Laboratory Safety and Methods of Blood Collection

treat all biological specimens, particularly the body fluids as potentially -

“infectious”

in the past, what was only considered infectious

only those contaminated with blood

today, what is considered potentially infectious?

all biological specimens

wear proper

PPE

girls must - their hair

tie

gloves must be

tight fitting

why should the gloves be tight fitting

it will be difficult to palpate the vein if gloves are too loose

what must be done before and after performing laboratory procedures

laboratory area must be disinfecred

dilution of sodium hypochlorite

1:10

ice cream container should have 1:10 dilution of -

sodium hypochlorite

what to do you do with apparatus contaminated with blood

submerged in the solution before it is cleaned in the sink

do you directly throw biological specimens in the sink

no, you disinfect it first

3 methods of blood collection

* skin puncture
* venipuncture
* arterial blood puncture

type of blood obtained in skin puncture

capillary blood

2 main types blood collection under venipuncture

* open (syringe)
* closed system

how do you match syringe to be used with that of the tube

if the tube indicates that it needs 3mL of blood, use a 3cc (3 mL) syringe

type of blood collection done by professionals as it is usually prone to complications

arterial blood puncture

arterial blood puncture is the last option when - blood is not doable

venous

last option of blood collection method when venous blood is not doable

arterial blood puncture

three variables in the laboratory

* pre-analytical
* analytical
* post- analytical

what type of laboratory variable is this given situation:

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using the wrong laboratory procedure

analytical

what type of laboratory variable is this given situation:

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typing 100 mg/dL instead of 100 mg/L

post-analytical

what type of laboratory variable is this given situation:

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when requesting blood glucose, 8 hrs (6-8 obsolete) of fasting is required and will affect the result

pre-analytical

what type of laboratory variable is this given situation:

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patient prep

pre-analytical

what type of laboratory variable is this given situation:

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in ammonia test, tourniquet is not needed in collecting blood as it may affect the result

pre-analytical

exposing bilirubin to sunlight

pre-analytical

how does posture affect pre-analytical variation in test results

increase in PIC

* protein
* iron
* cholesterol

how does diurnal rhythm affect pre-analytical variation in test results

1. increase in TIC

* TSH
* iron
* cortisol

in the morning (decrease in the afternoon)

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2. decrease in E

* eosinophil count

in the morning (increase in the afternoon)

how does exercise affect pre-analytical variation in test results

increase in WATCH MC

* WBC
* AST
* TP
* creatinine
* HDL
* myoglobin
* creatine kinase

how does stress affect pre-analytical variation in test results

temporary increase in WBC count in children

how does diet affect pre-analytical variation in test results

affect blood glucose and lipid content

how does smoking affect pre-analytical variation in test results

1. increase in

* WBC count
* hemoglobin levels (long-term smoking)

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2. decrease in

* pulmonary function (long-term smoking)

\[before blood specimen collection\]

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follow -

standard precaution

\[before blood specimen collection\]

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prepare the -

accession order

\[before blood specimen collection\]

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greet and - the patient

identify

\[before blood specimen collection\]

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let the patient VERBALLY state:

GANIA

* gender
* age
* name
* ID number
* address

true or false

\
when asking for the name of the patient, you state his or her name

false

how do you ask for the patient’s name verbally (in tagalog)

“ano po pangalan niyo” NOT “ano po pangalan ng pasyenye”

true or false

\
you also ask for the patient’s middle name

true- for an additional identifier

what do we look at in the case of inpatient

the patient tag

what do we look at in the case of an outpatient

none- we ask for the name

additional identifier you can ask from the patient

* middle name
* birthday

what are the two things you need to verify from the patient before collecting

* dietary restrictions
* latex sensitivity

true or false

\
you can let the patient hold your materials

false

what must be done before and after patient contact

proper handwashing

3 sites of skin puncture

* earlobe
* infant’s heel
* ring/great folder

equipment for fingersticks or heel sticks

* requisition form
* alcohol wipes
* gloves
* lancet


* gauze sponges
* microtainer collection tubes
* glucometer
* sharps container
* neonatal screen
* capillary tubes

When collecting from skin puncture for adults, we collect from the **-**

ring/great finger

when collecting from skin puncture for infants, we collect from the -

heel

in skin puncture, bihira magcollect sa -

earlobe

\[procedure for skin puncture\]

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wipe area with cotton wet with -

70% isopropyl alcohol

\[procedure for skin puncture\]

