Module 2. Blood Collection [LECTURE - PART 1] CLINICAL CHEMISTRY

How do you ask for the px ID in Conscious in-px?

Ask them to state their complete name, age and birthday

NEVER identify the patient by mainly checking their what?

ID bracelet

Who should you ask first when the px is mentally incompetent?

Nurse

In out-px, the px ID is the same as the conscious px although in out-px you should ask for the px’s?

Valid ID

This is the most analyzed specimen in clinical chemistry

Serum

Venous whole blood is only used in clinical chemistry when testing for the px’s?

HbA1C (glycosylated hemoglobin)

HbA1C is a test to estimate your blood sugar within?

3 months

Which blood specimen is rarely used in clinical chemistry?

Plasma

What does plasma have that causes turbidity on serum/plasma

Protein (coagulation factors; fibrinogen)

In clinical chemistry, when do we only use plasma?

When serum is not available (short draw)

Which of the blood specimen is not collected by a medical technologist?

Arterial blood

TRUE OR FALSE. Medtech neither collects nor process arterial blood

FALSE

Which blood specimen do we use in clinical chemistry when testing for the measurements of **blood gases** and **blood pH determination**

Arterial blood

Average blood of a human body

4\.73 Liters/5 quartz

Average blood of an adult male

5-6 Liters

Average blood of an adult female

4-5 Liters

COMPOSITION OF WHOLE BLOOD. Plasma

55-60%/2.84 Liters/3 quartz

COMPOSITION OF WHOLE BLOOD. Blood Cells

40-45%/1.89 Liters/2 quartz

What type of blood is oxygenated blood with bright red color

Arterial Blood

RBC w/ Hg in which Hg has oxygen

Oxyhemoglobin

What are the sites for Arterial puncture?

Radial, Brachial, Femoral, Scalp, Umbilical

When doing radial arterial puncture, in what angle should the syringe be?

45 to 90 degrees

TRUE OR FALSE. In doing artery puncture, you are required to use a tourniquet

FALSE

In doing brachial arterial puncture, in what angle should the syringe be?

45 degrees

Where can we find our brachial artery?

Cubital fossa

What is the anticoagulant used in arterial puncture?

Heparin

TRUE OR FALSE. The green top tube is never used in arterial blood collection even though it contains heparin.

TRUE

In arterial blood collection, this additive is put in the syringe itself

Heparin

What test do you use in determining if the artery is suitable for arterial blood collection, especially when collecting in radial artery

Modified Allen Test

When the modified allen test is positive it means the hand turns into what color?

Red/pink

When the modified allen test is negative it means the hand turns into what color?

Pale

In modified allen test, when the hand turns red/pink ______ seconds it means that the radial artery is suitable for blood collection

within 15 seconds

Capillary puncture is also known as?

Skin/dermal puncture

Capillary is usually used in _____________ px

Pediatrics and geriatrics

Why is capillary blood rarely used in clinical chemistry

Clinical chemistry requires a lot of blood for analysis

Composition of capillary blood

Arterial blood, venous blood, intracellular fluids

Aside from quantity insufficiency, we also do not use capillary blood in clinical chemistry because of?

Concentration difference

In what blood specimen is higher in glucose?

Capillary blood

What analytes are lower in capillary blood than in venous blood?

Potassium, total protein, calcium ions

What are the sites for capillary puncture?

Heel, finger

Heel pricking for capillary puncture for infants, specifically, which part of the heel should be punctured?

Lateral plantar area

What finger is suitable for capillary puncture?

Ring and middle finger

Which hand should be punctured in capillary puncture?

Non-dominant hand

Any antiseptic can be used in capillary puncture, except?

Povidone iodine

TRUE OR FALSE. Povidone iodine can interfere with Clinical chemistry test results

TRUE

It is the most common blood collection

Venipuncture

Deoxygenated blood with dark red color

Venous blood

Hg in the RBC that has no oxygen attached to it

Deoxyhemoglobin

Antecubital fossa is also known as?

