1. Mix tubes with anticoagulants 5-10x gently. Show
2. Avoid drawing from hematoma 3. Don't draw plunger back forcefully, and avoid frothing 4. Dry venipuncture site completely 5. Avoid probing, traumatic venipunctureIndwelling Pre-analytical testing phase It includes procedures such as laboratory handling and identification that take place prior to any laboratory testing. It has a proper control measures to avoid subsequent issues. It starts with the doctor's given order and ends when the laboratory testing has officially commenced. During this phase, aside from the ability to draw blood from the patient, the phlebotomist should also possess the skill of being able to identify factors that affect the process and address the same as needed. The laboratory test is used by the physicians to diagnose and monitor the presence of a disease. They compare the results to a reference range or reference interval. This range shows high and low limits of result values as compared to healthy individuals. Several factors are considered as part of the reference interval study or the interpretation of the data obtained. TRUE Laboratory test is used by physicians to diagnose and monitor the presence of a disease. The physicians compare the results to a reference range or reference interval. Reference range or Reference interval this range shows the high and low limits of result values as compared to healthy individuals. Several factors are considered as part of the reference interval study or the interpretation of the data obtained. Basal state It is an ideal in establishing reference range since it represents the condition of the metabolism of the body early in the morning or after approximately 12 hours of fasting. age factors that can influence the basal state. Age These are the factors (physiological variable) that affects blood collection Age Red Blood Cells (RBC), White Blood Cells (WBC), creatinine clearance Altitude red blood cells (RBC) Dehydration Hemoconcentration, Red Blood Cells (RBC), enzymes. Iron (FE), Calcium (Ca), Sodium (NA) Diet Glucose, lipids, electrolytes Diurnal Variation (Thyroid Stimulating Hormone) TSH, cortisol, Iron (Fe) Drug Therapy Enzymes, hormones Exercise/IM Injection (Potential of Hydrogen) pH, Carbon Dioxide Partial Pressure (PCO2 ), Creatinine Kinase (CK), Lactic Acid Dehydrogenase (LDH), glucose Fever Hormones, cortisol Gender Red Blood Cells (RBC), Hemoglobin (HgB), Hematocrit (Hct) Jaundice Yellow color interfaces due to increased biliburin Intramuscular Injection Creatine Kinase (CK) and the skeletal muscle fraction of LDH Position Protein, Potassium (K) Pregnancy Red Blood Cells (RBC) Smoking Cholesterol, cortisol, glucose, growth hormones (GH), triglyceride, White Blood Cells (WBC) Stress White Blood Cells (WBC), Iron (Fe), Adrenocorticotropic Hormone (ACTH), catecholamine, cortisol Temperature and Humidity Hemoconcentration Burns, Scars, &
Tattoos Problem areas to avoid and troubleshooting in the Site selection Burns, Scars, & Tattoos A site which has burns, scars or tattoos is not recommended because veins in the area may be difficult to examine and blood circulation maybe impaired. Burns may be too painful to touch and tattoos may also be susceptible to infection due to the dyes used that may interfere with the process. Damaged Veins Aside from encountering difficulty in puncturing the site when veins are damaged another problem is the possibility of getting inaccurate results. Veins could be Sclerosed or hardened or Thrombosed or clotted. Edema It is also known as oedema. It is an abnormal swelling caused by accumulation of fluid in the tissues. The tissues become fragile, making the task of locating the veins harder. This condition maybe due to reactions from medications, pregnancy, infections and other medical problems. Hematoma It is a solid swelling or mass of blood in the tissues which is caused by the leakage of blood from the vessels during venipuncture. This is not only painful because it obstructs the blood flow it could also lead to the contamination of blood sample. Mastectomy a treatment or procedure for breast cancer that requires removal of the breast through surgery. Blood drawing becomes a challenge since the lymph flow is obstructed, and there maybe swelling and infection after the surgery. In addition, tourniquet cannot be applied because it can cause injury. It should also be noted that it could also change the blood composition. Obesity A condition of an individual that is grossly overweight. Patients that are obese have veins are deep and they are harder to locate. A solution is to use a longer tourniquet or try locating the cephalic or cubital vein. Arterial
