9 - PHLEBOTOMY

4001

5001

Phlebotomy Area Workflow

1. Call out patient’s queueing number via queueing machine

   • _-: For senior citizens/PWD/pediatrics

   • _-: Regular ambulatory patients

IPSG 1

Phlebotomy Area Workflow

_ _: Proper patient identification

full name and birth date

Phlebotomy Area Workflow

IPSG 1: Proper patient identification

• Allow patient to speak out his/her (2)

• If patient’s speech is impaired:

  • Ask the accompanying relative/companion

  • Ask for an ID

  • Speak out patient’s name and birth date then allow patient to confirm his/her identity

• Two patient identifiers:

  • Full name

  • Birth date

accompanying relative/companion

ID

patient’s name and birth date

IPSG 1: Proper patient identification

• Allow patient to speak out his/her full name and birth date

• If patient’s speech is impaired:

  • Ask the _ _/_

  • Ask for an _

  • Speak out (2) then allow patient to confirm his/her identity

• Two patient identifiers:

  • Full name

  • Birth date

Full name

Birth date

IPSG 1: Proper patient identification

• Allow patient to speak out his/her full name and birth date

• If patient’s speech is impaired:

  • Ask the accompanying relative/companion

  • Ask for an ID

  • Speak out patient’s name and birth date then allow patient to confirm his/her identity

• Two patient identifiers:

  • _

  • _

3rd (middle), 4th (ring)

fleshy, perpendicular

first drop

CAPILLARY BLOOD COLLECTION

FINGER PUNCTURE

1. Position the patient so that the hand is easily accessible

2. Cleanse the fingertip of the _ or _ finger with. Allow the finger to dry

3. Using a sterile lancet, puncture the fingertip in the _ part of the finger, slightly to the side of the center and across (_ to) the grooves of the fingertip. This enables the blood to form as a drop on the fingertip. If the puncture is parallel to the lines of the fingerprint, the blood will not form as a drop but will run down the finger, making collection difficult

4. Wipe away the _ _ of blood with a sterile gauze to facilitate good flow of blood and remove the tissue debris

tissue fluid

CAPILLARY BLOOD COLLECTION

FINGER PUNCTURE

1. Allow another large drop of blood to form. Lightly touch the microtainer drop of blood. Collect drops of blood into the collection device by gently massaging the finger. Avoid excessive pressure that may squeeze _ _ into the drop of blood. Fill the microtainer tube(s) as needed

2. Cap and invert the microtainer to mix the blood collected

3. When finished, clean the site and apply pressure with a clean gauze to stop the bleeding

4. Properly label the microtainer tubes

clotting factors

CAPILLARY BLOOD COLLECTION

Order of Draw

Most sensitive to _ _ first

Blood gas specimens

Slides

EDTA specimens

Other tubes with additives

Non additives (serum specimens)

CAPILLARY BLOOD COLLECTION

Order of Draw

(5)

Bleeding Time Consent Form

sphygmomanometer, 40 mmHg, 20 mmHg

volar surface

BLEEDING TIME

Ivy’s/Template Method

1. Ask the patient to fill up the _ _ _ _. For pediatric and non-ambulatory patients, allow the relative or companion to fill up the form

2. Explain the procedure and the risk of scarring to the patient

3. Place a _, or blood pressure cuff, on the upper arm of the patient then inflate (_ _ for adults; _ _ for toddlers)

4. Cleanse the area on the _ _ of the forearm that is devoid of veins using alcohol

Adult Simplate

1, 2.5

1, 4

30

BLEEDING TIME

Ivy’s/Template Method

1. Using the bleeding template (_ _), make an incision on the patient’s volar forearm. Avoid any visible veins for the incision as it may affect the results

   • Incision 

     • Depth: _ mm

     • Length: _ mm

   • If Surgicutt:

