Question

Cases 1 Modified Allen Test and ABG Specime Case Study 14-1: Mod A hlebotomist has an Specimen onun specimen the night the same arm, and sin modified Allen lesti t and ABG Specimen Collection QUESTIONS 1. What error did the phlebotomist make? 2. How could the error have been avoided? 3. What could have caused the change in collateral ist has a request to collect a STAT ARC an a patient. He had collected an ABG he night before from the same patient on m. and since the patient had a positive llen test then, he skips the Allen test now to As he is preparing to insert the needle, the t's nurse enters the room and tells him to stop. alls him that the patient does not have adequate ollateral circulation in that arm and he must not circulation? save time. As he is pren putient's nurse enter She tells him that the patient does collect the specimen there. check the arm, a large hematoma had formed at the collection site. When he checked the patient's pulse below the collection site, it was so weak he could Study 14-2: ABG Hazards and Complications A phlebotomist had an order to collect STAT ABC and electrolyte specimens from a patient in the ICU. The patient was having difficulty breathing when the phlebotomist arrived. There was an IV in the patient's barely feel it right arm, so the phlebotomist performed the Allen test on the left arm. The test result was positive, so QUESTIONS the phlebotomist proceeded to collect the specimen from the radial artery of that arm. He had to redirect 1. What could have caused the weak pulse and what the needle several times before dark bluish-red blood should the phlebotomist do about it? finally pulsed into the syringe. When the syringe was 2. What error did the phlebotomist make that contrib- filled to the proper level, he withdrew the needle and uted to hematoma formation? held pressure over the site. As he was attempting to cap the syringe, the cap dropped into the patient's bed 3. What would cause the specimen to be bluish red? covers, so the phlebotomist asked the patient to hold 4. How can the phlebotomist be certain that the pressure while he retrieved it. Later, when he went to specimen is arterial blood? Case Study 14-3: Brachial Artery Puncture Problem A phlebotomist is sent to collect an ABG specimen the phlebotomist completes the draw. The phlebotomist from a patient in the cardiac care unit (CCU). The holds pressure and then applies a pressure bandage. patient has an IV in the right arm near the wrist and finishes the paperwork, and returns to the laboratory the left wrist has a rash. The phlebotomist has been with the specimen. trained to do brachial artery punctures, so he decides to use the brachial artery of the left arm. The physician QUESTIONS has specifically requested that the specimen be drawn without the use of lidocaine. The phlebotomist verifies that all other patient conditions have been met and proceeds with specimen collection. As he inserts the needle the patient winces in apparent great pain and moves his arm. No blood flows so the phlebotomist cautions the patient to keep still and redirects the needle. The syringe then rapidly fills with blood and potomist verifies 1. Why might the physician have purposely requested that the specimen be drawn without lidocaine? 2. What should the phlebotomist have done when the patient felt great pain? 3. What nerve lies near the brachial artery and may have caused the pain response!

Answer 1

14-1

1.The phlebotomist has not checked the positive sign for Allen's test .It is a must to get positive Allen's test to each time to perform an ABG test

2.The error could have been avoided simply by doing the Allen's test

3.The reason for changes in the collateral circulation may be due to

• Injury due to previous procedure
• Infarction

14-2

1.The weak pulse could be because of decreased blood pressure ,this has to be reported to the concerned nurse immediately fir intervention

2,In case of arterial puncture it takes a longer time to clot ,in case if proposer pressure is not applied it may lead yo bleeding and hematoma formation

3.The arterial blood are bright red in co log whereas the venous blood are dark red or bluish red in colour because it carries deoxygenated blood

4.The phlebotomist cn be certain when the blood spurts after pricing in the syringe and its colour should be bright red as it is oxygenated blood.