PART 1: Phlebotomy: Skin Puncture

SPECIMEN COLLECTION

SPECIMEN COLLECTION

______________ is the first step in most laboratory analysis.

Accuracy and precision

__________ can be measured by the proper specimen collection and handling

Test results

________ are therefore said to be as good as sample collection and handling.

collected, transported, and processed

This quality depends on how a specimen was _______________.

Blood

Main specimen is ______.

The Phlebotomist

• Frequently the only laboratory staff member that a patient sees
• Represents the professional image of the laboratory
• Expected to deliver unexcelled customer satisfaction

CHARACTERISTICS OF BLOOD

• It is in fluid form in vivo due to the naturally circulating anticoagulants, but in vitro it coagulates within 5-10 minutes.
• Red in color due to hemoglobin
• A ph average of 7.35-7.45
• Thick and viscous (3.5 – 4.5 times thicker than water)
• For adult males, they have approx. 5-6 liters of blood
• For adult females, have 4 to 5 liters of blood

fluid form in vivo

• It is in _________ due to the naturally circulating anticoagulants, but in vitro it coagulates within 5-10 minutes.

in vitro ; 5-10 minutes

• It is in fluid form in vivo due to the naturally circulating anticoagulants, but ________ it coagulates within ________.

5-6 liters of blood

• For adult males, they have approx. _______.

4 to 5 liters of blood

• For adult females, have _________.

What are the composition of blood?

• Liquid Portion

• Solid Portion

• Gaseous Portion

Liquid Portion

• Plasma

• Serum

Plasma

– liquid portion of the unclotted blood with the protein fibrinogen

Serum

– liquid portion of the clotted blood without the fibrinogen.

Plasma

- it is the liquid portion that has a anticoagulant

Serum

- it is the liquid portion that has no anticoagulant

Whole Blood

- if the sample is not placed inside the centrifuge and not spined yet we call the sample as _____.

Solid Portion

• Red blood cells

• White blood cells

• Platelets

Gaseous Portion

• Involves an exchange between oxygen and carbon dioxide

whole blood, serum, or plasma.

One of three different specimens may be used: _______, ______, _______.

2 hours

Whole blood specimen must be analyzed within limited time, ex. lavender tube

lyse

• Over time, cells will ______ in whole blood which will change the concentration of some analytes as potassium, phosphate and lactate dehydrogenase.

cellular metabolic processes

Some __________ will continue which will alter analytes concentration like glucose and lactate.

Serum

______ is the same as plasma except it doesn't contain clotting factors (as fibrin)

Plasma

________ contains all clotting factors.

clotting factors

Serum and plasma all have the same contents of electrolytes, enzymes proteins, hormones except ____.

Serum

_____ is mainly use in chemistry lab & serology

thrombin

Clotting factors + calcium → ________.

fibrin strands

Fibrinogen + thrombin → ______.

Clotting Factors

- it is important for our blood to solidify inside the body

Fibrinogen

- is a protein that will create fibrin strands

fibrin strands

- makes it possible for blood clot formation

PATIENT IDENTIFICATION PROCEDURES

1. Conscious In-patients
2. Sleeping patients
3. Unconscious patients/Mentally incompetent patients
4. Infants and Children
5. Outpatient patient

Conscious In-patients

– verbally ask their full names, verify it using the identification bracelet which includes first and last name, hospital number/unit number, room/bed and physician’s name.

Sleeping patients

– they must be awakened before blood collection. Identified same as conscious patients.

Unconscious patients/Mentally incompetent patients

– identified by asking the attending nurse or relative; ID bracelet

Infants and Children

– nurse, relative, or guardian may identify the patient or by ID bracelet

Outpatient patient

– verbally ask their full name, DOB and countercheck with driver’s license or id with photo. If the patient has id card or bracelet, same manner as with hospitalized patients.

Ambulatory patient

- Outpatient patient is also known as ________.

Pediatric patients

• Be gentle and treat them with compassion, empathy, and kindness.

• Attempt to interact with the pediatric patient, realizing that both the patient and the parent (if present) may have anxiety about the procedure and be unfamiliar with the new settings.

• Acknowledge the parent and the child. Be friendly, courteous, and responsive. Allow enough time for the procedure.

Adolescent Patients

• When obtaining a blood specimen from an adolescent, it is important to be relaxed and perceptive about any anxiety that he or she may have.

• General interaction techniques include allowing enough time for the procedure, establishing eye contact, and allowing the patient to maintain a sense of control.

Geriatric patients

• It is extremely important to treat geriatric patients with dignity and respect. Do not demean the patient. It is best to address the patient with a more formal title such as Mrs., Ms., or Mr. rather than by his or her first name.

• Senior patients may enjoy a short conversation. Keep a flexible agenda so that enough time is allowed for the patient.

• Speak slowly because elderly patients are frequently hearing impaired. Allow enough time for questions. The elderly have the right of informed consent. Too many times this fact is lost in dealing with any patient, but it seems more prevalent in dealing with aging patients.