Why tourniquet is used in phlebotomy

Step 2: Expose the open wound. Step 3: Apply firm, direct pressure to the wound site. Step 4: Choose a tourniquet. Step 5: Apply the tourniquet. Step 6: Assess for shock. What is the tourniquet used for? Tourniquets are tight bands used to completely stop the blood flow to a wound.

To control bleeding after an injury to a limb, tourniquets should ideally only be used by first responders trained in emergency first aid. Knowing when and when not to use a tourniquet to control bleeding can be difficult to ascertain. Do you keep tourniquet on when drawing blood? Some guidelines suggest removing the tourniquet as soon as blood flow is established, and always before it has been in place for two minutes or more.

How bad does a tourniquet hurt? The tourniquet is indicated for life-threatening extremity bleeding only. That is, it should not be used where direct pressure can easily stop the bleeding. A properly applied tourniquet should eliminate the distal pulse in the affected limb. Understand, too, that when a tourniquet is properly applied, it will hurt!

Why is a tourniquet placed 3 to 4? Tourniquets: Tied inches above the elbow immediately before the venipuncture procedure begins. Because tourniquets impedes blood flow, leaving it on for longer than 1 minute greatly increases the possibility of Hemoconcentration and altered tests results. What is the most important aspect of any phlebotomy procedure?

Why is a tourniquet placed 3 to 4 inches above the intended venipuncture site? However, there were significant decreases in erythrocyte deformability at 90, , s, and increases in erythrocyte aggregation at 5 and 30 s following removal of the tourniquet.

A significant increase in granulocyte respiratory burst at 60 s was observed, confirming leukocyte activation due to application of the tourniquet. Conclusions: Our blood sampling technique which mimicked the application and release of a tourniquet indicated unaltered values for routine blood gases, hematological testing and serum electrolyte levels.

Conversely, hemorheological measurements can be affected. ETS tubes are filled in a specific order to avoid additive contamination from tube to tube. Depending on the lab tests being collected, as well as facility protocol, you may be required to collect a "waste" or discard sample as your first tube. This tube is typically white or clear and collects approximately 3 to 5 mL of blood to prevent contamination of the sample.

A nonadditive red-top tube may also be used as a discard sample tube. Each tube needs to be mixed by inverting it a certain number of times. It's important not to invert tubes too quickly or you may cause hemolysis of the blood cells, which can lead to erroneous lab results.

Most tubes are inverted eight times. Red and gold tubes are inverted five times and light blue tubes are inverted four times. Place gauze lightly over the site just before withdrawing the needle so that when you remove the needle, you can apply immediate pressure. At this point, you may ask the patient to hold pressure with the gauze.

If the patient is unable, then you must complete this step. Hold the pressure for at least 2 minutes. If the patient is receiving anticoagulant therapy, such as heparin or warfarin, hold the pressure for 5 minutes.

Under no circumstances should you remove the needle from the tube holder before disposal because it increases your risk of a needle stick. Many facilities have computer-generated labels for tubes. If you're filling out the entire label, include the patient's last name and first initial, his or her date of birth, your initials, the time, and the date.

If the lab you drew requires special handling, such as placing the tube in an ice slurry or wrapping it in foil to protect it from light, now's the time to do so. If you aren't sure of special handling for a sample, call the lab and ask. It's better to clarify than to repeat a blood draw because of mishandling a sample.

Assess the insertion site for continued bleeding or bruising. If the site isn't actively bleeding, then apply a pressure bandage with gauze and tape.

If the site is still bleeding, continue to hold pressure and recheck the site in a few minutes. Follow your facility's policy for disposal of items with blood on them. Also throw away the tourniquet and any other used materials. Remove and throw away your gloves, and then perform hand hygiene with soap and water or sanitizing gel. You should also thank your patient, communicate any symptoms to report, and let him or her know that the provider will discuss any abnormal lab values.

If you used a phlebotomy tray or cart, remove it from the room and sanitize it per facility policy. Follow your facility's policy for lab sample transport.

If this is a stat lab or the sample requires special handling, it may be most efficient to bring the sample to the lab yourself. Be sure to keep the tubes upright and away from excessive movement during transport to reduce the risk of cell hemolysis.

The preanalytical phase of blood specimen collection and lab value determination is everything that happens from the time the test is ordered to the time the sample is analyzed.

There are multiple considerations during this phase. Granted, nurses don't have control over all preanalytical risks and concerns, but there's a lot you can do to minimize erroneous lab results and help decrease the likelihood of a second blood draw. After the results are obtained, it's imperative to ensure provider communication of their significance to the patient.

Depending on what lab test is ordered, you need to verify that it's the correct time to draw the lab. For example, when a drug's peak and trough levels are tested, make sure that you're drawing the peak level after the correct dosage and at the high point of the drug's pharmacologic peak. You should verify the peak time in a drug reference before the draw.

The trough is drawn just before a dose administration; usually, the third or fourth because this is when serum drug levels are at their lowest. You should avoid these areas for several reasons. Any area of the skin that's newly burned or injured may be painful for the patient and there's an increased risk of infection. Areas that have healed after an injury, including tattoos, may have significant scar tissue and impaired circulation that can cause erroneous results.

Tattoos can also hide underlying bruising or hematomas and often patients don't want a blood draw through a tattoo. Damaged veins from frequent blood draws, I. The removal of lymph nodes or impaired lymph circulation can cause not only an imbalance in blood composition, but also put a patient at increased risk for infection and lymphedema. Performing venipuncture on a patient's mastectomy side is the last resort and you should consult the patient's healthcare provider first.

You should avoid venipuncture on the extremity with an established I. If a patient has an I. If the patient has I. Sites that are swollen from an injury or I. Swelling in the arm or obesity can make it difficult to locate a viable vein for venipuncture. If the patient is obese, use a longer tourniquet or extra-large BP cuff too avoid patient discomfort. Believe it or not, tourniquet application is one of the most important steps in proper venipuncture.

You should place a tourniquet 3 to 4 in 7. Tie the tourniquet using a quick release knot, with the ends pointed away from the venipuncture site and the loop pointed toward the site. If the ends are pointing toward the insertion site, they can easily get in the way and cause contamination.

Remember, you shouldn't leave the tourniquet in place for more than 1 minute. Also, never place a tourniquet over a wound or acute injury. It's perfectly acceptable to place a sleeve or towel under the tourniquet to protect the patient from skin tears and discomfort.

This should be a key nursing intervention when you're drawing blood from an older adult patient with frail skin. As hospitals and other care centers decentralize ancillary services, nurses are being called on more frequently to draw blood.

Transitional and home care nurses often perform phlebotomy procedures, but rarely receive adequate education to do so. Procedural errors during the preanalytical phase are largely responsible for inaccurate lab results that lead to the need for additional blood draws or improper treatment. However, there's little room in nursing curricula to add more skills content. This leaves phlebotomy as a topic for continuing education.

Take the initiative to educate yourself about proper phlebotomy techniques and equipment before you're asked to draw blood. Appold K. Drawing blood from drug addicts. Journal of Continuing Education Topics and Issues. Daugherty K. Best practices in phlebotomy A qualitative study of phlebotomy device selection. Medsurg Nurs. E-Phlebotomy Training. Order of draw explained: clearing out any confusion.

Phlebotomy Handbook. Phlebotomy Essentials. Philadelphia, PA: Wolters Kluwer; Ropp P. Steps to lowering blood culture contamination rates in the ED. Nurs Manag. Vincent E. Issues of infection prevention and control in phlebotomy.