Phlebotomy Essentials (5E)

Phlebotomy Essentials (5e)

Chapter 9 — Preanalytical Considerations

Phlebotomy Essentials (5e)

Lesson Plan

Chapter 9 — Preanalytical Considerations

Goals of the Lesson:

Cognitive: Students will be able to identify potential problem situations associated with venipuncture, including physiologic, physical (e.g., medical devices), and anatomic difficulties. Students will be able to identify errors that occur during blood collection and will know the proper procedures for reporting such errors.

Motor: Students will be able to select a venipuncture site appropriately and complete draws on most patients.

Affective: Students will understand the need to properly report procedural errors.

Learning Objectives. The lesson plan for each objective starts on the page shown below:

Objective 9-1: Define the key terms and abbreviations listed at the beginning of this chapter...... 9-2

Objective 9-2: List and describe the physiological variables that influence laboratory test results and identify the tests most affected by each one. 9-3

Objective 9-3: List problem areas to avoid in site selection, identify causes for concern, and describe procedures to follow when encountering each. 9-4

Objective 9-4: Identify and describe various vascular access sites and devices and explain what to do when they are encountered. 9-5

Objective 9-5: Identify, describe, and explain how to handle patient complications associated with blood collection...... 9-7

Objective 9-6: Identify, describe, and explain how to avoid or handle procedural error risks, specimen quality concerns, and reasons for failure to draw blood. 9-8

You Will Need:

Suggested list of classroom materials and teaching aids for Chapter 9:

AllCLSI. Procedures for the Collection of Diagnostic Blood Specimens by Venipuncture. Approved Standard. [NCCLS Document H3-A6.]

9-3Photos of common problem sites

9-4Blood sampling device; saline lock with needleless entry stopcock; IV line; central venous catheter; implanted port; peripherally inserted central catheter

9-5Tourniquets; venipuncture equipment; artificial arms

9-6Samples of lipemic, icteric, hemolyzed & normal specimens; needles; protractor; artificial arm

Objective 9-1:Define the key terms and abbreviations listed at the beginning of this chapter.

Lecture Outline — Objective 9-1

Figures, Tables, and Features

Resources andIn-Class Activities

Outside Assignments/ Evaluation

Instructor’s Notes

Content / Text / PPt
Key Terms listed on p. 283 / 283 / All tables and figures are available in the Image Bank on the IRC. / Outside Assignment
SRC
Audio Glossary of key terms
Flash cards of key terms
Evaluation
WB
Matching 9-1: Key Terms and Descriptions
Knowledge Drill 9-2: Scrambled Words
Skills Drill 9-2: Word Building
Legend: PPt: PowerPoint; IRC: Instructor Resource Center (found at SRC: Student Resource Center (found at WB: Workbook.

Objective 9-2:List and describe physiological variables that influence laboratory test results and identify the tests most affected by each one.

Lecture Outline — Objective 9-2

Figures, Tables, and Features

Resources andIn-Class Activities

Outside Assignments/ Evaluation

Instructor’s Notes

Content / Text / PPt
Reference ranges/intervals
Basal state
Physiological variables
Age
Altitude
Dehydration
Diet
Diurnal/circadian variations
Drug therapy
Exercise
Fever
Gender
Intramuscular injection
Jaundice
Position
Pregnancy
Smoking
Stress
Temperature and humidity / 284–290 / 6–9 / Figures
9-1: Lipemic, icteric, and normal specimen.
p. 286
9-2: Jaundice
p. 289; PPt 9 / In-Class Activities
IRC
Critical Thinking Questions / WB
Matching 9-2: Physiological Effect and Test
Skills Drills 9-1: Requisition Activity
Legend: PPt: PowerPoint; IRC: Instructor Resource Center (found at SRC: Student Resource Center (found at WB: Workbook

Objective 9-3:List problem areas to avoid in site selection, identify causes for concern, and describe procedures to follow when encountering each.

Lecture Outline — Objective 9-3

Figures, Tables, and Features

Resources andIn-Class Activities

Outside Assignments/ Evaluation

Instructor’s Notes

Content / Text / PPt
Problem sites
Burns, scars, and tattoos
Damaged veins

Sclerosed
Thrombosed

Edema
Hematoma
Mastectomy

Lymphostasis

Obesity / 291–293 / 10–13 / Figures
9-3: Examples of bruising resulting from hematomas that formed during or immediately following venipuncture.
p. 292; PPt 12 / In-Class Activities
Discussion
Bring some photos of problem sites on patients to class to show students as you discuss them.
Materials
Photos of common problem sites / Outside Assignments
WB
Matching 9-3: Problem Site and Drawback
Legend: PPt: PowerPoint; IRC: Instructor Resource Center (found at SRC: Student Resource Center (found at WB: Workbook

Objective 9-4:Identify and describe various vascular access sites and devices and explain what to do when they are encountered.

Lecture Outline — Objective 9-4

Figures, Tables, and Features

Resources andIn-Class Activities

Outside Assignments/ Evaluation

Instructor’s Notes

Content / Text / PPt
Vascular access devices (VADs) and sites
Arterial line
Arteriovenous shunt, fistula, or graft

Never apply tourniquet or blood pressure cuff
No venipunctures

Blood sampling device
Heparin or saline lock
Intravenous sites
Previously active IV sites
Central vascular access devices (CVADs)

Central venous catheter (CVC)
Implanted port
Peripherally inserted central catheter

