Question

Case Studies Case Study 9-1: Pr Erica is a recent phleh was hired less than in her first job as a of employment are an is determined to do has been asked to col from a patient in an in 4. Problem Sites, Complications, and Procedural Errors cent phlebotomy program graduate who you've got to get the specimen," so Erica tries again es than a month ago by a major hospital to redirect the needle. Finally, blood spurts into the ab as a phlebotomist. Her first 3 months tube and a hematoma starts to form quickly. At first at are a probationary period, and she Erica thinks that she may have hit an artery, but the wed to do a good job. This morning she specimen is normal in color, so Erica dismisses the bed to collect a stat CBC and electrolytes thought. She quickly collects the specimens, covers the ant in an intensive care unit. The patient is site with gauze, and asks the patient to hold pressure perative but has difficulty breathing while she labels the tubes. When she has finished she mentions that she will hook up the thanks the patient and delivers the stat specimens to oxygen therapy as soon as the phlebotomist the laboratory hed with him. He has an IV in his left hand. ates the right antecubital area. She can feel QUESTIONS an cubital vein, but it is deep. The basilic vein sible and prominent, so she decides to use it to 1. What site selection issues were associated with the the specimen. When she inserts the needle into collection of this specimen? n, the vein rolls and her needle ends up beside 2. Were the site selection issues handled properly? the vein and slightly under it. She redirects the needle Explain why or why not. and the vein rolls again. The patient winces in pain but 3. What complications and procedural errors were says nothing. Noticing the look of pain on the patient's involved? face, Erica asks him if it hurts. The patient says yes and tells her that the pain is radiating down his arm 4. Were complications and procedural errors handled and his fingers are tingling. Erica asks him if he would properly? Explain why or why not. like her to remove the needle. The patient replies "No, responsive and cooperative The patient's nurse mention patient's oxygen therapy is finished with him. He h Erica palpates the right ante the median cubital vein, but Concerns

Answer 1

1.The first preferred site for venipuncture is median cubical vein ,if not accessible then cephalic vein has to be selected.The second preferred site is basilic vein on dorsal hand.The issue is before going for basilic the median cubital or cephalic vein should have been selected. Though the veins are deeper the resilience can be good and those veins don't slip upon pricking.

2.Thus was not handled properly because a prominent vein can be a sign of thrombosis. Further this site was selected just by observation leading to patient discomfort.

3.The complication is hematoma formation .The procedural errors are lack of pre-preparation and adequate post procedure.

4.The phlebotomist should have applied the pressure for upto 20 to 30 seconds

Apply ice to reduce swelling or hematoma formation

Application of antithrombolytic agents