03 - Patient Preparation for Blood Collection Flashcards
(94 cards)
1
Q
This is the first step in most laboratory analysis
A
Specimen Collection
2
Q
Bonus Point! :)
A
“Calm seas don’t make great sailors. Prominent veins don’t make great phlebotomists.”
3
Q
Accuracy and precision in blood collection can be measured by:
A
Proper specimen collection and handling
REMEMBER: Test results are, therefore, said to be as good as sample collection and handling
4
Q
Patient Identification Procedures
Conscious Inpatients
A
- Verbally ask their full names
- Verify it using the identification bracelet
Identification bracelet includes:
* First and last name
* Hospital number/ unit number
* Room/ bed
* Physician’t name
5
Q
Patient Identification Procedures
Sleeping Patients
A
- They must be awakened before blood collection
- Identified same as conscious patients
6
Q
Patient Identification Procedures
Unconscious Patients,
Mentally Incompetent Patients
A
- Asking the attending nurse or relative
- ID bracelet
7
Q
Patient Identification Procedures
Infants and Children
A
- Nurse or relative (may identify patient)
- ID bracelet
8
Q
Patient Identification Procedures
Outpatient Patient
A
- Verbally ask full names, DOB (countercheck with driver’s license/ ID with photo)
- If patient has ID card or bracelet, same manner as with hospitalized patients
9
Q
CHARACTERISTICS OF BLOOD
It is in **fluid form in ___* due to ___.
It coagulates in ___ within ___
A
CHARACTERISTICS OF BLOOD
It is in **fluid form in vivo* due to the naturally circulating anticoagulants
It coagulates in vitro within 5-10 minutes
-
NOTE:
- Vivo - inside the body
- Vitro - outside the body
10
Q
CHARACTERISTICS OF BLOOD
Blood is __ in color due to __
A
Blood is red in color due to hemoglobin
11
Q
CHARACTERISTICS OF BLOOD
Blood has a ph average of ___
A
7.4
12
Q
CHARACTERISTICS OF BLOOD
Blood is ____, ____ thicker than water
A
Blood is thick and viscous, 2.5-4.5 times thicker than water
13
Q
CHARACTERISTICS OF BLOOD
Volume of blood for both Adult Male and Female
A
Adult Male: 5-6 L (approximately)
Adult Female: 4-5 L
14
Q
COMPOSITION OF BLOOD
A
Liquid Portion
- Plasma- Liquid portion of the unclotted blood with the protein fibrinogen
- Serum - Liquid portion of the clotted blood without the fibrinogen
Solid Portion
* Red blood cells
* White blood cells
Gaseous Portion
* Involves an exchange between oxygen and CO2
15
Q
A fingerstick to obtain blood for routine laboratory analysis
This is usually preferred for?
A
Skin Puncture/ Capillary Puncture
Usually preferred for children
16
Q
SKIN/ CAPILLARY PUNCTURE
Length of lancet:
Depth of Incision:
A
Length of Lancet: 1.75 mm
Depth of Incision:
<2.0 mm for children
<2.5 mm for adults
17
Q
Skin/ Capillary Puncture
How should the cut be oriented during the puncture?
A
The cut should be oriented across the fingerprints to generate a large drop of blood using a single deliberate motion
18
Q
Preferred Sites for Skin/ Capillary Puncture
What is the most and least common?
A
- Lateral plantar heel surface
- Palmar surface of the non-dominant fingers (3rd and 4th)
- Plantar surface of the big toe
- Earlobes
-
Most common - Palmar surface of non-dominant fingers (3rd and 4th finger
Least site - Earlobes
19
Q
Sites to Avoid for Skin/ Capillary Puncture
A
- Inflammed and pallor areas
- Cold and cyanotic areas
- Congested and edematous areas
- Scarred and heavily calloused areas
20
Q
Advantages of Skin Puncture
A
- It is accessible to the operator
*Easy to manipulate - Ideal for peripheral blood smears
- It is less painful due to lesser nerve endings
- There is more free flow of blood de to thinner skin layer
- Less tissue juice contamination due to lesser tissues and muscles (Earlobe)
21
Q
Disadvantages of Skin Puncture
A
* Less amount of blood can be obtained
* Additional and repeated test cannot be done
* Blood obtained has tendencies to hemolyze easily
22
Q
Skin Puncture Equipment
A
- Alcohol, gauze, bandages
- Lancets
- Warming device
- Microcollection tube (Microtainer)
- Microhematocrit tube (Capillary Tube)
- Sealants
23
Q
Skin Puncture Equipment
CLSI recommends using ____ to clean capillary bed of the skin with a lancet or other sharp device
A
70% Isopropyl Alcohol
24
Q
Skin Puncture Equipment
These are used to eliminate alcohol residue and excess tissue fluid.
