Which of the following needles should a phlebotomist use for a venipuncture using a winged infusion set and a 5 mL syringe?
23-gauge
18-gauge
25-gauge
27-gauge
The Correct Answer is A
Choice A reason:
A 23-gauge needle is commonly used for venipuncture with a winged infusion set and a small volume syringe like a 5 mL syringe. This size provides a balance between patient comfort and the ease of drawing blood without causing hemolysis or excessive damage to blood cells. It is large enough to allow blood to flow easily into the syringe but small enough to minimize discomfort and the risk of bruising.
Choice B reason:
An 18-gauge needle is quite large and is typically used for situations requiring rapid administration of fluids or for blood donation where larger volumes are collected quickly. It is not ideal for a standard venipuncture, especially with a small syringe, as it can cause more pain and increase the risk of bruising.
Choice C reason:
A 25-gauge needle is on the smaller side and may be used for patients with very fragile veins or for pediatric patients. However, it may not be the best choice for a 5 mL syringe as it could make the blood draw process slower and more difficult, potentially leading to clotting in the needle or syringe.
Choice D reason:
A 27-gauge needle is very small and is typically used for subcutaneous injections, such as insulin injections, rather than for venipuncture. It would be too small for an efficient blood draw with a 5 mL syringe, as it would likely cause the blood to hemolyze or clot before the draw is completed.
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Correct Answer is D
Explanation
Choice A Reason:
Withdrawing the needle completely would be an incorrect action because it would end the procedure prematurely and require a new venipuncture, causing unnecessary discomfort to the patient. It should only be done if the venipuncture has been completed or if there is a need to stop due to a complication.
Choice B Reason:
Rotating the bevel of the needle could potentially reposition the needle for better blood flow if it has become occluded or is not properly aligned with the vein. However, this action should be done with caution to avoid causing injury to the vein or discomfort to the patient.
Choice C Reason:
Increasing tourniquet pressure is not advisable once blood flow has been established, as it could cause damage to the vein or hemolysis of the blood sample. The tourniquet should be released once the blood starts flowing into the first tube to avoid these issues.
Choice D Reason:
Activating a new evacuated tube is the correct action to take when blood flow stops upon attaching a second tube. This could indicate a problem with the vacuum in the tube rather than with the needle or the venipuncture site. Trying a new tube can resolve the issue without needing to adjust the needle or the patient's position.
Correct Answer is C
Explanation
Choice A Reason:
A patient's room number is not considered a unique identifier by the Joint Commission standards. Room numbers can change if patients are moved, and they do not reliably identify an individual.
Choice B Reason:
A patient's bed label is also not a unique identifier. Bed labels can be switched, and similar to room numbers, they are not specific to the individual patient.
Choice C Reason:
A patient's inpatient chart typically contains multiple unique identifiers, such as the patient's name, an assigned identification number, date of birth, or other person-specific identifiers. These are considered acceptable by the Joint Commission for verifying patient identity, ensuring that the service or treatment is intended for that individual.
Choice D Reason:
Patient's verbal confirmation alone is not sufficient for establishing correct inpatient identification. While it can be used as one method of identification, it should be supplemented with another identifier to meet the Joint Commission's requirement of using at least two patient identifiers.
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