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Phlebotomy     Dr. Asela KalingaNeerogya Health Care Pvt Ltd      Neerogya Health Care Pvt Ltd   Dr Asela
What is phlebotomy• withdrawal of blood from a vein, artery, or the  capillary bed for lab analysis or blood  transfusion....
Who is a phlebotomist• Collects blood and other specimens• Prepares specimens for testing• Interacts with patients & healt...
PhlebotomistNeerogya Health Care Pvt Ltd   Dr Asela
Laboratory work flow cycle       Neerogya Health Care Pvt Ltd   Dr Asela
Neerogya Health Care Pvt Ltd   Dr Asela
What do you keep•   Professionalism•   Confidentiality•   Attitude•   Appearance•   Safety                 Neerogya Health...
Professionalism  Neerogya Health Care Pvt Ltd   Dr Asela
Confidentiality• All employees are responsible for maintaining  confidentiality of medical information                Neer...
Attitude• Tone of voice and facial expression will  determine how patients respond to you.• Always be polite, friendly, ca...
Neerogya Health Care Pvt Ltd   Dr Asela
• polite           Neerogya Health Care Pvt Ltd   Dr Asela
• friendly             Neerogya Health Care Pvt Ltd   Dr Asela
• calm         Neerogya Health Care Pvt Ltd   Dr Asela
• considerate                Neerogya Health Care Pvt Ltd   Dr Asela
Appearance• Your personal appearance will also affect the  impression you make.• Comply with your facility’s dress code an...
Neerogya Health Care Pvt Ltd   Dr Asela
SafetyNeerogya Health Care Pvt Ltd   Dr Asela
Anatomy &         Physiology      Neerogya Health Care Pvt Ltd   Dr Asela
Anatomy is the branch of science concerned  with the study of the structure of the body.Physiology is the branch of scienc...
• The cardiovascular system consists of the  Heart, and Blood Vessels.• Its main function is circulate oxygenated blood  f...
Neerogya Health Care Pvt Ltd   Dr Asela
Structure of capillary     Neerogya Health Care Pvt Ltd   Dr Asela
How to select site for bleeding         Neerogya Health Care Pvt Ltd   Dr Asela
• Vein should feel like spongy tube.                Neerogya Health Care Pvt Ltd   Dr Asela
Neerogya Health Care Pvt Ltd   Dr Asela
Blood Components    Neerogya Health Care Pvt Ltd   Dr Asela
• Circulating whole blood is a mixture of:• Plasma (which contains fluid, proteins, and  lipids), and• Formed elements, co...
Whole            BloodNeerogya Health Care Pvt Ltd   Dr Asela
RBCNeerogya Health Care Pvt Ltd   Dr Asela
WBCNeerogya Health Care Pvt Ltd   Dr Asela
PlateletsNeerogya Health Care Pvt Ltd   Dr Asela
Blood Clot• When a blood sample is left standing without  anticoagulant, it forms a coagulum or blood  clot.• The clot con...
Neerogya Health Care Pvt Ltd   Dr Asela
Neerogya Health Care Pvt Ltd   Dr Asela
PlasmaNeerogya Health Care Pvt Ltd   Dr Asela
Serum• Serum contains all the same substances as  plasma, except for the coagulation  proteins, which are left behind in t...
Equipments   Neerogya Health Care Pvt Ltd   Dr Asela
•   Trays•   Blood Collection tubes•   Syringes•   Needles•   Lancets•   Tourniquets•   Sterilization•   Bandaging Materia...
• Marking Pen• Washing material• Cool box/ Refrigerator                Neerogya Health Care Pvt Ltd   Dr Asela
TraysNeerogya Health Care Pvt Ltd   Dr Asela
• Trays should be sanitized daily using  appropriate disinfectant• Kept Organized and well-stocked.                Neerogy...
Blood Collection tubes• glass or plastic tube with a rubber stopper.• It has a vacuum so that blood will flow into  the tu...
Green tube / Lavender•   EDTA to prevent clotting•   hematology studies.•   Should be completely filled•   Must be inverte...
Neerogya Health Care Pvt Ltd   Dr Asela
“MCV is not influenced by K3EDTA concentrations up to ten times normal, while K2EDTA, at high concentrations, results in a...
Red tube• No additives• Blood bank tests, toxicology, serology• Must not be inverted after filing                Neerogya ...
Neerogya Health Care Pvt Ltd   Dr Asela
Light blue• sodium citrate.• coagulation (clotting) studies.• must be completely filled• must be inverted immediately afte...
Neerogya Health Care Pvt Ltd   Dr Asela
Function of Sodium CitrateSodium citrate act as chelating agent to bind the  calcium in the blood.Calcium need    * To mak...
ESR tube           Neerogya Health Care Pvt Ltd   Dr Asela
Gel & Clot activator                Neerogya Health Care Pvt Ltd   Dr Asela
What is gel tube ?• Gel tubes are Serum tubes, with presence of  clot activator and separator Acrylic gel for  automatic s...
Gel Advantages• Gel forms Stable barrier between the Separated serum and clot.    – Prevents interference of substances re...
Neerogya Health Care Pvt Ltd   Dr Asela
• Fluoride tube• Inhibitor for glycolysis + anticoagulant• Sodium Fluride +potassium oxalate.• glucose levels.            ...
