CLINICAL LAB SCIENEC

280
ESSENTIALS OF CLINICAL LABORATORY SCIENCE
compliant, the patient may be asked to hold the gauze or cotton ball for a couple
of minutes or more. Discard used needles and any bloody materials in properly
designed receptacles. Place needles in sharps containers. Alcohol swabs and wrappers,
along with wrappers for sponges, may go into regular trash. Ensure tubes
of blood are properly labeled and placed in racks for transport. Place a bandage
over the puncture site and over the sponge to maintain pressure. Patients who
have a sensitivity to adhesive bandages should have paper tape placed over the
sponge covering the puncture site. After removing the gloves in an aseptic manner
to avoid contact with the outside of the gloves, discard the gloves in the
ordinary trash receptacle. The hands should again be washed thoroughly before
the specimens are transported to the proper location in a timely fashion.
Postphlebotomy Care at Site of Puncture
Again, and it bears repeating, the tourniquet should be released BEFORE the needle
is withdrawn from the vein. In some cases, the phlebotomist may release the tourniquet
immediately after entering the vein, if the vein is large enough to allow sufficient
flow of blood to fill the required tube(s). Failure to release the tourniquet before
pulling the needle from the vein is a common error by the beginner, and often results
in the formation of a hematoma. A hematoma may also appear while the sample is
being drawn if the skin of the patient is thin and fragile, as in the elderly. It is best to
remove the needle as quickly as possible to avoid unwarranted stress on the vein.
Following the procedure, the patient should be instructed to maintain firm pressure
directly on the site while the technician or phlebotomist places labels, prepares
blood, or identifies the samples. After several minutes of pressure, the phlebotomist
should remove the pressure materials (cotton or gauze) and examine the site for
continued bleeding or signs of a hematoma. If the needle transfixed the vein and
entered the tissue below the vein, bruising will almost certainly result. It may be necessary
to apply cold packs that are wrapped in cloths to avoid freezing of the skin.
The patient, if mentally alert and oriented, may be instructed to use a cold pack for
a day or so, for a few minutes at a time. Warm wet cloths will also help to remove
dead blood cells from beneath the skin following a day or two of cold treatment.
Completion of Procedure
Clean the area of used needles and any material that may have become bloodstained.
Do not leave any trash in the patient’s room. Patients have been injured
by forgotten hypodermic needles and lancets used for capillary punctures. If any
blood was spilled or dripped onto surfaces in the patient’s room or on the patient,
this matter should be properly taken care of before leaving the room.
Perform any documentation such as logging of specimens in the laboratory.
If the patient is fasting, as in an outpatient clinic, and there are no other dietary
restrictions, the patient may be informed that he or she may eat.
Inability to Obtain Specimen
If, on the first try, the phlebotomist or medical laboratory worker is unable to
obtain a specimen, a second attempt may be made. If the patient is overly anxious
or questions the phlebotomist’s qualifications or competency, it is best to
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