BMSC&BMW Lecture 1 PDF

BSMLS DC-104 Blood Collection- venous, arterial, capillary, for Bacterial culture, Haematological and Biochemical investigations. Heal puncture and use of butterfly needles. Avoiding counter puncture and haematoma. Managing Haemophobia. (BMSC & BMW –Theory)...

BSMLS DC-104 Blood Collection- venous, arterial, capillary, for Bacterial culture, Haematological and Biochemical investigations. Heal puncture and use of butterfly needles. Avoiding counter puncture and haematoma. Managing Haemophobia. (BMSC & BMW –Theory) Lecture-1 Rohit Kumar 13-Sep-2024  Syllabus (BMSC & BMW) Course content  Blood Collection- venous, arterial, capillary, for Bacterial culture, Haematological and Biochemical investigations. Heal puncture and use of butterfly needles. Avoiding counter puncture and haematoma. Managing Haemophobia.  Anticoagulants: Definition, various types of anticoagulants, minimum quantity required per mL, their mode of action.  Urine collection Routine, for Bacterial Culture and 24 hrs for biochemical parameters.  Swab collection from various sites - throat, nasal, pus wound, buccal etc. Histopathological and cytology sample collection procedure and specimen preservation techniques, FNAC, PAP smear.  Storage, packaging & Transportation of various samples - blood, CSF, urine, stool, sputum etc. for various departments or Laboratories away from the collection centre.  Biomedical Waste Management - Definition of biomedical waste, types of waste generated from Health Care Facility. Waste minimization - source reduction, imposition of methods and equipment. Segregation, collection, transportation, treatment, and disposal (including colour coding) of biomedical waste.  Syllabus (BMSC & BMW)  Liquid biomedical waste, Radioactive waste, Metals / Chemicals / Drug waste Biomedical Waste Management & methods of disinfection. Modern Technology for handling biomedical waste.  Occupational Hazards and Personal Safety - Occupational Safety and Health Administration (OSHA)  Different types of hazards - biological, chemical, physical.  Safety precautions in different Laboratories.  BMSC & BMW Unit-I  Blood Collection- venous, arterial, capillary, for Bacterial culture, Haematological and Biochemical investigations.  Heal puncture and use of butterfly needles.  Avoiding counter puncture and haematoma.  Managing Haemophobia. 1 Blood Collection- venous, arterial, capillary, for Bacterial culture, Haematological and Biochemical investigations. Blood Collection  Blood is a suspension of cells- erythrocytes, leucocytes and thrombocytes in fluid, plasma. The cellular fraction constitutes 45% of the volume of blood.  Chemically, blood is a very complex fluid containing a large variety of substances. Collection of blood Blood collection is three types. 1 Venous blood collection 2 capillary blood collection and 3 Arterial blood collection 1 Blood Collection- venous, arterial, capillary, for Bacterial culture, Haematological and Biochemical investigations. Venous Blood Venous blood is deoxygenated blood that flows from tiny capillary blood vessels within the tissues into progressively larger veins to the right side of the heart. Venous blood is the specimen of choice for most routine laboratory tests. The blood is obtained by direct puncture to a vein, most often located in the antecubital area of the arm or the back (top) of the hand. At times, venous blood may be obtained using a vascular access device (VAD) such as a central venous pressure line or an IV start. Most laboratory reference ranges for blood analytes are based on venous blood. Arterial Blood Deoxygenated blood is pumped from the right side of the heart to the lungs, where it takes up oxygen. The now oxygenated blood is pumped through the left side of the heart via arteries. The most common reason for the collection of arterial blood is the evaluation of arterial blood gases. Arterial blood may be obtained directly from the artery (most commonly, the radial artery) by personnel who are trained to perform this procedure and are knowledgeable about the complications that could occur as a result of this procedure. Arterial blood may also be obtained from a vascular access device (VAD) inserted in an artery, such as a femoral arterial line or catheter.  Blood Collection Capillary Blood Capillary blood is obtained from capillary beds that consist of the smallest veins (venules) and arteries (arterioles) of the circulatory system. The venules and arterioles join together in capillary beds, forming a mixture of venous and arterial blood. The specimen from a dermal puncture will therefore be a mixture of arterial and venous blood along with interstitial and intracellular fluids. Capillary blood is often the specimen of choice for infants, very young children, elderly patients with fragile veins, and severely burned patients. Point-of-care testing is often performed using a capillary blood specimen.  Types of vein used for the blood draw Although other arm and hand veins may be used, the median cubital and cephalic veins are the recommended locations for blood collection. The medial (ulnar) side of the arm is home to the basilic vein, while the lateral (radial) side is where the cephalic vein is found.  Different types of Blood Collection Area Arterial Venous Capillary  Blood Collection Avoid Puncturing These Areas  While it is important to know the best veins to access, it’s also important to know which areas to avoid.  