specimen collection ( capillary) Flashcards
(56 cards)
1
Q
“Proper patient identification is the first step in sample collection.”
A
SPECIMEN COLLECTION
2
Q
- Prime factor in order to attain accurate results in the clinical laboratory is
A
patient identification
3
Q
- Conscious Inpatients/Hospitalized patients
- Sleeping patients
- Unconscious
- Infants and Children and Mentally Incompetent
- Outpatient/Ambulatory patients
A
PATIENT IDENTIFICATION PROCEDURES
4
Q
- Ask full name (verbally), confirm using ID
bracelets - All of your question should not be answerable
by yes or no. - Every patient admitted in the hospital has an ID
bracelet
A
Conscious Inpatients/Hospitalized patients
5
Q
- Same as conscious, awakened before
collection - Awaken the patient. Ask their full name verbally
then confirm using ID bracelets.
A
Sleeping patients
6
Q
- Ask relative or nurse or physician and
record name of person, ID bracelets - For coma and ICU patients, confirm details to their relative (first asked), nurse, or physician. Confirm ID Bracelet
A
Unconscious
7
Q
Ask relative or nurse and record name of
person, ID bracelets
A
Infants and Children and Mentally Incompetent
8
Q
- Receptionist verifies the ID of the patient
o The receptionist in the laboratory is the
first to interact with the patient. - Patient may show ID with picture
- Clinic issued ID card
- In case there is no verification from the
receptionist and no ID, make the patient state
full name, date of birth and spell the last
name
o Usually, 2 or 3 items for verification is
needed.
▪ Name, Date of Birth, Age, Address - Items for verification depends on the SOP of
the hospital
A
Outpatient/Ambulatory patients
9
Q
Method for blood collection, for adult males:
A
5-6L of whole blood
10
Q
Method for blood collection, For adult females
A
4-5L of whole blood
11
Q
cells composed of 40-45%
A
(1.89L)
12
Q
Plasma composed of 55-60%
A
(2.84L)
13
Q
_____ only a fraction of the whole blood that is circulating in our body.
A
plasma and cellular components
14
Q
made up of water, proteins, nutrients, hormones, and electrolytes
A
PLASMA
15
Q
BUFFY COAT ( wbc and platelets )
PACKED RBC
A
CELLULAR COMPONENTS
16
Q
TYPES OF BLOOD SPECIMENS
A
- serum
- plasma
- whole blood
17
Q
_____ most common and the best specimen, but in case you want to decrease the turn-around-time and at
the same time for routine chem sometimes plasma is an
option
A
serum
18
Q
used in clinical chemistry depending on the anticoagulant used
A
Plasma
19
Q
- clear
- pale yellow in color
- plain tube
- clotted blood
- without fibrinogen
A
serum
20
Q
- clear to slightly hazy
- pale yellow in color
- anticoagulated tube
- unclotted blood
- with fibrinogen
A
plasma
21
Q
TYPES OF BIOLOGICAL SPECIMENS
A
- Saliva
- Urine
- Feces
- Synovial, Spinal, Amniotic, Pleural, Pericardial, Ascitic Fluid
- Various type of solid tissues
22
Q
Blood Collection
o 3 methods
A
- Arterial Puncture (artery)
- Skin puncture (capillaries)
- Venipuncture (veins)
23
Q
collect blood from the artery
A
- arterial puncture
24
Q
collect blood from the capillaries
A
skin puncture
25
defined as the process of collecting blood, comes from the Greek word “phleb” means veins and “tomy” meaning
slice or cut.
Phlebotomy
26
- Not all artery in the body can
be used as a site for arterial
puncture
- The usual artery that is used
for arterial puncture is the
brachial artery, radial artery
(preferred and common) and
femoral artery.
- The angle for the collection is
45 or 90 degrees.
- For infant or newborn, Scalp
and Umbilical artery
ARTERIAL PUNCTURE
27
* Blood is obtained/withdrawn from a patient’s artery
* Blood sample is collected without torniquet
ARTERIAL PUNCTURE
28
▪ pH measurement
▪ 𝑃𝐶𝑂2 level
▪ 𝑃𝑂2 level
▪ Bicarbonate level
Blood Gas Analysis
29
oxygenated blood with a bright red
color
Arterial blood
30
o test for collateral circulation
o important procedure performed before arterial puncture to know if there are other arteries to supply blood on that part of the body.
o Commonly used anticoagulant in arterial puncture is Heparin because it is the additive or anticoagulant that is best to use in collecting blood to be used for Blood Gas Analysis.
