Do They Draw Blood From Veins Or Arteries

Process of obtaining intravenous access

"Cartoon claret" redirects here. For the book, run across Drawing Blood.

In medicine, venipuncture or venepuncture is the process of obtaining intravenous access for the purpose of venous claret 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.^[1] In veterinary medicine, the process is performed by veterinarians and veterinary technicians.

It is essential to follow a standard process for the collection of blood specimens to get accurate laboratory results. Any error in collecting the claret or filling the test tubes may atomic number 82 to erroneous laboratory results.^[2]

Venipuncture is one of the most routinely performed invasive procedures and is carried out for whatever of five reasons:

1. to obtain claret for diagnostic purposes;
2. to monitor levels of claret components;^[3]
3. to administer therapeutic treatments including medications, nutrition, or chemotherapy;
4. to remove blood due to excess levels of iron or erythrocytes (red blood cells); or
5. to collect blood for after uses, mainly transfusion either in the donor or in another person.

Blood analysis is an important diagnostic tool available to clinicians within healthcare.

Blood is well-nigh ordinarily obtained from the superficial veins of the upper limb.^[1] The median cubital vein, which lies inside the cubital fossa anterior to the elbow, is shut to the surface of the skin without many large nerves positioned nearby. Other veins that tin be used in the cubital fossa for venipuncture include the cephalic, basilic, and median antebrachial veins.^[four]

Infinitesimal quantities of blood may be taken by fingerstick sampling and nerveless from infants by means of a heelprick or from scalp veins with a winged infusion needle.

Phlebotomy (incision into a vein) is also the handling of certain diseases such as hemochromatosis and primary and secondary polycythemia.

Complications [edit]

A 1996 study of blood donors (a larger needle is used in claret donation than in routine venipuncture) found that ane in half dozen,300 donors suffered a nerve injury.^[5]

Equipment [edit]

There are many ways in which blood can be drawn from a vein, and the method used depends on the person'due south age, the equipment available, and the blazon of tests required.

Virtually blood collection in the U.s., U.k., Canada and Hong Kong is washed with an evacuated tube arrangement. Ii mutual systems are Vacutainer (Becton, Dickinson and company) and Vacuette (Greiner Bio-One). The equipment consists of a plastic adapter, as well known as a tube or needle holder/hub, a hypodermic needle and a vacuum tube. Under certain circumstances, a syringe may be used, ofttimes with a butterfly needle, which is a plastic catheter fastened to a brusque needle. In the developing earth, the evacuated tube system is the preferred method of drawing blood.^{[ citation needed ]}

With evacuated or vacuum tubes [edit]

Greiner Bio-1 manufactured the first always plastic evacuated blood collection tube in 1985 under the VACUETTE brand proper name. Today, many companies sell vacuum tubes equally the patent for this device is at present in the public domain. These tubes are manufactured with a specific book of gas removed from the sealed tube. When a needle from a hub or transfer device is inserted into the stopper, the tube'due south vacuum automatically pulls in the required volume of blood.^{[ citation needed ]}

The basic Evacuated Tube Organization (ETS) consists of a needle, a tube holder, and the evacuated tubes. The needle is fastened to the tube holder by the phlebotomist prior to collection, or may come up from the manufacturer equally one unit of measurement. The needle protrudes through the cease of the tube holder, and has a needle on each terminate. After first cleaning the venipuncture site and applying a tourniquet, the phlebotomist uncaps the needle attached to the tube holder, inserts the needle into the vein, so slides evacuated tubes into the tube holder, where the tube's stopper is pierced by the back end of the needle. The vacuum in the tube then automatically draws the needed blood directly from the vein. Multiple vacuum tubes can be attached to and removed in turn from a single needle, assuasive multiple samples to be obtained from a unmarried procedure. This is possible due to the multiple sample sleeve, which is a flexible rubber plumbing equipment over the posterior terminate of the needle cannula which seals the needle until it is pushed out of the fashion. This keeps blood from freely draining out of the back of the needle inserted in the vein, as each examination tube is removed and the side by side impaled. OSHA safe regulations require that needles or tube holders come equipped with a safety device to cover the needle after the procedure to forbid adventitious needle stick injury.^{[half dozen]}

Fittings and adapters used to fill evacuated tubes from butterfly needle kits and syringes are also bachelor.^{[ commendation needed ]}

