Introduction Rough Draft for Final Project

In a clinical setting a lot can be required of attending nurses and medical assistants.

During a shift meds are passed, vitals are taken, and tests are ordered, all of which benefit the

patient's health. One of the best diagnostic tools is to have blood drawn from a patient, also

known as 'having labs ordered.' The blood can be viewed as concordance of the body, and

through blood a primary care provider can research and study different factors affecting the body.

To obtain blood is the first step in the process of studying a sample. In the following document

the steps in preparation, the drawing of the blood, the disposal of tools, and the proper way to

send labs will be outline in an easily accessible format.

It is important to review some basic terminology and physiology of the blood system

before beginning with any procedure. As a technician using phlebotomy in the work force the

first time drawing blood can be a bit nerve wrecking to some, and cause some basic steps and

skills to be forgotten. This is completely understandable, but must be overcome in a short amount

of time to begin giving a high level of care and treatment for patients.

Each patient’s diagnosis will almost always be based upon their lab results. Lab results

give clarity due to the fact that so much of the body is made up of blood. The average person has

about 5 l of blood in them. The blood is made up of two components, plasma which is a liquid

derived from the intestines and organs of the body, and the cells that make up the solids in the

blood are originally formed by bone marrow. ( page 17)The cell part of the blood can be divided

into three main group, erythrocytes, leukocytes, and platelets or thrombocytes. Erythrocytes are

commonly known as red blood cells and leukocytes are commonly known as white blood cells.

The white blood cells can be further divided into two main subgroups, Granulocytes, and Non
granulocytes. (page 17) The granulocytes are made up of Neutrophils, Eosinophils, and

Basophils. The non granulocytes are made up of Lymphocytes and Monocytes.(page 17) All of

these groupings of the different types of cells in the body are important to know during the

diagnosis of blood samples. Each of these components of blood can undergo changes leading to

positive or negative results on the body that could potentially cause severe damage to organs and

the body as a whole.

The damages to the body are a result of some disorder in a component of the blood.

Frances Fischbach in her manual of laboratory tests states the disorders of red blood cells,

leukocytes disorders, and platelet disorders as an introduction to the importance of the different

parts of blood needing to be in the right range of quantity. “With red blood cells a patient can

suffer from anemia which is a severe reduction in the circulation of red blood cells or

polycythemia which is an abnormal increase in the red blood cell count. The white blood cells

can suffer from a increase number of leukocytes called leuokocytosis or a decrease in the number

of leukocytes called leucopenia.”(Fischbach) Platelet count is also important. An example of a

direct result of thrombocytopenia which is a decreased number of platelets, can lead to

hemorrhaging which ultimately is a major cause of a stroke. The other example of platelet count

affecting a patient is when a person is suffering from thrombocytosis which is an increased

number of platelets. This can cause an abnormality in the way the blood clots which could lead

to abnormal bleeding or abnormal clotting. (Page 17)

The primary way to obtain blood from an individual is through venipuncture. The blood

is acquired from the preferred site of the antecubital vein. During your preparation of drawing

blood you will need to decide what size needle if most suitable for your patient. Fischbach states,

“The size of a needle and syringe is determined by the amount of blood needed as well as the
 size and integrity of the vein being used. Furthermore, many hospitals use the Vacutainer system

because it is cheaper. The Vacutainer System consists of a vacuum tube (Vacutainer tube), a

holder, and a multi sample collecting needle.” After you have chosen the proper needle you will

need to gather the vacutainer tubes with the correct colored tops. The colors of the test tubes are

correlated with the test being ordered. For example, if a primary care provider asks a technician

to obtain a CBC with DIFF, then the proper colored top would be lavender. A two columned table

will be documented later in the instructions listing the tube tops matched with the tests that can

be matched to the color.

As a technician in the form of a nurse or medical assistant one must remember that

drawing labs from a patient is to be done carefully. In Fishbach’s manual, the author gives a

clinical alert to possible problems that may arise if the venipuncture is done incorrectly. Please

review the following outlined information from Frances Fischbach’s manual of laboratory and

diagnostic tests :

• If oozing from the puncture site is difficult to stop, elevate the area and apply a pressure

dressing. Stay with the patient until the bleeding stops.

• Never draw blood for any laboratory test from the same extremity that is being used for

intravenous medications, intravenous fluids, or blood.

• In patients with leukemia or agranulocytosis and in others with lowered resistance, the

finger stick and earlobe puncture are more likely to cause infection and bleeding than

venipuncture. If a capillary sample is necessary in the patients, the cleansing agent should remain

in contact with the skin for at least 7 to 10 minutes. Alcohol is bactericidal; povodoneiodine is

the cleansing agent of choice on patients with leukemia.

• If difficulty in encountered obtaining blood

 • Warm the extremity (this must be done for all blood gases)

• Allow the extremity to remain in a hanging position for some time.

• Hematomas can be prevented by

• Using good technique

• Releasing the tourniquet before the needle is removed

• Applying sufficient pressure over the puncture site after completion of the procedure

With the understanding of the information listed above, and the general overview of

blood physiology the instructions can now be followed with a better understanding. The blood’s

components are diminutive yet must be balanced properly for the overall health and well being

of a patient. Medical technicians are responsible for making effective decisions towards how to

draw a patient’s labs, what tools will be needed, and how to properly treat the area of the

venipuncture. Keeping all these items in the foreground of one’s mind, the following set of

instructions, tables, and pictures will be easy to follow and helpful in one’s medical career and

treatment of patients.