These areas include:  Edematous sites (swollen sites filled with serous fluid)  Scarred or burned areas  Fistulas and grafts  Hematomas  From an IV cannula (unless permitted by your institution)  Sites above an IV cannula in the same vessel  Arm with PICC line  Arm with a preexisting or current blood clot  Arm on the side of a mastectomy  Via an open wound or area of infection  Arm in which blood is being transfused  Arm on the side of a surgical procedure  Blood Collection Important point to follow during blood collection After identifying the site for the blood draw, gather the appropriate supplies needed. Some institutions have kits with all of the needed supplies, while others will require the nurses to gather them individually. An important tip - take extra supplies into the patient’s room in case you need to attempt a second venipuncture. These supplies include:  Evacuated Collection Tubes (tubes specific to labs ordered)  Personal Protective Equipment (ie gloves)  Appropriate blood-drawing needles  Tourniquet  Hand Sanitizer  Alcohol swabs or Chlorhexidine wipes (CHG) for skin disinfection  Laboratory specimen labels  Gauze  Blood transfer device  Adhesive bandage/tape  Laboratory forms  Bio-hazard leak-proof transportation bags  Puncture-resistant sharps container  Heal puncture and use of butterfly needles. A butterfly needle, also known as a scalp vein set or winged infusion set, is a device used to draw blood from a vein or deliver intravenous (IV) therapy to a vein. A butterfly needle consists of a very thin needle, two flexible “wings,” a flexible transparent tubing, and a connector. Butterfly needles have advantages over straight needles when collecting blood or delivering IV fluid or medications. For instance, they allow for more precise placement, particularly in hard-to-access veins. There are cases in which other needles need to be used, though. A butterfly needle is a shorter needle with a thinner gauge, ranging from sizes 18 to 27. When measuring gauges, the higher the number, the thinner the diameter, making butterfly needles one of the thinnest needles for phlebotomists to use. Typically, 21 or 23 gauge are used for blood draws. Butterfly needles are also known as a winged transfusion set or a scalp vein for its ‘two wings’. Butterflies are not the standard needle for blood sample collection, but they are often utilized for patients with shallow or thin veins. The tubes of a butterfly needle vary from 8 to 15 inches. For most needle sets, shorter tubes are used for blood draws, whereas longer tubes are used for intravenous (IV) therapy. Heal puncture and use of butterfly needles.  Heal puncture and use of butterfly needles. What Butterfly Needles Are Used For Butterfly needles have a few different purposes, all of which are temporary. Blood Draw Phlebotomists regularly use butterfly needles to obtain blood samples for blood-based tests. Hydration Butterfly needles can also be used to deliver intravenous fluids if you are dehydrated and either cannot drink fluids or cannot drink enough to compensate for fluid loss. In some older people, or people receiving end-of-life care who need hydration, butterfly needles can be used subcutaneously (beneath the skin). Medication Butterfly needles are useful for delivering medications (such as pain medications) straight into a vein or infusing IV therapies (such as chemotherapy or antibiotics) intravenously.  Heal puncture and use of butterfly needles. How to Use a Butterfly Needle When using a butterfly needle, it is critical to follow the proper steps to avoid hemolysis, nerve damage, or patient discomfort. Follow the steps below for a safe procedure:  Wash your hands and then put on a sterile pair of gloves.  Attach the connector to a vacuum tube or a collection bag.  Tie a tourniquet around the patient’s arm and look for a vein.  When you have found a vein, disinfect the needle site and wait for it to dry before inserting the needle.  Insert the butterfly needle into the vein at a 30-degree angle. If you see blood through the tube, the needle is inserted correctly. If not, the vein collapsed, and you must look for another vein.  Once the vacuum tube is full of blood, remove the tourniquet.  Remove the needle and bandage the draw site.  Dispose of the needle properly and label the blood sample.  Butterfly Needle Advantages and Disadvantages Advantages The butterfly needle has several benefits, with the most prominent being its ability to help populations with superficial, sensitive, or smaller veins. With its thinner needle, patients often experience less pain from a butterfly needle than a standard needle. Its size decreases the risk of nerve damage and allows for a more stable infusion method when properly secured. Its stability and accuracy derive from its shorter length, in which phlebotomists can hold it closer to the stem and have more control. Disadvantages While the butterfly needle serves many purposes, it also has its downsides. For example, with such a small needle, it takes a much longer time to gather blood. In addition, phlebotomists often cannot obtain a large quantity of blood. There is also an increased chance of hemolysis – the rupturing of red blood cells – because of the needle’s smaller size. Aside from the medical consequences of butterfly needles, we must also acknowledge its economic cost. Butterflies are more expensive than standard needle sets and should only be used for individuals who need it.  