NHA Certified Phlebotomy Technician (CPT)Collection RoutineHard
A phlebotomy technician is collecting a blood specimen from a patient who has a mastectomy on the right side. The patient also has an IV running in her left antecubital fossa. Which of the following sites is the most appropriate for venipuncture?
- AThe right antecubital fossa.
- BThe left dorsal hand.
- CA finger stick on the left hand.
- DBelow the IV site in the left arm.
Show answer & explanationAnswer & explanation
Correct answer: B. The left dorsal hand.
A mastectomy often leads to lymphedema and increased risk of infection in the affected arm, making the right arm contraindicated. The left arm has an IV in the antecubital area, so drawing below the IV can dilute the specimen. Therefore, the left dorsal hand is the most appropriate alternative, as it is distal to the IV and on the unaffected side by mastectomy.
Why the other options are wrong
- A. The arm on the side of a mastectomy is contraindicated due to potential lymphedema and increased infection risk.
- C. While a finger stick is an option, it typically yields a smaller volume and may not be suitable for all tests ordered. The question implies a venipuncture is desired if possible.
- D. Drawing below an IV site can lead to specimen dilution and inaccurate results.
Difficult Venipuncture Site Selection
Choosing an appropriate venipuncture site when standard sites are contraindicated due to medical conditions or existing treatments.
- Avoid mastectomy side.
- Avoid IV arm, especially above or directly in the line.
- Consider alternative sites like dorsal hand or foot (with physician approval).
Memory trick: Mastectomy, IV, no go; find a clean flow.