There are several needle gauges for a phlebotomist to cull from. The most commonly used are every bit follows: a 21g (green pinnacle) needle, a 22g (black top) needle, a 21g (green label) butterfly needle, a 23g (light blue label) butterfly needle, and a 25g (orange or dark bluish label) butterfly needle (however this needle is only used in pediatrics or extreme cases as it is so small that it can oft event in hemolyzing the claret sample). There are also a variety of tube and bottle sizes and volumes for different test requirements.^[seven]

Additives and order of draw [edit]

The test tubes in which blood is collected may contain one or more of several additives. In full general, tests requiring whole blood call for blood samples nerveless in test tubes containing some grade of the anticoagulant EDTA. EDTA chelates calcium to preclude clotting. EDTA is preferred for hematology tests because it does minimum harm to cell morphology. Sodium citrate is the anticoagulant used in specimens nerveless for coagulation tests. The majority of chemical science and immunology tests are performed on serum, which is produced past clotting and then separating the claret specimen via centrifuge. These specimens are collected in either a not-additive tube or i containing a clotting activator. This clotting activator tin can interfere with some assays, so a plain tube is recommended in these cases, but will delay testing. Tubes containing lithium heparin or sodium heparin are too commonly used for a variety of chemical science tests, as they do non require clotting and can be centrifuged immediately afterwards collection. A combination of sodium fluoride and potassium oxalate is used for glucose tests, as these additives both forestall clotting and stop glycolosis, then that claret glucose levels are preserved afterwards drove.^[8] Another specialty tube is an opaque amber colored tube used to collect blood for low-cal sensitive analytes, such every bit bilirubin.^{[ commendation needed ]}

Examination tubes are labeled with the additive they contain, just the stopper on each tube is color coded according to condiment equally well. While colors vary betwixt manufacturers, stopper colors mostly are associated with each additive as listed below. Considering the additives from each tube tin can exist left on the needle used to fill the tubes, they must be drawn in a specific order to ensure that cross contamination volition non negatively affect testing of the samples if multiple tubes are to exist fatigued at once. The "guild of depict" varies by collection method. Beneath in the order of draw generally required for the Evacuated Tube Organisation (ETS) collection method are the almost common tubes, listing condiment and color:^{[9] [10]}

Vacutainer/sample tube types for venipuncture/phlebotomy edit

Tube cap color or type	Additive	Usage and comments
Blood culture bottle	Sodium polyanethol sulfonate (anticoagulant) and growth media for microorganisms	Usually drawn starting time for minimal run a risk of contamination.[11] Ii bottles are typically collected in one claret draw; ane for aerobic organisms and one for anaerobic organisms.[12]
Calorie-free blue	Sodium citrate (anticoagulant)	Coagulation tests such every bit prothrombin fourth dimension (PT) and partial thromboplastin time (PTT) and thrombin time (TT). Tube must be filled 100%.
Plain red	No additive	Serum: Total complement activeness, cryoglobulins
Aureate (sometimes ruby and grey "tiger tiptop"[13])	Jell activator and serum separating gel[14]	Serum-separating tube: Tube inversions promote clotting. Most chemical science, endocrine and serology tests, including hepatitis and HIV.
Nighttime green	Sodium heparin (anticoagulant)	Chromosome testing, HLA typing, ammonia, lactate
Mint green	Lithium heparin (anticoagulant)	Plasma. Tube inversions preclude clotting
Lavender ("regal")	EDTA (chelator / anticoagulant)	Whole blood: CBC, ESR, Coombs test, platelet antibodies, menses cytometry, blood levels of tacrolimus and cyclosporin
Pinkish	EDTA (chelator / anticoagulant)	Blood typing and cross-matching, directly Coombs test, HIV viral load
Royal blue	EDTA (chelator / anticoagulant)	Trace elements, heavy metals, virtually drug levels, toxicology
Tan	EDTA (chelator / anticoagulant)	Lead
Grey	Sodium fluoride (glycolysis inhibitor) Potassium oxalate (anticoagulant)[8]	Glucose, lactate[fifteen]
Xanthous	Acid-citrate-dextrose A (anticoagulant)	Tissue typing, Deoxyribonucleic acid studies, HIV cultures
Pearl ("white")	Separating gel, cumb and (10002)EDTA	PCR for adenovirus, toxoplasma and HHV-6

In children [edit]

Use of lidocaine iontophoresis is effective for reducing pain and alleviating distress during venipuncture in children.^[16] A needle-free powder lignocaine delivery system has been shown to decrease the pain of venipuncture in children.^{[17] [eighteen]} Rapid dermal anesthesia can be achieved by local coldhearted infiltration, merely it may evoke anxiety in children frightened by needles or distort the skin, making vascular admission more difficult and increasing the risk of needle exposure to wellness intendance workers. Dermal anesthesia can also be accomplished without needles by the topical awarding of local anesthetics or by lidocaine iontophoresis. By contrast, noninvasive dermal anesthesia can be established in v–xv min without distorting underlying tissues by lidocaine iontophoresis, where a direct electric current facilitates dermal penetration of positively charged lidocaine molecules when placed under the positive electrode.^{[ commendation needed ]}

