L02. Chapter 9 - Collecting and Processing Blood PDF

Chapter 9 Phlebotomy: Collecting and Processing Blood Specimens Preamble PowerPoints are a general overview and are provided to help students take notes over the video lecture ONLY. PowerPoints DO NOT cover the details needed for the Unit exam Each student is responsible...

Chapter 9 Phlebotomy: Collecting and Processing Blood Specimens Preamble PowerPoints are a general overview and are provided to help students take notes over the video lecture ONLY. PowerPoints DO NOT cover the details needed for the Unit exam Each student is responsible for READING the TEXTBOOK for details to answer the UNIT OBJECTIVES Unit Objectives are your study guide (not this PowerPoint) Test questions cover the details of UNIT OBJECTIVES found only in your Textbook! 1 Chapter 4 Objectives 1. Define quality assessment and identify the eight factors of specimen collection that are monitored by QA methods. 2. Explain the Patient Care Partnership and its importance. 3. Interpret principles and applications of Standard Precautions. 4. List three methods of obtaining a blood specimen and the composition of the blood for each method. 5. List the different colors and types of evacuated blood tubes available, the additives, if any in each and tests performed from each tube. 6. Name which tests are performed in panels and in the different departments of the laboratory 7. Differentiate between serum and plasma and which tubes yield which sample. 8. List special handling required by commonly ordered tests. 9. List the anticoagulants found in commonly used evacuated blood tubes and the mechanism of each for preventing clotting. 10. Describe the use of tourniquets, gloves, antiseptic, gauze pads, and bandages, needles (gauges/bore size), microscope slides, and blood drawing trays. 11. Identify the important aspects of preparing the patient for a venipuncture. 12. Identify the proper veins for collecting a venipuncture. 13. List phlebotomy problems and how to solve the problem. Chapter 4 Objectives (con’t) 14. Describe phlebotomy complications. 15. Discuss how to handle situations such as a fainting patient, a nauseous patient, a patient who has a seizure, and a patient who refuses to have his/her blood collected. 16. List special site-selection situations and describe how to handle those situations. 17. Describe the proper procedure for drawing a neonate and neonate screening. 18. Identify the proper place and procedure for performing a heel stick. 19. Identify the possible places for other skin punctures. 20. Describe the proper method of collecting a skin puncture. 21. Describe why certain areas are dangerous for a skin puncture. 22. Identify special precautions that should be taken when drawing a blood culture. 23. Describe the environmental factors associated with ETS. 24. List proper order of filling tubes with vacutainer and syringe collections. 25. Describe the collection of different types of body fluids such as urine and CSF and the testing that is performed on the different fluids. 2  Quality Assessment The term quality assessment is used to maintain and control processes involving the patient and laboratory analysis of specimens. The Patient Patient Care Partnership The Patient’s Bill of Rights Pediatric Patients Children: interact with both parent and child Take extra time/gain the child’s confidence; SMILE Adolescent Patients Teenagers: SMILE & be relaxed Explain the procedure; be aware of anxiety Make eye contact and allow for the patient to have a sense of control 3  The Patient Adult Patients Explain procedure; eye contact; SMILE Always respect the patient’s request within reason Patient may REFUSE to be drawn. It is their right. Just document on requisition Geriatric Patients IMPORTANT to treat with dignity and respect Address as Mr. or Mrs. (never “sweetie”, etc) Be aware of difficulties found in the elderly: hearing, sight, dementia Infection Control Isolation as Safety System Separation of a seriously ill patient to stop the spread of infection or to protect the patient from irritating factors Standard and Additional Precautions Contact Precautions Airborne Precautions Droplet Precautions Reverse Isolation Precautions 4 Specimen Collection Blood Collection Variables Blood Collection Procedures Fasting/Nonfasting Venous Blood Medicines Veins Activity Peripheral Time of day Capillary or skin Finger