Blood Collection - PowerPoint Presentation

Slide1

Blood Collection Slide2

Contact with patients

The

patient in a hospital is

anxious

(physical condition),

fearful,

ill health, and

he is physically uncomfortable as a result of his disease or injury. He is also separated from his family.

The medical

technologist

must show

the patient at all time the kindness and understanding that can mean so muchSlide3

A child - terrible

experience

, remembered

and feared for the child for many years.

Gain

the child trust before proceeding with blood collection.

The

child should be informed of what is going to happen; if the child is told that the puncture will not hurt the child trust will be lost because this statement is generally is not true. Slide4

phlebotomy procedures:

Blood specimens are commonly obtained from patient's vein (Vein puncture). Under some circumstances a skin puncture will be used for this purpose. Irrespective of the method used certain techniques are common to all phlebotomy procedures:

Check

the request form

:

The

correct patient identification:

The

correct specimen identification:

Safety

and infection control

Preparation

of the puncture site:Slide5

1- Check the request form

:

A

requisition form must

accompany

each sample submitted to the laboratory. This requisition form must contain the proper information in order to process the specimen. The essential elements of the requisition form are:

Patient's surname, first name, and middle initial.

Patient's ID number.

Patient's date of birth and sex.

Requesting physician's complete name.

Indicating the test(s) requested.

Source of specimen. This information must be given when requesting microbiology, cytology, fluid analysis, or other testing where analysis and reporting is site specific.

Date and time of collection.

Initials of phlebotomist

.Slide6

2-The correct patient identification:

Is

critical for hospital patients this is accomplished by checking the identification wrist band for the correct name and hospital identification number.

The

procedure for out patient is not as easy. The phlebotomist should ask the patient for his or her full name and any other information specific for the patient that can be verified by the requisition form. Slide7

3-The correct specimen identification:

A

properly labeled sample is essential so that the results of the test match the patient. The key elements in labeling are:

Patient's surname, first and middle.

Patient's hospital identification (ID) number.

Date, time and initials of the phlebotomist must be on the label of each tube. Slide8

4- Safety and infection control

Because

of contacts with sick patients and their specimens, it is important to follow safety and infection control procedures

.

Protect yourself

Protect the others (your colleague, visitors,…)

Protect the patientSlide9

Protect yourself

Wear

gloves and a lab coat or Change gloves after each patient or when contaminated.

Wash hands frequently.

Dispose of items in appropriate containers.

Dispose of needles immediately upon removal from the patient's vein. Do not bend, break, recap, or recapped needles to avoid accidental needle puncture or splashing of contents.

Clean up any blood spills with a disinfectant such as freshly made 10% bleach.

If you stick yourself with a contaminated needle:

Remove your gloves and dispose of them properly.

Squeeze puncture site to promote bleeding.

Wash the area well with soap and water.

Record the patient's name and ID number

.Slide10

Protect the patient

Place

blood collection equipment away from patients, especially children and psychiatric patients.

Practice hygiene for the patient's protection. When wearing gloves, change them between each patient and wash your hands frequently. Always wear a clean lab coat or gown.Slide11

5- Preparation of the puncture site:

The

puncture site should be cleaned by rubbing vigorously with a pad moistured with 70% isopropanol. The area is the dried with sterile gauze. Once the phlebotomy site has been cleaned the decontaminated area should not be touched.Slide12

Micro sample technique

Micro sampling refers to blood collection by skin puncture and is frequently used in the following types of patients:

Infants less than 6 months of age generally don’t have a large blood supply, and it is dangerous to remove the volume of blood involved in vein puncture.

In young children: If only a small amount of blood is needed, a skin puncture is performed on the finger.

When an adult has poor veins, when the veins can't be used of intravenous (IV) infusions, or in the case of a severely burned patient the patient, the patient, the finger may be used as a phlebotomy site

.Slide13

Reagent and equipment:

70% isopropyl alcohol.

Sterile gauze pads - for application on the site from which the needle is withdrawn.

Gloves - can be made of latex, rubber, vinyl, etc.; worn to protect the patient and the phlebotomist.

Sterile disposable blood lancet

Procedure:

Follow the procedure as outlined above for greeting and identifying the patient. As always, properly fill out appropriate requisition forms, indicating the test(s) ordered.

Verify the patient's condition. Fasting, dietary restrictions, medications, timing, and medical treatment are all of concern and should be noted on the lab requisition.

Position the patient. The patient should sit in a chair, lie down or sit up in bed. Hyperextend the patient's arm

.Slide14

Location of the puncture site:

The best locations for finger sticks are the 3

rd

and 4

th

fingers of the non-dominant hand. Do not use the tip of the finger or the center of the finger. Avoid the side of the finger where there is less soft tissue, where vessels and nerves are located, and where the bone is closer to the surface. The 2nd (index) finger tends to have thicker. The fifth finger tends to have less soft tissue overlying the bone. Avoid puncturing a finger that is cold or cyanotic, swollen, scarred, or covered with a rash.Slide15

When

obtaining blood from infants less than 1 year of age, blood is generally obtained from the heel of the foot. The site chosen should be on the inside (medial) or the outside (planter surface) of the foot. An imaginary line may be drawn from the middle of the large toe to the heel, and a line from between the fourth and the fifth toes of the heel. The area outside of these two lines is acceptable for puncture. Slide16

The puncture depth:

For

finger stick, the puncture should be no deeper than 3.1 mm because the distance between the skin surface and bone will vary from 3.1 to 10.9 mm. The distance to the bone is only 1.5 to 2.4 mm in infants 6 months old, so the finger is not used in this age group of infants unless special devices are used.