A
Gauze or cotton ball
Used to wipe away the first drop of blood
25
**Skin Puncture Equipment**
Used to cover the site after collection
Bandages
*Oftentimes, cotton*
26
**Skin Puncture Equipment**
Sterile, disposable, sharp instruments used for capillary puncture.
What should you remember?
Lancets
Their blades or points must permanently retract to prevent sharp injuries
27
Gauge of MicroFlow Lancet
Micro Flow Lancet (28 Gauge)
28
**Skin Puncture Equipment**
This is used to warm the site.
**Warming Device**
This warms the sites and increases blood flow up to seven times
It is important when performing heel sticks.
29
**Skin Puncture Equipment**
Water temperature of warming device
Must not exceed 42°C or it could scald the patient
30
**Skin Puncture Equipment**
This is a special small plastic tubes.
Also known as __.
**Microcollection Tubes**
Often referred to as **“bullets”**
*Most have color-coded stoppers that correspond to color-coding of ETS tubes*
31
32
**Skin Puncture Equipment**
Narrow-bore tube primarily used for manual hematocrit determinations.
Also known as ____.
Microhematocrit Tubes
Also known as **Capillary tubes**
*Either coated with heparin for collecting directly from a capillary puncture
Or
Plain to be used when filling with blood from an EDTA tube*
33
**Skin Puncture Equipment**
Claylike substances used seal one end of hematocrit tubes
Sealants
34
Examples of Sealants
- Paraffin Wax
- Clay Sealant
35
**Indications for Capillary Puncture**
* Can be done if small amount of blood is required
* There are no accessible veins
* Available veins are fragile or must be saved for other procedures such as chemotherapy
* Blood is to be obtained for POCT procedures, such as glucose monitoring
* Preferred specimen for some tests, such as newborn screening
36
37
This is the preferred specimen for newborn screening
Capillary blood
38
Skin Puncture Procedure
1. Identify patient properly
2. Verify patient’s condition
3. Position the patient
4. Choose the best location for fingerstick, namely the 3rd and 4th fingers of the non-dominant hand
5. Disinfect the site of collection in concentric fashion
6. Allow area to dry completely. Prepare the materials needed.
7. Make a skin puncture using a sterile lancet
8. Wipe away first drop of blood
9. Collect drops of blood into the capillary tube
10. Fill 2/3 of the tubes
11. Inverted capillary tubes to mix
12. Place cotton on puncture site and instruct patient to apply pressure until bleeding stops
13. Seal tubes with clay and paraffin wax
14. Dispose contaminated materials to appropriate containers
39
A process by which blood is obtained from a patient’s vein
What is the sample for this?
Venipuncture
Venous blood
40
Deoxygenated blood wit a dark red color
Venous blood
41
VENIPUNCTURE
Sample: ____
Sites: ____
Methods: ___
**Sample**: Venous flow
**Sites**: Antecubital fossa
- Veins of the wrist
- Dorsal aspect of the hand
- Veins of the ankle
**Methods**: Syringe and Evacuated tube
42
ANTECUBITAL FOSSA: VEINS
1. Median Cubital Vein
2. Cephalic Vein
3. Basilic Vein
43
This vein is the best site for venipuncture.
Why is it considered the best site?
Median Cubital Vein
- Largest
- Best anchored vein
44
Second vein of choice for venipuncture
Cephalic Vein
45
Third and last choice for venipuncture
Basilic vein
46
Why shouldn’t we choose the basilic vein as site for venipuncture?
