EXPERIMENT 2, 3, 4 Flashcards by Arriane Cyrel (MTI)

Activity 4:
= POSITIVE FOR HEMOLYSIS
= NEGATIVE FOR HEMOLYSIS

5% RCS + Distilled water

5% RCS + NSS

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Tourniquet Application

3 to 4 inches (7.5 to 10 cm)

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Tourniquet Alternative: (?) not more than 1 min (hemolysis, hemoconcentration, patient discomfort)

blood pressure cuff (40-60 mmHg)

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Venipuncture Site Cleansing:
Allow the area to dry for at least

30 seconds

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Vein Anchoring and Needle Insertion:

Median
Cephalic
Basilic

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Post-Procedure Steps:
Apply pressure stop bleeding: inadequate pressure causes hematoma for at least

2 mins

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Mix and Invert anticoagulant tubes
 EDTA:
 Blue top:

 EDTA: 8
 Blue top: 3-4

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WASTE DISPOSAL
Black –
Green –
Yellow -

Black – Non-infectious Dry Waste
Green – Non-infectious Wet Waste
Yellow - Infectious and Pathological Waste

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The quality of each test will always begin with how the (?) is collected.

specimen

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Presence of (?) may lead to error

clot

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• Various factors prior to testing can be considered as an (?), which can cause false readings during the test.

interference

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•Anything related to the collection of specimens for testing is considered as a

pre-analytical procedure.

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can arise from factors that could alter the quality of the specimen used.

• Pre-analytical errors

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• is the main specimen used in the Blood Bank laboratory.

Blood (as whole blood)

 Anticoagulated tube

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• Other specimens can be produced from a single (?) that can be used for immunologic testing for blood bank procedures.

whole blood sample

 Whole blood - plasma, RCS

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• Prior to collecting blood samples, an MLS must check first the conditions for extracting samples from a patient.

 Lab form/request

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• An MLS is given a (?) that would contain the information of the patient.

laboratory test requisition form (a.k.a. lab request form)

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• The request form will contain the following information:

 Patient name, age/sex, hospital/case number
 Patient Diagnosis
 Urgency of test result (Routine, STAT)
 Tests to be done, or test requested
 Fields for date and time of specimen collection

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•The list of tests requested will give you an idea on what equipment should you bring.

 Basic phlebotomy kit
 PPEs (Gloves, mask, etc.)
 Cleansing sets (alcohol, iodine, benzalkonium chloride, swabs and cotton balls)
 Disposal containers

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must allow for the proper collection of blood samples for testing.

• The phlebotomy kit/materials

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is more preferrable over a syringe for multiple tube collections.

• A multisample needle (a.k.a. 2-way needle)

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 Less risk for needle pricking
 Samples are less exposed to environmental contaminants

• multisample needle (a.k.a. 2-way needle)

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is advisable only if the patient requires a needle that is “different” from the size of the routine gauge needle.

syringe

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• Routine needle gauge sizes range from (?), with a length of

21G - 23G

1” - 1 ½”

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may also be used for small, friable veins.

• A butterfly needle setup

• OSHA mandates that safety features must be present in phlebotomy devices to minimize phlebotomy-borne injuries:  (safety)  (attached to adapter)  (green; ejection of the tube)

Re-sheathing devices for needles Flanges on tube holders One-press release mechanisms on tube holders

are the main containers for blood samples.

• Evacuated tubes

• Tubes contain additives that would preserve the following:

• State of fluidity (clotted, clot-free) • Soluble contents of blood (e.g. glucose, calcium, proteins) • Various blood cells • Volume of blood sample

• Evacuated tubes also have (?) within that would aspirate blood without the need for manual aspiration.

negative pressure (vacuum)

• Vacuum within the tubes would collect the required amount of blood, considering the amount of (?) within the tube.  Unsuccessful: altitude may be a factor

additive

• Tube Hemogard® and, sometimes the (?), are colored, to easily note the phlebotomist the contents of the tube.

rubber stopper

• This can also aid the phlebotomist in the (?) for blood samples with the tubes.