Neerogya Health Care Pvt Ltd   Dr Asela
Neerogya Health Care Pvt Ltd   Dr Asela
See expiry date on tube     Neerogya Health Care Pvt Ltd   Dr Asela
SyringesNeerogya Health Care Pvt Ltd   Dr Asela
Components of syringe     Neerogya Health Care Pvt Ltd   Dr Asela
Types of syringe• Luer lock syringe                Neerogya Health Care Pvt Ltd   Dr Asela
• Slip tip syringe                 Neerogya Health Care Pvt Ltd   Dr Asela
• Eccentric tip syringe                 Neerogya Health Care Pvt Ltd   Dr Asela
• Catheter tip syringe                Neerogya Health Care Pvt Ltd   Dr Asela
NeedlesNeerogya Health Care Pvt Ltd   Dr Asela
Components of needle    Neerogya Health Care Pvt Ltd   Dr Asela
Colour codeNeerogya Health Care Pvt Ltd   Dr Asela
Butterfly Needle  Neerogya Health Care Pvt Ltd   Dr Asela
• Winged infusion set• Difficult venupuncutre including pediatric  draws• with a syringe or a holder and vacuum  collectio...
Neerogya Health Care Pvt Ltd   Dr Asela
Neerogya Health Care Pvt Ltd   Dr Asela
LancetsNeerogya Health Care Pvt Ltd   Dr Asela
• Lancets are used for difficult  venupuncutre, including pediatric draws.                Neerogya Health Care Pvt Ltd   D...
TourniquetsNeerogya Health Care Pvt Ltd   Dr Asela
• Vein easier to SEE, FEEL, and PUNCTURE               Neerogya Health Care Pvt Ltd   Dr Asela
SterilizationNeerogya Health Care Pvt Ltd   Dr Asela
Bandaging Material   Neerogya Health Care Pvt Ltd   Dr Asela
Gloves• Gloves must be worn for all procedures  requiring vascular access.• Non-powdered latex gloves are most  commonly u...
Collecting of blood sample     Neerogya Health Care Pvt Ltd   Dr Asela
Greeting• Always greet patient in a professional, friendly  manner.• A good initial impression will earn the patients  tru...
• The more relaxed and trusting your  patient, the greater chance of a successful  atraumatic venupuncutre.• Good verbal, ...
Identification of patient• Make sure the name, medical record  number, and date of birth on your  order/requisition match ...
• Never rely on the patient name on the door or  above the bed. Patients are frequently moved  from room to room.         ...
Standard Precautions01. Hand wash                Neerogya Health Care Pvt Ltd   Dr Asela
Proper method                Neerogya Health Care Pvt Ltd   Dr Asela
Neerogya Health Care Pvt Ltd   Dr Asela
Applying glovesPatients are often reassured thatproper safety measures are beingfollowed when gloves are put on intheir pr...
Positioning the Patient     Neerogya Health Care Pvt Ltd   Dr Asela
• Comfortable position• Turn the arm so that the wrist and palm face  upward, and the antecubital area is accessible• When...
Neerogya Health Care Pvt Ltd   Dr Asela
Applying the tourniquet• Tie the tourniquet just above the elbow.                Neerogya Health Care Pvt Ltd   Dr Asela
• The tourniquet should be tight enough to stop  venous blood flow in the superficial arm veins                Neerogya He...
Neerogya Health Care Pvt Ltd   Dr Asela
• The tourniquet should be applied a maximum  of 1 – 2 minutes, approximately 2 to 3 inches  above the antecubital fossa  ...
• After applying the tourniquet, you may ask  the patient to make a fist to further distend  the arm veins                ...
• Patients often think they are helping by  pumping their fists• This is an acceptable practice when donating  blood, but ...
Preferred sites• The median cubital vein• Cephalic vein, or the Basilic vein.                 Neerogya Health Care Pvt Ltd...
• Veins on the back of the hand.• Use a much smaller needle for these hand  veins.               Neerogya Health Care Pvt ...
• Using the nondominant hand routinely for  palpation may be helpful when additional  palpation is required immediately be...
Never draw from these areas• Scarred, abraded, or inflamed skin                Neerogya Health Care Pvt Ltd   Dr Asela
Neerogya Health Care Pvt Ltd   Dr Asela
• Arms containing IV catheters               Neerogya Health Care Pvt Ltd   Dr Asela
• Oedematous arms             Neerogya Health Care Pvt Ltd   Dr Asela
• Occluded Veins• Shunts               Neerogya Health Care Pvt Ltd   Dr Asela
Neerogya Health Care Pvt Ltd   Dr Asela
Cleansing the site• Isopropyl alcohol swab• Outward expanding spiral starting with the  actual venupuncutre site.• Allow t...
Hold vein in place   Neerogya Health Care Pvt Ltd   Dr Asela
• Insert needle                  Neerogya Health Care Pvt Ltd   Dr Asela
Neerogya Health Care Pvt Ltd   Dr Asela
• Gently push the tube onto the needle holder  so that the catheter inside the needle holder  penetrates the tube.• Blood ...
Blood won’t flowIf you do not see blood flow, the tip of the     needle:1.   May not yet be within the vein.2.   May have ...
Incomplete collection or no blood is             obtained• Change the position of the needle. Move it  forward (it may not...
• 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.• Try another tube. There may be no vacuum in  the one being us...
Other Problems• A hematoma forms under the skin adjacent to  the puncture site - release the tourniquet  immediately and w...
• The blood is bright red (arterial) rather than  venous. Apply firm pressure for more than 5  minutes                 Nee...
Removing the Needle• Gently release the tourniquet before the last  tube of blood is filled• Remove the last tube from the...