For the heal puncture The depth of the puncture at any time must not be more than 2.4 mm in order to avoid damage to the bone. Because the blood supply for the infant's heal is located between 0.35 and 1.6mm below the surface of the skin, the puncture need not to be any deeper than 1.6 mm. Slide17

Performance of a skin puncture:

The

puncture site should not be cold; otherwise it must be warmed either by rubbing the site, hanging the hand or applying hot gauze on the puncture site.  

Using a sterile lancet, make a strong, fast and deep skin puncture just off the center of the finger pad. The puncture should be made perpendicular to the ridges of the fingerprint so that the drop of blood does not run down the ridges.Slide18

Wipe away the first drop of blood, which tends to contain excess tissue fluid. Collect drops of blood into the collection device by gently massaging the finger. Avoid excessive pressure that may squeeze tissue fluid into the drop of blood.

Have the patient hold a small gauze pad over the puncture site for a couple of minutes to stop the bleeding.

Dispose of contaminated materials/supplies in designated containers.

Label all appropriate tubes at the patient bedside.

Deliver specimens promptly to the laboratory.Slide19
Slide20

Discussion

Blood

from a skin puncture is a mixture of venous, arterial, and capillary blood. The concentration of some constituents in the blood will differ between skin puncture blood and an arterial or venous specimen. Because of this,

test reports should indicate if the blood sample was obtained from a skin puncture

.

Excessive

massaging or squeezing of the finger or foot will cause

tissue juice

to mix with and dilute the blood. This will result in erroneous and increased clotting of the blood

.Slide21

Since a deep puncture is not any more painful than a superficial puncture, it is best to go deep enough the first time thereby avoid puncturing the patient a second time.

Excess

crying will affect some test result (most notably, the white blood cell count may increase considerably). It is advisable to wait 30minutes to 1 hour following a crying episode before obtaining the blood specimen

.

The thumb, big toe, and ear lob should not be used as a skin-puncture site for phlebotomy.Slide22

Misidentification of a patient is series error and can have disastrous implication for the patient.

Betadine

(iodine) should not be used routinely to clean the phlebotomy area because contamination with this substance will cause some erroneous test results (falsely elevated potassium, uric acid, and phosphorus results).

Skin must be dried before puncture to avoid mixing of blood with alcohol and hemolysis of blood, and to avoid

hemoconcentration

.Slide23

Venipuncture

A

venipuncture

must be performed with care. The veins of a patient are the main source of blood for

testing

and the

entry point

for medications, solutions, and blood transfusions. Because there are only a limited number of easily accessible veins in a patient, it is important that everything be done to preserve their good condition and availability. Part of this responsibility lies with the medical technologist. The ideal procedure is to have the patient lie down. If this is not possible, the patient should sit in a sturdy, comfortable chair with his or he arm firmly supported on a table or chair arm and easily accessible to the technologist. A patient should never stand or sit on a high stool during any process of blood collection

.Slide24

Reagent and equipment:

Tourniquet.

Alcohol Wipes - 70% isopropyl alcohol.

Gauze sponges - for application on the site from which the needle is withdrawn.

Adhesive bandages / tape - protects the

venipuncture

site after collection.

Gloves - can be made of latex, rubber, vinyl, etc.; worn to protect the patient and the phlebotomist

.

Sterile disposable syringes, the choice of a syringe are governed by the amount of blood

required

Sterile, disposable needle. The choice of needle depends on the size of the vein. The most commonly used needles are 20, 21, and 22 gauge. The higher the gauge number, the smaller the inner diameter (bore) of the needle. The length of the needle also chosen according to the depth of the vein, the most commonly used depth is 1.5

inchSlide25

For vaccutainer system:

Evacuated Collection Tubes - The tubes are designed to fill with a predetermined volume of blood by vacuum. The rubber stoppers are color coded according to the additive that the tube contains. Various sizes are available. Blood should

NEVER

be poured from one tube to another since the tubes can have different additives or coatings (see illustrations at end).

Needles - The gauge number indicates the bore size: the larger the gauge number, the smaller the needle bore. Needles are available for evacuated systems and for use with a syringe, single draw or butterfly system.

Holder/Adapter - use with the evacuated collection system.

Needle disposal unit - needles should NEVER be broken, bent, or recapped. Needles should be placed in a proper disposal unit IMMEDIATELY after their use

.Slide26
Slide27

Procedure:

Procedure

for vein selection

Although the larger and fuller

median cubital

and

cephalic

veins of the arm are used most frequently, wrist and hand veins are also acceptable for

venipuncture.

