ASCP ASCP Venipuncture Complications and Special Procedures 3 — Questions and Answers
Question 1: When antecubital veins are not accessible for venipuncture in an adult, the recommended alternative site is:
- Femoral vein in the groin
- Hand veins on the dorsal surface (Correct answer)
- External jugular vein in the neck
- Foot veins (without a physician order)
Correct answer: Hand veins on the dorsal surface
Hand veins on the dorsal surface are the standard alternative venipuncture site when antecubital veins are inaccessible in adult patients.
Question 2: A patient has IV lines running in both arms. The BEST course of action is to:
- Draw below the IV site in the arm with the lower flow rate
- Consult nursing staff and draw from an alternative site such as a hand vein (Correct answer)
- Wait at the bedside until an IV is removed before collecting
- Use a foot vein without consulting anyone
Correct answer: Consult nursing staff and draw from an alternative site such as a hand vein
Drawing from an alternative site after nursing consultation prevents IV fluid contamination and specimen dilution.
Question 3: When palpating for a vein that cannot be visualized, the phlebotomist should use:
- The thumb for strongest pressure
- The index finger for tactile sensitivity (Correct answer)
- A sterile probe to avoid contamination
- The back of the hand for heat detection
Correct answer: The index finger for tactile sensitivity
The index finger provides the greatest tactile sensitivity for detecting the bounce and resilience of a vein beneath the skin.
Question 4: A vein collapses during collection with an evacuated tube. The BEST technique to manage this is:
- Switch to a larger evacuated tube to increase vacuum
- Tighten the tourniquet to force more blood into the vein
- Use a syringe or butterfly with a smaller tube to reduce vacuum on the vein (Correct answer)
- Redirect the needle deeper into the tissue
Correct answer: Use a syringe or butterfly with a smaller tube to reduce vacuum on the vein
Reducing vacuum by using a syringe or a small-volume tube allows the collapsed vein walls to refill and prevents them from being sucked shut.
Question 5: In an obese patient where veins are not palpable, which technique BEST promotes venous filling?
- Applying a cold compress to cause vasoconstriction
- Lowering the arm and applying a warm compress to promote vasodilation (Correct answer)
- Tapping the vein site rapidly and repeatedly
- Replacing the tourniquet with a blood pressure cuff at diastolic pressure
Correct answer: Lowering the arm and applying a warm compress to promote vasodilation
Warming the arm causes vasodilation and gravity from lowering the arm promotes venous filling, making veins more accessible in difficult patients.
Question 6: Which needle gauge is MOST appropriate when collecting from a patient with small, fragile veins?
- 16 gauge
- 18 gauge
- 21 gauge
- 23 gauge (Correct answer)
Correct answer: 23 gauge
A 23-gauge needle has the smallest diameter, producing the least trauma and least likely to collapse or rupture fragile veins.
ASCP ASCP Venipuncture Complications and Special Procedures 3
When antecubital veins are not accessible for venipuncture in an adult, the recommended alternative site is: