sources of error in venipuncture procedure include

Ask the patient to be seated comfortably in a chair. In this phase, the procedures involving phlebotomy, critical to the obtainment of diagnostic blood specimen, are poorly studied with regard to major sources of errors and procedures related to . Education and National Certifications Students should have or be pursuing a high school diploma or GED. These include collection of samples, transportation, storage, and methodology used as well as intercurrent issues of the patients. Emergency Department: 1.97%. Promotion of ideal phlebotomy practices and sample transport procedures are a pre-requisite for the effective laboratory functioning. 6. minutes and then reapplied before performing the venipuncture. Laboratory errors often are caused by events that precede specimen arrival in the lab and should be preventable with a better labeling processes . PLAY. For certain chemistry analytes, such as glucose and cholesterol, patients need to be fasting (absence of food and liquids) for at least 12 hours prior to veni-puncture. 5th ed. Outpatient: 0.35%. Inadequate discard volume drawn when collecting blood through vascular access device. Errors in data transmission include relaying or hearing verbal information incorrectly. There are four general categories of pre-analytical variability, including: test ordering, patient preparation, specimen collection, and specimen processing, transportation, and storage (5). Philadelphia, PA: Lippincott, Williams and Wilkins, 2008:245. Sderberg J, Brulin C, Grankvist K, Wallin O. Preanalytical errors in primary healthcare: a questionnaire study of information search procedures, test request management and test tube labelling. Problems can also arise in the sampling process. policies and procedures. Ask the patient to lie on his/her back in a comfortable position. Pre-pre-analytical comprises 46-68% of all errors and included inappropriate test request, patient/specimen misidentification, sample collected from infusion route, inappropriate container, handling, storage and transportation ( 6 ). Failure to dry the site completely after cleansing it with alcohol The smaller the gauge number, the smaller the diameter of the needle. The following are common sources of error in phlebotomy and laboratory testing. Ignoring some critical information like whether to collect the sample after food or before food will also result in wrong diagnosis. Collection of Diagnostic Venous Blood Specimens is the long-awaited 7th edition of the CLSI venipuncture standard. Pre-analytical errors (Contd) Patient Preparation: - Prior to collecting specimens for chemistry, certain patient variables need to be considered. McCall R, Tankersley C. Phlebotomy Essentials. In many patients, venous access is necessary for obtaining blood for laboratory testing and administering fluid and intravenous drugs. Gravity. 3.) 1,2. Gain the patient's trust and confidence c. Let the patient select the preferred needle size d. Explain the full procedure with details e. Put on gloves 5th ed. By the end of the 19th century (1875-1900), phlebotomy was declared quackery. Wash hands, tie tourniquet 3-4 inches above site (If it rolls up, it's too tight!) Pritha Bhandari Pritha has an academic background in English, psychology and cognitive neuroscience. Outline the process of application for State certification. Have the patient position his/her arm on the armrest so that their hand is readily accessible. Promotion of ideal phlebotomy practices and sample transport procedures are a pre-requisite for the effective laboratory functioning. Phlebotomy. Advanced Phlebotomy: This section covers variations influencing the collection of blood, complications requiring alternative procedures, sources of preanalytical errors, communication . Unfortunately, there is a limited number of studies into the quality of blood sampling by venipuncture and the level of phlebotomists' knowledge of the . However, in human medicine, immunoassays remain a prime . Procedures in Phlebotomy - E-Book-John C. Flynn 2013-08-07 Introducing the practices and procedures of phlebotomy, Procedures in Phlebotomy, 4th Edition provides easy-to-read guidelines for both basic and special . This indicates that blood has accumulated in the tissue surrounding the vein. False These errors can cause erroneous results that can cause serious patient harm. In this article, we discuss for each category the sources of variation, potential solutions, and appropriate QIs. Venipuncture is often difficult (fragile veins, hypotension, etc. Position the draw site for best visualization and/or palpation . Hemolysis 2. The goal of the Phlebotomy Certificate program is to train individuals to perform phlebotomy procedures, the collection of blood for diagnostic testing. Most common complication of phlebotomy procedure. Flashcards. To minimize the risk of errors all those issues need to considered and a total quality management system covering the complete POCT process should be established. The blood is normally drawn from a vein on the top of the hand or from the inside of the elbow. It is so important to the laboratory and to the patient and their satisfaction and quality of care. Safety in the Lab and Phlebotomy environment: 2 Demonstrate and practice techniques to safely . prophylaxis. Definition. The role of the phlebotomist and other healthcare providers who collect blood is crucial and begins the process of collection, testing, analysis, results/diagnosis and treatment. 