Question

Phlebotomy Scenarios:

Scenario 1:

Julie Smith is a recently certified phlebotomist who has been working at Northwood Hospital for several months. As she approaches room 825, she looks at her collection list to verify that it is the correct room for her first collection. Julie enters the room to find a middle-aged man who appears to be sleeping. Julie approaches the patient and says “Good day Mr. Ready. My name is Julie and I am from the lab. I need to draw some blood for some tests ordered by your doctor.” The man awakens and Julie again states that she is from the lab and needs to draw blood for some tests ordered by the doctor. The patient tells Julie to go ahead and get it done so he can go back to sleep. Julie then proceeds with the venipuncture. When the results on Mr. John Ready were called to the nurse, she was very surprised that the result of his CBC was normal. The nurse explained to the laboratory technologist that Mr. John Ready had a known diagnosis of lower GI bleeding. His hemoglobin had been very low for the past 24 hours because of the internal bleeding and she thought it was very surprising that his hemoglobin had normalized so quickly without having received a blood transfusion.

Questions:

1. What should the lab technologist or nurse do to investigate this situation? Who should they ask to take action?

2. What should the phlebotomy supervisor do about Julie?

Scenario 2:

Bobby Jones, a phlebotomist at Community Hospital, enters the room of Mrs. Mary Grayson with a physician's order for blood tests. After greeting Mrs. Grayson, identifying himself, and properly identifying the patient, using two methods of identification, Bobby prepares for the venipuncture.

As he approaches the patient's bed, he notices a sign posted above the bed that reads: "Restricted left arm use. Do not use left arm for venipuncture." Bobby prepares to use the patient's right arm and notices an intravenous (IV) line in Mrs. Grayson's right arm positioned in a vein slightly above her wrist on the dorsum (top) of her forearm.

Questions:

1. Where should Bobby look for a venipuncture site?

2. Before performing the draw, what should be done about the IV?

3. What kind of needle should Bobby use for the blood collection since a fingerstick is not feasible?

4. What is very important that Bobby does before leaving the patient?

Answer 1

Ans) Scenario 1:

1) Critical thinking skills are very important in the nursing field because they are what you use to prioritize and make key decisions that can save lives. Nurses give critical care 24/7, so the critical thinking skills of nurses can really mean the difference between someone living or dying.

- Recheck CBC, notify to doctor about this & lab main person.

2) Phlebotomist supervisor must ask Julie about the collection, & the processing of CBC in lab to rule out the cause.

Scenario 2:

1) The most commonly used site for a venipuncture is at the bend of the elbow, also called the antecubital fossa. Several veins in the antecubital fossa provide excellent access.

2) Ask the patient's caregiver if the IV can be turned off for a short period of time. The IV should be discontinued for at least two minutes before the venipuncture. Apply the tourniquet between the IV site and the area of the venipuncture. Perform the venipuncture.

3) While the size can vary, most needle sizes are 21 to 23 gauge. If a person uses the smaller-sized needles (such as 25 to 27 gauge), blood is more likely to get destroyed (hemolyze) or clot due to the smaller-sized needle.

4) After the blood draw:
Keep your bandage on for the recommended amount of time (unless you experience skin irritation at the puncture site).
Refrain from doing any vigorous exercise, which could stimulate blood flow and may cause bleeding from the site.