Phlebotomy Procedures in Adults PDF

NB 3172 GENERAL PHLEBOTOMY PROCEDURES IN ADULTS Dr Noor Hazfalinda Hamzah Introduction Phlebotomy means to cut into a vein The primary role of a phlebotomist is to obtain blood specimens for testing Requirement to be caring and kind willing to be hands-on with patients to be...

NB 3172 GENERAL PHLEBOTOMY PROCEDURES IN ADULTS Dr Noor Hazfalinda Hamzah Introduction Phlebotomy means to cut into a vein The primary role of a phlebotomist is to obtain blood specimens for testing Requirement to be caring and kind willing to be hands-on with patients to be able to put patients at ease - they might feel anxious about giving blood able to follow instructions and procedures able to work in a team but use your own initiative able to explain procedures to patients, careful and methodical  good communication skills including listening skills good organisational and observational skills Treat others the way you would want to be treated  don’t harm the patient don’t disturb any nursing care that the patient is receiving take the blood correctly so it can be used for testing label the samples carefully store the blood correctly deliver the samples promptly to the lab Roles and Responsibilities of the Phlebotomist Identification Proper Identification Is a- Three-Step Process ↳ Ask compara Validate Safety and Infection Control Contact transmission of infectious agents can be caused by either direct or indirect contact Direct Contact - Requires transfer of pathogens from reservoir to a susceptible host (person to person) Indirect Contact - Contaminated item is handled prior to contact with a susceptible host (person to contaminated item to person) Prevention of Nosocomial Infections disease Originate from hospital How to prevent infection Combines the good hand hygiene and the use of gloves when workers are exposed to contaminated products Handwashing 15 seconds - soap friction + + Primary means of preventing spread of infection (especially nosocomial) Minimum 15 seconds, soap, friction cot Wash hands before and after each blood draw Alcohol-based hand rub mask PPEXS exposure to blood borne pathogens such as hepatitis and HIV - provide the necessary Personal Protective Equipment to prevent exposure – lab coat, gloves, mask Needle stick Injury: Safety and Prevention Mandated the use of safety devices on needles for the prevention of exposure to blood borne pathogens All devices for phlebotomy should be equipped with needlestick prevention features Never recap/ bend/ break needles X + ecap X bene X break Summary 1. Phlebotomists are responsible for collecting, processing, and transporting blood specimens 2. Professionalism involves a positive attitude and appearance, proper communication to the patient, and providing quality customer service 3. Phlebotomists are employed at hospitals, rehabilitation centers, nursing homes, clinics, physician’s offices, ambulatory care centers, blood banks, and reference labs 4. Infection control and safety practices include hand hygiene and Standard and Isolation Precautions Blood Function 1. Supplies nutrients to tissues: O2, hormones, glucose 2. Removes end-products of metabolism: CO2, urea, creatinine 3. Provides defense mechanism: WBC, antibodies 4. Prevents blood loss: platelets, coagulation proteins Blood Composition Formed elements (~45%) RBC WBC Platelets Plasma (~55%) – Water (~92%) – Protein (~7%) – Antibodies – Salts – Enzymes  55%5 - plasma 3 - lenkocyte platelet 45% - erythrayle Whole Blood  When a blood sample is left standing without anticoagulant, it forms a coagulum or blood clot. The clot contains coagulation proteins, platelets, and entrapped red and white blood cells. L coagulation platelet protein KWBC entrapped RBL  Order Of Draw Chart but the ⑳ Invert 3 44 - & blue- & red & ~ line yellow ⑨ Invert 5 64 ⑨ purple 8 Crossmatchina Lactate Ethanol gorg -@ Blood Glucose Blue top tube Invert 3-4 times Anticoagulant = sodium citrate Fill light blue top tubes as far as vacuum will allow - FULL the tube Mix by gentle inversion Ideally, transport to the processing site or facility should occur within one hour of collection Coagulation studies: PT, APTT, INR -Contain Sodium citrate (Anticoagulant)  for blood clot formation ~ Sodium citrate takes out calcium from patient’s blood, which is => required for clot formation If sample is not mixed well, anticoagulant cannot remove calcium and sample will clot "Fishing" Digging around for vein can cause factors to activate – not enough sodium citrate to overcome that and sample will clot Hemolysis – falsely shortened clotting times Underfilled – falsely prolonged clotting times (Underfilled tubes, less than 90% full, may affect testing accuracy because of over-citration)  Invert 8-10 times Purple top tube Anticoagulant = EDTA (ethylene diamine tetra acetic) ~ ethylene Tetra di a mi n e Hematology studies: FBC, FBP FBC FBP , Grey-top tube Invert 8-10 times Anticoagulant = potassium oxalate Antiglycolytic agent = sodium fluoride Maintains plasma glucose levels Limited use: glucose, lactic acid oxalate - Anticoagulant : potassium Sodium fluoride Antuglycolytic : Red-top tube Invert 3-5 times No additives Blood bank tests, toxicology, serology  