/ 293–300 / 13–23 / Figures
9-4: Arms with AV shunts; fistula (left) and graft (right).
p. 293; PPt 15
9-5: Blood sampling device.
pp. 293–295; PPt 16
9-6: Saline lock with needleless entry stopcock.
p. 296; PPt 17
9-7:Patient's arm with an intravenous (IV) line.
p. 296; PPt 18
9-8: Central venous catheters. A. CVC placement. B. Groshong CVC. C. Hickman CVC.
p. 298; PPt 21
9-9: Implanted port. A. Port placement. B. PowerPort implanted port. C. PowerPort Duo implanted port.
p. 299; PPt 22
9-10: Peripherally inserted central catheter (PICC). A. PICC placement. B. PowerPICC catheter.
p. 300; PPt 23
Procedures
9-1: Performing Venipuncture Below an IV
p. 297 / In-Class Activities
Discussion
Bring in various vascular access devices, such as a blood sampling device, a saline lock with needleless entry stopcock, an IV line, a central venous catheter, an implanted port, and a peripherally inserted central catheter. Demonstrate on a student volunteer approximately where these devices are placed.
IRC
Critical Thinking Question
Materials
Blood sampling device
Saline lock with needleless entry stopcock
IV line
Central venous catheter
Implanted port
Peripherally inserted central catheter / Outside Assignments
WB
Matching 9-4: Scenarios and Vascular Access Devices
Labeling Exercise 9-2: VAD Identification
Skills Drill 9-3: Venipuncture Below an IV
Legend: PPt: PowerPoint; IRC: Instructor Resource Center (found at SRC: Student Resource Center (found at WB: Workbook

Objective 9-5:Identify, describe, and explain how to handle patient complications associated with blood collection.

Lecture Outline — Objective 9-5

Figures, Tables, and Features

Resources andIn-Class Activities

Outside Assignments / Evaluation

Instructor’s Notes

Content / Text / PPt
Patient complications and conditions
Allergies to equipment and supplies

Adhesive allergy
Antiseptic allergy
Latex allergy

Excessive bleeding
Fainting (syncope)
Nausea and vomiting
Pain
Petechiae — small red spots; may indicate likelihood of excessive bleeding
Seizures/convulsion / 300–304 / 24–28 / Figures
9-11: Phlebotomist caring for a patient who feels faint
p. 302
9-12: Petechiae.
p. 304; PPt 27
Procedures
9-2: Steps to Follow if a Patient Starts to Faint During Venipuncture
p. 302 / In-Class Activities
Discussion
Role play patient complication situations, with some students acting as patients and other students practicing how to react appropriately.
Have students time the length of tourniquet application while practicing venipuncture on artificial arms.
IRC
Critical Thinking Questions
Video: "How to Handle a Fainting Patient"
Materials
Tourniquets
Venipuncture equipment
Artificial arms / Outside Assignments
WB
Skills Drill 9-4: Fainting Procedure
Legend: PPt: PowerPoint; IRC: Instructor Resource Center (found at SRC: Student Resource Center (found at WB: Workbook

Objective 9-6: Identify, describe, and explain how to avoid or handle procedural error risks, specimen quality concerns, and reasons for failure to draw blood.

Lecture Outline — Objective 9-6

Figures, Tables, and Features

Resources andIn-Class Activities

Outside Assignments/ Evaluation

Instructor’s Notes

Content / Text / PPt
Procedural error risks
Hematoma formation
Iatrogenic anemia
Inadvertent arterial puncture
Infection
Nerve injury
Reflux of additive
Vein damage
Specimen quality concerns
Hemoconcentration from venous stasis
Hemolysis
Partially filled tubes
Specimen contamination
Wrong or expired collection tube
Troubleshooting failed venipuncture
Tube position
Needle position

Needle not inserted far enough
Bevel partially out of the skin
Bevel partially into the vein
Bevel partially through the vein
Bevel completely through the vein
Bevel against a vein wall
Needle beside the vein
Undetermined needle position

Collapsed vein
Tube vacuum / 304–315 / 29–37 / Figures
9-13: Correct filling of tube to avoid reflux.
p. 307
9-14: Normal serum specimen, specimen with slight hemolysis, and grossly hemolyzed specimen.
p. 308, PPt 11
9-15: Two examples of under-filled light-blue-top tubes.
p. 310: PPt 11
9-16: Normal draw tube shown with "Short draw" tube designed for partial filling. Arrow on tube indicates proper fill level.
p. 310
9-17: Needle position
p. 312; PPt 13.
Boxes
9-1: Situations That Can Trigger Hematoma Formation
p. 304
9-2: Ways to Help Prevent Hemoconcentration During Venipuncture
p. 308
9-3: Procedural Errors That Can Cause Specimen Hemolysis
p. 309 / In-Class Activities
Discussion
Have students identify specimens that are hemolyzed and to what degree.
Have students measure each other’s needle entry angle several times with a protractor when they are practicing on an artificial arm. Record and compare results with others.
IRC
Animation: "Reflux"
Animations of needle positions
Animation: "Hemolysis"
Materials
Samples of hemolyzed specimens
Needles
Protractor
Artificial arm / Outside Assignment
Study and Review Questions, text pp. 315–316
Case Studies, text p. 316–317
Evaluation
IRC
Test Generator
SRC
Test your knowledge with the interactive exercises found in the SRC.
WB
Matching 9-6: Sentence Beginning and Ending
Labeling Exercise 9-1: Identifying Venipuncture Problems
Knowledge Drill 9-1: Caution and Key Point Recognition
Knowledge Drill 9-3: Hematoma Formation
Knowledge Drill 9-4: Iatrogenic Blood Loss
Knowledge Drill 9-5: Hemoconcentration
Knowledge Drill 9-6: Serum Appearance
Crossword
Chapter Review Questions
Case Study 9-1
Case Study 9-2
Legend: PPt: PowerPoint; IRC: Instructor Resource Center (found at SRC: Student Resource Center (found at WB: Workbook

Page 9-1