry concerning tests — don’t explain what for, refer to physician or nurse

o Patient objections — remind them that testing is an important part of care; they do have right to refuse testing

Difficult patients — remain calm, professional, caring

Addressing needle phobia Addressing objects in

patient's mouth

219-220

13 NA In-Class ActivitiesDiscussionHave students role play proper bedside manner.

IRCCritical Thinking Question

Outside Assignments

WB

Matching 8-2: Situation and Action






Objective 8-2c: Describe how to verify fasting and other diet requirements and what to do when diet requirements have not been met.




Content Text PPt

Step 3: Verify diet restrictions and latex sensitivity Diet restrictions

o If not following, notify physician or nurse to see if testing should proceed; label specimen “nonfasting”

Latex sensitivityo If patient

is allergic, verify that all equipment used on him or her is latex-free

220-221

15 NA NA NA






Objective 8-2d: Describe each step in the venipuncture procedure, list necessary information found on specimen tube labels, and list the acceptable reasons for inability to collect a specimen.




Content Text PPt

Step 4: Sanitize hands Step 5: Position patient, apply tourniquet, and ask patient to make a fist Position patient Tourniquet application and

fist clenching(Procedure 8-1)o Positiono Tightnesso Sensitivity

Ask the patient to make a fist Step 6: Select vein, release tourniquet, and ask patient to open fist Prominent veins generally in

the dominant arm: palpate (Fig. 8-10)

Step 7: Clean and air-dry site Use antiseptic, and clean

using concentric circles Step 8: Prepare equipment and put on gloves Assemble supplies, put on

gloves, do not remove the needle sheath

Select appropriate ETS tubeso Check

expiration dates Winged infusion set

preparationo Verify

sterility and select

221-235

16–37 Figures

8-7: A phlebotomist applying hand sanitizer.p. 221

8-8: A. A patient seated in a special blood-drawing chair. B. A home-draw patient seated in a reclining chair.p. 221

8-9: Three examples of antecubital vein patterns. A. H-pattern. B. M-pattern. C. Atypical pattern.p. 226

8-10: A phlebotomist palpating the antecubital area for a vein.p. 226

8-11: Marking the site with an alcohol pad before cleaning the site.p. 227

8-12: Proper placement of

In-Class Activities

Have students practice proper tourniquet application and venipuncture site selection on each other. Practice routine venipuncture on an artificial arm. Have students practice routine venipuncture techniques on each other.

IRCCritical Thinking QuestionVideo: “Hand Washing/Hand Antisepsis”Video: “Good and Poor Workplace Ergonomics in Phlebotomy”Video: “Proper Tourniquet Application for Venipuncture”Video: “Collecting a Blood Specimen by Venipuncture Using the Evacuated Tube System”Video: “Specimen Labeling and Venipuncture Follow-up Procedures”

Outside AssignmentsWBLabeling Exercise 8-1: Patient ID and Blood Specimen LabelLabeling Exercise 8-2: Requisition and Blood Specimen LabelKnowledge Drill 8-5: Tourniquet RationaleSkills Drill 8-3: Routine ETS Venipuncture






Content Text PPt

appropriate small-volume tubes

Syringe equipment preparationo Select a

needle-locking syringe (per OSHA)

Position equipment for use Step 9: Reapply tourniquet, uncap and inspect needle

o Pick up and position blood collection equipment

o Remove the cover and inspect the needle

Step 10: Ask patient to remake a fist, anchor vein, and insert needle Anchoring (Fig. 8-12) Needle insertion (Fig. 8-13) Step 11: Establish blood flow, release tourniquet, and ask patient to open fist Step 12: Fill, remove, and mix tubes in order of draw or fill syringe Guard against reflux A downward arm position

helps maintain blood flow Fill ETS tubes until blood

ceases to flow due to vacuum; remove the tube; gently invert if it contains an additive (Fig 8-15)

Step 13: Place gauze,

thumb and fingers in anchoring a vein.p. 230

8-13: A. Illustration of a 30-degree angle of needle insertion. B. Illustration of a 10-degree angle of needle insertion.p. 231

8-14: Proper placement of fingers and thumb in advancing a tube in an ETS holder.p. 231

8-15: A phlebotomist mixing a heparin tube.p. 232

8-16: A phlebotomist comparing labeled tube with patient's ID band.p. 235

Procedures

8-1: Tourniquet Applicationpp. 223-225

8-2: Routine ETS

Venipuncture Procedure Evaluation formTransfer Device Procedure Evaluation form

Materials

Specimen collection equipment; tourniquets; venipuncture equipment; vein-locating device; artificial arm






Content Text PPt

remove needle, activate safety feature, and apply pressure Cover puncture site with

gauze and hold lightly in place

Withdraw needle Apply pressure Arm should be kept

extended or raised Step 14: Discard collection unit, syringe needle, or transfer device Step 15: Label the tubes (Fig. 8-16) Step 16: Observe special handling instructions Step 17: Check the patient’s arm and apply bandage Instruct patient to avoid

lifting Step 18: Dispose of contaminated materials Step 19: Thank patient, remove gloves, and sanitize hands Step 20: Transport specimen to lab

Venipuncturepp. 235-242






Objective 8-2e: Describe collection procedures when using a butterfly or syringe and the proper way to safely dispense blood into tubes following syringe collection.