2. Match. Inversion 5. Describe at least three sources of pre-examination . The activities involving phlebotomy, a critical task for obtaining diagnostic blood samples, are poorly studied as regards the major sources of errors and the procedures related to laboratory . A calm approach and skilled technique may help limit a patient's aversion to venipuncture. Problem #2: Decentralized phlebotomy Solution: Studies have repeatedly shown that a laboratory-based specimen-collection staff commits fewer patient identification and labeling errors and has lower blood culture contamination rates and fewer rejected specimens. Although other medical professionals (i.e. Describe the role of quality assurance in the practice of phlebotomy. Patient mismanagement from altered results. Repeated specimen rejection and the need to recollect blood samples create concerns about a laboratory's quality services and may . Created by. The data entry into the hospital information system (HIS) may be incorrect, or the wrong patient may be selected. For this reason phlebotomy has been considered a separate area of specialization in developed countries. policies and procedures. Write. Polycythemia vera True or False? The reason, for incorrect phlebotomy practice includes lack of attentiveness or possibly a heavy workload. Choose a vein, other than the vein with the IV. Test ordering, the first step of the pre . It is better to allow the nurse to print out the label and put it on the tube at the same time as collecting the sample. . STUDY. Philadelphia, PA: Lippincott, Williams and Wilkins, 2008:245. Discard tube/volumes 4. source of skilled phlebotomists with or without cer-tification, Ernst says. Explain the potential risks and complications of the venipuncture procedure. Procedure and Performance of a Venipuncture: Select the proper size needle and attach it to the syringe or Vacutainer. Errors in any aspect of blood sampling may require repeat samples, placing the patient at risk for blood loss and venous injury. Failure to properly label the specimen. Loosen the tourniquet once a vein has been selected 5.) therapeutic. Believe it or not, more than 2/3rd's of laboratory errors are . Complications that can arise from venepuncture include haematoma formation, nerve damage, pain, haemaconcentration . This course is intended to emphasize the pre-analytical variables that must be controlled during venipuncture and urine collection procedures in order to ensure the quality reporting of laboratory test results. Underfilling 6. Topics include basic infection control, universal precautions and safety; basic . In many studies of total testing errors, analytical errors are often <10% and their frequency is decreasing due to standardization of laboratory procedures and assays, automation within the clinical pathology laboratory, and advances in technology (Plebani 2006, 2010; Sakyi et al. Errors can arise from the precise conditions required to collect that sample size, or from the ability of the population . PHLEBOTOMY Medtexx Medical Corporation - 5 - Devices Used for Drawing Blood A variety of devices were used to draw blood, Lancet - The lancet was first used before 5th century B.C. There is no cost to participants, and transportation . Test. Venipuncture can be painful, and a patient may experience anxiety or fear before the procedure. Pre-analytic errors and specimen rejection can result in delayed patient treatment, increased length of stay, and the need to recollect specimens. Proper Procedure for Drawing Beneath an IV. This list summarizes the errors we will be exploring in this article: 1. a butterfly collection system is also called a (n)______ infusion set. Emphasis is placed on the knowledge and skills needed to collect all types of blood samples from patients. but in general, we camot design procedures that will eliminate errors. Multiple myeloma or Waldenstrom's macroglobulinemia (tumors that make large amounts of immunoglobulins) typically have very high ESRs even if they don't have inflammation. 