4 -

Patient Preparation, Specimen Collection, and Processing

Patient Identification

• Verbal identification involves asking the patient to state their full name.
• For infants, unconscious, or mentally incompetent patients, ask the relative or nurse for the patient's name.
• For sleeping patients, awaken them for identification
• Physical Identification confirms identity using patient bracelet/band or ID card
• Labeled Specimen Checking ensures labeling is accurate on the specimen and matches patient information.

Materials For Blood Collection

• Antiseptics are the solution used to clean the area before blood extraction
• Commonly used antiseptic is 70% isopropyl alcohol.
• Chlorhexidine gluconate (ChloraPrep) may be necessary if patient is sensitive to alcohol
• Cotton/Gauze cleans the puncture site before venipuncture using back-and-forth friction
• Tourniquet is a tool used to constrict/block blood flow by applying pressure to the arm of the patient.
• Needles aid as a puncture site for blood extraction
• Standard needles are 21 gauge, others include hypodermic and butterfly
• Butterfly needle are used on children
• Syringe serves as a vessel for aspirated sample
• Has clear barrel with visible markings
• Always disposable
• Blood Collection Tubes are made of glass or plastic.
• Plastic is preferred for safety
• Vacuum feature is negative pressure within the tube for proper collection of fluids
• Additives can be clot activator or anticoagulant
• Expiration Dates are printed on the exterior label of the tube

Securing The Puncture Site

• Tape or Band-aid seals the puncture site to promote healing with at least 1 to 2 minutes of applied pressure to the extracted area
• Hypoallergenic and latex free
• Micropore is most used
• Disposal Container closes with a puncture resistant tight fitting lid
• Must be properly labeled
• Gloves must be worn to protect against blood borne pathogens
• Wear non-sterile latex gloves wear the appropriate and right sized gloves not too loose or too tight

Types of Veins

• Cubital Fossa Vein Selection requires palpation
• The non-dominate are should be used first
• Type 2 veins are prefered

Arterial Puncture

• Arterial blood is extracted
• Oxygenated blood is extracted with bright red color
• No need to apply pressure during extraction
• Tourniquets are not to be used
• 23-25 gauge needle and heparin syringes are used
• Blood gas analyyis can be achieved
• The ideal location is the radial artery
• Avoid arm with IV or burns
• Blood with IV must be declared on the label
• Dont practice on yourself
• The Allen test is used to locate radial artery.

No Blood Flow Considerations

• Exessive pull of plunger will cause the blood extraction to be innefective.
• Incorrect needle position
• Bevel down should face up

Hematoma

• Occurs if needle penetrates the other side of the vien or puncture site.
• Possibly from too small of vein
• Pressures is not properly applied

Types of Blood Samples

• Whole blood: combination of 3
• Plasma Types- component of whole blood, when centrifuged, contains the yellow part and containes fibrinogen
• Blood is collected in tubes with aticoagulants
• Serum is where after collecting blood its left to stand a "clot" in tubes without anticoagulants
• Liquid protion is the serum, Does not contain firinogen
• "Cleaner sample" from plateletes

Clot Activator Particles

• Fibrinogen is a main protein with clot forming properties, activated by intristic or extrinstic properties

Intristic pathways

• Intristic pathways occurs when blood comes into contact with the coated side of the collection tube which activated coagulation cascasde
• Thrombin

Hemloysis Interferring Properties

• Are where desturction of red blood cells turns serum pink
• Occurs when using too smaal or shaking too much
• Affects glucose and alcohol

Hemolysis causes:

• Using a needle that is too small
• Pulling the plunger too fast
• Expelling blood vigorously into a tube
• Shaking or mixing tubes vigorously
• Extracting blood from a site before alcohol has dried
• Alcohol causes hemolysis and may glucose testing
• Certain blood conditions like hemolytic anemia

Icterus

• Is brought on by increase amounts of billirubin
• Affects results by interering with absorabance of lights
• Is brought about by billirubin.

Lympia

• Where fat is concetrated and can block lab machines
• High fat dies can caused this

Green Serum

• Results from high dose or bacterial infection
• Not very common

Colors Summary:

• Normal:Light, straw color like
• Hemolyzed:Red
• • Happens due to small needle usage or vigorous shaking of needle
• Icteric:Orange
• • brought about by increased amounts billirubin
• Lipemic: Milky
• • Results from high lipid centrations
• Green: Drug, contrast dye, or bacterial infection or even- increased cerloplasmin levels

Blood Collection Tubes

• Clotting accelerates with silica
• Anticoagulants prevent coagulation
• Plain colored tubes are those that are red
• Serums SST
• Sodium Citrate is a light blue color

The Evacuatation Process:

• Evacuated and Syringe draws must avoid contaimnation
• Blood cultures are always first
• Plain/serum seconed with exception of citrate which is 2nd
• Anticaogulant tubes are drawn last

Tube Inversion

• Must be inverted to homogenous
• Must be full inverted without airbubble

Specimen Handling and Transport

• Transport must be done in safe and convenient manner

Specimen that Need Cold Transport

• Ammonia
• Blood gases
• Catecholamines
• Gastrin
• Lactic Acid
• Renin
• Pyruvate

####Light Protected Samples

• Bilirubin
• Beta-carotene
• Folate
• Porphyrins
• Vitamin A
• Vitamin B6

Reasons of lab processing:

• Prevent hemolysis and shifts
• Unstable serum will degrade

Patient-related factors on lab ranges

• Factors include age, sex race and should be considered when test are analyized

Diets relation to levels

• Consider fasting/non-fasting state, diet type (high-fat, low-fat, vegetarian), and time since last meal. Lipemia may occur after a meal rich in fat.
• Lipemic samples have limited use in the laboratory.
• Prolonged fasting decreases amino acids, bilirubin, fatty acids, glucagon, growth hormone, ketones, lactate, triglycerides and increases glucose, HDL cholesterol, insulin, lactate dehydrogenase, triiodothyronine (T3)
• The most commone pre-collection variable is Food, but also the time passing and compositions of the food

Uncotrollable Affects

• Age
• Sex
• Race
• Biological

Controllable

• Lifestyle
• Smoking
• Drugs
• Diet

Allen Test

• The allen test radial artery
• Aclench hand that is heald back without collor is sign of test failier
• The open hand is tested to see the return of blood collor signall that the test and procedure can start