Phlebotomy Class 3 pt 2

What are small samples obtained by?

dermal/capillary puncture

capillary

microscopic blood vessel

What happens with excessive milking of finger during dermal puncture?

hemolysis, contamination of specimen

What should dermal punctures never be performed by and why?

surgical blade/hypodermic needle b/c too big and cause damage

• deep penetration can cause osteomyelitis (bone and bone marrow inflammation)

What is first drop of blood wiped with?

gauze, not alc

When do you perform fingerstick (3-4th finger)?

• cant find vein

• patient has burns, scars, non-intact skin

• severely obese

• physician only wants small amt of blood

• need to save vein integrity for other procedures

heel stick

dermal punctures on infants and toddlers up to 2 years old

• dont exceed 2.0 mm for infants, 0.85mm for preemies

• heel warmer should be placed on foot for 2-5 min

• do not perform punctures on previous punctures

• do not use back of heel or arch of foot

• always wipe away first drop of blood

What are newborns screened for in the hospital?

• cystic fibrosis

• hypothyroidism

• galactosemia

• bilirubin

• PKU

• sickle cell

• toxoplasmosis

• brotianides deficiency

• HIV

Bilirubin

test performed on babies via heel stick

• bilirubin overproduced, due to liver not breaking down and excreting red blood cells, so baby looks yellow

• use light therapy

What is order of draw for capillary?

E → EDTA tubes

H → Green

A → any other additive

S → red/gold/tiger/marble

What are errors before collection?

• patient misindentification

• improper time of collection

• wrong tube

• inadequate fasting

• exercise

• medication interference

• improper site prep

• poor coordination with other patients

What are errors during collections?

• extended tourniquet time

• hemolysis

• wrong order of the draw

• failure to invert tubes

• faulty technique

• inadequate quantity (QNS)

What are errors after collection?

• failure to separate serum from cells

• improper use of serum

• processing delay

• exposure to light

• improper storage conditions

• rimming clots

Be aware of possible difficult draws

page 90-91

What do you do if there is hematoma?

caused when bevel of the needle is not entirely in the vein and some blood leaks under the skin

• immediately stop, release the tourniquet, remove the tube, remove the needle, and apply firm pressure and an ice pack

What do you do if your patient has rolling veins?

anchor the vein and enter the vein quickly

What do you do if your patient has collapsing veins?

• release the tourniquet, remove the tube, remove the needle, and start a new puncture

• use a smaller gauge needle, smaller vacuum or pediatric sized tubes, or a syringe

What do you do if your patient has a seizure?

• support the patient, withdraw needle, and discard it

• call for help and ease the patient to the floor

• remove any objects that may injure the patient and be ready to support them

petechiae

tiny, non-raised, red dots that occur around restrictions due to backpressure in the circulatory system

• capillaries are leaking into the tissues near the skin’s surface

• happens if tourniquet is too tight, cord-like

thrombosis

blood clots, never draw from side with them

Needlestick Safety and Prevention Act (NSPA)

revises the bloodborne pathogens standard to include safer medical devices

• employer must establish a sharps injury log for percutaneous injury from contaminated sharps

  • type and brand of device involved in the incident

  • the department or work area where the exposure incident occurred

  • explanation of how the incident occurred

What are some environmental hazards?

biologic:

• infectious agents that cause bacterial, viral, fungal, or parasitic infections

sharps:

• needles, lancets, and broken glass can puncture, cut, and cause bloodborne pathogen exposure

chemical:

electrical:

fire/explosive:

physical:

allergic reaction:

bloodborne pathogens

biohazard, microorganisms like viruses and bacteria that are carried in the blood and can cause disease

Hepatitis B (HBV)

• virus that infects the liver, but can lead to more severe cirrhosis and liver cancer conditions

• no cure, but there is treatment

• primary concern for many employees

• exceptionally durable and can survive in dried blood for 7 days

What are symptoms of HBV?

• mild flu-like sympthoms

• some ppl are asymptomatic

• it can take 1-9 months before symptoms show

• 1-3 months, fatigue, possible stomach pain, loss of appetite, and nausea

• jaundice and darkened urine

What is the universal precaution from the CDC?

Whether or not you think the blood or bodily fluid is infected with bloodborne pathogens, treat it as if it is.

What is the standard precaution for blood?

Avoid all bodily fluids, secretions, and excretions (except sweat), regardless of whether or not they contain visible blood

What is the standard precaution for non-intact skin?

Mucous membranes are designed to reduce the risk of transmission of microorganisms from recognized and unrecognized sources of infections

What are the standard precautions?

• wear gloves when collecting and handling blood, bodily fluids, or tissue specimen. NEVER DOUBLE GLOVE

• wear face shields when there is danger of splashing onto mucous membranes

• dispose of all needles and sharp objects in puncture-resistant containers without recapping. ALWYAS activate the safety mechanism

• be aware that disinfectants are use to clean fluid spills

What should you do if you were exposed to blood or any other potentially infectious material?

1. wash or flush the exposed area with soap and running water

2. report the exposure to supervisor

3. refer to safety data sheet

4. fill out exposure report form

How do you decontaminate surfaces?

• a sodium hypochlorite solution (household bleach) with dilluted water

  • pour solution over blood and leave for at least 10 min

• lysol

How should bodily fluid spills be disinfected?

1:10 ratio solution

What additive is in Blood Culture Bottles?

Sodium polyanethol sulfonate

Who defined the order of draw?

CLSI

AAP states that heel punctures should not exceed __ for infants

2.0mm

(T/F) High Bilirubin is a result of the liver not breaking down and excreting red blood cells as it is supposed to do

True

The CLSI estimates __ of lab errors result from improper handling of a specimen before being analyzed

46% to 68%

On challenging draws what is something that can be done to aid in successfully collecting a sample?

asking where other phlebotomists have been successful before

(T/F) Hematoma is the most common complication of phlebotomy

True

The Occupational Safety and Health Administration is responsible for

Ensuring a safe and healthy work environment

The 7 environmental hazards include: sharps, physical, biologic, electrical, fire/explosive, allergic reaction, and __?

chemical

__ is the most commonly occurring nosocomial infection for lab employees

HBV

What precautions does the CDC recommend?

Universal

What requirement will the 1:10 cleaning solution need to meet to be used for medical asepsis?

EPA Registered Tuberculocidal