MLSP2 3.2 INTRO TO PHLEBOTOMY

Whole Blood

has Plasma and formed elements (unclotted)

Serum

• Liquid portion of clotted blood • Without anticoagulant • Contains albumin and globulin

Plasma

• Liquid portion of unclotted blood • With anticoagulant • Contains albumin, globulin and fibrinogen

Phlebotomy

• Is the process of collecting blood through the vein by using incision or puncture methods to draw blood for analysis or as part of therapeutic or diagnostic measures under the physician’s request.

Phlebotomist

people who are trained to draw blood from a person or animal for tests, transfusions, donation or research

• For diagnosis and treatment using blood samples • For transfusion, to remove blood from the donor • For removal of blood for polycythemia or therapeutic purposes

Main Goals of Phlebotomy

• To collect blood samples for laboratory testing or for transfusion. • Properly label collected blood samples with the necessary data to identify the patient. • Responsible in delivering or transporting collected samples within appropriate prescribed time limits.

Role of Phlebotomists

• Venipuncture • Capillary puncture • Arterial puncture

Methods of Blood Collection

Diet

- The tests most affected are glucose and triglycerides.

True

Serum or plasma collected from patients shortly after a meal may appear cloudy or turbid (lipemic) due to the presence of fatty compounds such as meat, cheese, butter, and cream.

True

Alcohol consumption → transient elevation in glucose

True

chronic consumption → liver function tests and triglycerides

True

Caffeine → hormone levels

Posture

Can cause variations in some blood constituents, such as cellular elements, plasma proteins, compounds bound to plasma proteins, and high molecular weight substances.

Exercise

- Increased activity of muscle enzymes - Elevated concentration of sex hormones - Elevated concentration of steroids

Stress

- nervous patient before sample collection may increase levels of adrenal hormones, increase WBC counts, decrease serum iron, and markedly affect arterial blood gas (ABG) results.

Smoking

- Acute effects : increase in glucose, BUN, cholesterol and triglycerides - Chronic effects: Increase in blood hemoglobin values (carboxyhemoglobin) Decrease in IgG, IgA, and IgM → weak immune system

Altitude

RBC counts and hemoglobin (Hgb) and hematocrit (Hct) levels are increased in high-altitude areas such as the mountains where there are reduced oxygen levels.

Age and Gender

- Laboratory results vary between infancy, childhood, adulthood, and the elderly → gradual change in the composition of body fluids. - Hormone levels vary with age and gender - RBC, Hgb, and Hct values → higher in male patients

Pregnancy

- caused by the physiological changes in the body including increases in plasma volume.

Antecubital fossa

The preferred site for venipuncture and is located anterior and below the bend of the elbow

Median Cubital Vein

vein of choice because it is large and does not tend to move when the needle is inserted. It is the easiest to access and least painful for the patient

Cephalic Vein

is the second choice for venipuncture. It is harder to palpate but is usually better when drawing blood from an obese patient.

Basilic Vein

last vein of choice for venipuncture as it is not well anchored and punctures on this vein are more painful. It has a tendency to “roll” and hematoma formation is more likely to occur

Quite often the veins cannot be seen but usually felt by touching or palpating with the index finger of the non dominant hand

They will reveal themselves as elastic tubes beneath the surface of the skin.

H-shaped vein pattern

- includes the cephalic, median cubital, and basilic veins in a pattern that looks like a slanted H.

M-shaped vein pattern

Includes the cephalic, median cephalic, median basilic, and basilic veins

Dorsal Hand Veins

are also acceptable for venipuncture

Foot Veins

are a last resort because of the higher probability of complications.

• Damaged Vein • Hematoma • Edema • Burns, Scars and Tattoos • Mastectomy • IV Line • Heparin and Saline Locks • Cannulas and Fistulas

Areas to be Avoided

Immediate Local Complications

Localized hemoconcentration or Venous stasis Remedy: One minute application of tourniquet

Syncope

Remedy: Let the patient lie down

Failure to obtain blood

Needle Position

Bevel Against the Wall of the Vein

Needle Too Deep/ Too Shallow

Collapsed Vein

Needle Beside the Vein

Faulty Evacuated Tube

Delayed Local Complications

Formation of blood clots inside the lumen of the vein due to trauma

Thrombophlebitis

Inflammation of the vein due to thrombus as manifested by an inflammatory reaction on the outer skin surface

Hematoma

Blue or black skin discoloration commonly due to repeated trauma or puncture of the veins

General Delayed Complications

Serum Hepatitis, AIDS Prevention:

• Use of disposable syringe or vacutainer set

• Follow the procedures from the Universal Precautions in handling infectious specimens

Collection Attempts

When blood is not obtained from the initial venipuncture, the phlebotomist should select another site. Repeat the procedure using a new needle

Nerve Injury

Temporary or permanent nerve damage can be caused by incorrect vein selection or improper venipuncture technique and may result in loss of movement to the arm or hand and the possibility of a lawsuit.

Iatrogenic Anemia

pertains to a condition of blood loss caused by treatment. An anemia can occur when large amounts of blood are removed for testing at one time or over a period of time.

Hemolyzed Samples

Rupture of the red blood cell membrane releases cellular contents into the serum or plasma and produces interference with many test results

Routine Samples

are usually collected early in the morning but can be collected throughout the day during scheduled “sweeps” (collection times) on the floors or from outpatients.

ASAP Samples

-means “as soon as possible.” The response time for the collection of this test sample is determined by each hospital or clinic and may vary by laboratory tests

Stat Samples

sample is to be collected, analyzed, and results reported immediately

Fasting Sample

npo (nothing per orem); “nothing by mouth” - FBS - Lipid Profile

Timed Samples

- Glucose Tolerance Tests

- 2-Hour Oral Glucose Tolerance Test

- Lactose Tolerance Test

Dry Chemical

ABC fire hydrant contains?

Class D

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