Med A 220 Ppt Doc


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Phlebotomy PPT

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Med A 220 Ppt Doc

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