It should not be chosen unless no other vein is more prominent.
This is due to **its closeness to brachial artery**
47
Sites to Avoid in Venipuncture
* Intravenous (IV) lines in both arms
* Burned or scarred areas
* Areas with hematoma
* Edematous arms
* Cast on arms
* Thrombosed veins
* Arms with arteriovenous (AV) shunt or fistula
48
THINGS TO REMEMBER FOR VENIPUNCTURE
* Verify that any **dietary restrictions** have been met (e.g. fasting if appropriate). Check for any sensitivity to latex.
* Apply the **tourniquet 4 to 4 inches** above the site. Instruct the patient to make a fist. Never leave the tourniquet longer than one minute.
* **Disinfect** the patient’s skin with an alcohol pad starting at the point where you expect the needle and moving outward in even widening concentric circles.
* Angle for needle insertion is between **15-30 degrees** with the bevel side up
* Always remove the tourniquet first before withdrawing the needle. For Evacuated Tube Method, remove the tube first and then the adapter with the needle.
49
This is essential so that the results of the test match the patient
Properly labeled sample
50
The key elements in labeling a sample are:
1. Patient’s surname, first, and middle
2. Patient’s ID number/ birthday and age
*Both must match the same on the requisition form*
3. Date, time of collection, and initials of the phlebotomist must be on the label of each tube
51
**Needle Specification**
The gauge of the needle is _____ to the size of the needle
Inversely proportional
The larger the gauge number, the smaller the needle bore and length
52
Standard gauge of needle for venipuncture
21 Gauge
53
Gauge of needle used for children and those with small and difficult veins
23 gauge
54
Gauge of needle for venipuncture used for blood donation
16 Gauge
55
Needle Length (Inches, Gauge)
1 inch or 1.5 inches
21 to 23 gauge
56
This needle system is used for patients with small and difficult veins
What are its components?
Syringe system
Components:
1. A plastic syringe
2. Hypodermic needle
3. Transfer device
57
Parts of a Syringe
**Syringe**
- Plunger
- Graduated barrels
**Needle**
- Hub
- Shaft
- Bevel
58
3 Basic Components of an Evacuated Tube System
1. Multisample needle
2. Tube holder/ adapter
3. Evacuated tubes
59
This component of ETS allows collection of multiple tubes during venipuncture
Multisample needle
60
This component of ETS can be screwed into a tube holder and has a bevel point on each end
Multisample needle
61
This component of ETS includes a plastic cylinder with a small opening for a needle at one end and a large opening for tubes at the other
Tube holder/ adapter
62
This component of ETS has a pre measured vacuum that automatically draw the volume of blood indicated on the label
Evacuated tubes
63
Parts of Evacuated Tube System
- Needle
- Tube advancement mark
- Rubber sleeve
- Holder
*Review the picture with labels*
64
This needle system includes a short needle with a plastic part resembling butterfly wings and a length of tubing
Butterfly System
65
Butterfly system with a Luer fitting
Syringe use
66
Butterfly system with a Luer adapter
ETS use
67
Most commonly used gauge for phlebotomy in butterfly system
23 Gauge
68
Most commonly used for phlebotomy
23 gauge
69
**Complications Encountered in Blood Collection**
Most common encountered in obtaining a blood specimen
Ecchymosis (Bruise)
70
**Complications Encountered in Blood Collection**
It is caused by leakage of a small amount of fluid around the tissue
Ecchymosis (Bruise)
71
**Complications Encountered in Blood Collection**
Second most common complication.
Before drawing blood, the collector should ask if he/ she had prior episodes of fainting.
Syncope (Fainting)
72
**Complications Encountered in Blood Collection**
When leakage of a large amount of fluid around the puncture site causes the area to swell
This most commonly occurs when:
**Hematoma**
Commonly occurs when:
- Needle goes through vein
- Bevel is partially in the vein
- Collector fails to apply enough pressure after venpuncture
73
**Complications Encountered in Blood Collection**
What are the reason for **Failure to Draw Blood**
**Vein is missed because of Improper needle positioning**
Other reasons:
- Excessive pull of plunger
- Piercing the other pole of the vein
- Incorrect bevel positioning and absence of vacuum
74
**Complications Encountered in Blood Collection**
An increased concentration of larger molecules and analytes (potassium) in the blood.
