(11) Specimen Rejection and Complications

Clotted

Failure to mix or inadequate mixing of samples collected into an additive tube.

Clotted

The red cells clump together making the sample unsuitable for testing.

Hemolysis

This is usually caused by a procedural error such as using too small of a needle or pulling back to hard on the plunger of a syringe used for collecting the sample.

red instead of straw colored

In hemolysis, the serum/plasma will appear

Quantity not Sufficient

QNS

Insufficient sample (QNS)

Certain additive tubes must be filled completely. Incorrect blood to additive ratio will adversely affect the laboratory test results. When many tests are ordered on the same tube be sure to know the amount of sample needed for each test.

Improper storage

certain tests must be collected and placed in ice, protected from light, or be kept warm after collection.

Wrong tube collected

A specimen is rejected when _ for test ordered. Always refer to the procedure manual when uncertain.

Improperly labeled specimen

Specimen rejection regarding the details on specimen

Ecchymosis (Bruise)

It is caused by leakage of a small amount of fluid around the tissue.

Ecchymosis (Bruise)

most commonly encountered complication in obtaining a blood specimen.

Syncope (fainting)

Second most common complication in blood collection

Syncope (fainting)

Before drawing blood, the collector should ask if he/she had prior episodes of fainting.

Hematoma

when leakage of a large amount of fluid around the puncture site causes the area to swell.

Hematoma

Most commonly occurs when the needle goes through the vein, bevel is partially inserted in the vein and if the collector fails to apply enough pressure after venipuncture.

Bevel

It is the slant portion of the needle

Failure to draw blood

A complication due to improper needle positioning, excessive pull of the plunger, piercing the other pole of the vein, incorrect bevel positioning, and absence of vacuum.

Petechiae

small red spots indicating that small amounts of blood have escaped into the skin epithelium.

Edema

swelling caused by an abnormal accumulation of fluid in the intracellular spaces.

Obesity

Complication where veins may be neither readily visible nor easy to palpate can use of a blood pressure cuff in locating the vein.

patient’s diastolic pressure, 1 minute

When using a bp cuff to locate a vein it should not be inflated any higher than the __ and should not be left on the arm for longer than

Hemoconcentration

Can caused by leaving the tourniquet on the patient’s arm too long.

Hemoconcentration

A complication that increases the concentration of larger molecules in the blood as a result of a shift in water balance.

potassium

Analytes that are increased in Hemoconcentration

Prolonged Tourniquet application

Primary effect is hemoconcentration. The hydrostatic pressure causes some water and elements to leave the extracellular space.

Hemolysis

rupture of red blood cells with th consequent escape of hemoglobin. Can cause th plasma or serum to appear pink or red.

• Mix tubes with anticoagulant additives gently

• Avoid drawing blood from a hematoma

• Avoid drawing the plunger of the syringe back to forcefully and avoid bubbles on the sample

• Make sure the venipuncture site is dry
• Avoid a probing, traumatic venipuncture

To prevent hemolysis:

fluid may dilute the specimen

Why should you collect from the opposite arm if patient undergoes IV therapy

at least 2 minutes

Turn off the IV for ___ before venipuncture

below

Apply the tourniquet __ the IV site. Select a vein other than the one with IV

5 mL

Perform the venipuncture. Draw ___ of blood and discard before drawing the specimen tubes for testing

1. Clotted

2. Hemolysis

3. Insufficient sample (QNS)

4. Wrong tube collected

5. Improper storage

6. Improperly labeled specimen

SPECIMEN REJECTION:

1. Ecchymosis (Bruise)

2. Syncope (fainting)

3. Hematoma

4. Failure to draw blood

5. Petechiae

6. Edema

7. Obesity

8. Hemoconcentration

9. Prolonged Tourniquet application

10. Other complications includes

11. IV Therapy

COMPLICATIONS ENCOUNTERED IN BLOOD COLLECTION: