It is a blood collection used an all labs to find out why symptoms are appear in the patient… Phlebotomy(“to cut a vein” in Greek) is the process of making incision in a vein. A person who practices phlebotomy is termed as phlebotomist.
Blood analysis is one of the most important diagnostic tools available to clinician within healthcare. Its data is relied upon in the clinical setting for interpretation of clinical signs and symptoms…
Requires social, clerical and technical skills Phlebotomy is a link between the patient and the laboratory Apart of the healthcare team
To collect blood for accurate and reliable test resultsAccurate identification and collection procedures are criticalImportant procedure to assist in the diagnosis and monitoring of patients
SAMPLE COLLECTION PATIENT PREPARATION PRIOR TO TEST ESR : FASTING Hb , TLC, DLC, PBF, RED CELL INDICES, RETICULOCYTE COUNT , PLATELET COUNT : NEED NOT FASTING 6 6
Identify tests & Determine : proper volume to be collected*NOTE : ◦ ”.5ml serum/plasma” ◦ = 1ml of whole or un-centrifuged blood) Determine proper procedure based upon age and size of patient Communicate with patient about previous blood collection experiences Collect proper patient identifiers, request and equipment.
OUTPATIENTS: Sitting in chair INPATIENTS: lying in bed or sitting in chair•Position checklist:–There is no danger of thepatient falling–There is easy access tothe arms–The patient is comfortable–There is adequate spaceto place supplies withinreach
IV lines Injuries Presence of edema Medication Patient alertness Patient emotional and mental status
Clean the selected pt. finger with spirit swab Pick up sterile blood lancet with your right hand. With your left hand, firmly grasp the pt. middle finger. make deep stab on the ball of the finger. Eliminate the first drop. after that collect blood for require tests…..
Blood from capillary network can be used to perform test for which only few drops of blood is required. Capillary blood is not recommended for those tests which require large amount of blood. It is not used for platelet count.Suitable for Hb , TLC, DLC, RBC count by microdilution method. For preparation of thin blood film to determine blood picture.
Blood is collected from theveins of the patient. it isrequire when the large amountof blood is required
Surface of the forearm, Wrist area above the thumb or indexfinger, Back of the wrist, Knuckle of the thumb or index finger, Foot orankle, Infants: head veins
Choose the veins that are large and accessible. Large veins that are not well anchored in tissue frequently roll, so if you choose one, be sure to secure it with the thumb of your non dominant hand when you penetrate it with the needle. Avoid bruised and scarred areas.
1. Median cubital vein - first choice, well supported2. Cephalic vein - second choice3. Basilic vein - third choice, often the most prominent vein, but it tends to roll easily and makes venipuncture difficult
INAPPROPRIATE SITES ARM ON SIDE OF MASTECTOMY EDEMATOUS AREAS HAEMATOMAS SCARRED AREAS ARMS WITH CANULAS SITES BEYOND IV LINE OF ANY KIND 24 24
Apply approximately 3-5 inches above anticubital fossa. (Not more than 1 min) If the skin appears blanched above and below the tourniquet it is too tight. If your finger can be inserted between the tourniquet and the patients skin it is too loose.
After tourniquet application have patient clench fist. Feel for a vein that rebounds (bounces) when pushed or tapped on. PALPATE any potential vein to help determine size, direction and depth. A slight rotation of the arm may help to better expose a vein that may otherwise be hidden.
Tricks to Help Distend Veins: ◦ Have the patient "pump" the hand 3 times. Dont overdue it because over-pumping can create hemoconcentration ◦ Warm the area with a hot pack or warm, moist cloth heated to approximately 42°C. ◦ If all else fails, consult another technician for their opinion and/or intervention.
After selecting a vein, clean the puncture site with a cotton ball saturated with 70% isopropyl alcohol or prepackage alcohol swabs. Rub the alcohol swab in a circular motion moving outward from the site Use enough pressure to remove all perspiration and dirt from the puncture site. Discreetly look at the swab when finished, if it appears excessively dirty repeat the cleansing process with a fresh alcohol swab. After cleansing do not touch the site, if the vein must be repalpated the area must be cleansed again. Some experts allow cleansing of the index finger before repalpating but this technique is debatable.
Clean the selected area with spirit swab. The patient arm is gripped tightly with the help of tourniquet. The vein is penetrated by positioning the needle at 20 to 30 degree angle.
After blood has been drawn, the patient should release the fist & the tourniquet is also released. A cotton ball is held firmly over the venipuncture site as soon as the needle is removed. After removing the needle the collected blood is dispensed in the appropriate tubes.