• Quickly place clean gauze over the site, and  apply pressure.• You may ask the patient to continue applying  pressure un...
• Apply pressure to the puncture site and  instruct the patient to keep the arm in a  straight position. Have the patient ...
• Take this time to invert any tubes that need to  have anticoagulant mixed with the blood.• Label specimens.             ...
Neerogya Health Care Pvt Ltd   Dr Asela
Re-inspect the puncture site to make sure  bleeding has stopped, and apply a bandage.               Neerogya Health Care P...
Needle disposal• Remove the needle from the holder if  appropriate, and properly discard it in an  approved sharps disposa...
Neerogya Health Care Pvt Ltd   Dr Asela
Neerogya Health Care Pvt Ltd   Dr Asela
Specimen Labeling• Label specimens at the bedside according to  your institution’s standard procedures, or  apply pre-prin...
Proper labelling generally includes• Patient’s first and last name• Hospital identification number• Date & time• Phlebotom...
Labeling Errors• Labeling errors are the most common cause of  incorrect laboratory results.• If detected, the incorrectly...
Finger stick-Specimen collection          Neerogya Health Care Pvt Ltd   Dr Asela
• A safety Lancet, which controls the depth of  incision• Finger-sticks should not be performed on  children under one yea...
• Select a safety lancet appropriate for the size  of the patient’s finger.• You may warm the finger prior to puncture to ...
• Collect blood into an appropriate tube.• Label specimens appropriately.• Make sure bleeding has stopped. Apply an  adhes...
Neerogya Health Care Pvt Ltd   Dr Asela
Heel stick• Veins of small children and infants are too  small for venupuncutre;• Butterfly needles may be used to collect...
Heel stick neonatal blood collection• These devices are designed to control the  depth of incision, since going too deep i...
• Firmly grasp the infants foot.• Do not use a tourniquet.• The heel may be warmed with a cloth to help  increase blood fl...
• Puncture the left or right side (outskirt) of the  heel, not the bottom of the foot.• Wipe away the first drop of blood ...
• Collect the blood into the appropriate tube.• Do not: Squeeze the infant’s foot too tightly  and wipe with alcohol durin...
• After collection is completed, apply pressure  to the puncture site with a sterile gauze pad  until bleeding has stopped...
Special    situations     Neerogya Health Care Pvt Ltd   Dr Asela
•   Patients refusing blood work•   Fainting•   Unsatisfactory Specimens•   Haemolysis•   Clots•   Insufficient volume•   ...
Patients refusing blood work• If someone hesitates to let you collect a blood  specimen, explain to them that their blood ...
Fainting• Rarely, patients will faint during  venupuncutre.• It is therefore important that patients are  properly seated ...
Signs and symptoms of fainting•   Weakness•   Lightheadedness•   Nausea•   Sweating•   Rapid breathing (hyperventilation)•...
what to do• Gently remove the tourniquet and needle  from the patients arm, apply gauze and  pressure to the skin puncture...
If the patient is seated                 Neerogya Health Care Pvt Ltd   Dr Asela
Get him or her to lie down. (If they are in a situation or place where they really cant liedown then sitting down is the n...
If someone faints:   – Check the ABCs (airway, breathing, circulation), and, if     necessary, begin CPR and call emergenc...
Recovery position  Neerogya Health Care Pvt Ltd   Dr Asela
Neerogya Health Care Pvt Ltd   Dr Asela
Unsatisfactory Specimens• They can cause misleading laboratory results• Must be rejected by the laboratory.• The patient m...
Neerogya Health Care Pvt Ltd   Dr Asela
Haemolysis• Haemolysis means the breakup of fragile red  blood cells within the specimen, and the  release of their hemogl...
Causes of Haemolysis• Using a too small needle for a relatively bigger  vein• Pulling a syringe plunger too rapidly• Expel...
Neerogya Health Care Pvt Ltd   Dr Asela
Neerogya Health Care Pvt Ltd   Dr Asela
• Haemolysis can cause falsely increased  potassium, magnesium, iron, and ammonia  levels, and other aberrant lab results....
Clots• Blood clots when the coagulation factors  within the plasma are activated.• Blood starts to clot almost immediately...
Neerogya Health Care Pvt Ltd   Dr Asela
Causes of Clots• Inadequate mixing of blood and anticoagulant• Delay in expelling blood within a syringe into a  collectio...
Insufficient volume• short draws will result in an incorrect ratio of  blood to anticoagulant, and yield incorrect  test r...
Neerogya Health Care Pvt Ltd   Dr Asela
Labeling Errors• Labeling errors are the most common cause of  incorrect laboratory results.• If detected, the incorrectly...
Neerogya Health Care Pvt Ltd   Dr Asela
Neerogya Health Care Pvt Ltd   Dr Asela
Causes• Failure to follow proper patient identification  procedure.• Failure to label the specimen completely and  immedia...
