Preparation of the Patient BLOOD SPECIMEN

COLLECTION PROCESSING

BY: Annabel Lapuz-Carungin, MD, RMT, PT, RN, RM, MAN

Preparation of the Patient

Factors might influence laboratory determinations: 1. 2. 3. 4. 5. 6. 7. 8. Diurnal variation Exercise Fasting Diet Ethanol consumption Tobacco smoking Drug ingestion Posture

 Some test requires at least 8 hours of fasting.

Blood
is the most frequent body fluid used for analytical purposes.
Three general procedures for blood collection: 1. Venipuncture (blood chemistry) 2. Arterial puncture (ABG) 3. Skin puncture (pediatric client)

Technique for Venous Puncture

1. Verify requisitions 2. Client identification 3. Specimen required (fasting/non-fasting) 4. Inform client of the procedure, client reassurance. 5. Proper positioning of client 6. Preparation of equipment & proper labelling 7. Selection of suitable vein for puncture.
Ideal: antecubital fossa (median cubital & cephalic vein)

9. Apply tourniquet 10. Perform the venipuncture (15 degree angle) 11. Release tourniquet 12. Place a sterile cotton & apply pressure 12. Withdraw needle 13. Transfer specimen 14. Check condition of client 15. Dispose contaminated materials
NOTE: Open & close of fist during phlebotomy is of no value and may increase in potassium hence, should be avoided.

8. Cleanse site with 70% alcohol or 1% iodine-saturated swabstick

COMPLICATIONS:
Prolonged application of a tourniquet results in increase blood concentration (hemoconcentration)

1. Missed vein

Hematoma collapse of small vein

2. Excessive pull on syringe plunger 3. Clients syncope 4. Excessive bleeding 5. Vein thrombosis 6. Infection of the site of venipuncture

Failure of to obtain blood after two attempts is an indication that another phlebotomist should make an attempt.

NOTE: Draw specimens into non-additive tubes before tubes with additives.

Fill additive-containing tubes in the following order:

1. Blood culture tubes (yellow/black stopper) 2. Red stopper tube 3. Blue stopper tube 4. Green stopper tube 5. Lavender stopper tube 6. Gray stopper tube

Commonly used evacuated tubes

(with the corresponding color coding and additive) STOPPER COLOR RED Red/gray, red/black Lavender Orange Blue Gray Green ADDITIVE None Contains separator material EDTA Thrombin Na Citrate a. Na flouride/K oxalate b. Iodoacetate Heparin ACTION Allows blood to clot
Material serves as a barrier between serum & cells

Binds calcium
Accelerates clot formation

Binds calcium Inhibits glycolytic enzyme Inhibits thrombin activation

Skin Puncture
used for pediatric patients uses a sharp lancet pierce the skin and a capillary tube for sample collection Site: Outer area of the bottom of the foot (Heel stick) Fleshy part of the middle of the last phalanx of the 3rd or 4th (ring) finger (Finger stick) Fleshy part of the earlobe

Sample Processing
(Pre-analytical Level)

1. Correct matching of blood collection tube(s) with the appropriate analyte request and patient/client identification labels. 2. Check if sample is acceptable for further processing  Amount/volume of sample sufficient  Proper anticoagulant or preservative  Timing is indicated  Specimen is intact  Properly transported 3. Centrifuge sample to separate serum/plasma from the cells

Once processed samples should be analyzed within 4 hours; to minimize the effects of evaporation, samples should be properly capped and kept away from areas of rapid airflow, light and heat

Refrigerated at 4C for 8 hours Frozen at -20C

Avoid repeated cycles of freezing and thawing. (occurs in frost-free freezers)

Sample Variables
1. Physiologic consideration a. Diurnal or circadian variation b. Exercise c. Diet d. Stress e. Gender f. Age g. Underlying medical conditions h. Drugs i. Posture 2. Proper patient preparation 3. Problems in collection, transportation, processing and storage

Thank You