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Venipuncture/Phlebotomy
Anatomy:
14G Angiocath, Largest size of a needle, Mass Trauma
16G, For surgical operations and mass infusions
18G, Blood products, large infusions
20G, multipurpose IV
22G, chemo infusions, small veins, pediatric patients
24G, pediatric patients, geriatric patients, fragile veins
Assepsis (wear latex gloves)
Tie a TQ around PT arm
Palpate for a vein, steralize the arm after
Prep a 25 to 27 G butterfly needle and attach it to the barrel
Remove sheath off the needle
Secure arm in place, enter the arm at a 20-40 degree angle
Attach vacutainer tube to barrel and attach to needle
Remove the needle, place gauze and tape it
Cap the vacutainer
Complete Blood count (CBC)
Red blood cells, which carry oxygen
White blood cells, which fight infection
Hemoglobin, the oxygen-carrying protein in red blood cells
Hematocrit, the amount of red blood cells in the blood
Platelets, which help blood to clot
Red blood cell count, hemoglobin and hematocrit
Lower - Lower than usual measures in these three areas are a sign of anemia.
Higher - A red blood cell count that's higher than usual is known as erythrocytosis. A high red blood cell count or high hemoglobin or hematocrit levels could point to a medical condition such as blood cancer or heart disease.
White blood cell count
Lower - A low white blood cell count is known as leukopenia. A medical condition such as an autoimmune disorder that destroys white blood cells, bone marrow problems or cancer might be the cause.
Higher - A white blood cell count that's higher than usual most commonly is due to an infection or inflammation. Or it could point to an immune system disorder or a bone marrow disease.
Platelet count
Lower - A platelet count that's lower than usual is known as thrombocytopenia.
Higher - A platelet count that's higher than usual is known as thrombocytosis.
Type & Cross-Match (T&C)
The Type and Cross-Match test is conducted to determine a patient's blood type (A, B, AB, or O) and Rh factor (positive or negative) and to identify compatible blood for transfusions.
Arterial Blood Gas (ABG)
An Arterial Blood Gas (ABG) test measures the levels of oxygen (O2), carbon dioxide (CO2), pH, bicarbonate (HCO3-), and other parameters in arterial blood to assess lung function and acid-base balance.
What Results may Indicate:
pH: 7.35-7.45.
Lower - Indicates acidosis
Higher - Indicates alkalosis
Oxygen (PaO2): 75-100 mmHg.
Lower - Indicates hypoxemia
Higher - N/A
Carbon Dioxide (PaCO2): 35-45 mmHg.
Lower - N/A
Higher - Indicates hypercapnia
Bicarbonate (HCO3-): 22-26 mEq/L.
Lower - Indicates metabolic acidosis
Higher - Indicates metabolic alkalosis
Venous Blood Gas (VBG)
A Venous Blood Gas test measures the levels of oxygen (O2), carbon dioxide (CO2), pH, bicarbonate (HCO3-), and other parameters in venous blood to assess the body's acid-base balance and oxygenation status.
What results may indicate:
pH: 7.31-7.41.
Lower - Indicates acidosis
Higher - Indicates alkalosis
Oxygen (PvO2): 30-40 mmHg.
Lower - Indicates hypoxemia
Higher - N/A
Carbon Dioxide (PvCO2): 41-51 mmHg.
Lower - N/A
Higher - Indicates hypercapnia
Bicarbonate (HCO3-): 22-28 mEq/L.
Lower - Indicates metabolic acidosis
Higher - Indicates metabolic alkalosis
Prothrombin Time/International Normalised Ratio (PT/INR)
The PT/INR test measures the time it takes for blood to clot, specifically evaluating the extrinsic pathway of the clotting cascade. The INR is calculated based on the PT to standardize results, particularly for individuals on anticoagulant therapy like warfarin.
PT: Typically 11-13 seconds.
INR: Normal range for most therapeutic ranges is around 2.0 to 3.0.
What Results may Indicate:
Higher PT/INR - Increased risk of bleeding; potential inefficacy of anticoagulant therapy.
Lower PT/INR - Higher risk of blood clots; potential overdose or insufficient anticoagulation for therapeutic targets.