Neerogya Health Care Pvt Ltd   Dr Asela
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Phlebotomy

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Transcript of "Phlebotomy"

  1. 1. Phlebotomy Dr. Asela KalingaNeerogya Health Care Pvt Ltd Neerogya Health Care Pvt Ltd Dr Asela
  2. 2. What is phlebotomy• withdrawal of blood from a vein, artery, or the capillary bed for lab analysis or blood transfusion. Neerogya Health Care Pvt Ltd Dr Asela
  3. 3. Who is a phlebotomist• Collects blood and other specimens• Prepares specimens for testing• Interacts with patients & health care professionals• plays a vital role in any health care system Other medical professionals, including doctors, nurses, technologists, and medical assistants must also be trained to collect blood specimens. Neerogya Health Care Pvt Ltd Dr Asela
  4. 4. PhlebotomistNeerogya Health Care Pvt Ltd Dr Asela
  5. 5. Laboratory work flow cycle Neerogya Health Care Pvt Ltd Dr Asela
  6. 6. Neerogya Health Care Pvt Ltd Dr Asela
  7. 7. What do you keep• Professionalism• Confidentiality• Attitude• Appearance• Safety Neerogya Health Care Pvt Ltd Dr Asela
  8. 8. Professionalism Neerogya Health Care Pvt Ltd Dr Asela
  9. 9. Confidentiality• All employees are responsible for maintaining confidentiality of medical information Neerogya Health Care Pvt Ltd Dr Asela
  10. 10. Attitude• Tone of voice and facial expression will determine how patients respond to you.• Always be polite, friendly, calm, and considerate. Neerogya Health Care Pvt Ltd Dr Asela
  11. 11. Neerogya Health Care Pvt Ltd Dr Asela
  12. 12. • polite Neerogya Health Care Pvt Ltd Dr Asela
  13. 13. • friendly Neerogya Health Care Pvt Ltd Dr Asela
  14. 14. • calm Neerogya Health Care Pvt Ltd Dr Asela
  15. 15. • considerate Neerogya Health Care Pvt Ltd Dr Asela
  16. 16. Appearance• Your personal appearance will also affect the impression you make.• Comply with your facility’s dress code and personal appearance policies. Neerogya Health Care Pvt Ltd Dr Asela
  17. 17. Neerogya Health Care Pvt Ltd Dr Asela
  18. 18. SafetyNeerogya Health Care Pvt Ltd Dr Asela
  19. 19. Anatomy & Physiology Neerogya Health Care Pvt Ltd Dr Asela
  20. 20. Anatomy is the branch of science concerned with the study of the structure of the body.Physiology is the branch of science concerned with the study of the function of the body. Neerogya Health Care Pvt Ltd Dr Asela
  21. 21. • The cardiovascular system consists of the Heart, and Blood Vessels.• Its main function is circulate oxygenated blood from the lungs to various organs, and return blood depleted of oxygen to the lungs, where it is re-oxygenated. Neerogya Health Care Pvt Ltd Dr Asela
  22. 22. Neerogya Health Care Pvt Ltd Dr Asela
  23. 23. Structure of capillary Neerogya Health Care Pvt Ltd Dr Asela
  24. 24. How to select site for bleeding Neerogya Health Care Pvt Ltd Dr Asela
  25. 25. • Vein should feel like spongy tube. Neerogya Health Care Pvt Ltd Dr Asela
  26. 26. Neerogya Health Care Pvt Ltd Dr Asela
  27. 27. Blood Components Neerogya Health Care Pvt Ltd Dr Asela
  28. 28. • Circulating whole blood is a mixture of:• Plasma (which contains fluid, proteins, and lipids), and• Formed elements, consisting of red cells, white cells, and platelets. Neerogya Health Care Pvt Ltd Dr Asela
  29. 29. Whole BloodNeerogya Health Care Pvt Ltd Dr Asela
  30. 30. RBCNeerogya Health Care Pvt Ltd Dr Asela
  31. 31. WBCNeerogya Health Care Pvt Ltd Dr Asela
  32. 32. PlateletsNeerogya Health Care Pvt Ltd Dr Asela
  33. 33. Blood Clot• When a blood sample is left standing without anticoagulant, it forms a coagulum or blood clot.• The clot contains coagulation proteins, platelets, and entrapped red and white blood cells. Neerogya Health Care Pvt Ltd Dr Asela
  34. 34. Neerogya Health Care Pvt Ltd Dr Asela
  35. 35. Neerogya Health Care Pvt Ltd Dr Asela
  36. 36. PlasmaNeerogya Health Care Pvt Ltd Dr Asela
  37. 37. Serum• Serum contains all the same substances as plasma, except for the coagulation proteins, which are left behind in the blood clot. Neerogya Health Care Pvt Ltd Dr Asela
  38. 38. Equipments Neerogya Health Care Pvt Ltd Dr Asela
  39. 39. • Trays• Blood Collection tubes• Syringes• Needles• Lancets• Tourniquets• Sterilization• Bandaging Material• Gloves• Sharp Disposal Container Neerogya Health Care Pvt Ltd Dr Asela
  40. 40. • Marking Pen• Washing material• Cool box/ Refrigerator Neerogya Health Care Pvt Ltd Dr Asela
  41. 41. TraysNeerogya Health Care Pvt Ltd Dr Asela
  42. 42. • Trays should be sanitized daily using appropriate disinfectant• Kept Organized and well-stocked. Neerogya Health Care Pvt Ltd Dr Asela
  43. 43. Blood Collection tubes• glass or plastic tube with a rubber stopper.• It has a vacuum so that blood will flow into the tube.• anticoagulants and/or other chemical additives.• Rubber stoppers of blood collection tubes are color coded.• Each type of stopper indicates a different additive or a different tube type. Neerogya Health Care Pvt Ltd Dr Asela
  44. 44. Green tube / Lavender• EDTA to prevent clotting• hematology studies.• Should be completely filled• Must be inverted after filling Neerogya Health Care Pvt Ltd Dr Asela