sticks Circadian/diurnal Heel sticks Posture Smoking Alcohol Composition of Blood Buffy Coat Spun down- Hematocrit 10 5  Specimen Collection Additives and Anticoagulants Additives Substances added to the blood draw tube Anticoagulants Substances that prevent blood from clotting Additive: Sodium Fluoride: Antiglycolytic agent Keeps glucose from breaking down Common Anticoagulants Dipotassium EDTA: Binds or chelates calcium Sodium Citrate: Binds Calcium Heparin: inhibits thrombin Oxalates: precipitate calcium Specimen Collection Adverse Effects of Additives Interferes with assay Ex. Sodium oxalate used for analysis of sodium Removal of constituents Ex. Use of oxalate for a calcium determination Effect on enzyme action Sodium fluoride destroys enzymes Alteration of cellular constituents Oxalate distorts cell morphology Incorrect amount of anticoagulant Lt. Blue top tubes – 1:9 ratio is a MUST 6  Specimen Collection Venipuncture Procedure Safe Blood Collection: Equipment and Supplies Safety devices are in place to help prevent accidental needle sticks Evacuated Blood Collection Tubes Order of Draw of ETS Tubes 1. Yellow OR Blood Culture bottles Aerobic 1st/ Anaerobic 2nd 2. Lt. Blue 3. Red, Gold, Speckled 4. Green 5. Lavender 6. Gray 7  Memory Jogger for Order of Draw Specimen Collection Syringe Technique Components Needles 21-23 gauge 1–1½ inch Syringe Barrel, graduated Plunger Syringe transfer device 8  Specimen Collection General Protocol 1. Pleasantly introduce yourself. 2. Identify the patient. Use two identifiers: Ask patient to STATE THEIR NAME Check armband if inpatient OR Check Drivers License or photo ID if outpatient 3. Check test requisitions. 4. Label specimen tubes after collecting blood. And before leaving the patient’s side Labels must contain 5 identifiers 1. Patient Name 4. Date of collection 2. Patient ID# 5. Time of collection 3. Collectors Initials Venous Blood Collection (Phlebotomy) Supplies and Equipment Gloves Non-sterile & Disposable Antiseptics 70% isopropyl alcohol Povidone-iodine 0.5% chlorhexidine gluconate Gauze pads/cotton balls Bandages Needle and sharps disposal containers 9  Venous Blood Collection (Phlebotomy) Supplies and Equipment (cont.) Sharpie Marker or Pen Tourniquet Latex, Needles Gauge Number related to diameter of the lumen The larger the gauge number, the smaller the actual diameter of the needle Color code—easier ID Length 1 to 1½ inch most common Slightly longer to accommodate resheathing feature ½ to ¾ inch for butterfly needle Venous Blood Collection (Phlebotomy) Evacuated tube system Most common system used Syringe system Most unsafe system used Different tube order of draw for syringe systems No anticoagulant in syringe Winged infusion set Most effective system for small fragile veins Very costly Combination systems Winged with ETS Winged with Syringe 10  Venous Blood Collection (Phlebotomy) Initiation of the Procedure Properly ID patient Wash hands Assemble all equipment Put on gloves Venous Blood Collection (Phlebotomy) Selection of an Appropriate Site Visually inspect both arms. Choose a site not previously used if possible Most common sites for venipuncture: 1. Median cubital vein 2. Cephalic vein 3. Basilic vein Apply tourniquet and palpate vein Have patient make a fist 11  Venous Blood Collection (Phlebotomy) Venous Blood Collection (Phlebotomy) Preparation of the Venipuncture Site Clean site with antiseptic in concentric circles Wipe dry with gauze using STERILE technique Performing the Venipuncture Anchor vein and inform patient of venipuncture Perform phlebotomy ETS: Needle insertion 30°. Fill in proper order and mix after each tube is removed Syringe: Needle insertion 30 °. Fill in proper order Butterfly: Needle insertion 10 °. Fill in proper order. Have patient release fist 12 Venous Blood Collection (Phlebotomy) Termination of the Procedure Release tourniquet when last tube is placed in ETS holder or when syringe is half full. ALWAYS Release tourniquet BEFORE removing needle!!! Place a gauze pad over the site and apply pressure If pressure is NOT applied it will cause a Hematoma LABEL all tubes Clean area appropriately Thank patient and wash hands Venous Blood Collection (Phlebotomy) Special Site Selection Situations Intravenous Lines Use alternate site If not available, draw below the IV site It below IV is not possible, have nurse turn off IV for 10 minutes and draw a discard tube