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Phlebotomy PPT

Phlebotomy PPT

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  • 1. Med A 220 Phlebotomy
    Venipuncture
  • 2. Phlebotomy
    What does it mean?
    Process of collecting blood
    Dates back to ancient Egypt
    Bloodletting-”bad” blood
    Greek translation
    Phlebos- vein
    Tome –incision
  • 3. Why collect blood?
    Diagnosis and treatment of disease
    Therapeutic purposes
    Blood donation
  • 4. Phlebotomist
    One who is trained in performing phlebotomy
  • 5. Phlebotomists Role
    Perform venipuncture accurately and efficiently
    Reliable test results
    Provide quality care
    Patient safety and confidentiality
    Phlebotomist safety (PPE)
  • 6. Circulatory System
    Knowledge of the anatomy and physiology important for safe venipuncture
    Blood forms in the bone marrow
    Blood transports oxygen and nutrients throughout the body and removes carbon dioxide
    Capillaries connect arteries to veins
  • 7. Circulatory System Cont’dArteries and Veins
    Arteries
    Carry oxygenated blood away from the heart
    Pulse
    Thick walls
    No Valves
    Veins
    Carry deoxygenated blood to the heart
    No pulse
    Thin elastic walls
    Valves
  • 8. More Circulatory Facts
    Our bodies contain approximately 6 liters of blood
    45% “formed elements” (erythrocytes, leukocytes, and Thrombocytes)
    55% liquid ”plasma” (a fluid allowing blood cells, electrolytes, proteins etc to travel the body via blood vessels).
  • 9. Important Terms
    Fibrinogen –substance in blood Converted by the blood clotting process to fibrin
    Fibrin- “sticky” web like substance –traps the formed elements-result is a “blood clot”
    Serum- clear liquid portion of blood extracted from the “blood clot” used for many tests
  • 10. Important Terms
    Centrifuge- machine which spins blood separating the RBC from the serum
    Anticoagulant-used to prevent blood from clotting. Found in certain blood tubes
    Buffy coat-layer separating plasma from RB
  • 11. Serum Blood Collection
    Diagnostic tests are most commonly performed on Serum, plasma, and whole blood
    Serum tests use a “serum separator” tube containing thixotropic gel
    Invert tube after draw in order to activate clotting
    Tube must be centrifuged after clot has formed
  • 12. Plasma and Whole Blood
    Plasma and whole blood
    Tube must be inverted after drawing to mix additives
    Tube must be centrifuged
    Certain Serum, Plasma, and Whole blood specimens will require special treatment and/or transport to laboratory.
  • 13. Phlebotomy Sites
    Order of Draw by sites
    Arm-Antecubital Space includes
    Median cubital
    Cephalic
    Basilic
    Veins in hand
    Veins in feet
  • 14. Preferred Sites in the arm
  • 15. Arteries of Arm
    Note locations of arteries in the arm. You DO NOT want to draw from an artery
    Brachial
    Radial
    Ulnar
    How can you distinguish an artery from a vein?
  • 16. Venipuncture Methods
    There are three main methods of drawing blood
    Syringe
    Vacuum Tube
    Butterfly
  • 17. Evacuated Tube Method
    This method includes:
    Vacutainer tube
    Adapter
    Double-pointed Needle
    Features of this method are:
    Closed system - needle stick risk low
    Vacuum draws blood inside the tube
    Safety needles meet OSHA guidelines
  • 18. Equipment/Supplies Needed
    Physician order and Lab requisition form
    Pen –black ink
    Appropriate PPE (gloves, gown, goggles)
    Needle holder and Needle (varying sizes)
    Tubes –varying sizes and types used
  • 19. More Equipment/Supplies
    Tourniquet or blood pressure cuff
    Alcohol or Betadine
    Cotton balls or gauze-preferred
    Bandages or tape
    Note: always ask patient about allergies
  • 20. A Specimen Collection Tray is a practical way to carry all necessary supplies
  • 21. Order of draw
    Why? Prevent carryover or contamination - Order may vary between laboratories.