Avoiding counter puncture and hematoma. A hematoma is an abnormal collection of blood outside of a blood vessel. It occurs when the wall of a blood vessel, artery, vein or capillary gets damaged and blood leaks into tissues where it does not belong. The hematoma may be tiny, with just a dot of blood, or it can be large and cause significant swelling. The blood vessels in the body are under constant repair. Minor injuries occur routinely, and the body is usually able to repair the damaged vessel wall by activating the blood clotting cascade and forming fibrin patches. However, the repair may fail if the damage is extensive, leading to continued bleeding. If there is tremendous pressure within the blood vessel, such as in a major artery, the blood will continue to leak through the damaged wall, and the hematoma will expand. Blood that escapes from within a blood vessel irritates the surrounding tissue and may cause symptoms of inflammation including pain, swelling and redness. Symptoms of a hematoma depend upon their location, size and whether they cause associated swelling or edema. Hematomas may occur anywhere in the body. Regardless of how the condition is described or where it is located, it remains a collection of clotted blood outside a blood vessel.  Avoiding counter puncture and hematoma. What are the types of hematomas? Hematomas are often described based on their location. The most dangerous kinds are those that occur inside the skull. Because the skull is an enclosed container, anything that takes up space increases pressure within and potentially impairs the ability of the brain to function. The different types of hematomas include the following: Epidural hematomas occur because of trauma, often to the temple, where the middle meningeal artery is located. Bleeding accumulates in the epidural space, outside the "dura" which is the lining of the brain. Because of the way the dura is attached to the skull, small hematomas can cause significant pressure and brain injury. Subdural hematomas also occur because of trauma, but the injury is usually to the veins in the brain. This causes a slower leak of blood, which enters the "subdural" space below the dura. The space below the dura has much more room for blood to accumulate before brain function suffers. As people age, they lose some brain tissue and the subdural space is relatively larger. Bleeding into the subdural space may be very slow, gradually stop and not cause acute symptoms. These "chronic" subdural hematomas are often found incidentally on CT scans as part of patient evaluations for confusion or after another traumatic incident. However, subdural hematomas may be large, cause associated brain swelling, and may be lethal.  Avoiding counter puncture and hematoma. Intracerebral hematomas occur within the brain tissue itself. Intracerebral hematomas may be due to bleeding from uncontrolled high blood pressure, an aneurysm leak or rupture, trauma, tumor or stroke. Scalp hematomas occur on the outside of the skull and often can be felt as a bump on the head. Because the injury is to the skin and muscle layers outside of the skull, the scalp hematoma itself cannot press on the brain. Because these hematomas are often easily visible and can be relatively large they often cause significant concern for the patient. Ear hematomas may occur if an injury causes bleeding to the outside helix or cartilage structure of the ear. Often called boxer's ear, wrestler's ear or cauliflower ear, the blood becomes trapped between the thin layer of skin and the cartilage itself. Since the ear cartilage gets its blood supply directly from the overlying skin, a hematoma can decrease blood flow, causing parts of the cartilage to shrivel and die. This results in a bumpy, deformed outer ear called a "cauliflower ear."  Avoiding counter puncture and hematoma. Septal hematomas occur with nasal trauma, such as a broken nose. If not recognized and treated, the cartilage can break down and cause a perforation of the septum. Intramuscular hematomas can be very painful due to the amount of swelling and inflammation. Some muscles are surrounded by tough bands of tissue. If excessive bleeding occurs, the pressure within these compartments can increase to the point that "compartment syndrome" can occur. In this situation, the blood supply of the muscle is compromised, and the muscle and other structures such as nerves can be permanently damaged. This is most commonly seen in the lower leg and forearm. Compartment syndrome may also be seen as a complication of fractures. This is a true surgical emergency. Medical care should be accessed immediately if compartment syndrome is suspected. For health care professionals, one clue to consider this diagnosis is finding a patient whose pain is out of proportion to the physical findings. Subungual hematomas are the result of crush injuries to the fingers or toes. Bleeding from this type of injury occurs under the fingernail or toenail, and because it is trapped, pressure builds up, causing pain. Trephination, or drilling a hole through the nail to remove the blood clot, relieves the pressure and resolves the injury. Over time, the nail repairs itself. Subcutaneous hematomas are bruises and contusions of the skin (ecchymosis). These occur due to trauma or injuries to the superficial blood vessels under the skin. Individuals who take anticoagulant medication are more prone to subcutaneous hematomas.  