Complications, Labeling and Specimen Handling

This is Unit Twenty-One of Medical Assistant Prep. Unit Twenty ended on knowing when to stop a draw. This unit takes up what can go wrong during one, and what happens to the specimen after it: labeling, packaging, handling and documentation. Carry one idea through this lecture. When a draw goes wrong, the order of your actions matters more than speed, and the label meets the specimen in front of the patient, never before. Two constructed cases at the end show both halves. By the end you will be able to respond when blood does not flow or a vein collapses. To manage a hematoma, fainting, bleeding and nerve pain. To label specimens correctly at the point of collection. And to package, handle and document a draw.

Three entries on stalled draws: no blood flow, a collapsing vein, and knowing when to stop.

Adjust, do not dig.

MAS 501 When Blood Does Not Flow

Sometimes a tube does not fill after the needle enters the skin. The needle may sit too shallow or too deep in the vein; move it slowly, a little forward or back, while keeping a firm anchor, or try another tube, since a tube can lose its vacuum. Never probe or dig with the needle; that injures tissue and nerves.

Too much suction.

MAS 502 A Collapsing Vein

A vein can collapse when too much suction is applied to it. Pulling a syringe plunger too quickly or forcefully can collapse the vein and damage the sample; a smaller tube or gentler pull may help. If the vein collapses, release the tourniquet, withdraw, and choose another site rather than forcing the draw.

Limits and colleagues.

MAS 503 Know When to Stop

An unsuccessful draw is stopped, not prolonged. Follow the practice's limit on attempts, and ask an experienced colleague to try instead of sticking the patient again and again. Document each unsuccessful attempt and the site used, so the next person knows what has already been tried on this patient.

Six entries on complications: hematomas, fainting signs and response, prolonged bleeding, nerve injury, and bandages.

Blood under the skin.

MAS 504 Hematomas

A hematoma is a collection of blood under the skin that forms when blood leaks from the vein around the puncture. Common causes include a needle passing through the vein, a needle inserted where veins branch, a tourniquet left on during withdrawal, and too little pressure afterward. If swelling starts during the draw, release the tourniquet, withdraw the needle, and apply pressure.

Sighing, pallor, sweating.

MAS 505 Signs That a Patient May Faint

Some patients have a fainting reaction during or after a blood draw. Warning signs include sighing, staring, pallor or sweating, and a slow pulse; the patient may feel lightheaded or nauseated. Ask patients before the draw whether they have ever felt faint during one, and watch closely throughout.

Safety first.

MAS 506 If a Patient Feels Faint

When a patient feels faint, the draw stops and safety comes first. Release the tourniquet and withdraw at once, pressing on the site. Call for help and lower the patient to lie down, or lower their head, keeping them from falling. Loosen tight clothing and stay. Tell the provider, who decides on further care, including whether to give fluids. If the patient loses consciousness, keep the airway clear and follow the emergency protocol. Document what happened and how they recovered. Never leave a lightheaded patient alone in a chair, because a fall is often worse than the faint.

Pressure, then help.

MAS 507 Bleeding That Will Not Stop

Most puncture sites stop bleeding within a few minutes of firm pressure. Patients taking anticoagulants may bleed longer; one procedure advises alerting a nurse or provider if bleeding continues beyond about five minutes. Do not bandage over active bleeding; keep pressure on, and get help.

Shooting pain.

MAS 508 Avoiding Nerve Injury

Nerves run near some venipuncture sites, and a misplaced needle can injure one. The basilic vein lies near an artery and a nerve, which is why the median cubital vein is preferred; never probe blindly for a vein. If the patient reports sharp, shooting pain or tingling during a draw, stop, remove the needle, and tell the provider.

Suited to the skin.

MAS 509 Choosing a Bandage

After the bleeding stops, cover the site with a bandage that suits the patient. Ask about allergies to tape, adhesive or latex; for fragile skin, such as older adults' skin, choose a gentle covering, because removing adhesive can tear it. Check the site again before the patient leaves.

Four entries on labeling: what a label carries, labeling at collection, special requirements, and finishing the draw.

Matching the requisition.

MAS 510 Labeling Blood Specimens

Every tube is labeled with the information the laboratory requires. That typically includes the patient's first and last name, a second identifier such as date of birth or record number, and the date and time of collection, plus the collector's initials where required. The label must match the requisition exactly. Any mismatch means the tube may be rejected.

Patient still present.