  45. 45. Neerogya Health Care Pvt Ltd Dr Asela
  46. 46. “MCV is not influenced by K3EDTA concentrations up to ten times normal, while K2EDTA, at high concentrations, results in a slight increase in MCV, as measured with three of the instruments2”. In addition, it has also been reported that “the difference in MCV between K2EDTA and K3EDTA was more marked under the condition of lower blood pH4”. Neerogya Health Care Pvt Ltd Dr Asela
  47. 47. Red tube• No additives• Blood bank tests, toxicology, serology• Must not be inverted after filing Neerogya Health Care Pvt Ltd Dr Asela
  48. 48. Neerogya Health Care Pvt Ltd Dr Asela
  49. 49. Light blue• sodium citrate.• coagulation (clotting) studies.• must be completely filled• must be inverted immediately after filling Neerogya Health Care Pvt Ltd Dr Asela
  50. 50. Neerogya Health Care Pvt Ltd Dr Asela
  51. 51. Function of Sodium CitrateSodium citrate act as chelating agent to bind the calcium in the blood.Calcium need * To make a Plt aggregation * To form fibrin. Neerogya Health Care Pvt Ltd Dr Asela
  52. 52. ESR tube Neerogya Health Care Pvt Ltd Dr Asela
  53. 53. Gel & Clot activator Neerogya Health Care Pvt Ltd Dr Asela
  54. 54. What is gel tube ?• Gel tubes are Serum tubes, with presence of clot activator and separator Acrylic gel for automatic separation of clot and serum during centrifugation. Neerogya Health Care Pvt Ltd Dr Asela
  55. 55. Gel Advantages• Gel forms Stable barrier between the Separated serum and clot. – Prevents interference of substances released from blood clot into serum ( eg : release of K+ / LDH from Lysed RBC’s). – Gel Serves as excellent tube medium for transportation and storage of Specimen.• Allows use of primary tubes on analyzers.• Allows storage of specimens in primary tubes.• Eliminates time of serum transfer and aliquoting, Hence Improves turnaround time.• Reduces the risk of contamination and exposure of sample to atmosphere during multiple transfers.• Reduces waste and contamination• Reduces labeling error, invited by repeated aliquoting.• Eliminates cost of secondary aliquot assembly - Aliquot tubes, transfer pipette tip , Multiple labels. Neerogya Health Care Pvt Ltd Dr Asela
  56. 56. Neerogya Health Care Pvt Ltd Dr Asela
  57. 57. • Fluoride tube• Inhibitor for glycolysis + anticoagulant• Sodium Fluride +potassium oxalate.• glucose levels. Neerogya Health Care Pvt Ltd Dr Asela
  58. 58. Neerogya Health Care Pvt Ltd Dr Asela
  59. 59. Neerogya Health Care Pvt Ltd Dr Asela
  60. 60. See expiry date on tube Neerogya Health Care Pvt Ltd Dr Asela
  61. 61. SyringesNeerogya Health Care Pvt Ltd Dr Asela
  62. 62. Components of syringe Neerogya Health Care Pvt Ltd Dr Asela
  63. 63. Types of syringe• Luer lock syringe Neerogya Health Care Pvt Ltd Dr Asela
  64. 64. • Slip tip syringe Neerogya Health Care Pvt Ltd Dr Asela
  65. 65. • Eccentric tip syringe Neerogya Health Care Pvt Ltd Dr Asela
  66. 66. • Catheter tip syringe Neerogya Health Care Pvt Ltd Dr Asela
  67. 67. NeedlesNeerogya Health Care Pvt Ltd Dr Asela
  68. 68. Components of needle Neerogya Health Care Pvt Ltd Dr Asela
  69. 69. Colour codeNeerogya Health Care Pvt Ltd Dr Asela
  70. 70. Butterfly Needle Neerogya Health Care Pvt Ltd Dr Asela
  71. 71. • Winged infusion set• Difficult venupuncutre including pediatric draws• with a syringe or a holder and vacuum collection tube system.• 21, 23, or 25 gauge• number-one cause of needlesprik injuries, so proper use of their safety devices is critical. Neerogya Health Care Pvt Ltd Dr Asela
  72. 72. Neerogya Health Care Pvt Ltd Dr Asela
  73. 73. Neerogya Health Care Pvt Ltd Dr Asela
  74. 74. LancetsNeerogya Health Care Pvt Ltd Dr Asela
  75. 75. • Lancets are used for difficult venupuncutre, including pediatric draws. Neerogya Health Care Pvt Ltd Dr Asela
  76. 76. TourniquetsNeerogya Health Care Pvt Ltd Dr Asela
  77. 77. • Vein easier to SEE, FEEL, and PUNCTURE Neerogya Health Care Pvt Ltd Dr Asela
  78. 78. SterilizationNeerogya Health Care Pvt Ltd Dr Asela
  79. 79. Bandaging Material Neerogya Health Care Pvt Ltd Dr Asela
  80. 80. Gloves• Gloves must be worn for all procedures requiring vascular access.• Non-powdered latex gloves are most commonly used; Neerogya Health Care Pvt Ltd Dr Asela
  81. 81. Collecting of blood sample Neerogya Health Care Pvt Ltd Dr Asela
  82. 82. Greeting• Always greet patient in a professional, friendly manner.• A good initial impression will earn the patients trust, and make it easier and more pleasant to draw a good specimen.• Knock on the patient’s door before entering.• Identify yourself by name and department.• Explain the reason for your presence. Neerogya Health Care Pvt Ltd Dr Asela
  83. 83. • The more relaxed and trusting your patient, the greater chance of a successful atraumatic venupuncutre.• Good verbal, listening, and nonverbal skills are very important for patient reassurance Neerogya Health Care Pvt Ltd Dr Asela