Elbow pit

What are the 3 sites for antecubital fossa?

Median cubital vein, Cephalic vein, Basilic vein

It is the most preferred site in antecubital fossa as this is the biggest and the most anchored.

Median cubital vein

Second most preferred site in antecubital fossa, it is farther from the body.

Cephalic vein

This is the least preferred in antecubital fossa as this is more painful due to the nerve endings near it.

Basilic vein

What is the most preferred site for obese px?

Cephalic vein

When antecubital fossa is not accessible, where are the other possible puncture site?

Other arm/hand veins

What are the sites to be avoided?

Arm w/ IV fluid, Hematoma, Burned/scarred area, Mastectomy area, Casts on arm, AV shunt/fistula

When one arm has an IV line injected and the other arm is not available for puncture what is the first thing that a medtech should do?

Ask the nurse to stop the IV line

How many minutes should you wait when the IV line has been stopped?

2 minutes

What is the condition when collecting blood in the arm that had an IV line?

Discard the 1st 5mL of blood collected

Why should you discard the 5mL of blood when collecting blood in the arm that had an IV line?

It is contaminated with IV fluid

What are the possible analytes that may INCREASE when the blood is contaminated with IV fluid?

Glucose, sodium, potassium, and fluoride

What is decreased when blood is contaminated with IV fluid?

Urea and creatinine

Evacuated Tube System is also known as the?

Closed Collection System

This is the most efficient way of collecting venous blood

Evacuated Tube System

The most frequently used method in venipuncture

Evacuated Tube System

Alternative method when drawing blood sample; used in thin veins

Syringe method

Syringe needle has ____ that serves as an indicator if the needle is outside or inside the vein

Hub

Some needle has some protective part called?

Hypodermic needle

Butterfly system is also known as the?

Winged Infusion Set

In the past, what was used as their IV injection that is no longer used now

Butterfly system

This is used for small and fragile veins, usually patients with pediatric/geriatric

Butterfly system

Luer fitting is partnered with?

Syringe barrel

Luer adapter is partnered with?

Tube holder of the ETS

Standard size of needle in ETS and Syringe

1\.0-1.5 inches

Standard size of needle in butterfly method

1/2-3/4 inches

Gauge is inversely proportional to the?

Bore

What is the standard size of gauge

21g

What is the size of the gauge used for children

23g

What is the size of the gauge used for butterfly needles

23-25g

What is the size of the gauge used for collection of blood through scalp or tiny veins (infants)

25g

What is the size of the gauge used for blood donation?

18g

Tourniquet application should be ______ inches above from the puncture site

3-4

Tourniquet should not be applied for ______ as it may cause ______

More than 1 minute; hemoconcentration

If you do not have any tourniquet, what can be the alternative?

Blood pressure cuff, gloves

When using blood pressure cuff as an alternative to tourniquet, what is the required mmHg?

60 mmHg

Antiglycolytic agent prevents what?

Glycolysis

This is used when there is an expected delay in measurement of glucose

Antiglycolytic agent

What are the two antiglycolytic agent?

Sodium fluoride and Lithium Iodoacetate

What is the optimal anticoagulant concentration of EDTA (lavender top)

1\.5-2.2 mg/mL of blood

What is the mechanism action of EDTA (lavender top)

Chelating calcium

This analyte is essential for blood coagulation

Calcium

EDTA (lavender top) is mostly used in?

Hematological studies

TRUE or FALSE. Aside from using EDTA for HBA1C testing in clinical chemistry, it can also be used to measure electrolytes.

FALSE

Inversion of EDTA (Lavender top)

8x

What is the Optimal Anticoagulant concentration of heparin (Light green/green top)

15-20 units/mL of blood

Mechanism of action of heparin?

Inhibits thrombin

This is a naturally occurring anticoagulant and it is present in our body

Heparin

Inversion of heparin (light green/green top)

8x

This is commonly used in clinical chemistry, especially in measuring electrolytes

Heparin

What is the additive in light blue top?

3\.2% Sodium Citrate