CPT Certification Study Guide

CPT Certification Study Guide What site should be used to collect blood from infant ? - HEEL , Never use finger If no accessible veins on geriatric patients what other option should be considered? - Dermal puncture What is the preferred location for veni puncture? - Antecubital fossa between the forearm and upper arm (fold of the elbow) Antecubital fossa - Contains several larger veins close to surface Fragile, small, often roll MORE painful, better to use butterfly needle on - Veins on dorsal side of hand (TOP) of hand What are the last choice veins - Ankle foot veins- difficult to access, easy to injure, painful Which veins are diabetes peripheral vascular disease compromised circulation? - Ankle foot veins Some facilities prohibit the use of which puncture site - Ankle foot veins What steps should you notice and apply before puncture? - Palpate selected vein, vein should be soft and flexible Depth helps with what before puncture? - Helps determine angle of insertion Direction helps with what before puncture? - Helps make sure needle is in inner portion of vein Dimension - Helps in choice of needle size What are the ways to identify a vein? - Place patient's arm below level of heart Apply warm compress to arm - check facility protocol NEVER slap or hit a patient's hand Where should you NOT draw blood from ? - Above IV line Arm with dialysis shunt Same side as mastectomy Do NOT draw blood: - Site that has EDEMA, or EXCESS FLUID Site that is SCARRED Site that has a HEMATOMA Poor vein choices - Sclerotic- hard,flexible, narrow Tortuous- twisted Thrombotic- hard, flexible, tender to the touch, fragile Phlebitic- tender, warm to the touch, appears red, have clots. Can cause pain to pt. Blood supply is poor on these veins Elder patients tend to have what type of veins? - Thrombotic- hard, flexible, tender to the touch, fragile Phlebitis- tender, warm to the touch, appears red, have lots What are 3 categories of blood vessels ? - Arteries Capillaries Veins Veins in intecubital fossa: median cubital - First choice In center Large Usually doesn't have Veins in antecubital fossa: cephalic vein - Lateral aspect of forearm (OUTER ARM) (BLUE) Large Not usually visible Can roll Veins in antecubital fossa: brachial vein - Last choice (MIDDLE) aspect of forearm (RED) Large CLOSE to BRACHIAL ARTERY, brachial nerve If you attempt draw and miss, STOP and do not readjust Capillary punctures (FINGER STICKS) - Use MIDDLE OR RING finger on ADULTS Use SIDE OF FINGER NEVER perform finger stick on finger that is COLD, BLUE, SCARRED, SWOLLEN, or has a RASH What procedure is NOT a veni puncture? - Capillary punctures because they stick capillaries and not veins using finger stick or heel stick For infants younger than 12 months use a ? - Heel stick to obtain capillary blood. The veins of an infant is too small for a standard veni puncture. *Infants dont have sufficient tissue on finger to sustain finger stick. *You can use a heel stick for any kind of blood drawing from infant What is the standard solution for cleaning a site before puncture? - 70% ISOPROPYL alcohol Intact skin prevents microorganisms from ? - Causing infection Venipuncture breaks skin What is the most common choice for cleaning the puncture site ? - Isopropyl alcohol Dries quick , not irritating, no residue, does not obscure site, less drying of skin What are some other choices used to clean puncture site? - Other choices: chlorhexidine, ethyl alcohol, povidone-iodine Scrub site in circular motion from inside