2015). Strategies to avoid these errors include th Laboratory errors constitute 1 of 7 quality events. . The adverse events that have been best documented are in blood transfusion services, where poor venepuncture practice or anatomical abnormality has resulted in haematoma . Errors occurring during the preanalytical phase - from the time the test is ordered by the physician until the sample is ready for analysis - can account for up to 93% of the errors currently encountered during the total diagnostic process, a review of multiple studies in 2002 showed similarly high levels of errors. The author identifies four errors in phlebotomy that are effectively indefensible in a court of law: patient misidentification, improper angle of insertion, improper vein selection, and ineffective training and evaluation of those performing venipunctures. The role of the phlebotomist and other healthcare providers who collect blood is crucial and begins the process of collection, testing, analysis, results/diagnosis and treatment. ScOoByBeArMaX. b. Learn. Course Outline: Chapter 1: Phlebotomy and the Health-Care Delivery System Dependence on accurate laboratory results for establishing diagnosis makes it mandatory for labs to Errors in test selection and ordering, patient identification and specimen labelling are pan-disciplinary and will not be discussed in this manuscript with particular reference to haematology. It is obvious from the above discussion that pre-analytical and post-analytical errors constitute majority of the errors. Venipuncture Procedure ----- ----- T3and T4Handling ----- . Sampling Errors. To minimize anxiety and divert attention before a phlebotomy procedure, the medical assistant should first: a. 3.1. Dependence on accurate laboratory results for establishing diagnosis makes it mandatory for labs to Topics in this course include medical terminology, related anatomy and physiology, blood collection procedures, and procedures for collection of other types of specimens within the scope of practice of the phlebotomist. Medication errors due to contamination. Erroneous Phlebotomy Technique The majority of errors in specimen labeling typically occur as failures in workflow or process rather than as failures to have delineated specimen labeling policies or procedures. Inpatient: 1.0%. correctly and safely. Spell. Sderberg J, Brulin C, Grankvist K, Wallin O. Preanalytical errors in primary healthcare: a questionnaire study of information search procedures, test request management and test tube labelling. Order of draw 3. Procedure for seating the patient: a. 1. Working Group for the Preanalytical Phase after a review of relevant literature sources in phlebotomy procedures. Diet influences certain tests which require fasting prior to specimen collection. Results: During the observation period, 200 blood samples were drawn into 457 tubes by 5 phlebotomists and none of the . Sources of error in venipuncture procedure include failure to mix blood collected in additive-containing tubes immediately An incubator temperature should be set at The antiseptic most commonly used for blood collection is Microorganisms likely to cause disease are those that thrive at temperatures between 96F and 101F Bacteria Reporting problems include exceeding the turnaround time for reporting or not notifying the appropriate health care provider. Instructions for lab procedures include sources of possible errors along with comments. the type of blood drawing done as part of the patient's treatment for certain blood disorders is called______ phlebotomy. Results: During the observation period, 200 blood samples were drawn into 457 tubes by 5 phlebotomists and none of the . Procedure for having patient lie down or if patient is already lying down: a. Test requests can also be misinterpreted, unintelligible or get lost (Figures 4-5 4-5)) (6, 7, 33, 34). Table 5. Error: Failure to properly cleanse site for blood culture collection; repalpating a site cleansed for blood culture collection; failure to allow antiseptic time to take effect prior to blood culture collection. Learn key terms, names, and much more related to Phlebotomy 4 Analytical Errors, Complications, Special Venipuncture with the help of our flashcards quizzes with ease. Secondly, what is one of the reasons for a failed venipuncture? In the present study, the preanalytical errors compound to about 0.38% (1802 samples) which is low. These negative outcomes can range from unnecessary redraws and delayed results, to improper treatment, misdiagnosis, and even death. Laboratory errors often are caused by events that precede specimen arrival in the lab and should be preventable with a better labeling processes . . assure free motion. The promotion of ideal phlebotomy practices and sample transport procedures is a pre-requisite for the efficacy of laboratory functioning. Other conditions which may have a markedly elevated ESR include: Rheumatoid arthritis, an autoimmune disease causing severe inflammation of the joints. Topics include: venipuncture procedure and safety, advanced techniques in blood collection, blood collection equipment and modern safety devices and equipment. It is imperative to follow procedures and protocols for all concerned to attempt to obtain meaningful, accurate values. nurses . It is imperative to follow procedures and protocols for all concerned to attempt to obtain meaningful, accurate