Phlebotomy Complications - Ccma
- Which immediate action is required when a hematoma begins forming during collection?
- Release tourniquet; remove needle; apply firm pressure. These measures halt blood leakage and promote hemostasis to minimize tissue damage.
- Which immediate adjustment can restore flow if the bevel is against the vein wall?
- Slightly reposition needle (pull back a small amount). Minor withdrawal relieves bevel occlusion against the vein wall, restoring proper blood flow.
- Identify the classic early signs of a vasovagal reaction during blood collection.
- Pallor, diaphoresis, dizziness, nausea. These symptoms arise from parasympathetic activation leading to vasodilation and reduced cerebral perfusion.
- Which tourniquet time limit helps prevent hemoconcentration during venipuncture?
- No longer than 1 minute. This duration minimizes venous stasis effects that could alter specimen analyte levels.
- Which immediate action is required if arterial puncture is suspected during collection?
- Stop draw; remove needle; apply firm pressure at least 5 min. Prolonged pressure is needed to achieve hemostasis given the higher arterial pressure.
- Which finding during venipuncture most suggests accidental arterial puncture?
- Bright red blood with pulsatile, rapid flow. Arterial blood exhibits these characteristics due to higher oxygen content and pressure.
- What is the most common immediate systemic adverse reaction during venipuncture?
- Syncope (vasovagal fainting). This reaction stems from vagal stimulation causing sudden hypotension and bradycardia during the procedure.
- Which immediate action is appropriate if a patient develops hives and wheezing during collection?
- Stop procedure; activate emergency response; monitor airway. These signs suggest anaphylaxis, necessitating rapid intervention to prevent respiratory compromise.
- What is a hematoma during venipuncture?
- Blood leaking into tissue causing swelling/bruising. It occurs when blood escapes the vessel into surrounding tissues due to improper technique.
- What is petechiae at a venipuncture site, and what does it suggest?
- Pinpoint red spots; suggests platelet disorder/bleeding risk. These capillary hemorrhages indicate potential coagulopathy, warranting caution during collection.
- What is nerve injury during venipuncture most likely to present as?
- Sharp shooting pain, tingling, or numbness radiating. Needle contact with nerves causes immediate sensory disturbances along the nerve pathway.
- What is the key complication risk when drawing blood from an arm with an IV infusion?
- Specimen dilution/contamination by IV fluids. IV fluids can mix with drawn blood, altering analyte concentrations and test accuracy.
- What is the most common local allergic reaction to antiseptics or adhesives after a draw?
- Contact dermatitis (itching, redness, rash). Hypersensitivity to these agents triggers localized inflammatory responses in susceptible individuals.
- What is the primary cause of a hematoma during venipuncture?
- Needle partially through vein or vein wall puncture. This allows blood to escape the vein into tissues, often from excessive manipulation.
- What position best helps prevent injury when a patient is about to faint during a draw?
- Supine with legs elevated. This position enhances venous return and cerebral perfusion to counteract vasovagal effects.
- Which specimen appearance most suggests hemolysis after centrifugation?
- Pink to red plasma/serum. Released hemoglobin from lysed RBCs imparts this color, indicating sample unsuitability for testing.
- Which immediate action is required when a patient reports electric-shock pain on needle insertion?
- Stop immediately; remove needle; document and report. Prompt cessation prevents further nerve trauma and allows for proper incident management.
- Which immediate action is required when a patient reports dizziness during collection?
- Stop draw; remove needle; place patient supine. These steps prevent progression to syncope and ensure patient safety by restoring blood flow to the brain.
- What is the definition of hemolysis in a blood specimen?
- Rupture of RBCs releasing hemoglobin into plasma/serum. Mechanical stress or improper handling damages erythrocyte membranes, compromising sample integrity.
- Which observation at the puncture site most strongly indicates a developing hematoma?
- Rapid swelling with discoloration at the site. These signs reflect blood accumulation outside the vein, requiring immediate intervention.
- Identify the correct response when a patient develops a rapidly enlarging bruise after needle removal.
- Apply firm pressure and elevate the arm. These actions promote hemostasis and reduce further extravascular blood accumulation.
- What complication is suggested when blood flow stops but the needle is still in the vein?
- Vein collapse or needle bevel against vein wall. These issues impede blood flow despite venous access, often from vacuum pressure or positioning.
- Which collection error is a common cause of hemolysis when using a syringe?
- Forcing blood through the needle into the tube. High shear force damages red blood cells, leading to hemoglobin release into the specimen.
- What is hemoconcentration in phlebotomy?
- Increased analytes from prolonged tourniquet/stasis. Prolonged stasis causes fluid shifts, elevating concentrations of non-diffusible blood components.
- Which action is appropriate if petechiae develop during site cleansing or tourniquet use?
- Notify supervisor; apply extra pressure after draw. This ensures oversight for bleeding risks and controls post-procedure hemorrhage.