Line Vascular Access Sites and Devices Arterial Line To obtain samples for arterial blood gas and laboratory studies, critically ill patients require arterial lines where a thin catheter is inserted into an artery. This also used to monitor blood pressure continuously. Neither tourniquet nor venipuncture are allowed in the arm with an arterial line. Arteriovenous Shunt or Fistula It is a passageway created thru surgery which is usually in the arms with the intention of connecting the artery and a vein directly. This maybe created for hemodialysis treatment or pathological process such as erosion of arterial aneurysm. Blood Sampling Device A blood sampling device is used to avoid the use of needle sticks, reduce infections, and reduce wastage from line draws. The device collects blood from the arterial or central venous catheter where it is connected. Heparin or Saline Lock It is commonly called a "hep-lock." It is an intravenous (IV) catheter attached to a stopcock or cap with diaphragm. The basic function is to provide access for administering medicine or drawing blood from the patient. This is threaded in the peripheral vein which is in the lower arm above the wrist for up to 48 hours. It is usually flushed with heparin or saline (to prevent clogging) and capped for future use. Intravenous (IV) Sites An IV line is a thin plastic tube or catheter inserted into a vein in the forearm to inject a volume of fluids into the bloodstream. The phlebotomist should avoid collecting blood from the arm with IV because the blood collected could be contaminated with IV fluid. If blood collection is necessary, collection site should be below the IV. Take note that collection of blood from known previously IV sites should be avoided for 24 to 48 hours.
Central Vascular Access Devices (CVADs) CVADs is also known as indwelling lines which is a tubing inserted to the main vein or artery used for blood collection, monitoring the patient's pressures and administering medications and fluids. Central Venous catheter lines 3 types of Central Vascular Access Devices (CVADs) Central Venous Catheter It is also known as a central line inserted into the large vein (subclavian) and advanced into superior vena cava. Implanted Port It is a surgically implanted disk-shaped chamber attached into the indwelling line. This is usually placed on the upper chest just below the collarbone. Peripherally Inserted Central Catheter (PICC) It is a flexible tube inserted into the veins of extremities and the central veins. Allergies to Equipment and Supplies 7 Complications associated with Blood Collection Allergies to Equipment and Supplies When the patient has adhesive allergy, a gauze should be placed over the site and should be removed after fifteen minutes. The alternative is to ask the patient to apply pressure for five minutes. For Antiseptic allergy, simply use a different antiseptic. And for latex allergy, look for a sign to indicate the allergy and use a non-latex alternative for gloves, tourniquet and bandages. Excessive Bleeding When a patient is on aspirin or anticoagulant, the bleeding may take a longer time. The pressure should be applied to the site until the bleeding stops. The attention of the authorized personnel should be called when the bleeding continues after five minutes. Fainting It is a temporary loss of consciousness which is caused by the insufficient flow of blood to the brain. If the patient is prone to fainting during venipuncture, they are asked to lie down during the procedure. Nausea and Vomiting When the patient feels nauseous and has the tendency to vomit, the phlebotomist has to discontinue the procedure until the patient feels better or until the feeling subsides. An emesis basin or wastebasket should be provided, and a cold damp washcloth should be applied in the forehead. Pain The patient should be warned before the needle insertion, and the phlebotomist should avoid redirection of the needle. If the patient complains of extreme pain or numbness, remove the needle and apply ice to the site because this could indicate nerve involvement. The phlebotomist needs to document the incident if the condition persists. Petechiae This condition involves the appearance of small red or purple spots that look like rashes, which appears on the arm when tourniquet is applied. Seizures/Convulsion When seizures or convulsions occur, the blood draw should be discontinued immediately. Hold pressure over the site but make sure that movement is not restricted, the mouth is free from any obstruction and the patient is protected from self-injury. Call the attention of the first-aid personnel. Hematoma Formation 10 Procedural Error Risks and Failure to draw blood Hematoma Formation The phlebotomist should hold pressure on the site immediately after discontinuing the draw. A cold compress