    Basic order:
    Sterile- sterile specimens
    Light blue-sodium citrate
    Red or plain tubes no additives or gel
    SST –Serum separator tube (Red/Gray, Yellow)
    Green –heparin
    Lavender-EDTA
    Gray –oxalate-fluoride
  • 22. A phlebotomist needs these skills
    The most important skill is:
  • 25. Good Therapeutic Communication
    People don’t like to have their blood drawn
    Use your therapeutic communication skills to:
    Put your patient at ease –show confidence
    Assess their comfort level
    Ask them about past experiences
  • 26. Preparing the patient
    Identify yourself and explain the procedure
    Remember your “bedside manner”
    Properly Identify your patient ask them to:
    State their name
    For non-English speaking photo ID
    Note fasting or non-fasting
  • 27. Preparing to draw
    Complete lab requisition and prepare labels
    Organize equipment and supplies
    Have spare tubes available
  • 28. Remember to
    Wash your hands
  • 29. Preparing cont’d
    Do Not draw from a resistant patient
    Do Not draw if you are not comfortable
    Uncooperative children must receive special care and be restrained for safety
    Note any allergies to latex, alcohol, or tape
  • 30. The Draw
    Position your patient for safety:
    sit
    lie down
    (note past history of fainting or loss of consciousness)
    Select the appropriate site and vein free of:
    Scars
    Hematomas
    A Pulse
  • 31. The Tourniquet
    To prevent inaccurate blood test results-do not leave on longer than one minute
    Tourniquet may be applied over clothing for patient comfort
    Remove tourniquet when blood flow is achieved or prior to inserting last tube
    Always remove tourniquet prior to removing needle.
  • 32. Proper completion of draw
    Remove tourniquet
    Remove needle and apply safety device while Applying pressure to site (patient can assist)
    Bandage appropriately
    Tend to the safety of your patient
    Label specimen tubes in front of patient
  • 33. Important Information
    If you haven’t succeeded in getting blood after 2 tries ask someone else to try
    If no blood appears after inserting needle-pull needle back or change position before withdrawing
    Tubes must be filled to appropriate levels for accurate test results
  • 34. Factors Affecting Lab Results
    Blood Alcohol-elevate results
    Diurnal rhythm-RX or daily activity level
    Exercise-runner’s anemia, change results
    Fasting-inaccurate results
    Hemolysis-destroys RBC’s
    Heparin-incorrect use interferes with results
    Stress-Increase in WBC’s
    Tourniquet on too long-dilution hemoconcentration
  • 35. Challenging Patients
    Pediatric
    The child, parents or guardians
    Approach-explain –get down to their level
    Resistant-restraints ?
    Geriatric
    Physical-skin, hearing or vision impaired
    Effects of disease-stroke, arthritis, Parkinson’s –tremors,
    Dementia-Alzheimer's
    Safety issues-wheelchairs, balance
  • 36. More Challenges
    Dialysis or Cancer patients -fistulas and shunts
    (AV-arteriovenous-permanent access for dialysis)
    Long-Term Care patients, Home Care, or Hospice Patients
    Traveling phlebotomists
  • 37. Problem Sites
    Burns, Scars, Tattoos
    Damaged Veins (sclerosed-thrombosed)
    Edema-swelling due to abnormal accumulation of fluid
    Hematoma-swelling or mass of blood
    Mastectomy-caution lymph node removal
    Obesity
  • 38. Complications or Conditions
    Allergies-adhesive, antiseptic, latex
    Excessive bleeding due to medications, hemophilia
    Fainting
    Nausea and vomiting
    Pain while drawing-what is normal –what is NOT-stopping the draw
    Seizures/Convulsions-stop draw immediately-get help
  • 39. Thanks to:
    Clinical Medical Assisting: A professional, Field Smart Approach to the Workplace, Textbook and Workbook
    Phlebotomy Essentials 4th Edition
    Laurel Lunden, BS CMA (AAMA) January 2010