hartman phlebotomy chapter 9

(LIS)laboratory information system

computer system integrating every part of the labatory testing process from orders through analysis and reports

Accession number

Number generated by laboratory information system (LIS) when specimen request is entered into the computer

how can you use the accession number?

can be used to trace specimens and results through the LIS at each stage f process

how can LIS help the process of blood collection?

1- deduce the chance of identification errors in patient care

2- PBT must take care they're entering info correctly

what info is on all requisition papers?

1- patients name

2- patient DOB

3- gender

4- name and contact info of health care provider

5- tests ordered ordered and Amy special requirements such as fasting , timed collection etc

6 also may include diagnosis codes, phone and address, hospital record number, insurance info

PBT mantra

I'm only here to draw blood you'll have to discuss your questions with your dr

why are blood tests ordered?

1- part of routine care

2- aid in diagnosis

3- to monitor specific medication or condition

provider

provides care ex dr or clinic

payer

pays med bill ex medicare or medicare

Analyte

Substance being measured in a diagnostic test

most lab tests require ...........blood

veinous

specimens are managed in different ways depending on.......

the analyte involved

CBC (complete blood count)

a set of tests that include all WBC, RBC and platelet measurements.

ESR (erythrocyte sedimentation rate)

The rate in which it takes for RBC's to settle off in an unclotted tube. Normal rate is 1 ml in 5 min.

what do blood cultures detect?

bacterial or fungal infections in patients blood

Electrolytes are

substances that affect the flow of nutrients and the removal or waste products in blood

name examples of analytes?

electrolytes, enzymes, proteins, antibodies, vitamins and minerals

test panel is a group of test that either

1- related to analytes ex electrolyte panel or lipid panel

2- related to a unifying condition ex hepatic panel (liver function test)

renal panel

kidney function test

hepatic panel

liver function test

basic metabolic panel

group of eight specific blood tests that provide important information about the current status of the patient's kidneys, electrolyte balance, blood sugar, and calcium levels

what tube for basic metabolic panel

SST or heparin tube

fasting sometimes requested

what's specifically tested for in BMP?

Glucose

calcium

sodium

potassium

carbon dioxide

chloride

blood urea

creatinine

BUN

blood urea nitrogen

waste product related to kidney function

Creatinine

waste product of muscle metabolism, filtered out of the blood by the kidneys, and excreted in urine

examples of panel tests

1- basic metabolic panel

2- comprehensive metabolic panel

3-lipid panel

4- CBC

comprehensive metabolic panel (CMP)

tests in addition to basic metabolic panel for expanded screening purposes: albumin, bilirubin, alkaline phosphatase, protein, ALT, and AST

what tubes for CMP?

SST, heparin(may be stat), sometimes fasting

lipid panel

series of blood tests (total cholesterol, high-density lipoprotein, low-density lipoprotein, and triglycerides) used to assess risk factors of ischemic heart disease

what tube for lipid panel?

SST, heparin(may be stat), usually fasting

complete bood count

common blood test to determine number of RBC, WBC and platelets in blood

CBC with differential

number of RBC and WBC and platelets and specific number of each type of WBC

what tube for CBC?

EDTA

be gentle

why use a tourniquet ?

to aid in locating the best site for venipuncture

where to use tourniquet?

3-4 inches above puncture site

when using a BP cuff as tourniquet how much do you inflate?

just below diastolic or no higher than 40 hg

why place tourniquet over clothing or on top of gauze?

to protect thin or fragile skin

Antecubital

anterior surface of elbow where blood is usually drawn

how long can you leave tourniquet on?

no longer than 1 min bc it will cause pain or mess up test

Hemoconcentration

a build up of blood cells (solid)relative to the liquid components of blood

what causes hemoconcentration?

leaving tourniquet on too long and it falsely elevates the blood cell count ....changes blood count

hemolysis

destruction of red blood cells

what causes hemolysis?

leaving tourniquet on too long

what if you leave tourniquet on over 1 min?

must wait 2 min b4 trying again

order of the end of a blood draw?

remove

1- tourniquet

2- tube (inversions)

3- needle

tourniquet makes blood pool and .............

makes veins easier to see

lactate is so sensitive to tourniquet use.......

some facilities dictate not using one when specimen tested for lactate

antecubital fossa

inside of elbow

what vein is PBT first choice?

median cubital

why is median cubital best vein choice ?

it's well anchored

using it has least chance of accidentally hitting a nerve or artery

2 kinds of vein formation?

M and H

veins in order of perference?

