Skill 18-10 PDF

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skills to know for exam 3...

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Skill Checklists for Taylor’s Clinical Nursing Skills. A Nursing Process Approach, 5th edition

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SKILL 18-10

Obtaining a Venous Blood Specimen for Culture and Sensitivity Goal: An uncontaminated specimen is obtained without injury to the patient and sent to the laboratory promptly.

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1. Gather the necessary supplies. Check product expiration dates. Identify ordered number of blood culture sets and select the appropriate blood collection bottles (at least one anaerobic and one aerobic bottle). If tests are ordered in addition to the blood cultures, collect the blood culture specimens before other specimens.

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2. Perform hand hygiene and put on PPE, if indicated.

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5. Check specimen label with the patient’s identification bracelet. Label should include the patient’s name and identification number, time specimen was collected, route of collection, identification of person obtaining the sample, and any other information required by facility policy.

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6. Assemble equipment on overbed table or other surface within reach.

Comments

3. Identify the patient. 4. Explain the procedure. Allow the patient time to ask questions and verbalize concerns about the venipuncture procedure.

7. Close curtains around the bed and close the door to the room, if possible. 8. Provide for good light. Artificial light is recommended. Place a trash receptacle within easy reach.

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9. Assist the patient to a comfortable position, either sitting or lying. If the patient is lying in bed, raise the bed to a comfortable working height, usually elbow height of the caregiver (VHACEOSH, 2016).

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10. Determine the patient’s preferred site for the procedure based on his or her previous experience. Expose the arm, supporting it in an extended position on a firm surface, such as a tabletop. Position self on the same side of the patient as the site selected. Apply a tourniquet to the upper arm on the chosen side approximately 3 to 4 in above the potential puncture site. Apply sufficient pressure to impede venous circulation, but not arterial blood flow.

Skill Checklists for Taylor’s Clinical Nursing Skills. Copyright © 2019 by Wolters Kluwer. Skill Checklists for Taylor’s Clinical Nursing Skills: A Nursing Process Approach, 5th edition, by Pamela Lynn.

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A Nursing Process Approach, 5th edition

Needs Practice

Satisfactory

Excellent

Name Unit Instructor/Evaluator:

Date Position Position

SKILL 18-10

Obtaining a Venous Blood Specimen for Culture and Sensitivity (Continued) Comments

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11. Put on nonsterile gloves. Assess the veins using inspection and palpation to determine the best puncture site.

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12. Release the tourniquet. Check that the vein has decompressed.

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13. Attach the butterfly needle extension tubing to the Vacutainer device.

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14. Move collection bottles to a location close to the arm.

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16. Using a new antimicrobial swab, clean the stoppers of the culture bottles with the appropriate antimicrobial, per facility policy. Cover bottle top with sterile gauze square, based on facility policy.

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17. Reapply the tourniquet approximately 3 to 4 in above the identified puncture site. Apply sufficient pressure to impede venous circulation, but not arterial blood flow. After disinfection, do not palpate the venipuncture site unless sterile gloves are worn.

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18. Hold the patient’s arm in a downward position with your nondominant hand. Align the butterfly needle with the chosen vein, holding the needle in your dominant hand. Use the thumb or first finger of your nondominant hand to apply pressure and traction to the skin about 1 to 2 in below the identified puncture site (Van Leeuwen & Bladh, 2017). Do not touch the insertion site.

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19. Inform the patient that he or she is going to feel a pinch. With the bevel of the needle up, insert the needle into the vein at a 15 to 30 degree angle to the skin (Malarkey & McMorrow, 2012; Van Leeuwen & Bladh, 2017). You should see a flash of blood in the extension tubing close to the needle when the vein is entered.

15. Clean the patient’s skin at the selected puncture site with the antimicrobial swab, according to facility policy. If using chlorhexidine, use a gentle back and forth motion for at least 30 seconds or use the procedure recommended by the manufacturer (INS, 2016a). Allow the skin to dry before performing the venipuncture. Do not wipe or blot. Allow to dry completely.

Skill Checklists for Taylor’s Clinical Nursing Skills.

Copyright © 2019 by Wolters Kluwer. Skill Checklists for Taylor’s Clinical Nursing Skills: A Nursing Process Approach, 5th edition, by Pamela Lynn.

3

A Nursing Process Approach, 5th edition

Needs Practice

Satisfactory

Excellent

Name Unit Instructor/Evaluator:

Date Position Position

SKILL 18-10

Obtaining a Venous Blood Specimen for Culture and Sensitivity (Continued) Comments

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20. Keeping the specimen bottle upright, fill the aerobic bottle first (Fischbach & Dunning, 2015; Laboratory Alliance of Central New York, LLC, 2017; Van Leeuwen & Bladh, 2017). Grasp the butterfly needle securely to stabilize it in the vein with your nondominant hand, and push the Vacutainer onto the first collection bottle (aerobic bottle), until the rubber stopper on the collection bottle is punctured. You will feel the bottle push into place on the puncture device. Blood will flow into the bottle automatically. Fill to the level indicated on the bottle; do not overfill (Fischbach & Dunning, 2015).

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21. Remove the tourniquet as soon as blood flows adequately into the bottle.

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22. Continue to hold the butterfly needle in place in the vein. Once the first bottle is filled, remove it from the Vacutainer and insert the second bottle. After the blood culture specimens are obtained, continue to fill any additional required tubes, removing one and inserting another. Gently rotate each bottle and tube as you remove it.

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23. After you have drawn all required blood samples, remove the last collection tube from the Vacutainer. Place a gauze pad over the puncture site and slowly and gently remove the needle from the vein. Engage needle guard. Do not apply pressure to the site until the needle has been fully removed.

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24. Apply gentle pressure to the puncture site for 2 to 3 minutes or until bleeding stops.

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25. After bleeding stops, apply an adhesive bandage.

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27. Discard Vacutainer and butterfly needle in sharps container.

26. Remove equipment and return patient to a position of comfort. Raise side rails and lower bed.

28. Remove gloves and perform hand hygiene. 29. Place label on the container, per facility policy. Place containers in plastic, sealable biohazard bag. Refer to facility policy regarding the need for separate biohazard bags for blood culture specimens and other blood specimens.

Skill Checklists for Taylor’s Clinical Nursing Skills. A Nursing Process Approach, 5th edition Copyright © 2019 by Wolters Kluwer. Skill Checklists for Taylor’s Clinical Nursing Skills: A Nursing Process Approach, 5th edition, by Pamela Lynn.

4

Needs Practice

Satisfactory

Excellent

Name Unit Instructor/Evaluator:

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Date Position Position

SKILL 18-10

Obtaining a Venous Blood Specimen for Culture and Sensitivity (Continued) Comments 30. Check the venipuncture sites to see if a hematoma has developed. 31. Remove other PPE, if used. Perform hand hygiene. 32. Transport the specimen to the laboratory immediately. If immediate transport is not possible, check with laboratory personnel or policy manual as to appropriate handling.

Copyright © 2019 by Wolters Kluwer. Skill Checklists for Taylor’s Clinical Nursing Skills: A Nursing Process Approach, 5th edition, by Pamela Lynn....