Partial Thromboplastin Time (PTT)
The PTT test is utilised to:
Monitor the effectiveness of heparin therapy, an anticoagulant medication that prevents blood clots.
Diagnose or monitor bleeding disorders like hemophilia or von Willebrand disease.
Assess clotting ability before surgeries or during pregnancy.
What Results may Indicate: 25-35 seconds.
Higher PTT: May indicate clotting factor deficiencies, liver disease, or the presence of anticoagulants.
Lower PTT: Uncommon and might suggest clotting disorders, but extremely low PTT values are rare.
Peripheral Blood Smear (PBS)
The PBS test serves multiple purposes:
Hematologic Disorders: Diagnosis and evaluation of various blood-related conditions such as anemia, infections, leukemias, and platelet disorders.
Systemic Diseases: Identification of abnormalities related to systemic diseases affecting blood cell production, function, or destruction.
Treatment Monitoring: Assessment of treatment effectiveness in managing blood disorders.
Red Blood Cells (RBCs): Assessing size, shape, and coloration of RBCs for signs of anemia or abnormal cell morphology.
White Blood Cells (WBCs): Identification of different types of WBCs, including neutrophils, lymphocytes, monocytes, eosinophils, and basophils, to detect infections, leukemias, or other disorders.
Platelets: Evaluation of platelet count, size, and morphology to identify platelet disorders or clotting abnormalities.
Basic Metabolic Panel (BMP)
The Basic Metabolic Panel (BMP) is a blood test that evaluates various fundamental aspects of overall health by measuring the levels of essential substances in the blood. It provides insights into the body's metabolic balance and the function of vital organs such as the kidneys and liver.
Glucose:
Normal Range: Typically between 70-100 mg/dL when fasting.
Higher Levels: Indicate hyperglycemia, suggestive of diabetes, stress, or prediabetic conditions.
Lower Levels: Suggest hypoglycemia, potentially due to excessive insulin, certain medications, or medical conditions.
Electrolytes:
Sodium (Na):
Normal Range: Around 135-145 mEq/L.
Higher Levels: May indicate dehydration, certain kidney diseases, or hormonal imbalances.
Lower Levels: Suggestive of overhydration, certain kidney conditions, or hormonal issues.
Potassium (K):
Normal Range: Typically between 3.5-5.0 mEq/L.
Higher Levels: May indicate kidney problems, severe tissue damage, or certain medications.
Lower Levels: Suggestive of vomiting, diarrhea, excessive sweating, or kidney issues.
Carbon Dioxide (CO2):
Normal Range: Usually between 23-29 mEq/L.
Higher Levels: May indicate breathing difficulties, metabolic alkalosis, or kidney issues.
Lower Levels: Suggestive of metabolic acidosis or respiratory alkalosis.
Chloride (Cl):
Normal Range: Typically 96-106 mEq/L.
Higher Levels: May indicate dehydration, kidney issues, or certain medications.
Lower Levels: Suggestive of overhydration, vomiting, or metabolic alkalosis.
BUN (Blood Urea Nitrogen):
Normal Range: Generally around 7-20 mg/dL.
Higher Levels: Indicative of kidney dysfunction, dehydration, heart failure, or excessive protein intake.
Lower Levels: Rarely a concern but might indicate liver disease or malnutrition.
Creatinine:
Normal Range: Typically 0.6-1.2 mg/dL.
Higher Levels: Indicative of impaired kidney function or other conditions affecting muscle breakdown.
Lower Levels: Rarely significant but may suggest low muscle mass or severe liver disease.
Comprehensive Metabolic Panel (Chem7)
The Comprehensive Metabolic Panel, also known as the Chem 7, is a blood test that provides a broader assessment of various metabolic and organ functions. It includes a set of tests that evaluate liver function, kidney function, electrolyte balance, and blood sugar levels. The Chem 7 is a blood test designed to assess the overall metabolic health of an individual by examining multiple components related to organ function, electrolyte balance, and blood sugar levels.
Glucose:
Normal Range: Fasting levels typically fall between 70-100 mg/dL.
Higher Levels: Indicate hyperglycemia, potentially suggesting diabetes or impaired glucose tolerance.
Lower Levels: Hypoglycemia may be indicative of excessive insulin, certain medications, or metabolic conditions.