Order of Draw

Glycolysis - refrigerate -

lowers 7mg/hr lowers 2 mg/dL/hr

are advisable to be worn whenever confronting a patient.

• Personal Protective Equipment (PPE)

• This must first protect the wearer, then must protect the patient second.

• Personal Protective Equipment (PPE)

will ensure that the user will have better protection than if it is not donned.

• Proper donning of PPEs

require wearing of gloves when performing phlebotomy.

• OSHA Bloodborne Pathogen Standard

• A new pair must be worn when handling each patient.

• Personal Protective Equipment (PPE)

as a nonrecommended material for medical practice

latex gloves

can also cause contamination and even allergies, thus it is not recommended.

• Powdered gloves

• Materials commonly used in gloves are the following:

 Nitrile  Neoprene  Polyethylene  Vinyl

must fit the hands of the wearer snuggly

• Gloves

must also be used prior and after the patient has been handled.

• Disinfectants and antiseptics

must not interfere with the test that will be done on the sample.

proper disinfectant

is considered the routine for antiseptic procedures.

• 70% isopropyl alcohol

is used for a higher degree of antisepsis.

Povidone iodine

used for blood culture

Povidone iodine

Examples of Antiseptics Used in Blood Collection

• 70% Ethyl alcohol • 70% isopropyl alcohol (isopropanol) • Benzalkonium chloride (eg. Zephran chloride) • Chlorhexidine • Hydrogen peroxide • Povidone-lodine (0.1% to 1% available iodine) • Tincture of iodine

must always be at the ready when collecting samples.

• Disposal containers

• Containers must be labelled with the (?) to determine the nature of waste within.

biohazard symbol

• must also be present to dispose of sharp materials.

Sharps containers

• Most have a red-colored body.

• Sharps containers

• It must not be overfilled as well.

• Sharps containers

• Must be leak-proof, rigid, puncture-resistant, and must have a locking mechanism.

• Sharps containers

are also necessary when labelling samples.

•Pens

• Must be indelible.

Pens

are also helpful when determining the time the sample was collected

• Watches

• Helpful for time-sensitive tests as well.

• Watches

must be available as well should there be a need to produce blood smears/films.

• Precleaned slides

is very crucial in specimen collection.

• Patient identification

• The phlebotomist must correctly identify the patient to be collected from to provide accurate results.

• Patient identification

can directly ask the patient (and if possible, ask to verify) name and other info.

• Phlebotomists

must also build rapport with the patient to provide a good and pleasing service.

• Phlebotomists

What if the patient is unconscious? • Check if the patient has a (?). Ask the watcher for the patient's info and verify. Ask for any identifications to accurately identify the patient. • (?) can also be used to identify patients. • If still in doubt, ask the (?) attending to the patient. • Always inform the patient of the (?) done to him/her; explain what is the purpose of collecting blood at the moment. • Ask the patient as well of any (?) concerning the materials that you are using.

watcher ID wrist bands nurse procedure/s allergies

• If fasting procedures are needed, ask the patient if they had adhered to the recommended

fasting time.

• After gaining the trust of the patient, get the (?) of the patient; ask if you can get blood from them. • If the patient hesitates, convince the patient of the need to collect blood but convince calmly. • If the patient still hesitates, it's best to stop convincing. Inform the nurse of the situation.

consent

is the primary site for blood collection.

antecubital fossa

Three major veins may be accessed at this site:

 Median vein/Median Cubital vein (most preferred)  Cephalic vein  Basilic vein – nerves

• Veins can be made more prominent and palpable by using a

tourniquet

• After choosing the vein, assemble and check the phlebotomy set and (?) the site to be punctured

cleanse

• It is preferrable to (?) first before assembly.

cleanse

• The most important aspect of cleansing is applying (?).

friction

• Needles must be free from (?). Check the syringe plunger can be pulled.

burrs

• Note that after (?), do not touch the site again with your fingers.

cleansing

• If you are prepared, you may (?) the patient that you will begin with the procedure.

inform

• Re-apply the tourniquet, tout the skin below the site to (?) the vein. • Estimate a (?) angle from the skin to the needle. • With a (?), insert the needle. • Establish (?). If the needle is equipped with a flashback or clear hub, check if blood went in the hub.

anchor 15° - 45° single, smooth, quick motion blood flow

• Slowly pull back the syringe plunger to aspirate blood. If using an (?), equip the evacuated tube at the other end of the multisample needle.