     • Depth: _ mm

     • Length: _ mm

2. Using filter paper, blot the blood from the incision every _ seconds

3. Time stops when there is no further bleeding after blotting

4. Write the results in the request slip and indicate the method used

seconds

5-15, 2-9

BLEEDING TIME

Ivy’s/Template Method

• Reporting: By _

• NV: _-_ mins* / _-_ mins**

  • *acc to orientation

  • **acc to 3rd yr lecture

ring

alcohol

lancet

BLEEDING TIME

Duke’s Method

1. Explain the procedure to the patient

2. Choose a fingertip for the procedure. Preferably, the _ finger as it has the least nerve endings

3. Clean the fingertip using _

4. Use a _ to prick the fingertip and observe for bleeding

filter paper, 30

seconds

5-15, 2-4

BLEEDING TIME

Duke’s Method

1. Using _ _, blot the blood from the puncture site every _ seconds

2. Record the results in the request slip and indicate the method

• Reporting: By _

• NV: _-_ mins* / _-_ mins**

three (3) red top, 1

3rd

1

three (3)

CLOTTING TIME

Lee and White Method

1. Extract _ _ _ tubes; each one contains at least _ mL of patient’s blood

2. Time starts when the _ tube is filled with blood 

3. Every _ minute, tilt tubes to observe for clot formation whilst holding the tubes at body temperature

4. Procedure stops when there is visible clotting formed in the _ tubes

5. Write the results in the request slip

minutes

6-15, 7-15

CLOTTING TIME

Lee and White Method

• Reporting: By _

• NV: _-_ mins* / _-_ mins**

lancet

fibrin strand, 30

fibrin strand

CLOTTING TIME

Slide Method

1. Prick the fingertip of the patient using a _

2. Place a large drop of blood on a glass slide

3. Use a lancet or applicator stick to observe for _ _ formation by passing it through the drop of blood every _ seconds

4. Test stops when a visible _ _ is observed

5. Record the results in the request slip and indicate the method used

minutes

2-4

CLOTTING TIME

Slide Method

• Reporting: By _

• NV: _-_ mins**

drop

35-45

feathered edge

BLOOD SMEAR PREPARATION

Peripheral Blood Smear

1. Place a _ of blood on one end of a glass slide

2. Using your dominant hand, place the edge of the other slide at an approximately _-_° angle on the first glass slide, in front of the blood drop. Using gentle pressure, gently pull the second slide back into the blood drop and allow the blood to spread to the edge of the slide

3. To spread the blood, rapidly but gently push the top slide forward through the remainder of the smear. It is important to keep gentle, equal pressure throughout the whole process, and do not lift the top slide before it reaches the edge of the bottom slide. A _ _ should be present

4. Label blood smear and allow to air dry

two (2)

thick smear, dime

thin smear, 45

BLOOD SMEAR PREPARATION

Malarial Smear

1. Place apart _ drops of blood on a glass slide

2. Make a _ _ using one drop of blood. Use the corner of a clean slide to spread the blood in a circular motion until it reaches the size of a _. Do not make the smear too thick or it will fall off the slide. (You should be able to read newsprint through it)

3. Make a _ _ using the other drop of blood. Use a spreader slide, held at a _° angle toward the drop of blood on the specimen slide. Wait until the blood spreads along the entire width of the spreader slide. While holding the spreader slide at same angle, push it forward rapidly and smoothly

4. Label the blood smears and allow to air dry

Therapeutic Drug Monitoring Tests

Last Dose

time of extraction

Notes

For _ _ _ _ e.g., Tacrolimus, Lithium Assay, Sirolimus, indicate Patient’s _ _ of said medicine and the _ of _

Microbiology

Notes

For all _ Tests, always indicate the time of extraction

blood cultures

Notes

For _ _ tests, indicate the time and site of extraction

Cellular Immunology

Official Doctor’s Request (ODR)

Notes

For _ _ tests, indicate the time of extraction, patient’s contact number and email (if any). Attach also the _ _ _ to the request slip

Nuclear Medicine or Research & Biotechnology

Notes

For _ _ or _ & _ test, indicate the time of extraction and attach the patient’s ODR then record the extraction in the assigned logbooks

hemolysis

clots

Notes

• If in doubt of any blood sample collected, opt to check:

  • For tests that require serum or plasma, centrifuge blood then observe for any _

  • For tests that require whole blood, use an applicator stick to see if there are any _