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ADVANCE PATHOLOGY
1.2A BASIC PRINCIPLES OF PHLEBOTOMY
PHLEBOTOMY: HISTORICAL PRACTICE
1.
2.
3.
4.
MODERN PHLEBOTOMY
Diagnosis and management of disease
Remove blood for transfusions
Therapeutic reasons:
Polycythemia
Hemochromatosis
BLOOD FUNCTION
Supplies nutrients to tissues:
O2, hormones, glucose
Removes end-products of metabolism:
CO2, urea, creatinine
Provides defense mechanism: WBC, antibodies
Prevents blood loss:
platelets, coagulation proteins
COAGULATION REACTION
Clotting factors + calcium thrombin
Fibrinogen + thrombin
fibrin strands
ANTI-COAGULANTS
Remove calcium
Neutralize thrombin
Whole blood
Plasma
Serum
APPEARANCE
Normal: clear and yellow
Abnormal:
BLOOD COMPOSITION
Have an expiration
date
COAGULATION
In vivo
Blood is fluid
Clot is formed to
protect injured vessel
In vitro
Spontaneous reaction
Advance
Pathology
RED-TOP TUBE
Glass
Plastic
No additive
Glass surface
activates clotting
sequence
Do not mix
SERUM: use for serum chemistry, Therapeutic Drug
Monitoring
Contain additive to activate clotting sequence
Contain inert gel serum separating tube (SST)
Do invert to mix additive and initiate clotting
sequence
SERUM: use for serum chemistry
PURPLE-TOP TUBE
Anticoagulant = EDTA
Binds calcium
PLASMA whole blood
BLUE-TOP TUBE
Anticoagulant = sodium citrate
Binds calcium
PLASMA whole blood
Must be full
Blood:anticoagulant ratio critical
Must be on ice if not analyzed within 30 minutes
Coagulation studies (e.g. Prothrombin, aPTT)
GREEN-TOP TUBE
Anticoagulant = heparin
Three formulations:
Lithium heparin
Ammonium heparin
Sodium heparin
Inhibits thrombin formation
Must be full and on ice if need pH, ionized Ca
Most plasma chemistry tests, STAT lab (plasma separator
tube/PST)
Decreases time needed for blood to clot,
Makes turnaround time better
GREY-TOP TUBE
Anticoagulant = potassium oxalate
Binds calcium
Paternity testing
DNA
SPS = sodium polyanethol sulfonate
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Advance
Pathology
MODES OF TRANSMISSION
Parenteral: any route other than the digestive tract
Intramuscular
Non-intact skin: chapped hands,
Intravenous
cuts, cuticles
Subcutaneous
Percutaneous: needles, sharps
Mucosal
Permucosal: mouth, nose, eyes
Ingestion
INFECTION CONTROL
Stop the spread of infection
Hand washing
Lab coat
Gloves
Mask
Standard precautions at all times
ENGINEERING CONTROL
1.
2.
3.
4.
6.
SAFETY PRACTICES
For infection to spread:
1. Infectious substance: HBV, HCV, HIV
2. Mode of transmission
3. Susceptible host
5.
Test
Whole blood: EDTA or heparin?
Plasma: EDTA or heparin?
Serum: trace free? Separator gel interference?
7.
Sharps container:
Biohazard marking
Puncture resistant
Latex allergy
Needles
MULTI-SAMPLE NEEDLE
PPE
Sharps containers
Safer medical devices
EQUIPMENT
PPE: gloves, lab coat, mask
Cleaning agent
Advance
Pathology
BUTTERFLY NEEDLE
8.
Tube holder/
vacutainer adapter
Threaded
Flanges
Syringe
Quick
Least risk of accidental needle stick
More control
Reposition easily
Will see flash of blood in syringe hub when vein
successfully entered
THE PATIENT
Approach
Communication
Empathy
Handling special situations
Patient identification
Arm band
Legal document
Prepare patient for blood draw
Latex allergy?
SELECTING THE SITE
Antecubital area most
often accessed
Hand or wrist
Remember: 2 arms
Use tip of index finger on
non-dominant hand to
palpate area to feel for
the vein
9. Syringe
10. Black
water proof
pen
Never pencil
Legal document
Print legibly
Required information: 5 items
Patient name
Identification number
VACUTAINER OR SYRINGE?
Vacutainer
Most economical
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Advance
Pathology
(military time)
Your initials
FAILURE TO OBTAIN BLOOD
Check tube position and vacuum
NO NEEDLE MOVEMENT
You must anchor the blooddrawing equipment on the
patients arm to minimize
chance of injury
FILL TUBES
Use correct order of draw:
Blood cultures
Red top
Green
Purple
Grey
WITHDRAW NEEDLE
First release tourniquet
Disengage tube
Place cotton directly over needle, without pressing down
Withdraw needle in swift, smooth motion
Immediately apply pressure to wound
Do not bend arm
Other arm
Hand
Use clean needle
Use fresh syringe if contaminated
Only try twice
POOR COLLECTION TECHNIQUES
Venous stasis
Drawing above IV
Traumatic stick
Inadequate mixing
Traumatic stick
Partially filled tubes
Short draw
Drawing above IV
Specimen handling
Exposure to light
Pre-chilled tube
Body temperature
VENIPUNCTURE PROCEDURE
Remain calm
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Advance
Pathology
Organize yourself
Organize your equipment: STICK TO ELEVEN
Gloves
Lab coat
Alcohol wipe
Cotton ball
Bandage/tape
Sharps container
Tourniquet
Needle
Water-proof marker
Wash hands
Put on gloves
Identify patient
Latex allergy?
Position arm
Apply tourniquet
Locate vein
Release tourniquet
Cleanse site in outward
rotation
Reapply tourniquet
Do not
contaminate
site
Anchor vein
Insert needle
Fill tubes
Quick mix
additive tubes
Release tourniquet
Withdraw needle
SYRINGE DRAW
1.
2.
SKIN PUNCTURE
Method of choice for infants, children under 1 year
Adults
Scarred
Fragile veins
Hardened veins
Patients with IV
CAPILLARY BLOOD
Mixture of arterial, venous, capillary blood and fluid from
surrounding tissues
Fluid from surrounding tissues may interfere and/or
contaminate the specimen
Warming skin puncture site increases arterial blood flow to the
area
Reference ranges often differ from venous (usually capillary
blood values are lower)
SKIN PUNCTURE EQUIPMENT
PPE
Cleaning agent
Advance
Pathology
3.
4.
5.
6.
Sharps container
Warming device
Commercial warmer
7.
Lancet
8.
9.
Heparin
Serum
Apply pressure to puncture site
Label specimen in sight of patient (indelible marker)
Always use
standardized equipment
Capillary tubes
Microtainers
Micropipet diluting
system
Glass slides: used to prepare
blood smears
1.
2.
3.
4.
5.
6.
7.
8.
9.
SKIN PUNCTURE
Capillary blood collection is inappropriate for:
Severely dehydrated patients
Patients with poor circulation
Coagulation studies requiring plasma specimens
Tests that require large volumes of blood (i.e. Erythrocyte
Sedimentation Rate (ESR) and blood cultures)
__________________________________________________________
END OF TRANX
Collect sample
Blood smear
EDTA
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