Unit+5-Lecture+1-Intro+to+Phleb-Safety

Hematology I - Unit 5 - Lecture 1

Phlebotomy/Lab Safety

Blood Borne Diseases

  • HBV: Hepatitis B Virus

  • HCV: Hepatitis C Virus

  • HIV/HTLV: Human Immunodeficiency Virus/Human T-Lymphocyte Virus

  • Syphilis: Caused by Treponema pallidum

  • Malaria: Most common transfusion-related infectious disease in many nations.

Biological Safety in the Laboratory

  • Laboratory workers face physical, chemical, and biological hazards.

  • It is crucial to follow accepted safety rules to ensure a safe workplace.

Hazards in the Laboratory

Physical Hazards

  • Includes electrical hazards, fire risks, and hazards from loose hair or clothing.

Chemical Hazards

  • Proper storage and handling of chemicals are essential.

Biological Hazards

  • Disinfect working areas before and after use.

  • No eating, drinking, smoking, or dipping in the laboratory.

  • Immediately clean spills, using a 10% bleach solution for biological specimens before cleaning.

Disposal of Blood Contaminated Waste

  • Sharps: Place in sharps containers only.

  • Broken Glassware: Place in sharps containers.

  • Contaminated Soft Trash: Use orange or red biohazard autoclave bags.

Techniques for Obtaining Blood Samples

Capillary Puncture

  1. Fingerstick for adults.

  2. Big toe stick for children.

  3. Heel stick for infants.

Venous Collection

  • Common sites include the median cephalic or median cubital vein and hand veins.

Arterial Blood Collection

  1. Radial artery at the wrist.

  2. Brachial artery inside the elbow.

  3. Femoral artery in the groin.

Basic Procedure Steps

  • Patient Identification: Confirm identity before proceeding.

  • Assess Patient's Disposition: Check their state and needs.

  • Check Requisition Form: Ensure all is in order before sample collection.

  • Prepare Puncture Site: Clean and ready the area.

  • Prepare Equipment: Gather all necessary tools.

  • Perform Venipuncture: Execute the procedure with care.

  • Collect Sample in Proper Container: Use the correct tubes.

  • Assess Complications: Watch for any issues.

  • Assess Need for Resample: Decide if a new sample is needed.

  • Label Collection Tubes: Do this immediately post-collection.

  • Send Specimens to Lab: Ensure timely dispatch with requisition form.

Patient Identification Process

  1. Ask client to state their name.

  2. Verify armband against requisition slip.

  3. If needed, have a nurse identify the patient with proper documentation.

Client Identification Protocol

  • Verify the “magic” number on armband matches lab orders.

  • Ask for the birthdate for additional confirmation.

  • Always label tubes post-collection immediately.

Blood Collection Equipment

Basic Phlebotomy Supplies

  • Requisition forms

  • Gloves

  • Tourniquet

  • Needles

  • Vacutainer system

  • Syringe and barrel

  • Tubes

  • Alcohol wipes

  • Cotton or gauze

  • Bandages or tape

Vacutainer Method Supplies

  • Choose the correct Vacutainer needle, hub, and tube(s).

  • Efficient method for blood collection.

Vacutainer Method Supplies

  • Disposable Hub: Ensures safety during use.

  • Safety Needle: Features a retractable sheath for safety.

  • Bevel End: Important for successful puncture.

Syringe Method Supplies

  • Use a syringe with a compatible safety needle.

  • A transfer device for handling specimens may be necessary.

Safety Needle Sizes

  • Gauge indicates needle diameter (lower number = larger diameter).

  • 16-18 gauge: For drawing ≤ 450 mL donor blood.

  • 21-22 gauge: Common for laboratory specimens.

  • 23 gauge: For blood collection in small veins (children or adults).

  • Needle length typically 1-1.5 inches.

Obtaining Blood by Venipuncture

Preparation Steps

  • Confirm patient identity and explain procedure.

  • Ensure the patient is seated or lying down.

Application of Tourniquet

  • Use to make veins prominent for easier collection.

  • Check for latex allergies before using a latex tourniquet.

Selecting Puncture Site

  • Inspect both arms for the best vein, typically the median cephalic vein.

  • Do not leave the tourniquet on for more than 2 minutes.

Superficial Veins of Anterior Surface of the Arm

  • Identify main veins:

    • Cephalic Vein

    • Median Cubital Vein

    • Basilic Vein

Preparation of the Puncture Site

  • Clean using 70% isopropyl alcohol before the procedure.

  • Do not touch the site once cleansed. Allow alcohol to dry.

Performing the Puncture

  • Hold needle at a 15-30° angle with bevel up.

  • Ensure a smooth entry to minimize discomfort.

Post-Puncture Care

  • Once blood is collected, release the tourniquet.

  • Apply pressure with gauze, cover site, and ensure bleeding has stopped.

  • Dispose of waste and label specimens correctly.

Complications in Phlebotomy

  • Address issues like hematoma formation immediately.

Patient Care and Comfort

  • Engage and reassure patients, especially when anxiety arises.

  • Ensure the environment is comfortable; monitor for any physical reactions, such as fainting.

Specimen Considerations

  • Preanalytical errors can lead to delays in patient care.

Specimen Rejection Criteria

  • Wrong tubes or improper fill levels.

  • Clotted anticoagulant specimens.

  • Hemolyzed specimens.

  • Not collected at the proper time.