One written report concluded that the iontophoretic administration of lidocaine was safe and effective in providing dermal anesthesia for venipuncture in children 6–17 years old. This technique may non be applicable to all children. Hereafter studies may provide data on the minimum effective iontophoretic dose for dermal anesthesia in children and the comparing of the anesthetic efficacy and satisfaction of lidocaine iontophoresis with topical coldhearted creams and subcutaneous infiltration.^[16]

Not-pharmacological treatments for hurting associated with venipuncture in children includes hypnosis and distraction. These treatments reduced self reported pain and when combined with cognitive-behavioural therapy (CBT) the reduction of pain was even greater. Other interventions take not been found to be constructive and these are proposition, blowing out air, and lark with parent coaching did not differ from command for hurting and distress.^[xix]

With needle and syringe [edit]

Some health care workers prefer to employ a syringe-needle technique for venipuncture. Sarstedt manufactures a blood-drawing system (S-Monovette) that uses this principle.^[twenty] This method tin be preferred on the elderly, those with cancer, severe burns, obesity, or where the veins are unreliable or delicate. Because syringes are manually operated, the amount of suction applied may exist easily controlled. This is particularly helpful when veins are pocket-size which may collapse under the suction of an evacuated tube. In children or other circumstances where the quantity of blood gained may be limited it tin can be helpful to know how much blood can be obtained before distributing it amongst the various additives that the laboratory volition require. Another alternative is drawing blood from indwelling cannulae.^[21]

Claret cultures [edit]

In that location are times when a blood civilisation collection is required. The culture will determine if in that location are pathogens in the claret. Normally blood is sterile. When cartoon claret from cultures apply a sterile solution such equally Betadine rather than alcohol. This is done using sterile gloves, while not wiping away the surgical solution, touching the puncture site, or in whatsoever fashion compromising the sterile process. It is vital that the procedure is performed in as sterile a manner as possible as the persistent presence of skin commensals in blood cultures could point endocarditis but they are most oftentimes found equally contaminants. It is encouraged to employ an abrasive method of skin grooming. This removes the upper layers of expressionless pare cells along with their contaminating bacteria.^[22] Povidone-iodine has traditionally been used simply in the United kingdom of great britain and northern ireland a 2% chlorhexidine in 70% ethanol or isopropyl alcohol solution is preferred and time must be allowed for information technology to dry out. The tops of any containers used when drawing a blood culture should also be disinfected using a similar solution. Some labs will actively discourage iodine use where iodine is thought to degrade the condom stopper through which blood enters the bottle, thus allowing contaminates to enter the container.^{[ citation needed ]}

The blood is collected into special transport bottles, which are similar vacuum tubes just shaped differently. The blood civilisation bottle contains send media to preserve any microorganisms present while they are existence transported to the laboratory for cultures. Because it is unknown whether the pathogens are anaerobic (living without oxygen) or aerobic (living with oxygen), blood is collected to examination for both. The aerobic bottle is filled first, and then the anaerobic canteen is filled. Withal, if the collection is performed using a syringe, the anaerobic canteen is filled first. If a butterfly collection kit is used, the aerobic bottle is filled beginning, and then that whatsoever air in the tubing is released into the oxygen-containing bottle.^{[ citation needed ]}

Specially designed claret culture drove bottles eliminate the demand for either the syringe or butterfly collection method. These specially designed bottles accept long necks that fit into the evacuated tubes holders that are use for regular venipuncture drove. These bottles also allow for collection of other blood specimens via evacuated tubes, to be collected without additional venipuncture.^{[ citation needed ]}

The amount of blood that is collected is critical for the optimal recovery of microorganisms. Up to 10mL of blood is typical, but can vary according to the recommends of the manufacturer of the collection bottle. Drove from infants and children are 1 to five mL. If too little claret is nerveless, the ratio of blood-to-nutrient broth will inhibit the growth of microorganisms. If too much claret is collected, at that place is the risk of a hospital-induced anemia and the ratio of claret-to-food broth will tilt in the reverse management, which also is not conductive to optimal growth.^{[ citation needed ]}

