MA 120 Midterm

whole blood composition

plasma - 55%

buffy coat (leukocytes & platelets) - <1%

erythrocytes - 45%

hemostasis

the stopping of bleeding

hemolysis

the bursting or breaking of blood cells

hematoma

bruise

hemoconcentration

causes a build up of blood components

plasma

This is the liquid portion of blood which contains all clotting factors, as it would in the body. 

serum

This is the liquid portion of blood which NO LONGER contains clotting factors, as it has been allowed to clot, and the clotting proteins are contained in the clot of RBCs, platelets and other formed elements below. 

whole blood

kept close to how it  naturally flows in our systems, is also used often.  This is all blood components together-- plasma, with clotting proteins floating freely, along with RBCs, WBCs, platelets, other formed elements.

additive types

clot activators

anticoagulants

no additive

clot activators

enable blood to clot, yields serum

anticoagulants

prevents blood from clotting, yields plasma or whole blood, depending on additive type

no additive

empty. contains no additive, blood will enter tube and clot naturally without properties altered. will yield serum.

order of draw

blood culture

light blue

red/gold/tiger

green

lavender

gray

culture

additive: growth medium

function: growth medium

yields: bacteria growth

tests: blood culture

light blue

additive: sodium citrate

function: anticoagulant

yields: plasma

tests: bleeding time

red

additive: none or silica

function: clot activator

yields: serum

tests: chemistry - CMP, lipids

gold/tiger

additive: silica & SST

function: clot activator

yields: serum

tests: chemistry - CMP, lipids

green

additive: heparin

function: anticoagulant

yields: plasma

tests: chemistry - STAT, electrolytes

lavender

additive: EDTA

function: anticoagulant

yields: whole blood

tests: hematology - CBC, HbA1c

gray

additive: sodium fluoride

function: anticoagulant

yields: plasma

tests: chemistry/glucose

OSHA

Occupational Health &Safety Administration

OPIM

Other potentially infectious materials

semen

vaginal secretions

cerebrospinal fluid

synovial fluid

pleural fluid

pericardial fluid

peritoneal fluid

amniotic fluid

bloodborne pathogens

viruses, bacteria or other microorganisms in human blood that can cause disease in humans, including Hepatitis B (HBV) and C (HCV) and the human immunodeficiency virus, or HIV

HBV

vertically or horizontally transmitted

30% chance of infection from needlestick

HCV

vertically or horizontally transmitted

3-5% chance of infection from needlestick

HIV

vertically or horizontally transmitted

0.3% chance of infection form needlestick

vertical transmission

from mother to baby

horizontal transmission

from person to person

universal precautions

the idea that we must treat all patients and body sample specimens as if they are potentially infectious

standard precautions

documented safety practices and equipment put in place by employers to comply with OSHA laws

include work practice controls and engineering controls

work practice controls

actions:

sanitize your hands between patients

activate needle guard and place in the sharps container

wear gloves when performing venipuncture

engineering controls

physical items:

hand sanitizer

antimicrobial soap

needle safety guard

biohazard sharps container

gloves

PPE

personal protective equipment

equipment or articles of clothing with intent to protect the wearer from potential exposure to a pathogen or chemical

gloves

face masks

face shields

lab coat

exposure control plan (ECP)

clean the affected area with soap and warm water for at least 30 seconds

notify instructor or supervisor

medical evaluation

document it

how often should OSHA bloodborne pathogen training be completed

annually

BBP

bloodborne pathogens

CDC

centers for disease control and prevention

phlebotomy

performing a surgical incision into the vein

3 overarching considerations of venipuncture

safety- includes the safety of everyone involved

patient experience- doing everything possible to create a comfortable and supportive experience for the patient

specimen viability- blood samples must be collected, handled and processed correctly in order to ensure they are able to be used for laboratory testing

before the procedure

clinical provider orders a diagnostic lab test

medical system creates the lab order or requisition by putting it in the EMR system

test is then looked up to make sure collection goes smoothly

in the venipuncture tray

multi-sample straight needle

tube holder

tourniquet

70% isopropyl alcohol wipes

cotton or gauze

tape

blood collection tube (vacutainer)

required PPE

clean, nonsterile, non-latex gloves\

face mask

face shield

long-sleeved lab coat

how are needles measured?