  84. 84. Identification of patient• Make sure the name, medical record number, and date of birth on your order/requisition match those on the patient’s armband.• Verify the patient’s identity by politely asking them to state their full name.• Properly identifying patients and specimens is probably the single most critical part of your job.• The consequences of misidentifying a specimen can be life threatening. Neerogya Health Care Pvt Ltd Dr Asela
  85. 85. • Never rely on the patient name on the door or above the bed. Patients are frequently moved from room to room. Neerogya Health Care Pvt Ltd Dr Asela
  86. 86. Standard Precautions01. Hand wash Neerogya Health Care Pvt Ltd Dr Asela
  87. 87. Proper method Neerogya Health Care Pvt Ltd Dr Asela
  88. 88. Neerogya Health Care Pvt Ltd Dr Asela
  89. 89. Applying glovesPatients are often reassured thatproper safety measures are beingfollowed when gloves are put on intheir presence. Neerogya Health Care Pvt Ltd Dr Asela
  90. 90. Positioning the Patient Neerogya Health Care Pvt Ltd Dr Asela
  91. 91. • Comfortable position• Turn the arm so that the wrist and palm face upward, and the antecubital area is accessible• When supporting the patient’s arm, do not hyperextend the elbow. This may make vein palpation difficult. Neerogya Health Care Pvt Ltd Dr Asela
  92. 92. Neerogya Health Care Pvt Ltd Dr Asela
  93. 93. Applying the tourniquet• Tie the tourniquet just above the elbow. Neerogya Health Care Pvt Ltd Dr Asela
  94. 94. • The tourniquet should be tight enough to stop venous blood flow in the superficial arm veins Neerogya Health Care Pvt Ltd Dr Asela
  95. 95. Neerogya Health Care Pvt Ltd Dr Asela
  96. 96. • The tourniquet should be applied a maximum of 1 – 2 minutes, approximately 2 to 3 inches above the antecubital fossa Neerogya Health Care Pvt Ltd Dr Asela
  97. 97. • After applying the tourniquet, you may ask the patient to make a fist to further distend the arm veins Neerogya Health Care Pvt Ltd Dr Asela
  98. 98. • Patients often think they are helping by pumping their fists• This is an acceptable practice when donating blood, but not in sample collection as this can lead to haemoconcentration Neerogya Health Care Pvt Ltd Dr Asela
  99. 99. Preferred sites• The median cubital vein• Cephalic vein, or the Basilic vein. Neerogya Health Care Pvt Ltd Dr Asela
  100. 100. • Veins on the back of the hand.• Use a much smaller needle for these hand veins. Neerogya Health Care Pvt Ltd Dr Asela
  101. 101. • Using the nondominant hand routinely for palpation may be helpful when additional palpation is required immediately before performing the puncture.• Often, a patient has veins that are more prominent in the dominant arm. Neerogya Health Care Pvt Ltd Dr Asela
  102. 102. Never draw from these areas• Scarred, abraded, or inflamed skin Neerogya Health Care Pvt Ltd Dr Asela
  103. 103. Neerogya Health Care Pvt Ltd Dr Asela
  104. 104. • Arms containing IV catheters Neerogya Health Care Pvt Ltd Dr Asela
  105. 105. • Oedematous arms Neerogya Health Care Pvt Ltd Dr Asela
  106. 106. • Occluded Veins• Shunts Neerogya Health Care Pvt Ltd Dr Asela
  107. 107. Neerogya Health Care Pvt Ltd Dr Asela
  108. 108. Cleansing the site• Isopropyl alcohol swab• Outward expanding spiral starting with the actual venupuncutre site.• Allow the alcohol to dry:- 1-disinfect the site 2-prevent a burning sensation Neerogya Health Care Pvt Ltd Dr Asela
  109. 109. Hold vein in place Neerogya Health Care Pvt Ltd Dr Asela
  110. 110. • Insert needle Neerogya Health Care Pvt Ltd Dr Asela
  111. 111. Neerogya Health Care Pvt Ltd Dr Asela
  112. 112. • Gently push the tube onto the needle holder so that the catheter inside the needle holder penetrates the tube.• Blood flow should be visible at this point. Neerogya Health Care Pvt Ltd Dr Asela
  113. 113. Blood won’t flowIf you do not see blood flow, the tip of the needle:1. May not yet be within the vein.2. May have already passed through the vein.3. May have missed the vein entirely.4. May be pushed up against the inside wall of the vein. Neerogya Health Care Pvt Ltd Dr Asela
  114. 114. Incomplete collection or no blood is obtained• Change the position of the needle. Move it forward (it may not be in the lumen) Neerogya Health Care Pvt Ltd Dr Asela
  115. 115. • or move it backward (it may have penetrated too far).• Adjust the angle (the bevel may be against the vein wall). Neerogya Health Care Pvt Ltd Dr Asela
  116. 116. • Loosen the tourniquet. It may be obstructing blood flow.• Try another tube. There may be no vacuum in the one being used.• Re-anchor the vein. Veins sometimes roll away from the point of the needle and puncture site. Neerogya Health Care Pvt Ltd Dr Asela
  117. 117. Other Problems• A hematoma forms under the skin adjacent to the puncture site - release the tourniquet immediately and withdraw the needle. Apply firm pressure. Neerogya Health Care Pvt Ltd Dr Asela
  118. 118. • The blood is bright red (arterial) rather than venous. Apply firm pressure for more than 5 minutes Neerogya Health Care Pvt Ltd Dr Asela
  119. 119. Removing the Needle• Gently release the tourniquet before the last tube of blood is filled• Remove the last tube from the needle• Withdraw the needle in a single quick movement Neerogya Health Care Pvt Ltd Dr Asela