values. Tourniquets left on for more than 2 minutes or vigorous hand exercises can elevate potassium and lactic acid levels, and falsely decrease blood pH. Lack of appropriate training can result in improper specimen collection, which can lead to serious complications . Key Concepts: Terms in this set (23) Which of the following is a condition that causes an elevated hematocrit? These negative outcomes can range from unnecessary redraws and delayed results, to improper treatment, misdiagnosis, and even death. can include phlebotomy chairs equipped with lock-in mechanisms to prevent falling and all necessary equipment and supplies required to perform phlebotomy procedures like antiseptic, gauze, Sharps container, tourniquets, vacutainer tubes, lancets, winged infusion sets, vacutainer needles and hubs, and personal protective equipment. Topics include basic infection control, universal precautions and safety; basic . SOURCES OF ERROR IN SPECIMEN COLLECTION, TRANSPORT PROCESSING AND STORAGE 5 1. Wrong tube Hemolysis Health Career Advisor: Jennifer Crowley, 847.635.1844, jcrowley@oakton.edu. McCall R, Tankersley C. Phlebotomy Essentials. The focus of this article will be those errors that occur during the actual performance of the venipuncture or skin puncture until the specimen is obtained. hematocrit. A checklist was used to collect data on the phlebotomy procedure and errors. Believe it or not, more than 2/3rd's of laboratory errors are . These tests are included in general health examinations and help investigate a variety of illnesses, including infection, allergy, and leukemia. Patient Identification The most serious error is failure to properly identify the patient. Potentially, sources of errors include all steps involved in testing. Discuss the scope of practice of the Certified Phlebotomy Technician. Essential Elements of a Phlebotomy Training Program is a resource for healthcare professionals and educators seeking to develop and implement phlebotomy training programs and courses. b. Updating of the CLSI venipuncture standard . Sources of error in venipuncture preparation include: 1. improper patient identification 2.Failure to check patient adherence to dietary restrictions 3.. Use of improper equipment and supplies 4. Venipuncture is most often done for laboratory testing. Potential effects of unsafe phlebotomy. Safety in the Lab and Phlebotomy environment: 2 Demonstrate and practice techniques to safely . sources of error common causes of false positive and negative reactions in both dat and iat are shown: false positive mechanism cold autoantibody in vitro complement fixation and auto agglutination technical dirty tubes colloidal silica anti-species antibody heterologous antibody in the antiglobulin reagent polyagglutinable red cells presence of In Pakistan, phlebotomy is the most underestimated procedure in laboratory medicine, although it is a complex process requiring knowledge and skill to perform. Assemble your equipment, this may also be completed in the . The white blood cell count and differential determine the number of white blood cells and the percentage of each type of white blood cell in a person's blood. Basic Phlebotomy: This section covers the laboratory environment, anatomy, safety and infection control, phlebotomy equipment, and the phlebotomy procedure. ______ is protective treatment for the prevention of disease once exposure has occurred. Venipuncture (sometimes referred to as venapuncture, venepuncture or even venu puncture) is the collection of blood from a vein which is usually done for laboratory testing. Beside general causes such as identification errors and unsuitable transportation, which do not noticeably differ from other areas of diagnostic testing, in red and bold font are highlighted those that are more critical for, or even specific to, coagulation testing. ); Patients are often not conscious nor contactable; Results are needed in short time; Operators are working under stress. A checklist was used to collect data on the phlebotomy procedure and errors. Potentially, sources of errors include all steps involved in testing. Have patient clench fist. Most errors arise during this laborintensive, preanalytical phase. Winged. Once the two minutes have passed, apply the tourniquet beneath the IV site. Venipuncture"veni," meaning vein, and "puncture," meaning to pierceis the act of drawing blood from a vein with a needle. Phlebotomy is a complex procedure that requires theoretical knowledge and manual skills, as well as accuracy, responsibility and ability of the individual performing the procedure (2, 15). In order to minimize the possibility of errors, phlebotomy procedures should be standardised, well-documented and written instructions should be available at every workstation. Hidden errors include hemoconcentration, incorrect order of draw, and (the most serious of all errors) misidentification of patient or specimens ( Table 5 ). Preanalytical variables associated with phlebotomy