The bottles are and then incubated in specialized units for 24 hours earlier a lab technician studies and/or tests it. This step allows the very small numbers of bacteria (potentially 1 or 2 organisms) to multiply to a level which is sufficient for identification +/-antibiotic resistance testing. Modern blood culture bottles have an indicator in the base which changes color in the presence of bacterial growth and tin can be read automatically by machine. (For this reason the barcoded stickers plant on these bottles should non be removed as they are used past the laboratory'southward automated systems.)^{[ citation needed ]}

Taking blood samples from animals [edit]

Claret samples from living laboratory animals may be collected using following methods:^{[23] [24]}

• Claret drove not requiring anesthesia:
  • Saphenous vein (rat, mice, guinea pig)
  • Dorsal pedal vein (rat, mice)
• Blood drove requiring anesthesia (local/general anesthesia):
  • Tail vein (rat, mice)
  • Tail snip (mice)
  • Orbital sinus (rat, mice)^[25]
  • Jugular vein (rat, mice)
  • Temporary cannula (rat, mice)
  • Blood vessel cannulation (guinea pig, ferret)
  • Tarsal vein (guinea pig)
  • Marginal ear vein or avenue (rabbit)
• Final process:
  • Cardiac puncture (rat, mice, republic of guinea pig, rabbit, ferret)
  • Orbital sinus (rat, mice)
  • Posterior vena cava (rat, mice)

The volume of the blood sample collection is very important in experimental animals. All nonterminal blood collection without replacement of fluids is limited upward to 10% of total circulating blood book in good for you, normal, adult animals on a unmarried occasion and drove may be repeated after three to 4 weeks. In case repeated blood samples are required at short intervals, a maximum of 0.6 ml/kg/twenty-four hours or one.0% of an animal's total blood volume tin exist removed every 24 hours. The estimated blood book in adult animals is 55 to lxx ml/kg trunk weight. Care should be taken for older and obese animals. If blood collection book exceeds more than than 10% of total blood volume, fluid replacement may be required. Lactated Ringer'due south solution (LRS) is recommended equally the best fluid replacement by National Institutes of Health (NIH). If the volume of blood collection exceeds more than than 30% of the total circulatory blood volume, adequate care should be taken so that the animal does non endure from hypovolemia.^[24]

Blood alcohol tests [edit]

It is by and large not advisable to utilize isopropyl alcohol to cleanse the venipuncture site when obtaining a specimen for a blood alcohol test. This has been related largely to the potential legal implications associated with the employ of alcohol-based cleaners that could theoretically impact analysis. Numerous law booze drove kits accept been marketed that incorporate a sodium fluoride/potassium oxalate preservative and non-alcohol-based cleansing agents to ensure proper collection. Using lather and hot water or a povidone-iodine swab are appropriate alternatives to isopropyl alcohol in this instance.^{[ citation needed ]}

See also [edit]

• Arterial claret is taken from an artery instead of a vein

References [edit]