It is a result of what?
Can be caused by what?
**Hemoconcentration**
- It is a result of a shift in water balance.
- Can be leaving the tourniquet on the patient's arm for too long
75
**Complications Encountered in Blood Collection**
Rupture of red blood cells with the consequent escape of hemoglobin
Can cause what?
**Hemolysis**
- Can cause the plasma or serum to appear pink or red
- "Hemo" - blood, "Lysis" - rupture
76
**Complications Encountered in Blood Collection**
Other complications --
- IV therapy
- Burned, damaged, scarred, and occluded veins
- Seizure and tremors
- Vomiting and choking
- Allergies and mastectomy patients
77
**Physiological Factors Affecting Test Results**
Posture
- Changing from a supine (lying) to a sitting or standing position
- Results in a shift of body water from inside the blood vessels to the interstitial spaces
78
**Physiological Factors Affecting Test Results**
Diurnal Rhythm
- Levels of certain hormones increase/ decrease during certain time of the day
- **Cortisol, Adenocorticotrophic Hormone** - Decreases in the afternoon
- **Iron, Eosinophil** - Increase in the afternoon
79
**Physiological Factors Affecting Test Results**
Exercise
Muscle activity elevates **creatinine, protein, creatinine kinase, AST, and LDH**
- Exercise activates coagulation and dibrinolysis
- Increases platelet and WBC
80
**Physiological Factors Affecting Test Results**
Stress
- Anxiety can cause a temporary increase in WBCs
81
**Physiological Factors Affecting Test Results**
Diet
- If a patient has eaten recently (less than 2 hours earlier), there will be a temporary increase in **glucose and lipid** content in the blood
- Serum may appear cloudy or turbid
82
**Physiological Factors Affecting Test Results**
Smoking
Patients who smoke before blood collection may have **increased WBC counts and cortisol levels**
- Long term smoking - Leads to decreased pulmonary function and results in increased hemoglobin levels
83
**Additives in Collection Tubes**
- Inhibit the use of glucose by blood cells
| What are examples?
**Antiglycolytic Agent**
E.g. Sodium Fluoride,
Lithium Iodoacetate
84
**Additives in Collection Tubes**
- Prevents blood from vlotting
- Mechanism by which clotting is prevented varies with the anticoagulant
Anticoagulant Agent
**EDTA, Citrate, Oxalate**
- Remove Calcium by forming insoluble salts
**Heparin**
- Prevents conversion of prothrombin to thrombin
*If Calcium is removed or thrombin is not formed, coagulation does not occur*
85
**True or False**
Mechanism by which clotting is prevented varies with the anticoagulant
True
86
**Complications Encountered in Blood Collection**
Small red spots indicating that small amounts of blood have escaped into the skin epithelium
Petechiae
87
**Complications Encountered in Blood Collection**
Swelling caused by an abnormal accumulation of fluid in the intracellular saces
Edema
88
**Complications Encountered in Blood Collection**
What is a disadvantage of **Obesity** in blood collection?
- Veins may neither be readily visible nor easy to palpate
Can use a **blood pressure cuff** in locating the vein.
* The cuff should not be inflated any higher than the patient
* Should not be left on the arm for longer than 1 minute
89
**Additives in Collection Tubes**
- Inert material that undergoes temporary change in viscosity during centrifugation which enables it to serve as a separation barrier between liquid (serum and plasma) and cells
Separator gel
90
# *
**Additives in Collection Tubes**
- Helps initiate or enhance clotting mechanism
**Clot Activator**
- Include glass or silica particles;
- Provides increased surface area for platelet activion and clotting factor such as thrombin
91
**Anticoagulant**
Combines with Calcium to form insoluble salt
Oxalate
92
**Anticoagulant**
Combines with Calcium in a non-ionized form
Citrate
93
# Anticoagulant
Combines with Calcium in a process called Chelation
Ethylenediamine Tetraacetic acid (EDTA)
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