Allen’s test
31
to know the pH level, 𝑃𝑂2 level, and if the oxygenation of the patient is okay
o Uses either a glass syringe or plastic syringe
Arterial Blood Gas Analysis (ABGA)
32
* Produces good result
* Advantage is it is
reusable
Glass syringe
33
* Contamination is less
because it is a one-time
use
* Allows more leakage
when collecting blood
Plastic Syringe
34
- Bright red color
- Obtained from artery
- Oxygenated
Arterial Blood
35
- Dark red color
- Obtained from vein
- unoxygenated
Venous Blood
36
5 SITES FOR ARTERIAL PUNCTURE
- radial artery
- brachial artery
- femoral artery
- scalp artery
- umbilical artery
37
Commonly used in newborn patients
Scalp Artery
38
Ideal site for arterial puncture in newborn
patients
Umbilical Artery
39
* Length of lancet:1.75 mm
* Depth of incision (depends on the patient)
o Infants and children: <2.0 mm
o Adults: <2.5 mm
* Distance from skin surface to bone or cartilage: 1.5-2.4
mm
o Prevent contact with bones to avoid infection
Capillary Puncture or microsampling
40
When to use skin puncture, aka Capillary Puncture or microsampling
o Small amount of sample needed
o Repeated venipuncture resulting to severe vein damage
o Burn patient with bandage
41
* No accessible veins
* Fragile veins
* Thrombotic veins/ those with clot-forming tendencies
* POCT (point of care testing) samples
o Random Blood Sugar using glucometer
* Newborns and infants
Indications for skin puncture
42
* Lateral plant heel surface
(newborn and infants <1)
* Palmar surfaces of fingers
(3rd and 4th)
* Plantar surface of the big toe
* Earlobes – least site
Preferred sites for skin puncture
43
* Central arch area of an infant’s heel
* Fingers of newborn or infant, 1 y.o.
* Thumb, index and 5th fingers
o Thumb has pulse
o Pinky finger has insufficient depth
* Fingers on the side of mastectomy
* With scarred areas
o Bruises, edematous, cyanotic, calloused,
infected, recently punctured
Sites not recommended or should be avoided
44
collects blood from the capillary, the blood that is collected is a mixture of arterial and venous blood along with
interstitial and intracellular fluid.
Between the arterial and venous, it is more of the arterial blood. Mixture of oxygenated and
deoxygenated blood.
Skin puncture
45
Patient tends to develop iatrogenic anemia, also known as hospital induced anemia. Anemia acquired due to repeated blood collection
Disadvantage of performing skin puncture
46
person who can benefit with skin puncture
- Pediatric children
- Obese patients
- Chemotherapeutic patients
- burn patients
- adult patients
47
* EDTA > Other additive tubes > Serum tubes
o Example: purple, green, red
Order of filling microsampling
48
1. Hold finger between your index finger and thumb
2. Puncture the finger using a quick, smooth motion
3. Wipe away the first drop of blood (contains alcohol and interstitial fluid)
4. Collect sample
Skin puncture procedure:
49
* BGA of newborn and infants, measuring pH and 𝑝𝐶𝑂2 but not 𝑝𝑂2
* Preferred site: Earlobe
* Commonly used site: Lateral plantar heel surface
* Massage or apply warm compress on the site of puncture to enhance blood circulation.
o Heel warmer or warm towels
Arterialized Capillary Blood
50
a parameter of BGA that determines how
much oxygen is present or the partial pressure of the oxygen present.
▪ Cannot accurately measure this as
there is deoxygenated blood in the
sample
𝑝𝑂2
51
1. Warm the earlobe or heel surface with paper towel
saturated with warm water (39-45⁰C).
2. Flick the earlobe with the index finger.
3. Cleans the area with 70% alcohol.
4. 2 Heparinized tubes are placed in the center of next drop
of blood and filled capacity without air bubbles.
5. Both ends are sealed in clay after the insertion of flea.
o flea- small metal bar used to stir blood inside
6. Blood is stirred using a magnet.
Arterialized Capillary Blood Procedure
52
o Arterial blood pressure is <95mmHg
(hypotensive)
o Area has poor blood supply
o Patient has decreased cardiac output
o Patient with vasoconstriction
Capillary arterialization should not be done
53
minute metal filling that help mix the specimen while the blood is entering the tube
- moves the blood for a homogenous mixture
Flea
53
best site for BGA for new
born
Indwelling umbilical artery
54
1. Choose puncture site.
2. Cleanse the area with 70% alcohol.
3. Puncture across the finger line and wipe the first drop of blood that could contain interstitial fluid that could affect the
result.
4. Collect blood using the capillary tube through capillary action. Prevent performing milking of the site
SKIN PUNCTURE PROCEDURE
55