POST-LAB ETS

• REMEMBER THE ORDER OF DRAW, ESPECIALLY WHEN USING THE (?)!

ETS

• Make sure that the (?) within the tube is exhausted before removing. Do not overfill, do not underfill.

vacuum

• (?) the tubes once filled with blood according to the recommended number of inversions

Invert

• Once the procedure is finished, remove the (?) first (if not yet removed), followed by the (?) (if using ETS), then the (?) with a smooth but quick motion.

tourniquet tube needle

• If any (?) is present on the needle, apply it ASAP.

safety device

SPECIMEN COLLECTION: NOTES • Always treat your patients like one of your (?). • Ensures better interaction now and even on future interactions. • Make sure that when collecting, (?) are avoided (can be a sign that the needle is not inserted well; can cause hemolysis on the sample)

relatives bubbles

• The order of draw must be followed to avoid carry-over of additives.  Most:  least:

 Most: EDTA  least: Heparin

• may be necessary on patients who are uncooperative or have impulsive movements.

Restraints

• Avoids injury on the patient that can cause legal problems in the future.

Restraints

are rarely, if not, unused in blood banks.

• Icteric samples

Presence of bilirubin

• Icteric samples

• As well as (?) and samples with observable hemolysis.

lipemic

• Some analytic procedures in the blood bank (i.e. hemoglobin determination) are read spectrophotometrically, thus (?) are not advised.

icteric and lipemic samples

• As for hemolysis, some tests would consider hemolysis as (?).

positive reactions

Ensure an amount of blood is drawn corresponding to the volume of the

additive/anticoagulant.

Anticagulated (EDTA) Optimum Blood-to-Additive Ratio =

1:9

(?) to the line indicated on the evacuated tube label. Do not overfill

Fill the tube

In the Blood Bank laboratory, various samples derived from blood are used for (?).

immunologic purposes

The following are the different samples used in the Blood Bank laboratory, together with its sources and uses.

 Serum - clotted  Plasma - unclotted/anticoagulated

SERUM AND PLASMA Collected by:

Routine venipuncture (mixed with anticoagulant)

SERUM AND PLASMA Uses:

 Detecting antibodies  ABO Reverse typing  Antibody Screen and Identification  Screening for Transfusion  Transmissible Infections (TTI's)

RED CELL SUSPENSION Prepared by:

 Washing RBCs from tube segments or centrifuged whole blood samples  Makes use of normal saline solution (NSS) as a washing and a suspending liquid (0.85-0.9%)  Conventional RCS preparations for tube method testing would have a characteristic "tomato red" color.

RED CELL SUSPENSION Uses:

 As reagent cells  As sample cells  Crossmatch procedures (Tube and card)

 As reagent cells

o ABO Reverse typing (Tube and card method) o Antibody screen o Antibody Identification

 Crossmatch procedures (Tube and card)

o ABO Forward Typing and Rh Typing (Tube and card method)

RED CELL SUSPENSION Concentrations:

 2% - 5%  0.8%

: for tube method procedures; allows for better visualization in test tube procedures

 2% - 5%

: for gel card methods; often commercially made

 0.8%

RCS Requires the following reagents:

o 0.85% Physiological Saline Solution o Centrifugated anticoagulated whole blood

RCS Vessels that may be used:

o Graduated centrifuge tubes o Test tube o Reagent antiserum vial with droppers

varies per protocol, but must meet standards

RCS concentration

RCS  Determine first the (?)  Consider the (?) of the containment vessel before preparing  It's best to (?) first before preparing  (?) may require CLS to determine first the antigens present

percentage capacity calculate Reagent RCS

EXPERIMENT 2, 3, 4 Flashcards

(109 cards)