RPT OBTAINING BLOOD SAMPLES

Phlebotomy

The insertion of a needle or cannula(small tube) into a vein for the purpose od withdrawing blood.

POL

physicians office laboratoy

what are the first steps in preparing to draw blood for testing?

review the written testing request, & assemble the equipment & supplies

The first thing to do while reviewing test order

1st review the pt's blood-collection order to determine what tests will be done.

All specimens, collection tubes & slides should be labeled with

Patients name, date & time of collection, the initials of the MA, & any other info depending on office

During venipuncture or capillary what are the standard supplies

Alcohol & cotton balls(or alcohol wipes), sterile gauze, & adhesive bandages

what is a tourniquet

a flat, broad length of vinyl or rubber or a piece of fabric with a velcro closure

when greeting patients to make sure its the right one what should we ask them to say

to state their full name & be sure you hear both the first & last names correctly & that it matches the order

the presence and levels of what affect blood

food & fluid intake or by other daily life activities

what does the glucose tolerance test require the patient to follow(what instructions)

certain pretest restrictions to minimize the influence of the restricted food or stres on the blood. the patient needs to eat high-carbohydrate diet for 3 days before test & to fast 8-12 hours before appointment.

what does the GTT measure & what does it detect

a pt's ability to metabolize carbs & detects hypoglycemia & diabetes mellitus

which center has classified all phlebotomy procedures as a risk for exposure to contaminated blood & blood products

CDC (the centers for disease control & prevention)

how do GLOVES help

protect against spills & splashing contaminated blood

how do GARMENTS help

protect your clothing from spills or splashes & provide measure of protection from contaminated materials

how do MASKS/GOGLES help

safeguard mucous membranes in your mouth, nose, & eyes from infection

what guidelines is there to follow to form a chain of custody for blood samples drawn for drug & alcohol analysis.

the patient must sign a consent

If an accident occurs while venipuncture what guidelines should I follow

1. report the incident to the staff members.

2. wash the injured area carefully & apply sterile bandage

3. record the time & date of incident, names of the people involve & the nature of exposure

4. depending on situation you may receive meds

5. Me & the patient will be involved in follow-up studies

OSHA

Occupational Safety & Health Administration

veins commonly used for venipuncture

Cephalic vein, basilic vein & the median cubital vein

what is the antecubittal fossa

the small depression inside the bend of the elbow

Evac. Systems (VACUTAINER)

use a special double-pointed needle, a plastic needle holder/adapter & collection tubes

why is the VACUTAINER method better? 2reasons

1. easy to collect several samples from one venipuncture

2. the potential for exposure to contaminated blood is reduced

when should you not use the VACUTAINER method?

if pt. has a small or fragile veins, the vacuum created when the collection tube is pressed over the needle point can cause the veins to collapse.

Evac. Systems

When should you use the Needle & Syringe Systems

when an evacuation system is not suitable, when pt. is a hard-stick

the smallest gauge needle you can use for venipuncture

no smaller than 23 Gauge to avoid hemolyzing the blood

Evac. Systems

when should you use the Butterfly System/Winged Infusion Set

patients with small or fragile veins

the tubing length of the butterfly system

5-12 inches

because the butterfly system is motionless what is the benefit?

the needle causes less trauma to the vein & surrounding tissue, the needle gauge is also 23

Collection tubes, what is something peculiar?

they are diff. colors, each color identifying the type of additives(if any)

Why is it important to fill the tubes in a specific order?

preserve blood sample's integrity by preventing carryover of tube additives from one tube to the next

Order of draw (collection tubes)

Yellow, Light Blue, Red, Tiger(Gold/Red), Green, Lavender, Gray

what additive does the yellow tube have?

Sodium Polyanetholaulfonate

what additive does the light blue tube have?

Sodium Citrate

what additive does the Red tube have?

Clot activator/Silicone coated

what additive does the tiger(gold/red) tube have?

Clot activator/silicone serum separator

what additive does the Green tube have?

Heparin

what additive does the Lavender tube have?

Ethylenediaminetetraacetic acid(EDTA) (anticoagulant)

what additive does the Gray tube have?

Potassium Oxalate or sodium fluoride (anticoagulant)

What test types is the yellow tube for?

Blood Cultures

What test types is the light blue tube for?

Coagulation Studies (PT & PTT)

What test types is the red tube for?

Blood chemistries, HIV/AIDS antibody, viral studies, & serologic studies

What test types is the tiger tube for?

test requiring blood serum, routine blood donor screening, & infectious disease testing

What test types is the green tube for?