before needed collection tubes Edema Abnormal accumulation of fluid in tissues Scarring or Burn Patients Veins are difficult to palpate in these areas Dialysis Patients Do not draw from a vein with a cannula or fistula Mastectomy Patients Do not perform venipuncture on the side of a mastectomy 13  Venous Blood Collection (Phlebotomy) Phlebotomy Problems 1. Refusal by the patient to have blood drawn 2. Difficulty in obtaining a specimen 3. Movement of the vein 4. Sudden movement by the patient or phlebotomist that causes the needle to come out of the arm prematurely 5. Improper anticoagulant 6. Inadequate amount of blood in an evacuated tube 7. Fainting or illness subsequent to venipuncture Venous Blood Collection (Phlebotomy) Phlebotomy Complications 1. Vascular complications Bleeding from the site and hematomas most common 2. Infections 2nd most common problem 3. Anemia Iatrogenic (physician induced) 4. Neurological complications Post phlebotomy – seizures or pain 5. Cardiovascular complications Hypotension, syncope, shock and cardiac arrest 6. Dermatological complications Allergic reaction to iodine 14  Venous Blood Collection (Phlebotomy) Blood Culture Collection Must be sterile Clean with alcohol followed by iodine Special tubes (yellow) or bottles are used A request for BC x 2 -- collect in two different locations Skin Punctures 15  Venous Blood Collection (Phlebotomy) Capillary or Peripheral Blood Collection by Skin Puncture Different from venous: Contains venous, arterial and tissue fluid MUST ALWAYS WIPE AWAY THE FIRST DROP Used for Blood Spot Collection for Neonatal Screening Programs Capillary Blood for Testing at the Bedside (Point-of-Care Testing) Capillary Blood Collection Supplies and Equipment Lancets (Designed either for finger or heel) Capillary tubes Gauze pads Band-Aids Preparation of the Site Use alcohol to cleanse Wipe dry with gauze pad Puncturing the Skin Use a lancet for finger sticks Use a tenderfoot lancet for heel sticks ( stability of the chemical constituents). NOTE: NEVER FREEZE CSF ALWAYS Check the laboratory manual for details concerning test storage. Some tests must be protected from light or put on ice (see handout) 20  Urines Urine Urines give a great amount of information to the physician. Types of Urine Specimens Random Specimen–any time First Morning Specimen–first urine Midstream Clean-Catch Specimen–start/collect 24-Hour or Timed Specimen–collected over a period of time Catheter Collection Specimen-Collected by a tube inserted into bladder Suprapubic Aspiration Specimen-Collected by a needle inserted into the bladder from the abdominal wall Pediatric Specimen-Collection-Bag attached to urethral area to collect urine 21  Urine Containers for Urine Collection Urine Collection Cups Urinalysis Tubes 24-Hour Collection Containers Some contain acid (check test to be done) Urine Culture Containers Urine Transport Tubes Collecting Urine Specimens Collection of Routine Specimens Collection of Timed Urine Specimens Collection of Urine for Culture Urine Preservation of Urine Specimens Decomposition of urine begins in 30 minutes Refrigerate if testing must be delayed Labeling and Processing of Urine Specimens Labels Collection Date and Time Collection Method Proper Preservation Light Protection 22  Body Fluids Body Fluids 23  Body Fluids Cerebrospinal Fluid Spinal fluid collected by a spinal tap Testing for meningitis; Must be tested immediately Collect 3 tubes: 1st – Chemistry; 2nd –Microbiology; 3rd – Hematology Synovial Fluid Fluid found in the joint spaces Testing for crystals Pericardial, Pleural, and Peritoneal Fluids Serous fluids found in the cavities Testing for cell counts in inflammation Seminal Fluid Semen analysis Testing for infertility and post vasectomy assessment Swabs for Culture Throat Culture Collection Strep Screen or culture Feces Testing for occult blood, O & P Sweat Testing for Cystic Fibrosis Saliva Used for testing a variety of analytes. Viruses, bacteria, hormones, and drugs 24 Chain-of-Custody Specimen Information Chain of custody documentation must be signed by every person who has handled the specimens involved in the case in question. Postamble READ the TEXTBOOK for the details to answer the UNIT OBJECTIVES. USE THE UNIT OBJECTIVES AS A STUDY GUIDE All test questions come from detailed material found in the TEXTBOOK (Not this PowerPoint) and relate back to the Unit Objectives 25