or ice pack maybe offered to help address the swelling. -Excessive or blind probing These are the conditions that can trigger hematoma: Iatrogenic Anemia This results from blood loss due to blood draw. It is important to ensure to collect only the required specimen volume because if 10% of the blood volume is removed at once from the body, the patients could face a threat. Inadvertent Arterial Puncture This happens when blood is filling up the tube rapidly and there is a rapid formation of hematoma on the site. Infection Infection can be avoided by making sure that tapes or bandages are not opened ahead of time; needles are not preloaded into the tube holders, insertion site of the needle is not touched after sterilization; cap is removed just before venipuncture, and; patients are advised to keep the bandage on the site for at least 15 minutes. Nerve Injury Nerve injuries happens when there is improper site selection, rapid needle insertion, excessive redirection of the needle and blind probing. If the initial attempt is not successful, the phlebotomist should try to redirect the needle by using a slightly forward or backward movement. The next step is to remove the needle and look for an alternative site. Reflux of Anticoagulant To avoid blood that has already been drawn to flow back into the vein from the collection tube, which may cause adverse reaction because of the presence of tube additives, make sure to keep the arm of the patient in a downward position and the tube just below the venipuncture site. Vein Damage Damaging the vein could be avoided by following the proper technique and avoiding blind probing. Hemoconcentration 5 Specimen Quality Hemoconcentration It is a decrease in the fluid content or plasma volume which is usually caused by tourniquet that stagnates the normal flow of blood, leading to the increase in concentration of red blood cells and other nonfilterable large molecules. Hemolysis It is also called Haemolysis, refers to the rupture pes of the red blood cells. The hemoglobin is then released to the surrounding fluid. Partially Filled Tubes This happens when the phlebotomist pulls a tube before reaching the required volume which may lead to the incorrect blood-to-additive ratio. Specimen Contamination This means that the specimen is compromised due to incorrect handling, which includes allowing alcohol, powder or other materials into the sample. Getting glove powder or perspiration into films and specimens, using the wrong antiseptic, or simply not following the proper antiseptic procedure could interfere with the results. Wrong or Expired Collection Tube It should not be used because the manufacturer could not warrant the quality of the seal and pressure after the expiration date declared in the tube. Venipuncture attempts could fail due to improper seating of the tube and failure of the needle to go through the stopper. TRUE The phlebotomist must be aware and must take measures to ensure that the proper procedures are followed. TRUE The needle position is critical to the success of the venipuncture TRUE -Needle not inserted far enough The phlebotomist should ensure that the following do not happen: Collapsed Vein This usually occur when conditions are less than ideal, which leads to the veins being blocked, resulting to insufficient blood flow. This happens when there is a strong pressure in the vacuum of the tube or plunger, the tourniquet is too close to the site or it is too tight, or when the tourniquet was removed during the draw. Tube Vacuum To avoid failure due to loss of vacuum, the phlebotomist should make sure that the bevel is not partially out of skin and the tube itself is not damaged. What can happen to the sample if a phlebotomist fails to notice the collection tube used is expired when drawing blood for testing?If a blood collection tube is used past its expiration date, the vacuum may not draw the amount of blood needed to fill the tube completely. Short-filled tubes may not be acceptable for testing and the specimen would have to be recollected.
What is the most serious error in phlebotomy?The most serious error is failure to properly identify the patient. Even if everything else is done perfectly, the final result will not apply to the patient incorrectly presumed to be the source.
How can you prevent hemolysis quizlet?How to prevent hemolysis? 1. Mix tubes with anticoagulants 5-10x gently.
Which of the following precautions should a phlebotomist take when perform venipuncture on a patient who is on active anticoagulant therapy?Phlebotomy 1. |
What can happen to the sample if a phlebotomist fails to notice the collection tube used is expired when drawing blood for testing quizlet?
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