2. COMPLICATIONS IN BLOOD COLLECTION
Failure to obtain blood
This is the primary cause
Possible causes include: bevel on lower wall of vein,
needle inserted too far, needle partially inserted,
collapsed vein, needle slipped to side of vein from
rolling veins
Simple maneuver will correct the problem; rotate 45
degrees allow blood to flow
3. COMPLICATIONS IN BLOOD COLLECTION
Hematomas
Caused by leakage of blood into the tissues around the
venipuncture site
Result in swelling and discoloration
May cause anxiety, discomfort, pain to the patient, and even
nerve injuries
Possible causes are:
Failure to remove the tourniquet prior to remove the
needle
Apply inadequate pressure to site after needle removal
Excessive probing to obtain blood
Insert needle through the vein
Bending the arm while applying pressure
Using veins that are too small or fragile
4. COMPLICATIONS IN BLOOD COLLECTION
Nerve Injury
Usually caused by incorrect technique and site
selection
Possible causes are:
Improper vein selection
Using jerky movements
Inserting the needle too far
Movement by the patient while needle is in vein
Lateral redirection of the needle
Blind probing
6. COMPLICATIONS IN BLOOD COLLECTION
Causes of hemolyzed specimens are:
Using too small diameter needle (above 23 gauge)
Using small needle with large evacuated tube
Using improperly attached needle on a syringe,
causing frothing of specimen
Pulling back plunger of syringe too fast
Drawing blood from site that contain hematoma
7. COMPLICATIONS IN BLOOD COLLECTION
Causes of hemolyzed specimens are:
Vigorously missing tubes
Forcing blood from syringe into evacuated tube
Apply tourniquet too close to puncture site or for too
long
Using fragile hand veins
Perform venipuncture before alcohol is dried
Partially filled sodium fluoride tubes
Readjustment of needle in veins or using occluded
veins
8. COMPLICATIONS IN BLOOD COLLECTION
Other factors that cause hemolysis are:
Rimming clots
Centrifuge at higher than recommended speed
Elevate or decrease temp of blood
Using pneumatic system without shock absorber
9. COMPLICATIONS IN BLOOD COLLECTION
Specimen contamination
May include carryover, draw from edema or hematoma
sites, arms containing IV, site contaminated with alcohol
or iodine
Technical problems
Problems with equipment, tubes, syringes, etc
Patient Complications
Difficult patient, geriatric population, pediatric
population, obese patient
Must use the right equipment – appropriate size needle
10. OTHER COMPLICATIONS
Vascular – bleeding from site and hematoma formation
Infections – introducing bacteria into the blood stream
Anemia – as a result of significant blood draw for
testing
Neurologic – seizures or pain
Cardiovascular – orthostatic hypotension, syncope,
shock, cardiac arrest
Dermatologic – localized reaction to iodine or cleaning
agents
Gastrointestinal – nausea and vomiting
11. Quality Assurance in Specimen Collection
Perform QC on all equipment – run controls,
maintenance, keep logs
Check all equipment
Follow facility protocol
12. Quality Assurance Terminology
Quality control – a process that monitors the
accuracy and reproducibility of results through the
use of control specimens
Control – a specimen with a known value to the
analyte/determinant
Standards – highly purified substances of a known
composition
Accuracy – closeness of the result to the true value
Precision – represent how close repeated results
are to each other
13. POINT OF CARE TESTING
Done at the bedside
Advantages are shorter turn around time, smaller
quantity of specimen, convenience for patient,
shorter patient care stay and improved patient care
management
Disadvantages are higher costs, integrating the
results into charts and quality controls
14. POINT OF CARE TESTING
THINGS TO CONSIDER
Cost of maintenance of competency and training
personnel
Labor associated with processing specimen and
maintaining the machine/equipment
Reagents, controls, maintenance and depreciation
costs
Proficiency testing and any state licensing costs
15. POINT OF CARE TESTING
REGULATION
All laboratory and sites performing testing are regulated by Clinical
Laboratory Improvement Amendments of 1988 (CLIA ‘88)
States and city (government) may enact mandatory regulations which
may include the qualification of personnel performing the test
If a site is only performing ‘waived tests’ they must have ‘certificate of
waiver’ license. These sites will not be routinely inspected
They must follow the manufacture instructions on performing the tests
Agencies such as the Joint commission, College of American
Pathologists and Veteran Administration does not recognize the waive
category of testing – as they are not regulated
16. POINT OF CARE TESTING
CATEGORIES OF POINT OF CARE TESTING
WAIVED TESTS
Simple procedures. If performed incorrectly will have little or no
negative outcomes
MODERATELY COMPLEX TESTS
Usually automated, more complex than waived tests.
Example: routine chemistries, blood counts
HIGHLY COMPLEX TESTS
Usually manual testing that require considerable judgment for
interpretation of results
Example: microbiology tests and cross match
PROVIDER PERFORMED MICROSCOPY (PPM) TESTS
Examination of slides from freshly collected body fluids
17. POINT OF CARE TESTING
POCT can be automated and non automated
Automated – glucose, electrolytes, PT, PTT,
hematocrit, blood gases, urea, cardiac enzymes
Non automated – fecal occult blood, pregnancy tests,
rapid strep, HIV
With today’s advance technology (wireless
connectivity) the use of handheld POCT is increasing
18. SPECIAL PROCEDURES
BLOOD BANK SPECIMENS
Strict patient identification and labeling is required
Any doubt or mislabeling requires a re-draw
Undetected errors may result in the patient receiving
incompatible blood or blood products – which could
be fatal
Specimens include: type, screen, cross match and
donor specimens
19. SPECIAL PROCEDURES
BLOOD CULTURES
Usually requires two sets which should be drawn 30-60
minutes apart
Must be drawn before antibiotic is given. However, if
antibiotics must be given urgently, both sets of blood cultures
must be drawn immediately from two different sites
Skin antiseptic is the most critical part of collection
Iodine, chlorhexidine and 70% ethyl alcohol are most
commonly used. A 30 -60 seconds friction scrub is most
appropriate
20. SPECIAL PROCEDURES
COAGULATION SPECIMENS
Remember the 9:1 ratio
Discard tube if using butterfly and blue top is the
first tube
GLUCOSE TOLERANCE TEST
Make sure patient is fasting, except drinking water.
Usually 10-12 hours
Collect fasting, given 100g of glucose, collect 1 hour
and 2 hours post finish drinking glucose drink
21. SPECIAL PROCEDURES
LACTOSE TOLERANCE TEST
Similar to GTT but uses Lactose instead of glucose
PATERNATY TESTING
Requires chain of custody
Specific identification and fingerprinting may be necessary
Usually include ABO and Rh typing, cheek swab to collect
DNA
DRUG/FORENSIC MONITORING
Urine or blood
Chain of custody