MAS 511 Label at the Point of Collection

Label tubes immediately after collection, while the patient is still with you. Recheck every label against the requisition, and against the patient's stated name and date of birth, before the specimens are sent. Labeling at the moment of collection keeps the identity check, the specimen and the label together, which is what prevents mix-ups.

The lab's own rules.

MAS 512 Some Tubes Need More

Some specimens carry extra labeling requirements set by the laboratory. For example, one laboratory requires blood bank tubes to carry the collector's legible full signature, not only initials. Learn your laboratory's special requirements before you collect tubes that need them, because the lab will reject tubes that lack them.

In order.

MAS 513 Wrapping Up the Draw

Finish the procedure in a set order before the patient leaves. Discard the needle in the sharps container, check labels and forms, discard other waste properly, clean your hands, tell the patient the procedure is over, and check the site for bleeding. Ask how the patient feels before they stand up.

Seven entries on handling and documentation: packaging, special handling, spills, rejection, the record, and two constructed cases.

Bag and pocket.

MAS 514 Packaging Specimens for Transport

Specimens are packed safely for transport to the laboratory. Place them in a leak-proof plastic bag, with the requisition in a separate outside pocket so that the paperwork stays clean. Keep tubes upright and handle them gently on the way to the laboratory, to avoid hemolysis and leaks.

Cold, dark, timed.

MAS 515 Special Handling Requirements

Some tests require special handling between collection and the laboratory. Depending on the test, the laboratory may require a specific temperature, protection from light, or delivery within a set time; the test catalog gives the requirement for each test. Look up special handling before you draw, so the right supplies are ready.

Soak, then disinfect.

MAS 516 Cleaning Up a Blood Spill

Blood spills are cleaned promptly, wearing gloves and other protective equipment as needed. Soak up as much blood as possible with paper towels and discard them as infectious waste, then disinfect the area with an approved disinfectant as the practice's procedure directs. Clean up at once, and report a spill that involved a sharps injury or a splash, following the exposure plan.

Another needle.

MAS 517 Why Specimens Get Rejected

Laboratories reject specimens that cannot give reliable results. Common reasons include missing or mismatched labels, the wrong order of draw, underfilled tubes, and hemolysis. Every rejection means the patient needs another needle and another trip, so preventing rejection is part of patient care, not paperwork.

The story of the draw.

MAS 518 Documenting the Draw

Every draw is documented as the practice requires. Record the date and time of collection, matching the labels. Record the tests collected and tubes used. Record the site, such as the right arm, and the number of attempts. Record any complication, such as a hematoma or fainting, and what was done. Record your name and where the specimens went. A complication left out of the record cannot be followed up by anyone else, so tell the provider too, and record the provider's response.

A hematoma, then a faint.

MAS 519 A Draw That Did Not Go to Plan

A constructed draw goes wrong twice. As the first tube fills, swelling rises near the needle. The assistant releases the tourniquet, withdraws, activates the safety device and presses gauze with his arm straight and raised. Then he sighs, goes pale and sweats. She lowers the table, helps him lie back, calls a colleague, who alerts the provider, and stays beside him with pressure on the site. His color returns and the provider checks him. She completes the draw from his left arm with him lying down, labels in front of him, checks both arms and documents each event and time. Removing tourniquet and needle stopped the hematoma, and lying him down prevented a fall. Her record tells the next person to have him lie down from the start.

Two patients, one last name.

MAS 520 A Labeling Near Miss

A constructed near miss pays off the opening idea. Two patients with the same last name are ten minutes apart, and a coworker suggests prelabeling both sets of tubes. The assistant declines; the practice labels in front of the patient. Asked to state his name and date of birth, the first patient gives a birth date that does not match the label waiting on the printer, which belongs to the other patient. She prints his correct labels, draws, labels in front of him and checks against his requisition. Prelabeled, his blood would have gone to the lab under another name, possibly unnoticed. She reports the near miss, since similar names on one schedule are a known risk. A wrong label is worse than none, because nobody downstream has reason to question it.

Look at what you can now do. You can adjust when blood does not flow, change sites when a vein collapses, and stop an unsuccessful draw. You can manage a hematoma and a fainting reaction in the right order, keep pressure on prolonged bleeding, and stop for nerve pain. You can label every tube at the point of collection, matching the requisition exactly. And you can package and handle specimens, prevent rejection, and document the whole draw. Unit Twenty-Two turns to the heart's electrical system and setting up an electrocardiogram.