include _____ specimens, transporting specimens, and proccessing specimens. Additional errors within the ordering process may occur during the test requesting procedure itself. Identify patient 2.) These include collection of samples, transportation, storage, and methodology used as well as intercurrent issues of the patients. results by the clinicians to reduce or eliminate the errors that may arise during the various steps. Study free Phlebotomy flashcards about Phlebo Procedures-12 created by luparl to improve your grades. Complications that can arise from venepuncture include haematoma formation, nerve damage, pain, haemaconcentration, extravasation, iatrogenic anaemia, arterial puncture, petechiae, allergies, fear and phobia, infection, syncope and fainting, excessive bleeding, edema and thrombus. When using a syringe, make sure that you pull the plunger in and out to. The most frequent sources of pre-analytical errors are summarized in this slide. The magnitude of these errors in terms of best use of healthcare re-sources and potential for patient harm is applicable in all labora- Because these errors often are unknown, the analyst may inadvertently report erroneous patient results which could be harmful to the safety and well-being of the patient. However this is one of the most frequent sources of error. The activities involving phlebotomy, a critical task for obtaining diagnostic blood samples, are poorly studied as regards the major sources of errors and the procedures related to laboratory . The dependence on accurate laboratory results for diagnostics makes it mandatory for labs to ensure accountability and accuracy of results to negate incorrect diagnosis as a consequence of faulty reporting. Palpate veins in antecubital area (Figure 8) 4.) During initial training, in-services and routine patient encounters, healthcare professionals can be expected to perform work properly. This procedure is without complications, which sometime can be fatal. Hematology instruments are described . teams include physicians, dentists, nurses, dietary interviewers, and medical and laboratory technicians. Upon successful completion of this course you will earn 2 continuing education . Hemoconcentration The increase in proportion . It is so important to the laboratory and to the patient and their satisfaction and quality of care. Stroke/hemorrhage due to modification of blood thinner dosage based on inaccurate coagulation results. Consequence: Unnecessary administration of antibiotic & extended length of hospitalization due to false-positive blood culture. In most circles, the terms venipuncture and phlebotomy are used interchangeably. Venipuncture Procedure-Confirmatory 1.) This course is intended to emphasize the pre-analytical variables that must be controlled during venipuncture and urine collection procedures in order to ensure the quality reporting of laboratory test results. However, Venipuncture is also called phlebotomy, is a procedure in which a needle is used to take blood from a vein. The curriculum at Oakton is in compliance with standardized educational curricula and accepted routes for national . Laboratory errors constitute 1 of 7 quality events. SOURCES OF ERROR IN SPECIMEN COLLECTION, TRANSPORT PROCESSING AND STORAGE 5 1. Unsafe phlebotomy can cause adverse effects for patients; such effects are rare, but range from pain or bruising at the site of puncture, to fainting, nerve damage and haematoma. In medicine, venipuncture or venepuncture is the process of obtaining intravenous access for the purpose of venous blood sampling (also called phlebotomy) or intravenous therapy.In healthcare, this procedure is performed by medical laboratory scientists, medical practitioners, some EMTs, paramedics, phlebotomists, dialysis technicians, and other nursing staff. Now you can perform the venipuncture. Common Sourses of Specimen Collection Errors include: IV Contamination Traumatic Hemolysis Wrong Patient Identification. Show the patient the equipment b. When performing a repeat venipuncture because the first was a short sample, pour the blood from . Venipuncture requires good skills in order to perform the procedure not only . Very serious errors in test results will occur is plasma from a _____top tube and a light-blue top tube is . Ask the patient's nurse to turn off the IV for about two minutes prior to the venipuncture procedure. As an interdisciplinary researcher, she enjoys writing articles explaining tricky research concepts for students and academics. To get the most accurate results, chemists must either take samples from a large population size or obtain multiple samples from the population size selected. hub. . It's a minimally invasive way to collect blood cells and plasma, the liquid component of blood, for analysis. results by the clinicians to reduce or eliminate the errors that may arise during the various steps. the practitioner manually perforated the vein. Describe at least three sources of pre-examination .