1- median cubital

2- cephalic

3- basilic

median cubital also known as

median basilic

the primary consideration for PBT to choose a venipuncture site?

the patients safety which means avoiding nerves and arteries

avoid veins that are hard to see or palpate

least favorable vein?

basilic bc near brachial artery and ante brachial cutaneous nerves

most reliable way to choose a vein?

palpation

when palpating veins consider the following factors?

1- vein health

2- vein depth

3- anchoring of vein

4- diameter of vein

vein health?

vein should be springy and uniform not hard or bumpy

vein depth?

veins may not be seen on obese people. no matter of the depth of vein the angle is same

might need longer needle

anchoring of the vein?

meaning they don't roll. palpation helps determine rolling

diameter of vein?

helps determine gauge of needle

water encouraged in both fasting and not fasting draws

water

when vein difficult to locate?

1- hang Arm straight down causing blood to pool

2- warm cloth or heat pack veins dilate

3- make fist will cause blood to surge

4- do not pump repeatedly can cause hemoconcentration or hemolysis

5- ask where has been successful b4

6- never slap veins

if no arm veins suitable then use

back of hand

dorsal aspect

back of hand

never use veins in wrist bc of

nerves, tendons and arteries

if no veins in arms or hand then try

lower leg , ankle or foot

draw sites in lower limbs are elevated risk for

thrombosis

thrombosis

blood clot

dr orders

leg, ankle, and foot draws need dr approval

what is first priority for PBT when selecting a site?

safety and health. select a site with least discomfort

clean site?

70% alcohol in circles starting inside working out and let dry

how to clean for blood culture?

most common chloraprep

can use alcohol but 3 pads for 60 sec

if iodine then clean off with alcohol so no trace

iodine allergy

shellfish

when testing for alcohol level how to clean site?

use something other than alcohol or iodine so not to contaminate blood

how to anchor vein?

use thumb to anchor vein pulling skin below site

info about inserting needle

bevel up

30% angle

"Blown" Veins

needle thru vein

what problems can prevent blood flow?

1- vein have moved or rolled

2- needle gone thru vein

3- bevel not fully inserted into vein or vein collapsed

do not probe for vein, if blood isn't immediate you might create a

hematoma

Hematoma

leaked blood beneath skin

PBT can move needle ........... but never .........

forward and back

side to side

if you cannot get blood from a site what do you do?

remove tourniquet , remove needle ans select another site

how many tries to stick?

2 attempts then get a supervisor

describe how most venipuncture are done?

in antecubital area of arm with a straight 21 gauge multisample needle in evacuated tubes

what's so great about multisample needles?

easier to handle and pose less risk of accidental needle stick

what to ask patient b4 stick?

1- have you had difficulties drawing blood b4

2- have you met the fasting requirements

3- no food or gum

what equipment is needed when performing routine venipuncture with multisample needle and evacuated tubes?

1- requisition

2- soap water sanitizer

3- gloves or PPE

4- tourquinet

5- 70% alcohol

6- multisample needle

7- needle holder

8- collection tubes

9- specimen labels

10- 2 gauze

11- bandage

12-pen

Discard tube

also called a clear tube, used to collect and discard approximately 5mL of blood to prevent IV or tissue fluid contamination of a specimen

must be a citrate tube or no additive

Butterfly needle

a small, winged-tip needle used to initiate intravenous access

higher risk for needle stick

what tubes to use for elderly or pediatric ?

smaller tubes bc put less pull on veins

how to treat pediatric patients?

1- appropriate equipment

2- appropriate vocabulary

3- get on physical level

when pediatrics in hospital setting getting blood drawn they have an increased chance of iatrogenic anemia which is

anemia resulting from excessive blood removal

no more than ........... of patients blood should be drawn in a day

2.5 %

no more than ......... of patients blood should be drawn in a 30 day period

5%

how to treat obese patients when trying to draw blood?

1- vein location hard bc veins deeper

2- allow arm to dangle

3- apply warm pack

4- ask patient about a successful site used before

5- bp cuff inflated to diastolic

6- still use 30 degree angle

7- anchor veins firmly

8- only two attempts

when dealing with patient with cognitive impairment or mental health disorder?

1- patient behavior unpredictable

2- keep supplies out of reach

3- have another staff member in room

4-have family member there

5- be prepared to remove needle and tourniquet quickly

when dealing with patients having a seizure?

1- if seizure remove tourniquet and needle and discard

2- keep patient safe from head injury

3- protect patient and PBT from needle stick

syncope

fainting

how to handle fainting during a blood draw?

1- very common

2- no warning

3- patients usually inform you if it happens often

4- should recline if possible

5- if fainting release tourniquet and needle

6- keep patient safe

7- get help

8- if feeling faint b4 stick use cold cloth, rest juice or snack