Case_Study

case study hematoma formation Mrs. M.S. is a large, overweight, elderly woman who needs blood drawn for electrolytes, CBC and a prothrombin time. Mimi is a new phlebotomist at the local blood drawing center who must collect the blood sample from Mrs. M. S. Mimi correctly verifies the identification of the patient by asking Mrs. M.S. her name and date of birth. Mimi then selects the tubes she needs, prepares the vacutainer, and selects the optimal site for venipuncture. Mimi carefully palpates the antecubital area of Mrs. M.S.’s left arm and is only able to locate the cephalic vein. Because Mrs. M.S. has very large arms, Mimi can only feel a small portion of the vein, and she therefore enters the vein at a larger angle than normal. Blood slowly enters the tube. Mimi also notices a raised area is forming around the needle. Mimi has only one more tube to collect and therefore fills the third tube before withdrawing the needle from the vein. Note: If you find any information from the internet or any other source that is helping you answer the questions, be sure and cite your source (website). Remember, this is your own work! The appearance of plagerism must be avoided. 1. This phlebotomist drew the cephalic vein. What would you have done with this situation regarding vein selection' If I was unable to locate the median cubital of Mrs. M.S. arm then the next choice would have to be the cephalic vein or possible a dorsal side of her hands and wrist (if better located.) Now because Mimi can only feel a small portion of the cephalic vein then I would have used a butterfly needle or a smaller straight needle because it would be less painful for the patient and possibly easier in this sort of situation for me. 2. What other veins in the antecubital area are acceptable for venipuncture' Name the vein and their relative location. What is the order of preference of these 2 veins and the cephalic vein that she drew' The other veins in the antecubital area are the median cubital vein and the basilic vein. Median is relatively located in the inner side of the arm in the bend of the elbow between the cephalic vein (outer edge of the arm) and the basilic vein (located inner periphery of the bicep muscle.) The order of vein preference is first the median, the cephalic as a second choice and then the basilic vein last since is relatively close to arteries and essential nerves. 3. What is the normal angle for needle penetration of a vein according the CLSI' Provide a range, using degrees as your unit of measurement. The normal angle for needle penetration of a vein according to CLSI is in a range of 15-30 degrees. 4. Is the blood sample that Mimi obtained useful' If not, why not' No, the blood collected by Mimi is not useful because drawing from a hematoma may cause erroneous results on the test being called. 5. What tubes does Mimi need to collect for electrolytes' The tube Mimi needs to collect for an electrolyte test is a mint green top tube. 6. What tubes does Mimi need for the CBC' The tube Mimi needs to collect for a CBC test is a lavender top tube. 7. What tubes does Mimi need for the prothrombin time' The tube Mimi needs to collect for a prothrombin time test is a light blue top tube. 8. What is the order of draw using a straight needle' The order of draw using a straight needle is first the light blue top, then the mint green top and last the lavender top tube. 9. What length needle would be appropriate for this situation' A 22 gauge needle would be appropriate for this situation or a 22g or 23g butterfly needle could be an alternate. 10. What did Mimi do wrong in this procedure' Mimi’s first mistake was entering the vein at a larger angle, especially on a small vein like Mrs. M.S. Her second mistake was proceeding to draw her tubes after noticing a hematoma forming at the puncture site. 11. What is ‘vein patency’ and how do you establish vein patency prior to performing a venipuncture' Vein patency is the accessibility of a vein. You establish a vein through palpating checking for the depth, width, length and direction of vein on the arm and with a still pressure checking for a pulse because more likely if so this site could be an artery, which is never good to hit in a venipuncture. With all of this considered you can determine the gauge of needle needed, what system to use, how long and how far to go in the selected vein site.