Electrolyte Studies & arterial blood gases

What test types is the lavender tube for?

Hematology studies

What test types is the gray tube for?

Blood glucose

What does NIOSH stand for?

National Institute for Occupational Safety & Health

severa types of safety devices for collecting blood specimens have been developed, what are these:

-Retracting needles

-Hinged or sliding shields that cover phlebotomy & winged steel (butterfly) needles

-self-blunting phlebotomy & winged steel needles

-retractable lancets

why are blood culture specimens collected?

-to test for the presence of bacteria in blood

Why is it important that when doing blood culture that no skin organisms contaminate the specimen

Skin organisms like staphylococci & streptococci can cause false positive blood culture test result

Why when doing blood culture, should this procedure go first than any other venipuncture?

The eliminates the probability of contaminating the culture with additives from other tubes

How should the skin be cleanse when doing a blood culture?

1 With isopropyl alcohol

2 Iodine or chlorhexidine solution

what happens to two separate blood culture collection bottles?

One for aerobic & one for anaerobic culture

difference between capillary puncture & venipuncture

Capillary: releases a smaller amt. of blood

cap. puncture how can blood be collected? 3ways

1. Glass tubes Small 2. glass microscopic slides 3.directly on reagent strip on a special paper

where is cap puncture usually done on adults & children? is there an alternative site?

Great (middle) finger or the ring finger(use patients non-dominant hand)

alternative site: the lower part of the earlobe, unless the patient's ear is pierced.

where is cap puncture usually done in infants?

the underside of the heel

Lancets why are they used?

used in cap puncture. when the amt. of blood required for a specific procedure is not very large or when technical difficulties prevent use of the venipuncture technique.

what is a lancet?

a small, disposible instrument in which a sharp point used to puncture the skin and make a shallow incision (between 2.0-3.0 mm deep for an adult & NO deeper than 2.4mm for an infant)

Automatic Puncturing devices

loaded with lancet, used in cap puncture. The depth is mechanically controlled, more accuracy & comfortable.

Why are the automatic puncturing devices used?

depending on the desired depth of the puncture

Micropipettes

a small pipette that holds a small, precise volume of fluid

Microtainer tubes, used for cap puncture

Small plastic tubes with a wide-mouthed collector, similar to a funnel, that allows blood to flow quickly & freely into the tube, they're similar to colecction tubes because they also have different colored tops

reagent products & smear slides

Both used in cap puncture, you directly put the blood on top of the strip

What are some things that we can't tell patients, even if they're worried?

DO NOT SAY ABOUT;

-Prognosis

-medical condition

-blood type

-other medical information

Preventation of hematomas

releasing tourniquet before withdrawing the needle and applying the proper pressure over the puncture site after the needle has been withdrawn.

Chemicals I might encounter in lab work include the following:

-Anticoagulants(cause the blood to remain in a liquid

-Serum separators(form a gel-like barrier between serum & the clot in a coag. blood sample.

-Stains(color particular cells, making microscopic studies easier to complete)

Phenylketonuria

rare metabolic disorder. It doesnt break an amino acid necessary, & it accumulates in the body & causes brain damage.

when is PKU usually done?

24/48 hours after birth & the newborn must ingest proteins prior to test to ensure accuracy.

How do you perform the PKU test?

a cap puncture on the infants heel. Collect drops of the infant's blood, usually three or four, on a special card or paper.

What information does the PKU testing need?

•Mothers name & address

•Doctors name & contact

•baby's name, DOB & Weight

•Gestational Age

•Date & Time of the collection

What does hematologic tests include?

Blood cell counts, morphologic studies, coagulation studies, & the nonautomated erythrocyte sedimentation rate test, & they can either be performed on venous or capilary.

What elements does whole blood contain?

RBC's, WBC's & platelets & plasma

What does a complete blood (cell) count (CBC) include?

*RBC count

*WBC count

*Differential WBC count= the % of each type of WBC in the first 100 leuks of a sample.

*Platelet Count

*Hematocrit determination= what % is made up of RBC's after the sample spun in a centrifuge.

*Hemoglobin determination= amt. of hgb. by weight/volume

What do you do during differential cell count?

Prepare a blood smear slide & stain the smear

WBC staining characteristics

Neutrophils & Lymphocytes= dark purple nucleus

Basophils & Eosinophils= purple nucleus

Monocytes= Largest WBC

what do you measure in Hematocrit test?