Electrolytes:
Sodium (Na):
Normal Range: Usually 135-145 mEq/L.
Higher Levels: Indicate dehydration, certain kidney diseases, or hormonal imbalances.
Lower Levels: Suggestive of overhydration, certain kidney conditions, or hormonal issues.
Potassium (K):
Normal Range: Typically between 3.5-5.0 mEq/L.
Higher Levels: May indicate kidney problems, severe tissue damage, or certain medications.
Lower Levels: Suggestive of vomiting, diarrhea, excessive sweating, or kidney issues.
Carbon Dioxide (CO2):
Normal Range: Usually between 23-29 mEq/L.
Higher Levels: May indicate breathing difficulties, metabolic alkalosis, or kidney issues.
Lower Levels: Suggestive of metabolic acidosis or respiratory alkalosis.
Chloride (Cl):
Normal Range: Typically 96-106 mEq/L.
Higher Levels: May indicate dehydration, kidney issues, or certain medications.
Lower Levels: Suggestive of overhydration, vomiting, or metabolic alkalosis.
BUN (Blood Urea Nitrogen):
Normal Range: Generally around 7-20 mg/dL.
Higher Levels: Indicative of kidney dysfunction, dehydration, heart failure, or excessive protein intake.
Lower Levels: Rarely a concern but might indicate liver disease or malnutrition.
Creatinine:
Normal Range: Typically 0.6-1.2 mg/dL.
Higher Levels: Indicative of impaired kidney function or other conditions affecting muscle breakdown.
Lower Levels: Rarely significant but may suggest low muscle mass or severe liver disease.
Liver Enzymes (AST, ALT, ALP):
AST (Aspartate Aminotransferase):
Normal Range: Usually below 40 units/L.
Higher Levels: May indicate liver damage, heart issues, or muscle injury.
ALT (Alanine Aminotransferase):
Normal Range: Typically below 40 units/L.
Higher Levels: Suggestive of liver damage, hepatitis, or other liver disorders.
ALP (Alkaline Phosphatase):
Normal Range: Generally between 44-147 units/L.
Higher Levels: May indicate liver or bone disorders, gallbladder issues, or certain cancers.
Total Protein and Albumin:
Total Protein:
Normal Range: Typically 6.0-8.3 g/dL.
Higher or Lower Levels: May indicate liver or kidney diseases, nutritional deficiencies, or other conditions.
Albumin:
Normal Range: Usually between 3.4-5.4 g/dL.
Higher or Lower Levels: May indicate liver or kidney diseases, malnutrition, or inflammatory conditions.
Bilirubin:
Normal Range: Usually below 1.2 mg/dL.
Higher Levels: Indicative of liver dysfunction, hemolysis, or bile duct obstruction.
Thyroid Panel
A Thyroid Panel is a blood test that measures the levels of hormones produced by the thyroid gland. The thyroid is a small butterfly-shaped gland located in the neck and plays a crucial role in regulating metabolism and energy production. A Thyroid Panel typically includes several tests to assess thyroid function.
TSH (Thyroid Stimulating Hormone):
Normal Range: Typically between 0.4 - 4.0 mIU/L.
Interpretation:
Normal TSH: Indicates the thyroid is functioning within the expected range.
Elevated TSH: Suggests hypothyroidism (underactive thyroid), which may be due to issues with the thyroid gland or pituitary gland.
Low TSH: Suggests hyperthyroidism (overactive thyroid), often due to thyroid disorders or excessive thyroid medication.
Free T4 (Free Thyroxine):
Normal Range: Usually between 0.8 - 1.8 ng/dL.
Interpretation:
Normal Free T4: Indicates adequate production of the thyroid hormone T4.
Low Free T4: Suggests hypothyroidism, particularly if TSH is elevated.
High Free T4: Suggests hyperthyroidism, especially if TSH is low.
Free T3 (Free Triiodothyronine):
Normal Range: Generally between 2.3 - 4.2 pg/mL.
Interpretation:
Normal Free T3: Indicates sufficient levels of the active thyroid hormone T3.
Low Free T3: May suggest hypothyroidism, especially if TSH and Free T4 are also low.
High Free T3: May suggest hyperthyroidism, particularly if TSH is low and Free T4 is elevated.
