Principles of Medical Laboratory Science 2 PDF

Principles of Medical Laboratory Science 2 1 Lesson 1: Specimen Collection not well anchored and has more nerve...

Principles of Medical Laboratory Science 2 1 Lesson 1: Specimen Collection not well anchored and has more nerve endings nearby. Venipuncture / Phlebotomy ↳​ A medical procedure that involves using a needle to extract blood from a vein. ↳​ Blood is easier extracted from veins because arteries are deeper, surrounded by nerves, and have higher pressure. ↳​ CLSI Dorsal Puncture ↳​ Clinical Laboratory Standard Institute ↳​ If the antecubital veins are not accessible, the other arm and hand veins are used. Patient Identification ↳​ The dorsal veins are smaller, so using them may ↳​ You can identify a patient by asking their full be very painful. name and birth date. ➙​ Note: The underside of the wrist is never ➙​ Check the patient’s ID band/bracelet bearing used as a venipuncture site. the patient’s name and hospital ID number. ↳​ If the patient is sleeping, wake them up gently and properly identify them. ↳​ If the patient is unconscious, young, mentally incompetent or non-English speaking, ask a relative or the patient’s nurse or physician to identify the patient. ↳​ If the patient is a neonate/infant, look for the ID band or ask the attending nurse, relative, or guardian. Phlebotomy Sites Antecubital Veins of the Arm ↳​ Triangular-shaped space in front of the elbow ↳​ joint. ↳​ There are three veins where blood is extracted Leg, Ankle, and Foot Veins from: ↳​ Must not be used in venipuncture without the ➙​ Median Vein = First-choice vein; safest, permission of a physician due to complications easiest to access, and least painful. It is the such as thrombosis. preferred venipuncture site. ↳​ If the antecubital and dorsal veins cannot be ➙​ Cephalic Vein = Second choice for accessed, these veins are the last resort. venipuncture. It is harder to palpate but is ↳​ If the patient is diabetic, ask the physician. usually better when drawing blood from an Intravenous Lines obese patient. ↳​ When IV lines are present, extract from the hand ➙​ Basilic Vein = Is the last choice vein because without the line. it is the most painful among the three. It is  2 ➙​ You can also extract as long as the site is below the IV line. Finger ↳​ If both arms have IV lines, you can stop the IV for ↳​ The third or fourth finger is usually preferred for 2 minutes. adults and children. The thumb is not recommended because it has a pulse and may Mastectomy Patient bleed too much. ↳​ Samples should not be extracted from the same ↳​ The ridge of the finger should be punctured to side as the mastectomy. avoid blood from spreading to other areas of the ↳​ If the patient had bilateral mastectomy, ask the finger. physician. Heel Capillary Puncture ↳​ This site is used for infants under one year old or ↳​ Involves pricking the skin with a needle or lancet who are not walking. The puncture should be to collect a small sample of blood. made in an area of the heel that’s unlikely to hit a ↳​ Puncture should be less than 2 millimeters. bone. ➙​ Done if there are not accessible veins, ↳​ In infants you should not puncture the middle of POCT procedures, obtaining blood from the foot to not the calcaneus bone. infants or children, and for newborn screening. Venipuncture Equipment Tourniquet Arterialized Capillary Blood ↳​ A constriction device applied to a patient’s arm ↳​ For blood gas analysis (NB and infants) - with the aim of inflating the veins by restricting measures pH and pCO2 but not PO2. venous blood for a period of time. ↳​ Earlobe = Preferred site due to vascularity ↳​ Lateral plantar heel surface - most commonly Needles used site ↳​ Are sterile and for single use only. ↳​ Indwelling umbilical artery - best site for blood ↳​ Three types are multi-sample, hypodermic, and gas analysis (newborn) winged infusion needles. Needle Gauge Microhematocrit Tubes ↳​ Holds 50-75 ul of blood ↳​ Is classified according to the diameter of the ➙​ Red/Green Band = Heparin tubes lumen. ➙​ Blue Band = Non Additive tubes ↳​ The higher the number, the smaller the diameter. Evacuated Tube System (ETS) Lancets & Microcollection Containers ↳​ Contact activated lancets are designed to ↳​ A closed collection system composed of activate only when firmly pressed against the multi-sample needle tube holders, and evacuated skin, ensuring a consistent puncture depth and tubes, which prevents exposure to contaminants. minimizing the risk of injury by automatically ↳​ One end of the needle is pierced through the vein retracting the needle after use. and the other end is in the stopper of the ➙​ Pink = Pedia evacuated tube allowing the blood to flow into the ➙​ Blue = Adults tube. ↳​ Microcollection containers are small tubes used ➙​ This allows numerous tubes to be collected to collect blood samples from a finger or heel in a single venipuncture. prick.  3 Phlebotomy Needles Hypodermic Needle Citrates (Light Blue & Black) ↳​ Used in the syringe system and comes with ↳​ Prevents clotting by binding calcium. different gauges and lengths for different types of usage. Heparin (Light & Dark Green) ↳​ Prevents clotting by inhibiting thrombin and Winged Infusion Needle (Butterfly) thromboplastin. ↳​ Used for difficult to extract veins as those of ➙​ Thrombin is a clotting protein and pediatric or elderly patients because it is more thromboplastin serves as the catalyst in the flexible than the needle or syringe. reaction. Multi-Sample Needles Oxalates (Gray) ↳​ Used in the evacuated tube system and are ↳​ Prevents clotting by precipitating calcium. equipped with safety features. Sodium Polyanethol Sulfonate (Yellow) Blood Collection Tubes Color Coding ↳​ Prevents clotting and is most common in blood culture bottles. Antiglycolytic Agents (Gray) Sodium Fluoride ↳​ Prevent the breakdown of glucose by blood cells or glycolysis. ↳​ It preserves glucose and prevents bacterial growth. ➙​ It is usually used with potassium oxalate for rapid response. Clot Activators (Red & Gold) ↳​ Enhance coagulation in serum specimen tubes (Red). ↳​ Serum is more preferred than plasma due to the absence of the clotting protein known as fibrinogen. ↳​ There are two types of activators: ➙​ Clotting factors such as thrombin ➙​ Substances that provide more surface for platelet activation such as glass (silica) particles and inert clays (celite). Thixotropic Gel (Gold) ↳​ Inhibits cells from metabolizing substances and moves between cells and serum or plasma when Additives of Blood Collection Tubes centrifuged. Anticoagulants Ethylenediaminetetraacetic Acid (EDTA) - (Lavender & Pink) ↳​ Prevents clotting by binding calcium.  4 ↳​ Gold tubes are not used in blood banking as it ➙​ Room number and bed number if inpatient could potentially interfere and compromise with ➙​ Type of test ordered procedures done. ➙​ Date when the test is to be performed ➙​ Billing information (If required) Order of Draw for Multiple Tube Collections ➙​ Test status ↳​ Refers to the specific order that must be followed ➙​ Special precaution by a phlebotomist when collecting blood samples to prevent any cross-contamination, especially when dealing with multiple collection tubes. ↳​ Not following the prescribed sequence affects the test results due to cross-contamination. ↳​ Blood Collection Tube Information 1.​ Patient Full Name 2.​ Patient Birth Date 3.​ Date of Collection 4.​ Time of Collection 5.​ Phlebotomist Initials ↳​ Requisition Form ↳​ Must include: ➙​ Requesting physician ➙​ Patient full name ➙​ Medical record number (if inpatients) ➙​ Birthday and age of patient