1. ^ ^{a b} Higgins, Dan (28 September 2004). "Venepuncture". Nursing Times. 100 (39): 30–1. PMID 15500234.
2. ^ Dg, Dayyal. "PROCEDURES FOR THE COLLECTION OF Blood FOR HEMOTOLOGICAL INVESTIGATIONS". BioScience Pakistan. BioScience Islamic republic of pakistan. ISSN 2521-5760.
3. ^ Lavery, I; Ingram, P (August 2005). "Venepuncture: Best Exercise". Nurs Stand. nineteen (49): 55–65. doi:10.7748/ns2005.08.19.49.55.c3936. PMID 16134421.
4. ^ Ialongo, Cristiano; Bernardini, Sergio (2016-02-15). "Phlebotomy, a bridge between laboratory and patient". Biochemia Medica. 26 (1): 17–33. doi:10.11613/BM.2016.002. ISSN 1330-0962. PMC4783087. PMID 26981016.
5. ^ "'A Fiddling Sting' Tin can Become a Debilitating Injury". Retrieved 25 March 2020.
6. ^ McCall, Ruth (2020). Phlebotomy Essentials (7th ed.). Wolters Kluwer. p. 193. ISBN9781496387073.
7. ^ Perry, Sally (2007). "Ask the Lab: Hemolyze blood specimens". Nursing.advanceweb.com. Retrieved 2013-12-29 .
8. ^ ^{a b} Castellini MA, Castellini JM, Kirby VL (1992). "Effects of standard anticoagulants and storage procedures on plasma glucose values in seals". J Am Vet Med Assoc. 201 (ane): 145–8. PMID 1644639.
9. ^ "Collection". www.osfhealthcare.org . Retrieved 2019-12-08 .
10. ^ Christopher Parker (2019-01-31). "Phlebotomy Services". University of Due north Carolina Schoolhouse of Medicine.
11. ^ Pagana, KD; Pagana, TJ; Pagana, TN (nineteen September 2014). Mosby's Diagnostic and Laboratory Exam Reference - E-Book. Elsevier Health Sciences. p. 13. ISBN978-0-323-22592-2.
12. ^ "Chapter 3.iv.ane: Blood cultures; general detection and estimation". Clinical Microbiology Procedures Handbook. Wiley. 6 Baronial 2020. ISBN978-1-55581-881-4.
13. ^ "Test Tube Guide and Order of Draw" (PDF). Guthrie Laboratory Services. June 2019. {{cite web}}: CS1 maint: url-status (link)
14. ^ "Specimen requirements/containers". Pathology & Laboratory Medicine, UCI School of Medicine . Retrieved 2020-09-ten .
15. ^ Amitava Dasgupta; Jorge Fifty. Sepulveda (20 July 2019). Accurate Results in the Clinical Laboratory: A Guide to Error Detection and Correction. Elsevier Science. p. 131. ISBN978-0-12-813777-two.
16. ^ ^{a b} Rose, John B.; Galinkin, Jeffrey 50.; Jantzen, Ellen C.; Chiavacci, Rosetta Yard. (2002). "A Study of Lidocaine Iontophoresis for Pediatric Venipuncture". Anesthesia & Analgesia. 94 (four): 867–71, table of contents. doi:ten.1097/00000539-200204000-00017. PMID 11916787. S2CID 25591907.
17. ^ Lacroix, Helene (October 2008). "A needle-free powder lignocaine delivery arrangement reduced the pain of venipuncture in children". Prove-Based Nursing. eleven (4): 106. doi:10.1136/ebn.11.four.106. PMID 18815318. S2CID 44888650.
18. ^ Robertson, J (January 2006). "Liposomal lidocaine improved intravenous cannulation success rates in children". Evid-Based Nurs. 9 (ane): ten. doi:10.1136/ebn.nine.1.x. PMID 16437788. S2CID 45422187.
19. ^ Robertson, J (July 2007). "Review: Distraction, Hypnosis, and Combined Cerebral-Behavioural Interventions Reduce Needle Related Pain and Distress in Children and Adolescents". Evid-Based Nurs. 10 (3): 75. doi:10.1136/ebn.10.3.75. PMID 17596380. S2CID 34364928.
20. ^ "Blood drove with the Due south-Monovette" (PDF) . Retrieved 27 May 2020.
21. ^ Lesser, Finnian D; Lanham, David A; Davis, Daniel (6 May 2020). "Blood sampled from existing peripheral Iv cannulae yields results equivalent to venepuncture: a systematic review". JRSM Open. 11 (5). doi:10.1177/2054270419894817. PMC7236571. PMID 32523703.
22. ^ Garcia, RA; Spitzer, ED; Beaudry, J; Brook, C; Diblasi, R; Gilleeny-Blabac, K; Haugaard, C; Heuschneider, South; Kranz, BP; McLean, K; Morales, KL; Owens, S; Paciella, ME; Torregrosa, E (Nov 2015). "Multidisciplinary Team Review of Best Practices for Collection and Handling of Blood Cultures to Determine Effective Interventions for Increasing the Yield of True-positive Bacteremias, Reducing Contagion, and Eliminating False-positive Cardinal Line-associated Bloodstream Infections". Am J Infect Control. 43 (eleven): 1222–37. doi:10.1016/j.ajic.2015.06.030. PMID 26298636.
23. ^ Hoff, J. (2000). "Methods of Blood Collection in the Mouse" (PDF). Lab Animal. 29 (ten): 47–53.
24. ^ ^{a b} Parasuraman, S; Raveendran, R; Kesavan, R (2010). "Blood sample collection in small laboratory animals". Journal of Pharmacology and Pharmacotherapeutics. 1 (2): 87–93. doi:ten.4103/0976-500X.72350. PMC3043327. PMID 21350616.
25. ^ Parasuraman, Subramani; Zhen, Khor Ming; Raveendran, Ramasamy (22 May 2015). "Retro-orbital Blood Sample Collection in Rats-a Video Commodity". Pharmacology, Toxicology and Biomedical Reports. 1 (2): 37–xl. doi:10.5530/PTB.1.two.i.

Do They Draw Blood From Veins Or Arteries,

Source: https://en.wikipedia.org/wiki/Venipuncture

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