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true or false

\
you allow the site to dry before collecting blood

true (even for venipuncture)

\[procedure for skin puncture\]

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what kind of material do we use in cleansing the area to ensure that we put the right amount of alcohol on it for it is already pre-wet

alcohol swabs

\[procedure for skin puncture\]

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what do you use to let the site dry

* sterile cotton or if not available.
* sterile gauze

\[procedure for skin puncture\]

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our practice in the hospital to let the site dry

let it air dry

\[procedure for skin puncture\]

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puncture the preferred site using a -

sterile disposable lancet

\[procedure for skin puncture\]

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how deep is a sterile disposable lancet

2-3 mm in depth

\[procedure for skin puncture\]

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true or false

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it must be bloody when puncturing (the bloodier, the better) because more specimen will be collected

true

\[procedure for skin puncture\]

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true or false

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feather lancets are more bloody than the regular lancet because it has a triangular shape

true

\[procedure for skin puncture\]

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what do we immediately do after we puncture

immediately put the needle in the sharps container

\[procedure for skin puncture\]

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why do we wipe off the first drop of blood and collect the subsequent drops

because it contains contaminants, like tissue fluids that may affect the tests

\[procedure for skin puncture\]

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why should we avoid squeezing the site of puncture

as this will lead to the alteration of the composition of the blood

\[procedure for skin puncture\]

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why do we not need to worry of pricking the patient too hard or too deep

because the lancets have a stopper. the prick or cut would not exceed the stopper

\[skin puncture\]

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what is the purpose of the uneven part of the mouth of the microtainer

for scooping or pansandok of the blood

\[skin puncture\]

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recommended brand for evacuated tubes and microtainers and what is the problem with other brans

BD- for other brands, there are instances where the vacuum does not work or the amount of blood that the tube collects is too much or not enough

microtainers

k2 edta color

microtainers

lavender

microtainers

microtainerslithium heparin color

green

microtainers

lithium heparin and gel for plasma separation color

microtainers

mint green

microtainers

NaFl/Na2 edta color

grey

clot activator and gel for serum separation color

gold

k2 edta number of inversion

10

lithium heparin number of inversions

10

lithium heparin and gel for plasma separation number of inversions

10

NaFl/Na2 edta number of inversions

10

clot activator and gel for serum separation number of inversons

5

no additive number of inversions

0

additive for whole blood hematology/determination, tube inversions, prevent clot

k2 edta

additive for plasma determinations in chemistry, tube inversions, prevent clotting

* lithium heparin
* lithium heparin and gel for plasma separation

additive for glucose determinations (tube inversions ensure proper mixing of additive and blood)

Na/FI/Na2 edta

additive for serum determinations in chemistry

clot activator and gel for serum separation

additive for serum determinations in chemistry, serology, and blood bank (no additive)

red

sites for venipuncture

MCB

* median cubital
* cephalic
* basilic

\[syringe method procedure\]

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number of inches in one’s arms in applying tourniquet and what manner

3-4 inches (half-knot manner)

the veins should be selected in terms of -

availability

first choice because it is the least painful and the most stable. Basilic vein is the last choice because it is the most painful and least stable

median cubital vein

technique to easily locate the vein

by tightly applying the tourniquet

in syringe method, what is used to clean the puncture site

70% alcohol

in syringe method, what needle is used? include measurements

* 20-21 gauge needle attached to a syringe at

angle and depth of needle in syringe method

* 15 degree
* 0.5-1 cm

old and new motion for cleansing in syringe method

* old: circular motion from inner to outer area
* curent: up and down motion

in syringe method, tourniquet should not exceed -

1 minute

gauge of needle that have bigger holes and tend to obtain more blood

gauge 21

after obtaining blood, how do you stop it from bleeding in syringe method?

by applying pressure and not flexing the arm

in syringe method, what do you do if bleeding is not arrested

elevate the arm and apply more pressure

in syringe method, why should you not inject the blood into the tube but rather detach the needle and transfer the blood into the tube (whose cap are opened)?

* injecting it into the tube is prone to hemolysis
* the needle may pass through the tube since some tubes are made of platic

after doing the syringe method, where do you throw the barrel and other materials contaminated with blood?

yellow bag

after doing the syringe method, where do you throw sharp objects like the needle?

syringe method

after doing the syringe method, where do throw other wastes like the injection wrapper

black bag

in syringe method, what information do you include in labelling the specimen?

* name
* age
* sex
* birthday
* date
* time
* collector’s inital

in evacuated tube method, what type of needle is used in collecting blood?

two way needle