Lecture Outline — Objective 8-2e Figures, Tables, and Features



Content Text PPt

Butterfly Procedure (Procedure 8-3) Follow ETS steps 1-4 Position patient and apply

tourniquet Choose a vein, release

tourniquet, relax hand Clean and air-dry site Prepare equipment and put

on gloves Reapply tourniquet, uncap

and inspect needle Anchor vein, and insert

needle Establish blood flow and

release tourniquet Fill, remove, and mix tubes

in order of draw Place gauze, remove needle,

activate safety device, and apply pressure

Discard collection unit Follow ETS steps 15–20 Syringe Procedure (Procedure 8-4) Follow ETS steps 1-7 Prepare equipment and put

on gloves Reapply tourniquet, uncap

and inspect needle Ask patient to make a fist,

anchor vein, and insert needle

243–249

NA Procedures

8-3: Venipuncture of a Hand Vein Using a Butterfly and ETS Holderpp. 243-246

8-4: Needle-and-Syringe Venipuncturepp. 247-249

8-5: Using a Syringe Transfer Devicepp. 250-251

In-Class ActivitiesIRCCritical Thinking QuestionVideo: “Blood Collection from a Hand Vein Using a Butterfly and ETS Holder”Video: “Collecting Blood from an Antecubital Vein Using a Needle and Syringe”Video: “Transferring Blood from a Syringe into ETS Tubes”Butterfly Procedure Evaluation formSyringe Procedure Evaluation form

Outside AssignmentsWBSkills Drill 8-4: Using a Syringe Transfer DeviceSkills Drill 8-5: Highlights of Hand Venipuncture ProcedureSkills Drill 8-6: Highlights of Needle-and-Syringe Venipuncture Procedure






Content Text PPt

Establish blood flow, release tourniquet, ask patient to open fist

Fill syringe Place gauze, remove needle,

activate safety device, and apply pressure

Discard needle, fill tubes, discard syringe and transfer device

Follow ETS steps 15–20 Using a transfer device to fill tubes (Procedure 8-5) Remove the needle from the

syringe and discard it in a sharps container

Attach the syringe hub to the transfer device hub, rotating it to ensure secure attachment

Hold the syringe vertically with the tip down and the transfer device at the bottom

Place an ETS tube in the barrel of the transfer device and push it all the way to the end

Follow the order of draw if multiple tubes are to be filled

Keep the tubes and transfer device vertical

Let the tubes fill using the vacuum draw of the tube. Do not push on the syringe plunger

If you must underfill a tube,






Content Text PPt

hold back the plunger to stop blood flow before removing it

Mix additive tubes as soon as they are removed

When finished, discard the syringe and transfer device unit in a sharps container






Objectives 8-3 and 8-4: Identify challenges and unique aspects associated with collecting specimens from pediatric and geriatric patients. Describe why a patient would require dialysis and how it is performed, and exhibit an awareness of the type of care provided for long-term care, home care, and hospice patients.

Lecture Outline — Objectives 8-3 and 8-4 Figures, Tables, and Features



Content Text PPt

Pediatric venipuncture Challenges Dealing with parents or

guardians Dealing with the child Pain interventions Selecting a method of

restraint Equipment selection Procedures Geriatric venipuncture (Table 8-3) Challenges

o Skin changes

o Hearing impairment

o Visual impairment

o Mental impairment

o Effects of disease Arthritis Coagulation

problems Diabetes Parkinson’s and

stroke Pulmonary function

problems o Other

251–258

38-48 Figures

8-17: A seated adult restraining a toddler.p. 254

8-18: An elderly patient in a wheelchair.p. 257

8-19: A phlebotomist making a visit to a rehabilitation center.p. 258

8-20: A traveling phlebotomist getting supplies from the back of her vehicle.p. 258

Tables

8-3: Tests Commonly Ordered on Geriatric Patientsp. 255

In-Class ActivitiesIRCCritical Thinking Questions

Outside Assignments

Study and Review Questionstext pp. 259-260Case Studiestext pp. 260-261

EvaluationIRCTest Generator

SRCTest your knowledge on the interactive exercises on the SRC.

WBMatching 8-3: Geriatric Patient Tests and Indications for OrderingKnowledge Drill 8-1: Caution and Key Point RecognitionKnowledge Drill 8-2: Scrambled WordsKnowledge Drill 8-6: Geriatric ChallengesSkills Drill 8-2: Word



Lecture Outline — Objectives 8-3 and 8-4 Figures, Tables, and Features



Content Text PPt

problems: disease; loss of immune function; loss of appetite; poor nutrition

Safety issues Patients in wheelchairs

(Fig. 8-18) Blood collection procedures

o Patient identification

o Equipment selection

o Tourniquet application

o Select venipuncture site

o Clean the site

o Perform the venipuncture

o Hold pressure

Dialysis patients Long-term care patients Home care patients Hospice patients

BuildingCrosswordChapter Review QuestionsCase Study 8-1: Patient ID and Specimen LabelingCase Study 8-2: Blood Volume, Equipment Selection, and Syringe Transfer Technique





Chapter 8 Lesson Plan - Lippincott Williams &...

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