Phlebotomy
No Results
No Results
processing….
Phlebotomy is a technique in which a needle is temporarily inserted into a vein to provide venous access for venous blood sampling. [1, 2, 3] Veins have a three-layered wall composed of an internal endothelium surrounded by a thin layer of muscle fibers, which in turn is surrounded by a layer of connective tissue.
Identification of the optimal site for venous access (see Technical Considerations) involves both visual and tactile evaluation. After applying a venous tourniquet, the physician should inspect and palpate potential sites, starting with the nondominant extremity. On palpation, the vein should be soft and bouncy, it should refill after being depressed, and it ideally should be well supported by the surrounding tissue.
Phlebotomy is commonly performed with either an evacuated tube system (eg, Vacutainer; BD, Franklin Lakes, NJ) or a syringe and needle or winged butterfly needle device (see Technique).
Indications for phlebotomy include the following:
Contraindications for phlebotomy include the following:
The superficial veins of the upper extremities, particularly those in the antecubital fossa, are the ones most commonly selected for phlebotomy because they are usually readily visible and easily palpable. The antecubital fossa contains four veins (see the images below). Of these, the median cubital vein is usually the vein of choice for phlebotomy: It is typically more stable (less likely to roll), it lies more superficially, and the skin overlying it is less sensitive than the skin overlying the other veins.
In many cases, the metacarpal veins are easily visualized and palpated (see the image below). However, obtaining needle access on the dorsal hand is more painful, and the metacarpal veins are more likely to roll and collapse on vacuum application than the antecubital veins are.
It appears that the device used to collect blood is the strongest independent predictor of hemolysis in blood samples drawn in the emergency department (ED). An ED study suggested that the most effective strategy to reduce the rate of hemolysis in the ED is to use butterfly needles for phlebotomy rather than intravenous catheters. [4]
Lavery I, Ingram P. Venepuncture: best practice. Nurs Stand. 2005 Aug 17-23. 19 (49):55-65; quiz 66. [Medline].
Phlebotomy. WebPath. Available at http://library.med.utah.edu/WebPath/TUTORIAL/PHLEB/PHLEB.html. Accessed: November 30, 2017.
Ernst DJ. Flawless phlebotomy: becoming a great collector. Nursing. 1995 Oct. 25 (10):54-7. [Medline]. [Full Text].
Wollowitz A, Bijur PE, Esses D, John Gallagher E. Use of butterfly needles to draw blood is independently associated with marked reduction in hemolysis compared to intravenous catheter. Acad Emerg Med. 2013 Nov. 20 (11):1151-5. [Medline].
Gil Z Shlamovitz, MD, FACEP Associate Professor of Clinical Emergency Medicine, Keck School of Medicine of the University of Southern California; Chief Medical Information Officer, Keck Medicine of USC
Gil Z Shlamovitz, MD, FACEP is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association
Disclosure: Nothing to disclose.
Vincent Lopez Rowe, MD Professor of Surgery, Program Director, Vascular Surgery Residency, Department of Surgery, Division of Vascular Surgery, Keck School of Medicine of the University of Southern California
Vincent Lopez Rowe, MD is a member of the following medical societies: American College of Surgeons, American Surgical Association, Pacific Coast Surgical Association, Society for Clinical Vascular Surgery, Society for Vascular Surgery, Western Vascular Society
Disclosure: Nothing to disclose.
Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference
Disclosure: Medscape Reference Salary Employment
Phlebotomy
Research & References of Phlebotomy|A&C Accounting And Tax Services
Source
0 Comments