Hypothyroidism:
TSH Elevated, Free T4 and Free T3 Normal/Low: Primary hypothyroidism.
TSH Elevated, Free T4 and Free T3 Low: Severe hypothyroidism.
TSH Elevated, Free T4 Normal/Low, Free T3 Elevated: Possible hyperthyroidism with secondary hypothyroidism.
Hyperthyroidism:
TSH Low, Free T4 and Free T3 Elevated: Primary hyperthyroidism.
TSH Low, Free T4 Elevated, Free T3 Normal/Low: Subclinical hyperthyroidism.
Subclinical Thyroid Dysfunction:
TSH Elevated, Free T4 and Free T3 Normal: Subclinical hypothyroidism.
TSH Low, Free T4 and Free T3 Normal: Subclinical hyperthyroidism.
Hashimoto's Thyroiditis: An autoimmune condition causing hypothyroidism, often associated with elevated TSH and normal/low Free T4.
Graves' Disease: An autoimmune condition causing hyperthyroidism, often associated with low TSH and elevated Free T4 and Free T3.
Thyroid Nodules: May lead to thyroid hormone imbalances, and additional tests or imaging may be necessary.
Cardiac Enzymes
Cardiac enzymes are specific proteins released into the bloodstream during heart muscle damage. Elevated levels of these enzymes can indicate heart-related issues, such as a heart attack. Common cardiac enzymes include creatine kinase (CK), creatine kinase-MB (CK-MB), and troponin. Cardiac enzyme tests are performed to assess whether there has been damage to the heart muscle. Elevated levels of specific enzymes can indicate myocardial infarction (heart attack) or other cardiac conditions.
1. CK (Creatine Kinase):
Normal Range: Levels vary based on age, sex, and muscle mass.
Interpretation:
Elevated CK: Indicates damage to muscles, including the heart, but lacks specificity for cardiac injury.
CK-MB Fraction: Helps determine if the CK elevation is due to heart muscle damage.
2. CK-MB (Creatine Kinase-MB):
Normal Range: Typically less than 5% of total CK.
Interpretation:
Elevated CK-MB: Specifically indicates heart muscle damage.
CK-MB Index: The ratio of CK-MB to total CK (expressed as a percentage) can further aid in determining cardiac specificity.
3. Troponin:
Normal Range: Usually undetectable or very low.
Interpretation:
Elevated Troponin:
Strongly indicates myocardial infarction or significant heart muscle injury.
Troponin I and Troponin T are highly specific to cardiac tissue.
Levels may continue to rise for several hours and remain elevated for days.
Non-ST Elevation Myocardial Infarction (NSTEMI) vs. ST Elevation Myocardial Infarction (STEMI):
NSTEMI: May have elevated Troponin without significant CK-MB elevation.
STEMI: Often associated with marked elevation in both Troponin and CK-MB.
Other Causes of Elevated CK:
Skeletal muscle injury, trauma, or surgery can lead to elevated CK.
CK-MB and Troponin are more specific to cardiac injury.
Isolated CK-MB Elevation: May suggest myocardial injury without general muscle damage.
Troponin Elevation Without CK-MB: May indicate minor myocardial injury or demand ischemia.
Brain Natriuretic Peptide (BNP)
The BNP test is performed to assess the level of B-type Natriuretic Peptide in the blood. BNP is produced by the heart, specifically the ventricles, in response to increased pressure or stress on the heart muscle. The test is primarily used to diagnose and monitor heart failure.
Normal Range:
Typically, BNP levels are considered normal when they are below 100 pg/mL (picograms per milliliter).
Heart Failure Threshold:
BNP levels between 100 pg/mL and 400 pg/mL are often considered suggestive of heart failure.
Levels above 400 pg/mL may indicate more severe heart failure.
Severity of Heart Failure:
The severity of heart failure is generally correlated with higher BNP levels.
However, the exact threshold for categorizing heart failure severity may vary.
Lipid Panel (HDL & LDL)
A lipid panel is a blood test that measures various components of cholesterol and triglycerides, providing valuable information about cardiovascular health. Two key components of a lipid panel are High-Density Lipoprotein (HDL) cholesterol and Low-Density Lipoprotein (LDL) cholesterol.