  120. 120. • Quickly place clean gauze over the site, and apply pressure.• You may ask the patient to continue applying pressure until bleeding stops. Neerogya Health Care Pvt Ltd Dr Asela
  121. 121. • Apply pressure to the puncture site and instruct the patient to keep the arm in a straight position. Have the patient hold pressure for at least 3 minutes. Neerogya Health Care Pvt Ltd Dr Asela
  122. 122. • Take this time to invert any tubes that need to have anticoagulant mixed with the blood.• Label specimens. Neerogya Health Care Pvt Ltd Dr Asela
  123. 123. Neerogya Health Care Pvt Ltd Dr Asela
  124. 124. Re-inspect the puncture site to make sure bleeding has stopped, and apply a bandage. Neerogya Health Care Pvt Ltd Dr Asela
  125. 125. Needle disposal• Remove the needle from the holder if appropriate, and properly discard it in an approved sharps disposal container.• Discard all waste and gloves in the appropriate biohazardous waste container.• Wash hands. Neerogya Health Care Pvt Ltd Dr Asela
  126. 126. Neerogya Health Care Pvt Ltd Dr Asela
  127. 127. Neerogya Health Care Pvt Ltd Dr Asela
  128. 128. Specimen Labeling• Label specimens at the bedside according to your institution’s standard procedures, or apply pre-printed labels.• Proper labelling is the single most critical task you are asked to perform Neerogya Health Care Pvt Ltd Dr Asela
  129. 129. Proper labelling generally includes• Patient’s first and last name• Hospital identification number• Date & time• Phlebotomist initials• Your institution may provide bar coded computer generated labels that contain this information. Neerogya Health Care Pvt Ltd Dr Asela
  130. 130. Labeling Errors• Labeling errors are the most common cause of incorrect laboratory results.• If detected, the incorrectly labeled specimen will be rejected.• If undetected, it will produce incorrect results which might adversely affect your patient’s care Neerogya Health Care Pvt Ltd Dr Asela
  131. 131. Finger stick-Specimen collection Neerogya Health Care Pvt Ltd Dr Asela
  132. 132. • A safety Lancet, which controls the depth of incision• Finger-sticks should not be performed on children under one year of age.• If possible, use the fourth (ring) finger or the middle finger.• Many patients prefer that you use fingers on their nondominant hand.• Choose a puncture site near the right or left edge of the finger tip.• Clean the site as you would for routine venupuncutre. Neerogya Health Care Pvt Ltd Dr Asela
  133. 133. • Select a safety lancet appropriate for the size of the patient’s finger.• You may warm the finger prior to puncture to increase blood flow.• Make the puncture perpendicular, rather than parallel, to the finger print.• Wipe away the first drop of blood using gauze to remove tissue fluid contamination. Neerogya Health Care Pvt Ltd Dr Asela
  134. 134. • Collect blood into an appropriate tube.• Label specimens appropriately.• Make sure bleeding has stopped. Apply an adhesive bandage if necessary.• Discard sharps appropriately. Neerogya Health Care Pvt Ltd Dr Asela
  135. 135. Neerogya Health Care Pvt Ltd Dr Asela
  136. 136. Heel stick• Veins of small children and infants are too small for venupuncutre;• Butterfly needles may be used to collect venous blood in older children. Neerogya Health Care Pvt Ltd Dr Asela
  137. 137. Heel stick neonatal blood collection• These devices are designed to control the depth of incision, since going too deep into an infant’s heel could injure the heel bone, and cause osteomyelitis (bone infection). Neerogya Health Care Pvt Ltd Dr Asela
  138. 138. • Firmly grasp the infants foot.• Do not use a tourniquet.• The heel may be warmed with a cloth to help increase blood flow.• Wipe the collection site with an alcohol prep pad, and allow the alcohol to dry.• Wipe the site with sterile cotton or gauze, to be sure all the alcohol has been removed. Neerogya Health Care Pvt Ltd Dr Asela
  139. 139. • Puncture the left or right side (outskirt) of the heel, not the bottom of the foot.• Wipe away the first drop of blood since it may contain excess tissue fluid or alcohol which could alter test results. Neerogya Health Care Pvt Ltd Dr Asela
  140. 140. • Collect the blood into the appropriate tube.• Do not: Squeeze the infant’s foot too tightly and wipe with alcohol during the collection Neerogya Health Care Pvt Ltd Dr Asela
  141. 141. • After collection is completed, apply pressure to the puncture site with a sterile gauze pad until bleeding has stopped.• Do not apply an adhesive bandage to an infant’s foot since it may injure its delicate skin. Neerogya Health Care Pvt Ltd Dr Asela
  142. 142. Special situations Neerogya Health Care Pvt Ltd Dr Asela
  143. 143. • Patients refusing blood work• Fainting• Unsatisfactory Specimens• Haemolysis• Clots• Insufficient volume• Labeling Errors Neerogya Health Care Pvt Ltd Dr Asela
  144. 144. Patients refusing blood work• If someone hesitates to let you collect a blood specimen, explain to them that their blood test results are important to their care.• Patients have a right to refuse blood tests• If the patient still refuses, report and document patient refusal Neerogya Health Care Pvt Ltd Dr Asela