length and gauge

length of a needle

measured from hub to tip

gauge of needle

diameter of lumen (open space inside needle)

physical parts of the needle

tip

bevel (slanted opening)

shaft

hub

safety guard

3 essential steps at first contact with patient

1. identify yourself

2. confirm the patient (2 pieces of identification)

3. cleanse - the area and your hands

tying a tourniquet

3-4 inches above antecubital space

tied without rolling

not too tight

tucked portion should be small for easy removal later

not left on for longer than 60 seconds - lead to hemoconcentration

order of draw preference

1. median cubital vein

2. cephalic vein (lateral side)

3. basilic vein (medial side)

venipuncture sites not to choose

inflammation, bruising, wounds, recent phlebotomy site, burns, rashes, any damage

covered by tattoo (unless no other choice, ask first)

vein on side that has been affected by lymph node removal, mastectomy

patient doesn’t want you to

palpating veins

the act of using your fingers to feel, move, and sense structures in the body

finding veins suitable for drawing blood

how to palpate veins

use tops of the finger pads

start by moving tips along areas of the skin where anatomically, the veins should be

push down, slowly pull up

push and pull around

how veins feel

elastic

strong, but not rigid

can be pushed out of position, but will resist and regain position once pressure is removed

no pulse

the 3 D’s

depth

diameter

direction

final preparation

release the tourniquet

cleanse the site

stage equipment

don gloves

confirm alcohol is dry

Prior to Needle Insertion

retie the tourniquet

uncap the needle and inspect

anchor the vein: holds vein in place to prevent rolling out of the way and tautens the skin at the insertion point, which helps the needle glide in smoothly and helps reduce pain for the patient

gentle weight foundation

needle angle: 15-30 degree angle to the skin surface

drawing blood

insertion

establish blood flow

remove the needle

insertion

proceeds confidently without hesitation

is quick and controlled

enters into taut skin

smoothly moves forward

maintains the same speed of forward motion until it suddenly stops at the anticipated center of the vein

establish blood flow

use free hand to pick up the first vacutainer in the order of draw and push it onto the needle inside the tube holder

May only adjust the needle in and out, no side to side, no angle changes, no fishing around

after first tube is full, remove carefully and perform 2-3 light inversions

place second tube and whenever the last tube begins filling with blood release the tourniquet

pick up cotton and hover over the site

removing the needle

swiftly remove the needle at the same angle it was inserted, apply the needle safety guard on a hard surface

when the needle is clear of the arm, immediately apply pressure using the gauze, pressure should be held for 2 minutes to help avoid bruising (hematoma)

ask the patient to hold pressure on the site for you

After the draw

processing specimens immediately after the draw

finishing up with the patient

finishing up

completion of specimen processing before testing

processing specimens immediately after the draw

inversions: holding all tubes, perform at least 6-8 inversions. Most tubes require 8-10

labeling tubes: all tubes will be labeled with patient’s full name, patient’s date of birth, date and time of blood collection, name and credentials of the phlebotomist

tubes should be labeled in front of the patient to ensure they know their blood is being processed correctly

finishing up with the patient

addressing the venipuncture site: remove cotton, inspect site, ensure stoppage of bleeding or hemostasis

re-dress the site: once site has stopped bleeding, throw away the old cotton, apply new cotton, apply taped dressing if no allergy

finishing up after the draw

disinfect the area:

• Dispose of all garbage or medical waste into the appropriate receptacle.

• The needle assembly is deposited as one unit into the Sharps Container.  DO NOT DISASSEMBLE.

• Any vacutainers not used for testing, or wasted, also go into the Sharps Container.

• Any dressings with blood can go into a biohazard waste bag.

• Any plastic garbage goes into the normal waste bin.

• Wipe down the entire area, any areas touched by the patient, equipment or yourself, with a disinfectant wipe.

• Leave the lab, exam room or draw space clean and ready for the next patient.

completion of specimen processing before testing

The blood samples may need further processing...

• Some may need immediate refrigeration

• Some need to sit at room temperature for at least 30 minutes

• Some need to be frozen

• Some need processing immediately

• Some may be used for Point-Of-Care testing

• Some need to be centrifuged, if you can believe that!

the procedure must be documented in the patient’s medical record, includes adding a CPT code to bill for the blood draw