Total Cholesterol:
Desirable: Below 200 mg/dL
Borderline High: 200-239 mg/dL
High: 240 mg/dL and above
HDL Cholesterol:
Desirable: 60 mg/dL and above (higher values are better)
Poor: Below 40 mg/dL (lower values are associated with higher risk)
LDL Cholesterol:
Optimal: Below 100 mg/dL
Near Optimal: 100-129 mg/dL
Borderline High: 130-159 mg/dL
High: 160-189 mg/dL
Very High: 190 mg/dL and above
Triglycerides:
Normal: Below 150 mg/dL
Borderline High: 150-199 mg/dL
High: 200-499 mg/dL
Very High: 500 mg/dL and above
Lactic Acid Panel
A lactic acid panel, also known as a lactate test, measures the levels of lactate in the blood. Lactate is a byproduct produced when the body breaks down glucose for energy. Elevated levels of lactate in the blood can indicate various medical conditions, including metabolic disorders and certain types of shock. The test is commonly used in emergency medicine and critical care settings.
Lactate Levels:
Normal - Typically less than 2.0 mmol/L (millimoles per liter). Values can vary slightly among different laboratories.
Elevated - Indication of Tissue Hypoxia:
Elevated lactic acid levels often indicate an imbalance between oxygen supply and demand at the cellular level.
Commonly associated with conditions causing tissue hypoxia, such as shock or severe illness.
Types of Lactic Acidosis:
Elevated lactic acid can be categorized into Type A (due to inadequate oxygen delivery) and Type B (non-hypoxic) lactic acidosis.
Type A is often associated with conditions like sepsis, shock, and cardiovascular emergencies.
Type B may result from metabolic disorders or medications affecting lactate metabolism.
Erythrocyte Sedimentation Rate (ESR)
The Erythrocyte Sedimentation Rate (ESR) is a blood test that measures the rate at which red blood cells settle in a tube over a specific period. This test is a non-specific indicator of inflammation and is often used to help diagnose or monitor inflammatory conditions.
Normal Range:
The normal range for ESR varies with age and gender. For adults, typical values are up to 20 mm/hr.
Pediatric reference ranges differ and should be considered.
Elevated ESR:
Indication of Inflammation:
Elevation in ESR is a non-specific marker of inflammation in the body.
It reflects the increased presence of acute-phase proteins and fibrinogen in the blood, leading to faster settling of red blood cells.
Examples of inflammatory conditions include infection, tissue damage / necrosis, certain cancers and autoimmune disease.
C-Reactive Protein (CRP)
The CRP test measures the levels of C-reactive protein in the blood, which is a marker of inflammation. The primary purpose of this test is to identify and monitor inflammation in the body. It is often used to help diagnose or evaluate the severity of conditions associated with acute or chronic inflammation, such as infections, autoimmune disorders, and cardiovascular diseases.
Normal Range:
In a standard CRP test, normal levels are often below 1.0 mg/L.
In a high-sensitivity CRP (hs-CRP) test, normal levels may be below 3.0 mg/L.
Low Levels:
Low or undetectable CRP levels are generally considered normal in the absence of inflammation.
In some cases, very low levels may be observed in healthy individuals.
Moderate Elevation (1-10 mg/L):
Mild to moderate elevation may suggest the presence of inflammation or infection.
It can be indicative of various conditions, including viral or bacterial infections, autoimmune disorders, or tissue injury.
High Elevation (>10 mg/L):
Higher CRP levels may be associated with more severe inflammation.
In the context of cardiovascular risk assessment, levels above 10 mg/L may be indicative of an increased risk of cardiovascular events.
Plasma Viscosity (PV)
The plasma viscosity test measures the thickness or flow resistance of blood plasma. This test is used to assess the viscosity of the liquid component of blood, providing information about blood flow and potential underlying health conditions.
Normal Range -Between 1.4 and 1.8 centipoise (cP).
Elevated Results
Elevated plasma viscosity may indicate conditions such as dehydration, hyperproteinemia (increased protein levels in the blood), or inflammatory disorders.
It can also be associated with conditions affecting blood flow, such as polycythemia or certain cardiovascular diseases.
Low Results
Low plasma viscosity is less common but may be seen in conditions like hypoproteinemia (low protein levels in the blood) or conditions affecting blood composition.
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