  145. 145. Fainting• Rarely, patients will faint during venupuncutre.• It is therefore important that patients are properly seated or lying in such a way during venupuncutre so that if they do faint, they won’t hurt themselves.• self-limited Neerogya Health Care Pvt Ltd Dr Asela
  146. 146. Signs and symptoms of fainting• Weakness• Lightheadedness• Nausea• Sweating• Rapid breathing (hyperventilation)• Dimming of vision• Difficulty hearing or ringing in the ears Neerogya Health Care Pvt Ltd Dr Asela
  147. 147. what to do• Gently remove the tourniquet and needle from the patients arm, apply gauze and pressure to the skin puncture site.• Call for help.• If the patient is seated, place his head between his knees.• A cold compress on the back of the neck may help to revive the patient more quickly. Neerogya Health Care Pvt Ltd Dr Asela
  148. 148. If the patient is seated Neerogya Health Care Pvt Ltd Dr Asela
  149. 149. Get him or her to lie down. (If they are in a situation or place where they really cant liedown then sitting down is the next choice.)Help restore blood flow to the brain by raising the persons legs above the level of thehead (about 30cm). Once the victim is lying down, elevate his feet about 12 inches above the ground. Neerogya Health Care Pvt Ltd Dr Asela
  150. 150. If someone faints: – Check the ABCs (airway, breathing, circulation), and, if necessary, begin CPR and call emergency medical services. Continue CPR until help arrives or the person responds and begins to breathe. – If the person is breathing but unconscious, then put them in the recovery position. – Loosen constrictive clothing. The person should revive quickly. If the person doesnt regain consciousness within one minute, or if there are any serious injuries as a result of falling from the faint, call for emergency medical assistance. Also call immediately if there are symptoms of stroke (e.g. slurred speech or difficulty moving a limb) after fainting. – Stay with the person while they are recovering. They may feel tired or weak for several hours afterwards. Neerogya Health Care Pvt Ltd Dr Asela
  151. 151. Recovery position Neerogya Health Care Pvt Ltd Dr Asela
  152. 152. Neerogya Health Care Pvt Ltd Dr Asela
  153. 153. Unsatisfactory Specimens• They can cause misleading laboratory results• Must be rejected by the laboratory.• The patient must then undergo another venupuncutre to get a better specimen.• It costs time & money to redraw the specimen.• The credibility of the laboratory is reduced if too many unsatisfactory specimens are drawn. Neerogya Health Care Pvt Ltd Dr Asela
  154. 154. Neerogya Health Care Pvt Ltd Dr Asela
  155. 155. Haemolysis• Haemolysis means the breakup of fragile red blood cells within the specimen, and the release of their hemoglobin and other substances, into the plasma.• A haemolyzed specimen can be recognized after it is centrifuged by the red color of the plasma. Neerogya Health Care Pvt Ltd Dr Asela
  156. 156. Causes of Haemolysis• Using a too small needle for a relatively bigger vein• Pulling a syringe plunger too rapidly• Expelling blood vigorously into a tube• Shaking a tube of blood too hard. Neerogya Health Care Pvt Ltd Dr Asela
  157. 157. Neerogya Health Care Pvt Ltd Dr Asela
  158. 158. Neerogya Health Care Pvt Ltd Dr Asela
  159. 159. • Haemolysis can cause falsely increased potassium, magnesium, iron, and ammonia levels, and other aberrant lab results. Neerogya Health Care Pvt Ltd Dr Asela
  160. 160. Clots• Blood clots when the coagulation factors within the plasma are activated.• Blood starts to clot almost immediately after it is drawn unless it is exposed to an anticoagulant.• Clots within the blood specimen, even if not visible to the naked eye, will yield inaccurate results. Neerogya Health Care Pvt Ltd Dr Asela
  161. 161. Neerogya Health Care Pvt Ltd Dr Asela
  162. 162. Causes of Clots• Inadequate mixing of blood and anticoagulant• Delay in expelling blood within a syringe into a collection tube• Inadequate sample Neerogya Health Care Pvt Ltd Dr Asela
  163. 163. Insufficient volume• short draws will result in an incorrect ratio of blood to anticoagulant, and yield incorrect test results.• Short draws can be caused by:• A vein collapsing during phlebotomy.• The needle coming out of the vein before the collection tube is full.• Loss of collection tube vacuum before the tube is full. Neerogya Health Care Pvt Ltd Dr Asela
  164. 164. Neerogya Health Care Pvt Ltd Dr Asela
  165. 165. Labeling Errors• Labeling errors are the most common cause of incorrect laboratory results.• If detected, the incorrectly labeled specimen will be rejected.• If undetected, it will produce incorrect results which might adversely affect your patient’s care. Neerogya Health Care Pvt Ltd Dr Asela
  166. 166. Neerogya Health Care Pvt Ltd Dr Asela
  167. 167. Neerogya Health Care Pvt Ltd Dr Asela
  168. 168. Causes• Failure to follow proper patient identification procedure.• Failure to label the specimen completely and immediately after collection. Neerogya Health Care Pvt Ltd Dr Asela
  169. 169. Neerogya Health Care Pvt Ltd Dr Asela
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