Avoiding counter puncture and hematoma. Intra-abdominal hematomas and hemorrhage may be due to a variety of injuries or illnesses. Regardless of how the blood gets into the abdomen, the clinical finding is peritonitis (irritation of the lining of the abdomen). Hematomas may occur in solid organs such as the liver, spleen or kidney. They may occur within the walls of the bowel, including the small intestine (duodenum, jejunum and ileum) or the large intestine (colon). They may also form within the lining of the abdomen called the peritoneum or behind the peritoneum in the retroperitoneal space ("retro" means behind). Subchorionic hematoma: A subchorionic hematoma is a collection of blood that forms during pregnancy beneath the chorionic membrane, specifically between the placenta and uterus. This is one of the most typical ultrasound findings in the early stages of pregnancy.  Managing Haemophobia. What is hemophobia? Hemophobia, or blood phobia, is the medical term used to describe an intense and irrational fear of blood. Generally speaking, phobias are extreme, often irrational fears that interfere with an individual's ability to function in their day-to-day lives. Unlike individuals with everyday fears, people with a phobia will often go to great lengths to avoid being exposed to the fear or perceived danger, even if there’s no actual risk or danger. People with phobias often feel powerless against their phobia. For example, individuals with hemophobia may miss important doctor’s visits to avoid getting their blood work done and may dread situations involving blood (e.g., seeing someone with a bloody nose). In addition, Halloween decorations depicting blood, though fake, can still trigger someone's hemophobia. Likewise, bloody images on television, such as those from horror movies or television shows involving murder, can do the same.  Managing Haemophobia. What causes hemophobia? The exact cause of hemophobia is not completely understood. However, it is known that individuals who have a family history of phobias or anxiety disorders are more likely to develop a phobia. Other times, phobias can be triggered by specific stressful or traumatic events, like having a bad experience when receiving an injection or witnessing a bad injury. Additionally, there is evidence that some people may be more prone to developing phobias because of their personality traits. For example, individuals who have a tendency to feel distress and nervousness in new situations may have a higher risk of developing anxiety disorders, including specific phobias. What are the signs and symptoms of hemophobia? The signs and symptoms of hemophobia develop when individuals are exposed to the sight of blood, including medical procedures, injuries involving blood, severe wounds, and even the thought of blood alone. The sight of needles can also trigger someone's hemophobia as they may be afraid of watching the blood enter the syringe. Common symptoms include feelings of intense anxiety or panic, an overwhelming need to escape situations involving blood, and feeling powerless over the fear. The psychological symptoms are often accompanied by physical ones, like shaking or trembling, palpitations, sweating, lightheadedness, and trouble breathing. Unlike most other phobias, hemophobia triggers a marked vasovagal response, which is why individuals are more likely to have fainting episodes upon the sight of blood. Managing Haemophobia.  Managing Haemophobia. How is hemophobia diagnosed? Diagnosis of hemophobia is based on a psychological evaluation, which is a structured interview with a mental health professional that provides information to assess the individual's behavior, personality, thought processes, and cognitive abilities, and subsequently, identify any disturbances. Currently, the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) differentiates phobias into three groups: agoraphobia, or the fear of public places; social phobia, or the fear of social situations and interactions; and specific phobias, which are an irrational fear of an object or situation. In turn, specific phobias are subdivided into five categories, including fear of animals (e.g., spiders, snakes, dogs), fear of the natural environment (e.g., heights, storms, darkness), fear of blood and invasive medical procedures (e.g., blood, needles, injections), situational fears (e.g., elevators, flying); and finally, fears that do not fall into the previous categories. How is hemophobia treated? Treatment for hemophobia is similar to that of other specific phobias. Psychotherapy, particularly cognitive behavioral therapy, can be beneficial for individuals, as it teaches them to understand that their extreme fear is irrational, and the likelihood of their worst fears coming true is very low. Another treatment option is exposure therapy, where an individual is gradually and systematically exposed to the objects of their fears (e.g., needles, fake blood, pictures of injuries)  Managing Haemophobia. What are the most important facts to know about hemophobia? Hemophobia refers to the intense and irrational fear of blood that interferes with an individual's ability to function in their day-to-day lives for at least 6 months. Currently, it is listed under specific phobias in the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) as blood-injection-injury phobias. Other phobias in this category include the fear of needles, as well as the fear of physical injuries. Most cases of hemophobia can be treated with cognitive behavioral therapy or by gradually exposing individuals to the object(s) of their phobia.