Palpate and trace the path of veins with the index finger. Arteries pulsate, are most elastic, and have a thick wall.

If superficial veins are not readily apparent, you can force blood into the vein by massaging the arm from wrist to elbow, tap the site with index and second finger, apply a warm, damp washcloth to the site for 5 minutes, or lower the extremity over the bedside to allow the veins to fill.Slide28

Performance of a venipuncture:

Approach the patient in a friendly, calm manner. Provide for their comfort as much as possible, and gain the patient's cooperation.

Identify the patient correctly.

Properly fill out appropriate requisition forms, indicating the test(s) ordered.

Verify the patient's condition. Fasting, dietary restrictions, medications, timing, and medical treatment are all of concern and should be noted on the lab requisition.

Prepare the blood collection assembly, the needle is firmly adjusted to the tip of the syringe, a check is then made to see that the plunger is not stick with the barrel

.

Position the patient. The patient should sit in a chair, lie down or sit up in bed. Hyperextend the patient's

armSlide29

Apply the tourniquet 3-4 inches above the selected puncture site. Do not place too tightly or leave on more than 2 minutes.Slide30

The patient should make a fist without pumping the hand

.

Select the

venipuncture

site. Slide31

Prepare

the patient's arm using alcohol swab Cleanse in a circular fashion, beginning at the site and working outward. Allow to air dry.

Grasp the patient's arm firmly using your thumb to draw the skin taut and anchor the vein. The needle should form a 15 to 30 degree angle with the surface of the arm. Swiftly insert the needle through the skin and into the lumen of the vein. The needle should be in the bevel up position (needle opening facing upward).

When the last tube to be drawn is filling, remove the tourniquet. Slide32

Remove the needle from the patient's arm using a swift backward motion.

Press down on the gauze once the needle is out of the arm, applying adequate pressure to avoid formation of a hematoma.

Dispose

of contaminated materials/supplies in designated containers.

Mix and label all appropriate tubes at the patient bedside.

Deliver specimens promptly to the laboratory.Slide33
Slide34
Slide35

Discussion

:

There

are certain areas are to be avoided when choosing a site of vein puncture:

Extensive scars

from burns and surgery - it is difficult to puncture the scar tissue and obtain a specimen.

The upper extremity on the side of a

previous mastectomy

- test results may be affected because of lymphedema.

Hematoma

- may cause erroneous test results. If another site is not available, collect the specimen distal to the hematoma.

Intravenous therapy (IV)

/

blood transfusions

- fluid may dilute the specimen, so collect from the opposite arm if possible. Otherwise, satisfactory samples may be drawn below the IV by following these procedures:

Turn off the IV for at least 2 minutes before

venipuncture.

Apply the tourniquet below the IV site. Select a vein other than the one with the IV.

Perform the

venipuncture.

Draw 5 ml of blood and discard before drawing the specimen tubes for testing. Slide36

Hematoma

forms

under the skin adjacent to the puncture site - release the tourniquet immediately and withdraw the needle. Apply firm pressure.

Causes of hematoma:

The

needle may have gone through the vein

.

Remove the needle before removing the tourniquet.

The needle may not fully penetrate the upper most wall of the vein. (Partial penetration may allow blood to leak into the soft tissue surrounding the vein by way of the needle bevel). Failure to apply pressure to

the venipuncture

site.Slide37

To prevent hemolysis (which can interfere with many tests):

Mix tubes with anticoagulant additives gently 5-10 times

Avoid drawing blood from a hematoma

Avoid drawing the plunger back too forcefully, if using a needle and syringe, and avoid frothing of the sample

Make sure the

venipuncture

site is dry

Avoid a probing, traumatic

venipuncture

Massaging, squeezing, or probing a siteSlide38

Prolonged tourniquet application (no more than 2 minutes) may cause:

Hemoconcentration

which is defined as increased concentration of larger molecules and formed elements in the blood of non-filterable elements (i.e. proteins).

May lead to vein collapse.

Tissue ischemia.

Air must never be pumped into a vein because a few cubic centimeters of air pumped into a vein could cause death

.

Plunger of syringe must not be pulled pack with too much force, to avoid hemolysis of blood, or the force may pull the wall of the vein down on top of the bevel of the needle causing the blood flow to stop.Slide39

If an incomplete collection or no blood is obtained:

Change the position of the needle. Move it forward (it may not be in the lumen)  

Or move it backward (it may have penetrated too far).

Adjust the angle (the bevel may be against the vein wall).

Loosen the tourniquet. It may be obstructing blood flow.

Re-anchor the vein. Veins sometimes roll away from the point of the needle and puncture site.Slide40

If blood stops flowing into the tube:

The vein may have collapsed; remove the tourniquet to increase venous filling. If this is not successful, remove the needle, take care of the puncture site, and redraw.

The needle may have pulled out of the vein. Hold syringe firmly during drawing blood and keeping the index finger alongside the hub and

brancing

index on the patient arm. Slide41

Blood collecting tubes

Several types of blood collecting tubes are available, which are discriminated by their top color.

We choose the suitable tube based on the test requested. Slide42

Thank you