The blood in the anticoagulant tubes are mixed carefully. The tubes are covered with appropriate stoppers. the needle should be disposed by using needle destroyer. Disposed used cotton, syringes into a non- penetrable containers. (Blue basket)
Maintain stability of Coagulation Factors Prevent clot formation in sample prior to testing Prevent Factor activation in tube - even if clot does not form Additives in tube must not interfere with individual Coagulation Factors
19 - 21gauge to avoid hemolysis in adults and 21 - 23 for pediatric samples. Non-wettable, siliconized surface or plastic tubes so as not to activate factors Contains buffered Sodium Citrate which…Ratio 1:9 1part anticoagulant 9 part bloodSample is mixed by inversion of tube 2 to 3 times.
Consider all patients as potentially infectious Wear coat or apron when there is a possibility of a splash Wear mask/eye protection when there is a possibility of a splash All sharps must be disposed into a puncture- proof biohazard container.
Frequent hand washing is an important safety precaution Wash hands when changing gloves and between patients if gloves become soiled Gloves are required to be worn during the phlebotomy procedure Wear gloves when handling body fluids
BEVEL ON UPPER WALL OF VEIN DOES NOT ALLOW BLOOD TO FLOW•SOLUTION•PULL BACK SLIGHTLY THE NEEDLE.•BE ALERT TO HEMATOMANEEDLE PARTIALLY INSERTED CAUSES BLOOD LEAKAGE INTOTISSUE(HEMATOMA LIKE)•SOLUTION•RELEASE TORNIQUET AND REMOVE NEEDLE•APPLY FIRM PRESSURE OVER SWOLLEN AREA (OR ELEVATE AFFECTED ARM).REASSURE PATIENT THAT BRUISE WILL ASSURE. REPEAT VENIPUNTURE AT A DIFFERENT SITE(OPPOSITE ARM OR DISTAL DISTAL TO ORIGINAL ARM)NEEDLE INSERTED THROUGH BOTH VEIN WALLS•SOLUTION•RELEASE TORNIQUET AND REMOVE THE NEEDLE•APPLY FIRM PRESSURE OVER SWOLLEN AREA(OR ELEVATE AFFECTED ARM).REASSURE PATIENT THAT THE BRUISE WILL RESOLVE. REPEAT VENIPUNCTURE AT A DIFFERENT SITE (OPPOSITE 38 ARM OR DISTAL TO ORIGINAL SITE)
COLLAPSED VEIN.REDUCED OR NIL BLOOD FLOW•ALLOW VEIN TO RECOVER BY RELEASING TORNIQUET•REAPPLY TORNIQUETNEEDLE NOT COMPLETELY IN VEIN OR HASNOT REACHED THE VEIN•ADVANCE THE NEEDLE FORWARD UNTIL YOU FEEL THE „GIVE‟ AS NEEDLE PENETRATESCORRECT INSERTION OF NEEDLE•BLOOD FLOWS FREELY INTO NEEDLE 39
FAINTING HAEMATOMA When the needle has Patient become dizzy & gone completely may faint during through the vein & not collection enough pressure is applied. The tourniquet & Should be aware of the needle should be patient condition removed immediately throughout the and firm pressure is procedure applied to the area for atleast 5 min.
EXCESSIVEPETECHIAE Small red spots BLEEDING appearing on patient skin, indicating minute Patient on amount of blood anticoagulant therapy escaping into the skin epithelium This defect is due to coagulation defect. Remember to apply pressure to the Make sure bleeding has venipuncture site until stopped before leaving bleeding stops patient side
COLLAPSEDSEIZURES VEIN This is rarely occur If the syringe during blood plunger is collection withdrawn quickly Immediately call Release tourniquet, for help from the remove syringe nursing station
Intravenous HEMO therapy CONCENTRATION Increase conc. Of Veins are visible & larger molecule or palpable but elements in the partially occluded. blood. Prolong tourniquet Avoid arm with IV application. line Exessive massaging or squeezing a site.
For many purposes blood may be safely persevered at 4ºC in Refrigerator.EDTA is best preservative for Hemogram.Tri-sodium citrate best for coagulationstudy. Before procedure, the blood should be first allowed to warm up to room temperature, then mixed, preferably by rotation, for atleast 2 min.
RBCs starts to swell resulting in increase in PCV. The reticulocytes count decrease as early as 6 hours Osmotic fragility increases. Prothrombin time slowly increases. ESR decreases. Reticulocytes decreases after 6 hrs. The red cells may leads to progressive crenation and sphering. The nucleated red cells disappear from the blood within 1-2 days
It is best to count leucocytes and platelets within 2 hours If any delay: Some but not all neutrophils are affected. The nuclear lobes may become seperated and the cytoplasmic margin may appear less well defined. small vacuoles appear in the cytoplasm Some of the lymphocytes undergo some changes. Few vacuoles may be seen in the cytoplasm & and the nucleus may undergo major budding so as to give rise to the nuclei with 2 or 3 lobes. Platelet count, TLC, RBCs count decreases.