5-6 times Yellow-top tube Invert Contains sodium polyanethol sulfonate (SPS) used for blood bank studies, HLA phenotyping, and paternity testing ( Sodium Polyanethol sulfonate (SPS)  Aerobic duly Buterfly needle : air dekat depan Sebule Blood Culture Bottles Needle 3 Syringe : Anaerobic dulu Sthab air deleat belakang Different blood culture bottles are used for aerobic, anaerobic The idea is to prevent air being introduced into the ANAEROBIC bottle and altering its environment. If a butterfly needle and needle-safety connector device is used the AEROBIC bottle should be filled first as there will likely be air in the tubing. If a needle and syringe is used the ANAEROBIC bottle should be filled first as any air is likely to be at the top of the syringe and thus introduced into the second bottle. Type and Amount of Specimen: Dependent upon Test Whole blood: EDTA or heparin? Plasma: EDTA or heparin? Serum: trace free? Separator gel interference? Amount of sample needed to perform test Multiple labs needing the same specimen at the same time What do you need to prepare Tourniquets: Slows venous blood flow down Causes veins to become more prominent NEVER leave on for >1 minute extreme AVOID rigorous fist clenching or hand pumping (potassium, lactic acid) Latex allergy Needles NEVER reuse a needle NEVER use if shield is broken NEVER recap, cut, bend or break Drop immediately into sharps container after venipuncture Size of needle is indicated by gauge: Larger gauge number indicates smaller needle diameter 21, 23 gauge needles routinely used for phlebotomy Butterfly Needle: Most often used with syringe Expensive, thus not used for routine draws Used for small, fragile veins Increased risk of needle stick injury Labeling Blood Collection Tubes permanent Black indelible marker (water proof) Never pencil Legal document Print legibly Required information: 5 items Patient name Identification number/ RN Date of draw (mm,dd,yyyy) Time of draw (military time) Phlebotomist signature: first initial, last name Vacutainer or Syringe? Vacutainer Most often used Most economical Quick Least risk of accidental needle stick Syringe More control Reposition easily Will see ‘flash’ of blood in syringe hub when vein successfully entered  Artery or Vein? Veinbouncy resident At a venipuncture site, a vein will feel bouncy and resilient, while an artery will feel firm and pulsate. In case of an accidental puncturing of an artery, withdraw the needle and apply firm pressure for at least 5 minutes. Instruct the patient to remain still and notify a nurse to assist in hematoma prevention. 32 Selecting the Site: Antecubital area most often accessed Hand or wrist Remember: 2 arms Use tip of index finger on non-dominant hand to palpate area to feel for the vein & Best van to perfor -O venipuncture Inserting the Needle: Anchor the vein Grasp arm with your non-dominant hand Use thumb to pull skin taut Smoothly and confidently insert the needle bevel up 15-30 degree angle No Needle Movement! You must anchor the blood-drawing equipment on the patient’s arm to minimize chance of injury Be careful not to Push needle further into vein when engaging evacuated tube Pull needle out of vein when disengaging tube Pull up or press down when needle in vein Withdraw Needle First release tourniquet Disengage tube Place cotton directly over needle, without pressing down Withdraw needle in swift, smooth motion Immediately apply pressure to wound Do not bend arm Recheck Draw Site Failure to obtain blood - X X X X X X Poor Collection Techniques: Using wrong anticoagulant Venous stasis Prolonged application of tourniquet (>1 min) Hemodilution Drawing above IV Short draw (blood to anticoagulant ratio) Hemolysis Traumatic stick Too vigorous mixing Alcohol still wet Using too small of needle Forcing blood into syringe Venipuncture Procedure Locate vein Release tourniquet Cleanse site in outward rotation Allow to air dry  Reapply tourniquet Do not contaminate site Anchor vein Insert needle Fill tubes Quick mix additive tubes Release tourniquet Withdraw needle  Engage safety device Dispose of needle immediately Apply pressure to puncture site Label tubes Recheck puncture site Thank patient Remove gloves, wash hands Hand Vein Draw  ~ Pakai Skin Puncture (capillary blood) lance + Method of choice for infants, children under 1 year Adults Scarred Fragile veins Hardened veins Home glucose monitoring (POCT) Patients with IV Lancet Micro-specimen containers Skin Puncture Site Selection: Skin Puncture Procedure Hold finger between your index finger and thumb Puncture the finger using a quick, smooth motion Wipe away the first drop of blood Get may be contaminated I squee Finger too tightly L dilute specimen w with tissue fluid/debris plasma - ↑ nemolysis Special situations Fainting Rarely, patients will faint during venipuncture. It is therefore important that patients are properly seated or lying in such a way during venipuncture so that if they do faint, they won’t hurt themselves. self-limited Gently remove the tourniquet and needle from the patients arm, apply gauze and pressure to the skin puncture site. Call for help. A cold compress on the back of the neck may help to revive the patient more quickly.