You measure a pt's hematocrit % by collecting a small sample of the pt's blood in a MICROHEMATOCRIT TUBE, sealing the tube & spinning it in a centrifuge.

What happens during the hematocrit process

Heavier RBC's move to one end of the tube & lighter plasma moves to the other end. Between the RBC's and plasma is the buffy coat(WBC's & platelets) ALWAYS RUN TWO SAMPLES

Automated hematocrit Readers

devices like ultracrit are CLIA waived testing devices for rapid & accurate measurement of hematocrit. Results are obtained in less than a minute. often used blood banks to rapidly screen donors to see if they quialify.

Hemoglobin Test

determines the concentration of hgb in the blood by lysing(rupturing) the RBC's (hemolysis) & evaluating the color of the sample.

How is the hemoglobin test done?

with a hemoglobinometer-alsoa photoelectric colorimeter(uses light to read color), these analysers measure the amot. of hgb in a whole blood sample using a photometer(measure absorbed light)

what are some automated hemoglobin analyzers?

HemoCure HB 301 Analyzer, & the HemoPoint H2 Hemoglobin Measurement System (Stanbio Laboratory)

Why do some doctors order coagulation tests? 2reasons

1. identify potential bleeding problems before surgical procedures

2. monitor therapeutic drug levels when a pt. is receiving meds like hep or coumadin(warfarin)

how are coagulation tests performed?

PT & PTT, also performed using automated devices like the COAGUCHEK XS system or the ALERE INRATIO SYSTEM

Erythrocyte Sedimentation Rate (ESR) what does it measure?

measures the rate RBC's, the heaviest blood component, settle to the bottom of a blood sample.

what is ESR used for?

diagnostic tool, for inflammatory disease, cancer, & thryoid disease.

How do you do the ESR test?

trasnfer freshly collected, anticoagulated blood to calibrated tube & place the tube in a sedimenation rack. You examine the tube an hour later to determine how far the RBC's have fallen. the tests results are recorded as millimeters per hour (mm/hr)

Guidelines to follow when performing ESR:

1. ONLY fresh blood

2.Draw blood on anticoagulant tubes

3. Temperature, either too hot or too cod, will affect the test. near 70 degrees.

4. Position the sample tubes vertically in the rack, CANNOT LEAN.

5. No vibrating or bumping the rack during the test

6. NO putting bubbles into the sample when transferring blood into the tube.

7. WATCH TIME & read the results at exactly one hour.

What do chemical tests analyse

Several dozen chemicals found in human blood

how to perform Blood Glucose Monitoring

requires sterile lancets to do a capillary puncture. Collect blood on the reagent strips that change color in accordance with glucose levels present in the blood. the level is determined either by comparing the color on the strip with color standards provided with the reagent strips or by feeding the strip into a handheld reading device.

Hemoglobin A1c, what does it measure?

used to monitor the health of diabetic pt's, which measures the amt of glycosylated hemoglobin in the blood.

Once HgbA1c is formed how long does it remain in the life of the RBC

90 to 120 days

3 options to perform the HgBA1c test

1. Sending it to an outside reference lab. Results are available in 1-7 days.

2. Performing it in the office lab if the necessary equipment is available. Results are usually available in less than 10mts.

3. Taking the test at home. Several home tests are available, allowing the patient to monitor his own HgBA1c, Levels and therefore, the efficiency of his diabetes treatment.

this test should be done together with blood glucose monitoring

Advantages of HgBA1c

1 No pretesting prep. The test may be done w/o regard to meals.

2. Better overall assessment of long term blood glucose control. Blood glucose testing gives information about glucose levels at one point in time. HgBA1c gives information over of 2-3 months.

*pt's should have this checked 2-3 months

Cholesterol tests

analyzes a variety of blood chemicals including glucose, total cholesterol, HDL cholesterol & triglycerides.

What do serologic tests detect? Hint* 4 things

1.the presence of specific substances in a blood sample.

2.to detect disease antibodies, drugs, hormones, & vitamins in the blood

3. determine blood types

4. to test urine & other body fluids

Immunoassays methods

Western bold & ELISA(Enzyme linked immunosorbent assay) test HIV infection Dx.

Rapid Screening tests

1.like pregnancy tests

2. Mononucleosis (Lifesign status mono)

3. HIV(clear view HIV)

4. Helicobacter Pylori (H. Pylori rapid test device)

In what position should the arm be when doing venipuncture?

downward

What finger should be used to palpate the vein?

the index finger

when you insert the needle into the vein, what degree should the needle be positioned?

15 degree angle, bevel up & alligned parallel to the vein